PTSD May Affect Women in the Military Differently Than Men

Key Points

• Women in the military have a higher likelihood of developing PTSD compared to civilians or male service members.
• Women warriors are more likely to experience military sexual trauma, which is as likely or more likely than combat trauma to cause PTSD.
• Female service members are also at a greater risk of developing comorbidities, such as depressive and anxiety disorders. 

One of the most familiar facts about post-traumatic stress disorder (PTSD) is that it's far more prevalent among military service members than the general populace. Less widely known is the fact that women soldiers are at a distinctly higher risk.

PTSD is most closely associated with combat, but other forms of trauma—this includes military sexual assault, aka military sexual trauma (MST)—can be equally traumatizing, if not more so.

How many women in the military have post-traumatic stress disorder?

According to the United States Department of Veterans Affairs (VA), women are the fastest-growing group of veterans. They made up 9.4 percent of the total veteran population in 2015, representing about 2 million people, and are projected to account for 16 percent by 2040.

Among the general populace, the lifetime prevalence of PTSD for women is 10 percent to 12 percent, compared to 5 percent to 6 percent for men, according to the American Psychological Association (APA).

Adjusting for age, race and ethnicity, women veterans have the highest rates of lifetime and past-year PTSD—13 percent compared to civilians or male veterans at 6 percent—according to the VA.

More research is needed to determine what percentage of nonbinary and transgender service members are affected. Still, evidence published by the VA suggests these populations are markedly more vulnerable than their cisgender counterparts.

Of veterans who completed the 2020 Wounded Warrior Project (WWP) Annual Warrior Survey, 20 percent were women. More than 80 percent of those women reported living with PTSD.

Research indicates service members of color, especially Black, Latina and Hispanic women, have a notably higher likelihood of developing PTSD and other psychiatric conditions, such as anxiety and depression, than their white counterparts.

Why are women at higher risk of developing PTSD?

A 2014 study published in the journal Women's Health Issues suggested that combat-related trauma is a primary source of post-traumatic stress among service members overall. Research suggests it affects men and women to roughly the same degree.

Men are indeed more likely to be deployed to a combat zone, but the same is true for 84 percent of women warriors. Female soldiers were deployed an average of three times, according to the 2020 Annual Warrior Survey. Women who deployed to a combat zone were 1.2 times more likely to develop PTSD than those who weren't.

However, many women in the military who have post-traumatic stress have never seen combat.

"The primary reason female veterans are more likely to experience PTSD is that they more frequently experience traumatic events," said Rosalind Pistilli, L.C.S.W., a veteran and therapist at Open Arms Counseling and Transition Center in Denver.

"These traumatic events include sexual harassment, intimate partner violence and sexual assault," said Frank Anderson, M.D., a psychiatrist in Harvard, Massachusetts, specializing in trauma and the author of the memoir "To Be Loved: A Story of Truth, Trauma, and Transformation" (to be released in May 2024).

Experiences of military sexual trauma are associated with PTSD to a degree that's "comparable to or greater than" the likelihood of a PTSD diagnosis related to severe combat exposure, according to the VA.

Data from several sources paints the same picture:

• Women in the military who experienced MST were nearly three times as likely to report moderate to severe PTSD symptoms than those who hadn't, according to the Wounded Warrior Project.
• In the U.S., about 81 percent of women and 43 percent of men report having experienced some form of sexual assault or harassment, according to the National Sexual Violence Resource Center (NSVRC).
• Approximately 1 in 6 American women will endure rape or attempted rape in their lifetime, compared to 1 in 33 men, according to the Rape, Abuse and Incest National Network (RAINN).
• Among veterans, roughly 1 in 3 women and 1 in 50 men report having experienced military sexual trauma or sexual harassment or assault during military service, according to VA data.
• Roughly 11 percent of respondents reported having experienced MST. Of this number, 78 percent were women, according to the 2020 Annual Warrior Survey.

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Gender-based differences in coping strategies could further increase women's susceptibility to post-traumatic stress disorder, according to the National Alliance on Mental Illness (NAMI).

Their research suggests women are more likely to take a "tend-and-befriend" approach to stress—it involves caring for people and reaching out for respite—instead of the usual "fight-or-flight" response. Women tend to rely more on others in times of distress, so they may be more at risk of developing PTSD if they don't receive the aid they need.

Such was the case for Arielle Jordan, L.C.P.C., a veteran, trauma therapist and owner of Mindset Quality in Frederick, Maryland. She filed a complaint against her sergeant for allegedly using a racially derogatory term. Instead of protection and support, she claims she received retaliation.

"Throughout my high-risk pregnancy, I received no support or check-ins to ensure my well-being. The same lack of empathy persisted when my daughter was born with terminal congenital heart disease," said Jordan, who was 17 when she enlisted. "Additionally, despite presenting doctor's notes confirming my high-risk condition, I unjustly suffered the consequences of lost student loan repayment due to being marked absent."

Jordan said the experience shattered her trust, along with her emotional health and financial security, causing her to develop intense fear, anxiety and agitation, all of which interfered with her ability to function or feel any sense of "normalcy." She was ultimately diagnosed with PTSD and sought eye movement desensitization and reprocessing (EMDR) therapy.

"Another reason PTSD may be more prevalent in women is that they're more inclined to seek help for their symptoms, resulting in a higher rate of diagnoses," said Cassandra Boduch, M.D., a psychiatrist at PsychPlus in Plano, Texas.

This gender difference is likely influenced by various social, cultural, and societal factors, she added.

