Women Veterans: The Effects of Combat Deployment
Patricia Rochedieu
Liberty University
Introduction to Human Services
HSCO 500
Mrs. Jennifer Griffin
November 17, 2014

Abstract
The relocation and adjustment processes occurring within persons facing involuntary deployment are most certainly filled with anxiety and uncertainly. This discussion will focus on women veterans who have served on the front lines and the affects of combat deployment. Examinations defining the trials and tribulations faced by the female military member will place attention on the psychological and psychosocial transactions that occur during military operations and the challenges women face. Expansion of this topic will include a dialogue that offers insight into the growing concerns shaping the outcomes of the female member’s deployment to include military sexual trauma, eating disorders, depression, substance abuse, adjustment disorders, sleep disturbances and spiritual and existential struggles. Although this topic will only provide a brief glimpse into the female veteran’s plight it opens up a forum for further discussions within this topic with the intentions of highlighting the effects of combat deployment on women veterans who served on the front lines.

Women Veterans: The Effects of Combat Deployment
The participation of women deployed to combat areas throughout the world is vital to the successful outcomes of any mission. Women in the military are well trained and possess specific military skills invaluable to combat maneuvers and infantry tactics. Many branches of the military capitalize on these attributes that either mirror the skills of their male counterparts or exceed them.
The challenges faced by women soldiers and sailors in combat are not so comparable and are in some respects considerably different. The psychological and psychosocial elements are strikingly opposite from that of their male counterparts and focus on elements not only unique to the female human body, but to their individual developmental diversity.
Gender further dictates references to femaleness related to membership in society and overcoming this single obstacle can, for some women, become an overreaching challenge. Mainstream acceptance into a predominately male field discriminately presents issues that quantitatively articulate antiquated beliefs that females in the services are inferior participants.
Widespread, sexist attitudes abound with unfounded sentiments phrasing women as being ill equipped for battle; individuals who should be left behind attending to secretarial duties.
Military Sexual Trauma January 2013, the military officially lifts the ban on women in combat roles. The Joint Chiefs of Staff overturned the 1994 ban citing that women, who already make up fifteen percent of the force, have increasingly found themselves in the "reality of combat" during Iraq and Afghanistan (Fishel, 2013). The military’s delayed acknowledgement of the roles women occupy in direct combat are likened to the lack of experience and response in addressing sexual trauma in women.
Researchers have consistently reported the prevalence rates of sexual assault of women during military service of twenty-one to twenty-five percent or higher and of sexual harassment of twenty-four to sixty percent (Kelly, Skelton, Patel, & Bradley, 2011). Keep in mind that these numbers are only representative of females who have reported such occurrences. The reality is that these statistics are indicative of volunteer testimony and do not represent the exact number of accounts, which may be quite higher.
The Department of Defense in 2010, reported a shocking number of women, nineteen thousand in total who were victims of sexual assault and rape (Hannum, 2012). These crimes desecrate a woman’s sense of camaraderie in the field and complicate their care when they return home because of the additional trauma and betrayal experienced beyond physical, spiritual, or other emotional injuries (Hannum, 2012)
In a national random sample of women seeking health care in a Veterans Administration Medical Center, one in every four women report experiencing sexual trauma while on active duty (Kelly et al., 2011). This makes the point clear that women are acutely at risk for exposure to some form of sexual assault.
Valid concerns remain and largely in part to the military’s retarded progress in defining military sexual trauma. Women who are not adequately diagnosed or treated for sexual trauma may develop mental health issues associated closely to the affects of their experiences. In one study of sexually traumatized female veterans, post traumatic stress disorder was a strong correlate and significant predictor of chronic pain, consistent with other reports of suicidal ideation and suicide attempts (Kelly et al., 2011). In another study it was found, in a small sample of active duty women, that military sexual harassment was more strongly associated with post traumatic stress disorder than combat exposure (Lehavot & Tracy, 2014).
Interestingly, most discussions, research, and studies do not adequately address the underlying causes of military sexual trauma, nor do they assess existing sexual misconduct in the military. Oftentimes, well-understood boundaries are crossed and women through shame or guilt do not report sexual harassment, trauma or rape and unknowingly perpetuate acceptance of this behavior. It is, intelligible then to say that in order for a marked change to occur, women must band together and passionately support one other through affirmative action aimed at totally eliminating any further abuses of military sexual trauma.
Eating Disorders Eating disorders affecting female veterans range from anorexia to bulimia and include obesity. This examination runs the gamut and while most eating disorders have not been studied among female veterans, the prevalence of the problem remains a constant.
