PTSD: Reclaiming Control By: Robert ‘Bob’ Cuyler, PhD Psychologist and Trauma Expert
PTSD and the Female Veteran, Part III For this month’s column, I’m continuing my dialogue with my colleague Lori-Ann Landry, a social worker in private practice in Denver with extensive experience in PTSD treatment and research. Q: I am curious in your practice and treatment of PTSD if you see a difference in how symptoms manifest for male versus female veterans? A: Absolutely. I think this can relate to how males and females are socialized differently growing up. We know from neurodiversity research that there are definite differences in how symptoms can manifest based on gender which can lead to delayed diagnosis and treatment as well as emphasizing the need for careful history taking and personalized treatment plans. I think the same is true for how PTSD can manifest in males versus females, leading to similar delays in diagnosis and treatment. Some examples for women: there can be a greater level of masking learned earlier in life, a pressure to “stay strong,” to keep household and family management intact, and a tendency to prioritize others’ needs over our own mental health. Women’s symptoms can sometimes be more internally focused with anxiety and depression as most prominent features. For men, symptoms can be more externalized with risktaking behaviors, irritability, aggression and substance use. Stigma around vulnerability with pressure to “tough it out” in fear of judgment and rejection can lead to delayed treatment for men. Men may also experience more traditional “fight or flight” responses to triggers, while a womens’ responses are more likely to be “tend and befriend,” where we will manage threats through connection/community and nurturing needs. That being said, there are core commonalities such as hypervigilance, numbing, avoidance, sleep disturbance and delayed access of treatment, though for different reasons as identified above. Q: In looking at these differences, do you see additional variations in PTSD caused by combat trauma versus military sexual trauma (MST)? 22
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A: That’s a great question and we’re definitely seeing variations based on type of trauma events. In bigger picture, combat trauma is ‘within systems’, for example our country against another country where many people are experiencing similar trauma concurrently. There is an enemy that has been defined. There is a level of honor in combat even if at the core, symptoms of shame can be similar. The violation of trust in combat that occurs is about losing trust in the safety of your larger environment. With MST, it is an interpersonal violation of trust, sometimes with colleagues or leadership that are supposed to be keeping you safe. The hypervigilance is more at the person-toperson level, readily leading to distrust and isolation. The sense of shame can be more individualized. In combat trauma spaces/ communities become unsafe and with MST, people become unsafe. In summary, we see a lot of individual variations, some related to gender, others to more unique background and personal variables. All of this points to the need for careful individualization of treatment approaches and availability of a range of options that best fit for each veteran.
Dr. Cuyler is chief clinical officer of Freespira, an FDA-cleared non-medication treatment that helps people with panic and PTSD manage their symptoms by learning how to regulate their breathing. www.freespira.com