"For example, men are more often encouraged to be self-reliant and stoic, which can make them less likely to seek emotional support," she said. "However, it's important to note that individual experiences can vary, and not all women seek help, nor do all men avoid it."

No matter who is suffering, open conversations about mental health should be encouraged. They are essential to reduce the stigma and promote help-seeking behavior.

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Why is military sexual trauma more likely to cause PTSD?

Sexual assault is traumatic for multiple reasons, noted Colleen Keiser, L.P.C., a counselor at Thriveworks in Cypress, Texas.

"First and foremost, sexual assault often occurs in situations where the individual should feel safe," said Keiser, a military veteran who was diagnosed with PTSD. "And in the case of the military, these are your fellow service members that have promised to protect and defend.

"We expect trauma from combat. We don't expect trauma from those closest to us."

"Moreover, because perpetrators are rarely strangers, victims may question whether they should have anticipated the assault," Pistilli added. "They may also have to see their attacker—and complicit bystanders—afterward, causing them to feel unsafe in places they'd previously felt safe in."

Say the assault happened at home, for example. Their home becomes a trigger for trauma, Pistilli added. It's not the safe space it used to be.

The profound violation of personal boundaries, coupled with the stigma and shame surrounding sexual assault, can compound the trauma, Keiser explained.

"After combat, people bring empathy and often even appreciation," she said. "With sexual assault, there is often shame, guilt and judgment from others and even ourselves."

Sexual harassment can have similar effects.

"It's a form of gender-based violence against women and can escalate the messages of discrimination they may have already experienced," Keiser said. "In a predominately male world, sexual harassment in those situations can be every bit as damaging as sexual assault."

Pistilli experienced sexual harassment in the military after reporting three men in her squadron for allegedly viewing porn on government computers, which was illegal.

"The rest of the squadron made my life a living hell as a result. I started getting write-ups for the most ridiculous things, including things I hadn't done. It had a deep impact on my life," she said. "I was suicidal, depressed, gained weight and started smoking heavily. Now, I usually try to avoid even talking about my military service, and I've just recently felt comfortable adding it to my resume and having 'veteran' on my driver's license.

"I left the military in 1997 but wouldn't talk about being a veteran until 2018."

Factors that can raise service members' risk of developing post-traumatic stress disorder, according to Keiser, Jordan and Pistilli, include the following:

• Additional life stressors
• Combat experience
• Deployment in difficult environments
• Difficulty adjusting to civilian life
• Discrimination
• Existing psychiatric conditions, such as anxiety, depression or substance use disorder
• Exposure to violence
• Family history of mental health problems
• Insomnia or trouble sleeping
• Lack of access to mental health care
• Lack of social and familial support
• Past trauma
• Racism
• Sexism

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How do women in the military experience PTSD differently?

Chemically and neurologically, the brain's response to trauma is consistent, regardless of gender, Pistilli noted. Each person's experience, however, is unique.

Research suggests gender can influence how trauma affects people and how they cope.

"People of all genders present with re-experiencing, avoidance, numbing and hyperarousal symptoms of PTSD, but other symptoms can be remarkably different for men and women," Pistilli said.

"Specifically, women tend to respond to trauma 'internally' and are more likely to develop depression and anxiety," Anderson said. "In contrast, men tend to react to trauma more externally, leading to anger, aggression and, often, substance use."

Additionally, men and women in the military are susceptible to physical symptoms and sleep disturbances, but these may manifest in distinct ways.

"Women are more likely to experience bouts of crying, intense fear, unexplained anxiety or panic attacks," Pistilli said. "Men are more likely to experience unexplained anger, irritability and decreased enjoyment of activities."

Women undergoing chronic stress, for example, may experience irregular or absent menstrual cycles and difficulty getting pregnant. Chronic stress can also exacerbate health conditions such as endometriosis, according to a 2016 report.

"More research is needed to determine why these differences exist," Keiser said.

Some experts suggest these differences are likely due to genetics and the interaction of psychosocial and hormonal factors. Others argue that, while these may be contributing factors, cultural ideas of femininity and masculinity can bring differences to the forefront.

How to help a veteran with PTSD

"The best way to support a veteran with post-traumatic stress disorder is to create an environment in which they feel safe and comfortable sharing their emotions," Jordan said.

"Listen without judgment or an agenda. Just sitting in that space with someone who is struggling is immensely helpful," Keiser said.

Help validate their experiences and encourage them to talk to a professional. They can seek help through the VA medical system or private care.

"Don't assume that only those [veterans] who have served in combat can present with PTSD," Keiser added.

Adequate access to mental health care is the "most vital" factor in preventing and managing symptoms of PTSD, Pistilli said, adding that the VA has recently made "massive strides" in PTSD treatment for all veterans.

Yet, many people with PTSD—and this is especially true for those with moderate to severe symptoms—have difficulty accessing services, according to WWP.

Keiser suggested you share the following resources with female veterans in need of care for PTSD:

• Women Veterans Call Center (855-829-6636)
• VAWnet.org (an online network focused on violence against women)
• Suicide and Crisis Hotline (988)

If someone is in immediate danger of self-harm, Keiser suggested calling 911 or offering to accompany them to a doctor's office or emergency room.

The bottom line

Post-traumatic stress disorder can be a devastating and dangerous condition, but it is treatable. Know that if you're experiencing symptoms of post-traumatic stress, you're not alone.

It's not your fault; you're not broken, weird or hopeless, Keiser stressed. It's OK to not be OK.

"You are so much stronger than you think, and you are more than what has happened to you. Take it one day at a time or one minute at a time," Keiser said. "Forward momentum is progress, no matter how small. You matter. Your story and experience matter."