General population studies have found the incidence of bulimia nervosa and anorexia in adult women to be one to four percent (Mitchell, Rasmusson, Bartlett, & Gerber, 2014). While there has been very few analysis of eating disorder prevalence among veteran women, a multi-site study reveals less than one percent of women veterans suffer from these diseases (Litwack, Mitchell, Sloan, Reardon, & Miller, 2014). Underreporting is cited as an indicator of these results and points to an ever growing epidemic that pivots between bulimia and obesity.
In a sample of female veterans seeking outpatient treatment for trauma-related mental health conditions, thirteen percent reported binge eating, four percent reported purging, and eight percent reported extreme caloric restriction as a method of weight regulation (Mitchell et al., 2014). Eating disorders have been found to exist concurrently with other disorders and extend into higher rates of comorbid psychopathology, including comorbid depression, anxiety disorders, and substance abuse (Litwack et al., 2014).
The over utilization of food for purposes of creating euphoric feelings is not a new development and one that most women and men alike partake in for purposes of merriment on special occasions or celebrations. The point at which food consumption becomes an obsession or disease however, is sometimes difficult to assess and oftentimes happens in secret.
Over time noticeable, physical changes to the individual’s body may become apparent. Several reasons may underlie an eating disorder and typically present to the female veteran in a context more closely associated to trauma-related disorders. Early detection, although difficult to define, is paramount for timely intervention and successful recovery.
Depression
The military typically discusses their members in terms of gender, women and men. When speaking directly about depression and its association with veterans, the approach of some military analysts purport, that more women than men for whom major depressive disorder has affected was preceded by adolescent depression (Boyle, 2014) Men diagnosed with major depressive disorder more frequently had their mental health concerns attributed more closely with military action, involvement and its direct correlation with front line duty.
Suicide prevention programs, actively supported by the United States Navy, aimed at females, illustrates the shadows of two women seated on the shoreline in front of an aircraft carrier seemingly engaged in discussion with each other, with the words embossed beneath them reading, “Be a Shipmate, Lend an Ear, Save a Life”. Sailors throughout the fleet are encouraged to work together as commands, units, and installations to other groups to recognize suicidal tendencies and behavior and act to prevent it (Boyle, 2014). The problem with these programs, as noted by the writer, is that many women, for fear of rejection or the appearance of weakness by their male shipmates tend not to disclose feelings of depression. A recent study supports this belief and reports that ninety-three percent of the women veterans polled agreed that they failed to receive the respect they deserved or earned because they were a woman (Lehavot & Tracy, 2014). Revealing any form of weakness by the female, even diagnosable ones, tend to produce negative consequences and confirmed biases that women are not suited for military duty.
Another concern with suicide prevention and major depressive disorder programs as offered by the U.S. Navy are very gender-specific. The campaign does not show a man and a woman engaged in discussion or two men, it depicts two women. Sexism in the armed forces such as this may yet be another indicator for the possible reasons for the significant overlap of mental health concerns among women who exhibit major depressive disorder and other indicators of trauma related symptoms.
Empirical evidence further suggests that women veterans who experience traumatic events are more likely than men to meet the criteria for depression and may also be significantly at risk for developing comorbid mental health issues that may result from military service that symptomatically occurs in part due to biological decreases in parasympathetic activity (Tan et al., 2013). Does this mean that women are not biologically fit for combat duty? Evidence based material from this particular study may indicate so. Fortunately, this is but one study conducted by a handful of researchers and is not indicative of all females.
Research also asserts that women veterans with major depressive disorder endorsed higher pain-related complaints related to back pain and headaches, but that no gender diagnosis interactions were significant (Runnals et al., 2013). The discussion continues to address women, specifically disabled women veterans, as complaining more than men with regard to pain levels.
The assessments in the study mentioned above were gathered from a random set of veterans and scarcely provides the means of addressing an individual’s pain levels to that of occurrences and relatedness to major depressive disorder. The discussions were hypothetically based and omit that one person’s threshold of pain may differ dramatically from another and assessing such pain as the source or causal affect of depression suggests that all persons who suffer from pain also suffer from major depressive disorder; probable maybe, applicable to everyone, no.
Substance Abuse
Psychosocial stage five of Erik Erickson’s theories discusses identity-vs.-confusion. This stage allows a child to explore their independence and embrace a sense of self. Completing this stage successfully leads to fidelity, which Erikson describes as an ability to live by society's standards and expectations (Feldman, 2014, p. 240).
One may wonder what this psychosocial stage has to do with the female veteran’s gender and substance abuse. Researches delving into the problems of drug and alcohol use and trauma exposure among male and female veterans before, during, and after military service surmise that men are more likely to drink alcohol with a higher rate of alcohol abuse or dependence than women and women are more likely to develop post traumatic stress symptoms such as depression than men (Kelley et al., 2013). This statement is closely related to boys play with truck and cars and girls play with dolls. The thinking whether intentional or not as conducted by these researches in their evidenced based research is highly skewed towards Erickson’s stage five theories.
