Sexual Trauma Tied to PTSD in Female Veterans

ALBUQUERQUE — Sexual trauma is the primary cause of posttraumatic stress disorder in female veterans, according to a psychologist who provides care at a trauma clinic for female veterans in New Mexico.

Diane T. Castillo, Ph.D., estimates that 80%–90% of female veterans who walk into the Women's Trauma Clinic with posttraumatic stress disorder (PTSD) had suffered sexual trauma before, during, and/or after their military service.

Most PTSD in male veterans is entirely combat related, but that is the case for only about 8% of cases in female veterans, she says. She calculates that about 70% of female PTSD patients have only sexual problems but adds that some women veterans have suffered sexual and combat traumas.

Dr. Castillo, coordinator of the Women's Stress Disorder Treatment Team in the Albuquerque-based New Mexico Veterans Affairs Health Care System, gave an overview of experiences from her clinic at a psychiatric symposium sponsored by the University of New Mexico.

Dr. Castillo said that the prevalence of sexual trauma in female PTSD patients varies among veterans' centers, but that it is higher overall than the prevalence that is found in the general population. PTSD prevalence among female veterans, she added, has inched up from about 8% during the Persian Gulf War to close to 9%.

Dr. Castillo presented a complex portrait of the traumas experienced by her patients, augmenting her talk with a videotape, “Women Who Served in Our Military: Insights for Interventions,” which was produced by the Veterans Affairs' National Center for PTSD and narrated by television journalist Jane Pauley.

The traumas discussed during the symposium ranged from a sexual assault by two male noncommissioned officers who were never prosecuted to the persistent sexual harassment of women while on duty in Iraq and in the Persian Gulf War. Many, but not all, women soldiers were in sexually threatening circumstances, Dr. Castillo said, telling of the exception: a reserve unit from Las Vegas, N.M., whose members, male and female, had served together for many years and looked out for one another like extended family in Iraq.

Preliminary data from an ongoing research project in her center suggest anger is a common manifestation of PTSD in women veterans, Dr. Castillo said. She has been administering the Buss-Durkee Hostility Inventory to males with PTSD and other psychiatric disorders and to female PTSD patients in her clinic.

Stressing that the sample of females screened is still small, she said her findings so far suggest that:

Males with PTSD have higher anger scores, in particular for assault and verbal hostility, than do females with PTSD.

Males and females with PTSD score comparably on cognitive measures such as resentment, suspicion, and guilt.

Females with PTSD score higher for resentment and suspicion than do males with other psychiatric disorders.

Dr. Castillo and her copresenter, Dr. Stephanie K. Fallon, described a treatment program built around therapy groups at the clinic. Victims of sexual trauma receive free care, they said. The first step, an assessment, includes an initial interview and computerized psychological testing.

Identifying suicidal patients is crucial at this stage, according to Dr. Castillo: “If a person is actively suicidal, this is not the time to do trauma work.”

Dr. Fallon, associate director of residency training at the NM VA Health Care System, said medications are used to ease symptoms such as insomnia and nightmares but are secondary to the group work at the clinic. “The cornerstone of treatment for PTSD is psychotherapy, not medication,” she said.

All groups are optional and female veterans who agree to psychotherapy start first with a support group designed to educate them about therapy and about PTSD.

Most PTSD in male veterans is combat related, but that is the case for only about 8% of female veterans. DR. CASTILLO

ALBUQUERQUE — Sexual trauma is the primary cause of posttraumatic stress disorder in female veterans, according to a psychologist who provides care at a trauma clinic for female veterans in New Mexico.

Diane T. Castillo, Ph.D., estimates that 80%–90% of female veterans who walk into the Women's Trauma Clinic with posttraumatic stress disorder (PTSD) had suffered sexual trauma before, during, and/or after their military service.

Most PTSD in male veterans is entirely combat related, but that is the case for only about 8% of cases in female veterans, she says. She calculates that about 70% of female PTSD patients have only sexual problems but adds that some women veterans have suffered sexual and combat traumas.

Dr. Castillo, coordinator of the Women's Stress Disorder Treatment Team in the Albuquerque-based New Mexico Veterans Affairs Health Care System, gave an overview of experiences from her clinic at a psychiatric symposium sponsored by the University of New Mexico.

Dr. Castillo said that the prevalence of sexual trauma in female PTSD patients varies among veterans' centers, but that it is higher overall than the prevalence that is found in the general population. PTSD prevalence among female veterans, she added, has inched up from about 8% during the Persian Gulf War to close to 9%.

Dr. Castillo presented a complex portrait of the traumas experienced by her patients, augmenting her talk with a videotape, “Women Who Served in Our Military: Insights for Interventions,” which was produced by the Veterans Affairs' National Center for PTSD and narrated by television journalist Jane Pauley.

