Many female veterans’ PTSD caused by military rapes, not combat
An estimated 3,500 New Mexican female veterans have Post-Traumatic Stress Disorder (PTSD), a psychological syndrome commonly tied to combat. The vast majority of them were traumatized not by war, however, but by sexual assaults by fellow servicemen, according to New Mexico Veterans Affairs (VA) Health Care System officials.
“Eighty to 90 percent” of the state’s female veterans with PTSD identify military sexual assault as their traumatic experience, VA Stress Disorder Treatment Team Coordinator Diane T. Castillo told Veritas New Mexico.
Women veterans are up to 10 percent more likely than males to suffer PTSD and up to a quarter of female veterans are affected by PTSD symptoms, Castillo said.
Hispanic women veterans may be at particular risk, meaning that military rape-associated PTSD may be a bigger problem in New Mexico than elsewhere, Castillo believes.
“Our research tells us that higher rates of PTSD are found in ethnic minorities, particularly Hispanic veterans,” Castillo said. “New Mexico female veterans are in a more vulnerable position and will present with higher rates of PTSD.”
But that picture is extrapolated largely from decades-old data for Vietnam-era veterans and enrollment at a women’s PTSD study currently under way in Albuquerque, Castillo acknowledged. No recent comprehensive study of ethnicity and rates of military sexual assault have been done and it is not yet clear why servicewomen from different ethnic populations would suffer different rates of sexual trauma or PTSD.
Nationwide, an estimated 21 percent of female veterans — and 1 percent of male veterans — receiving care at VA facilities, report having been victims of rape in the military, according to a new study by researchers at the VA’s National Center for Posttrumatic Stress Disorder in Palo Alto, Calif. (New Mexico VA researchers recently published a separate study that similarly concludes about 1 percent of male veterans have been raped by other soldiers.)
PTSD symptoms can include recurrent nightmares, intrusive traumatic memories, anxiety, social isolation, self-medication with drugs and alcohol, hostility, attention problems and suicidal thoughts.
A recently published study of Gulf War veterans by the VA’s National Center for PTSD in Boston, found that female veterans with PTSD who had been raped, experience long-term impacts to physical health, as well as their psychological well-being and quality of life.
The VA now screens all new female patients for PTSD and rape.
Only about a quarter of the state’s female veterans are seen at the Albuquerque VA hospital. There, they are screened for PTSD, depression, substance abuse, traumatic brain injury, and military sexual trauma.
Those who are deemed “at risk” for PTSD are enrolled in the Women’s Stress Disorder Treatment Team.
The VA has a 26-patient residential program for inpatient psychiatric care, called “Ward 7,” and a separate 24-patient program for veterans diagnosed with both substance abuse disorder and PTSD.
These programs “have rooms designated for female veterans with doors that lock, rooms with female-only bathrooms, and rooms located near the nurse’s station to assure the safety, privacy and dignity” of women being treated in a “predominantly male-populated” hospital, Castillo said.
But only a few women — two to three at any given time — are treated as inpatients at the Albuquerque VA Medical Center, Castillo said.
Others are treated on an outpatient basis. The VA also provides psychological care via video links with field clinics in communities across New Mexico.
A recent Government Accountability Office (GAO) report found that hundreds of women at VA inpatient mental health facilities across the U.S. have been sexually assaulted by other veterans, but that most of the assaults recorded by VA facility police were not reported up the chain of command, as required by federal law.
Neither Castillo nor NM VA Health Care System spokesman William Armstrong knew of any sexual assaults at the Albuquerque VA facility. Veritas NM filed a public records request Tuesday with the facility’s law enforcement office to confirm that none have occurred.
Veterans hospitals across the U.S. have also been criticized for reliance on off-label drug “cocktails” used to sedate traumatized veterans, leading to adverse reactions and several overdose deaths. (The New York Times spotlighted the 2009 death of Albuquerque U.S. Air Force veteran Anthony Mena in February; Mena died of an interaction of eight prescribed psychoactive drugs.)
Castillo emphasizes cognitive therapy and “prolonged exposure” therapy for her PTSD patients. Castillo pioneered the use of these therapies in group settings in 2004.
The months-long interventions help veterans identify “triggers” and their own distorted thoughts, such as the belief that they are ‘not safe anywhere,’ Castillo said — and to desensitize themselves to memories of traumatic events by repeatedly reviewing and describing those memories in safe environments.
“Negative, distorted thoughts serve to maintain PTSD symptoms and are directly challenged therapeutically,” Castillo said. “The female veterans are no longer positive for PTSD diagnosis after treatment as long as six months later. These women are also showing sustained improvement in general functioning in their lives.”
But many VA patients are still treated with psychiatric medications, Castillo acknowledged.
“A lot of medications, mostly SSRI antidepressants, are used to help manage symptoms,” Castillo said. “Years ago, there were even some antipsychotics but we learned very quickly that those don’t help. They just sedate.”
Zoloft and Prozac are still used, and increasingly, patients are prescribed the antihypertension drug Prazosin to dampen adrenaline production.
“There is some evidence Prazosin is very effective for nightmares — very promising,” Castillo said.
Prescribing multiple heavy-duty psychiatric medications is now discouraged, Castillo said.
Researchers and clinicians do not speak in terms of “curing” PTSD, Castillo was quick to note.
“Can we say a patient will never have another nightmare? No. But we can equip them with the tools to cope with that nightmare,” she said.
Securing charges against the soldiers who sexually assaulted their female compatriots is not common, and some researchers have concluded that military sexual assaults are under-reported because of victims’ fears of being blamed for their assaults, or of being branded “troublemakers.”
“We as clinicians do not encourage our clients to attempt to identify their assailants,” Castillo said. “I’m not privy to the rates of conviction, but by the time our veterans feel safe enough to talk to us, it may be one year later, it may be 30 years later. Seeking resolution that way is potentially difficult because it may be completely denied and then there is no resolution.”
For information about the NM VA Women’s Comprehensive Care Clinic, call (505) 265-1711, extension 4621.