Measures assessing a control group of combat related exposure for both men and women examined the gender difference. The result of the multi-group showed direct effect results suggesting that the relationship between trauma exposure and alcohol use is similar for male and female veterans (Kelley et al., 2013). Problematic is that the research although conducted within the same study is contradictory and as such may lead to potential misdiagnosis of the female veteran due to gender norms.
A study reporting the proportion of female veterans who engage in problem substance abuse use shows a higher than estimated use. Assessed in 2008, alcohol use among 48,481 active duty personnel, thirty percent female, found that women were 1.21 times more likely than men to begin heavy weekly drinking with thirty-two percent of women reporting binge drinking post military action (Carroll-Chapman & Wu, 2013).
These numbers demonstrate a sample group, but illustrate the need for additional attention to be given to women veterans suspected of suffering from post traumatic stress symptoms and redirected and be inclusive of potential problem substance abuse diagnoses. Although researchers have documented gender-related differences in the associations between post traumatic stress symptoms and alcohol dependence / abuse, they have not systematically examined whether there are similar differences….knowing whether gender-related differences exists could help inform both prevention and intervention efforts (Kachadourian, Pilver, & Potenza, 2014).
Adjustment Disorders Deployment efforts to foreign countries whether as a military action or war displace families and test relationships. Relationship adjustment and posttraumatic stress disorder symptoms were assessed across a sample of married soldiers recently returned from combat duty in Iraq and were linked to problems with relationship positive bonding, commitment and negative communication (Erbes, Meis, Polusny, & Compton, 2011). Individuals functioning within high stress environments in life and death situations may experience difficulty reintegrating into a safe, daily routine of family life. Feelings of numbness and avoidance may be encountered to the exclusion of spouses and family members in an effort to disassociate or hide any feelings of anxiety. The female veteran returning home after deployment may reenter into her home as a wife, mother, sister, or daughter. The experience of combat is distinct to each individual who faces it and sharing difficult events may invoke difficult images and become discussions and stories better left untold. Emotional closeness and intimacy are core predictors of couple satisfaction and stability and over time the ability to express and experience intimacy may be greatly limited among those with these symptoms of emotional numbing (Erbes et al., 2011). This may be in part to the veteran attempting to distance herself from unpleasant memories and struggling with the inability to freely express combat occurrences without fear of upsetting her partner, child or family member. The failure to share may be due in part to a fear of re-experiencing events (intrusive memories, nightmares, flashbacks, and emotional and psychological reactively to trauma cues) and ineffective coping mechanisms for dealing with personal distress (Erbes et al., 2011).
Individual differences regulating emotions can be detrimental to the functioning of intimate relationships and may cause one to avoid uncomfortable yet important discussions with intimate partners, causing tension, conflict and/or inhibited intimacy (Reddy, Meis, Erbes, Polusny, & Compton, 2011). The paradoxical effects of avoidance of uncomfortable emotions and coping strategies that alienate intimate partners are counteractive. The veteran’s intentions to shield the ones they love from difficult discussions may be misread as emotional numbness. Positive engagement from the veteran’s family can significantly decrease the soldiers need for internalization and emotional distress allowing the individual to successfully reintegrate into the family. Romans 8:25, English Standard Version (ESV), provides comfort, “But if we hope for what we do not see, we wait for it with patience”.
Sleep Disturbances
Sleep problems often coincide and contribute to other health problems for active duty soldiers and veterans, complicating their return from deployment and combat and elevating their risk for a number of serious physical and mental health problems, including post-traumatic stress disorder (PTSD) and depression (Breus, 2013). Importance is placed upon a solider being highly vigilant at all times while on the front lines in what is designated as the “red zone” or “hot zone” which is a defined as a highly active area where combat and enemy fire is anticipated or occurring. Deployment to these areas for most military members lasts for months and for some years. Maintaining hyper vigilance is imperative to survival but in doing so has the tendency to create disruptions in sleep patterns.
While there has been little focus on sleeps issues among women veterans, in a descriptive study of one hundred and seven women veterans with insomnia, fifty-five percent had post-traumatic stress disorder and greater psychosocial distress (Hughes, Jouldjian, Washington, Alessi, & Martin, 2013). Active duty soldiers who recently returned from combat deployment in Iraq or Afghanistan report experiencing increased sleep disruption, and insomnia (Gehrman et al., 2013). Further research has revealed that not only are women veterans at a higher risk for insomnia, they are likely to show an association between poor sleep and psychiatric comorbidities including depression, anxiety and panic disorder (Hughes et al., 2013).
Attention to experiences of night terrors and nightmares in the female veteran are rarely researched in empirical studies. Most studies focus efforts on determining the causes for sleep disruption rather than remedies aimed at alleviating them.