The traumas discussed during the symposium ranged from a sexual assault by two male noncommissioned officers who were never prosecuted to the persistent sexual harassment of women while on duty in Iraq and in the Persian Gulf War. Many, but not all, women soldiers were in sexually threatening circumstances, Dr. Castillo said, telling of the exception: a reserve unit from Las Vegas, N.M., whose members, male and female, had served together for many years and looked out for one another like extended family in Iraq.

Preliminary data from an ongoing research project in her center suggest anger is a common manifestation of PTSD in women veterans, Dr. Castillo said. She has been administering the Buss-Durkee Hostility Inventory to males with PTSD and other psychiatric disorders and to female PTSD patients in her clinic.

Stressing that the sample of females screened is still small, she said her findings so far suggest that:

Males with PTSD have higher anger scores, in particular for assault and verbal hostility, than do females with PTSD.

Males and females with PTSD score comparably on cognitive measures such as resentment, suspicion, and guilt.

Females with PTSD score higher for resentment and suspicion than do males with other psychiatric disorders.

Dr. Castillo and her copresenter, Dr. Stephanie K. Fallon, described a treatment program built around therapy groups at the clinic. Victims of sexual trauma receive free care, they said. The first step, an assessment, includes an initial interview and computerized psychological testing.

Identifying suicidal patients is crucial at this stage, according to Dr. Castillo: “If a person is actively suicidal, this is not the time to do trauma work.”

Dr. Fallon, associate director of residency training at the NM VA Health Care System, said medications are used to ease symptoms such as insomnia and nightmares but are secondary to the group work at the clinic. “The cornerstone of treatment for PTSD is psychotherapy, not medication,” she said.

All groups are optional and female veterans who agree to psychotherapy start first with a support group designed to educate them about therapy and about PTSD.

Most PTSD in male veterans is combat related, but that is the case for only about 8% of female veterans. DR. CASTILLO

ALBUQUERQUE — Sexual trauma is the primary cause of posttraumatic stress disorder in female veterans, according to a psychologist who provides care at a trauma clinic for female veterans in New Mexico.

Diane T. Castillo, Ph.D., estimates that 80%–90% of female veterans who walk into the Women's Trauma Clinic with posttraumatic stress disorder (PTSD) had suffered sexual trauma before, during, and/or after their military service.

Most PTSD in male veterans is entirely combat related, but that is the case for only about 8% of cases in female veterans, she says. She calculates that about 70% of female PTSD patients have only sexual problems but adds that some women veterans have suffered sexual and combat traumas.

Dr. Castillo, coordinator of the Women's Stress Disorder Treatment Team in the Albuquerque-based New Mexico Veterans Affairs Health Care System, gave an overview of experiences from her clinic at a psychiatric symposium sponsored by the University of New Mexico.

Dr. Castillo said that the prevalence of sexual trauma in female PTSD patients varies among veterans' centers, but that it is higher overall than the prevalence that is found in the general population. PTSD prevalence among female veterans, she added, has inched up from about 8% during the Persian Gulf War to close to 9%.

Dr. Castillo presented a complex portrait of the traumas experienced by her patients, augmenting her talk with a videotape, “Women Who Served in Our Military: Insights for Interventions,” which was produced by the Veterans Affairs' National Center for PTSD and narrated by television journalist Jane Pauley.

The traumas discussed during the symposium ranged from a sexual assault by two male noncommissioned officers who were never prosecuted to the persistent sexual harassment of women while on duty in Iraq and in the Persian Gulf War. Many, but not all, women soldiers were in sexually threatening circumstances, Dr. Castillo said, telling of the exception: a reserve unit from Las Vegas, N.M., whose members, male and female, had served together for many years and looked out for one another like extended family in Iraq.

Preliminary data from an ongoing research project in her center suggest anger is a common manifestation of PTSD in women veterans, Dr. Castillo said. She has been administering the Buss-Durkee Hostility Inventory to males with PTSD and other psychiatric disorders and to female PTSD patients in her clinic.

Stressing that the sample of females screened is still small, she said her findings so far suggest that:

Males with PTSD have higher anger scores, in particular for assault and verbal hostility, than do females with PTSD.

Males and females with PTSD score comparably on cognitive measures such as resentment, suspicion, and guilt.

Females with PTSD score higher for resentment and suspicion than do males with other psychiatric disorders.

Dr. Castillo and her copresenter, Dr. Stephanie K. Fallon, described a treatment program built around therapy groups at the clinic. Victims of sexual trauma receive free care, they said. The first step, an assessment, includes an initial interview and computerized psychological testing.

Identifying suicidal patients is crucial at this stage, according to Dr. Castillo: “If a person is actively suicidal, this is not the time to do trauma work.”

Dr. Fallon, associate director of residency training at the NM VA Health Care System, said medications are used to ease symptoms such as insomnia and nightmares but are secondary to the group work at the clinic. “The cornerstone of treatment for PTSD is psychotherapy, not medication,” she said.

All groups are optional and female veterans who agree to psychotherapy start first with a support group designed to educate them about therapy and about PTSD.

Most PTSD in male veterans is combat related, but that is the case for only about 8% of female veterans. DR. CASTILLO