Recently, innovative medical studies may have impinged upon a temporary cure for consistent disruptions in sleep patterns due to reoccurring nightmares or trauma images. Physicians working within the veteran’s administration propose that the use of continuous positive airway pressure (CPAP) as utilized with obstructive sleep apnea patients may alleviate the occurrences of frequent nightmares (Celmer, 2013). Sadeka Tamanna, M.D., MPH, Medical Director of the Sleep Disorders Laboratory at Veterans Administration Medical Center in Jackson Mississippi stated that “One out of six veterans suffers from post-traumatic stress disorder, which affects their personal, social and productive life.” “Nightmares are one of the major symptoms that affect their daily life (Celmer, 2013).” Not only are women veteran at a high risk for insomnia they are also two to three times more likely to develop post-traumatic stress disorder compared to men (Hughes et al., 2013).
Such evidence clearly argues for the importance of increasing research regarding the symptoms and cures for sleep disorders in not only the female veteran, but in all returning military members. The bidirectional relationship between sleep disorders as a risk factor for psychiatric disorders as well as physical health hazards require additional knowledge that is capable of delving into the different stressors that affect women veterans and most importantly how to properly manage and treat them.
Spiritual and Existential Struggles Today, as many of the US military gains in Iraq are unraveling, veterans and others are wondering as well: Was I justified in Iraq? Is there meaning in violence? (Peters, 2014). High on the list of emotions is guilt with soldiers often carrying this burden home from experiences in war. Why did I live and my buddy died? The experiences of war can live on forever in the hearts and minds of the troops who were forced to make survival and fighting for justice, peace and safety their first priority (Sherman, 2011). The daily struggles of war create a deep need for religious and spiritual connections with God. The acts of violence whether as the perpetrator or victim is forever imbedded in the minds of those educated, who responded to the call to become a trained and experienced killer.
The loss of war weighs heavily and to help with the healing many veterans who have come back to civilian life and lost their faith are seeking to reestablish a relationship with the Lord. The Heroes to Heroes program takes former United States soldiers struggling after combat on a pilgrimage to the Holy Land in Israel and helps to restore their faith (Sudilovsky, 2014). The article describes how one individual who suffered from serious injuries contemplated suicide, but after visiting Israel felt how empowering reestablishing his relationship with the Lord was. He is quoted as saying, “The first time I came here it really opened my life, my heart, my mind to how ridiculous an idea it was to kill myself…the healing process just won’t come by itself, it has to be something spiritual (Sudilovsky, 2014).” Everyone needs help in healing and at times it takes the belief in something or someone bigger than them to acknowledge how great and wonderful life can be when it is walked with the Lord. Proverbs 3:5-6 reads, “Trust in the Lord with all your heart, and do not lean on your own understanding. In all your ways acknowledge him, and he will make straight your paths (Bible, NIV).” There is a new understanding about the war’s scars: In addition to physical, mental, and emotional injuries, many veterans and their loved ones and supporters are now beginning to better understand “moral injury”, described as a wound or corrosion of the soul (Hannum, 2012). It was found in a Pew survey conducted in the year 2011 that faith strongly increases the changes that a veteran will readjust more easily to civilian life (Hannum, 2012). The question remains two fold; one will the veteran seek the spiritual help he or she so desperately needs to recover both mentally and spiritually and two will there be an outreach from the church available when the individual seeks it. Logan Mehl-Laituri, an Army war veterans is quoted as saying, “Veterans are losing faith because the church doesn’t want to listen when they come home…a lot of them lose faith because faith fails tremendously in the face of combat (Hannum, 2012). While not all military members will agree with this statement. The fact that even one solider feels this way should be of concern for the church. Mehl-Laituri further explains that while the military prepares soldiers to be good marksmen, there’s no effort to make moral sense of what they’ll be doing – killing people. “What about loving your enemies?” “What does it mean to be a Christian soldier? (Hannum, 2012).” 1 Peter 2:19-23 ESV reads, “For this is a gracious thing, when, mindful of God, one endures sorrows while suffering unjustly. For what credit is it if, when you sin and are beaten for it, you endure? But if when you do good and suffer for it you endure, this is a gracious thing in the sight of God. For to this you have been called, because Christ also suffered for you, leaving you an example, so that you might follow in his steps. He committed no sin, neither was deceit found in his mouth. When he was reviled, he did not revile in return; when he suffered, he did not threaten, but continued entrusting himself to him who judges justly”. These discussions while focusing primarily on women veterans who have served on the front line and the effects of combat deployment placed attention on the psychological and psychosocial transactions that occur during military operations and the challenges women face. Expansion of this topic included a dialogue that offered insight into the growing concerns shaping the outcomes of the female member’s deployment to include military sexual trauma, eating disorders, depression, substance abuse, adjustment disorders, sleep disturbances and spiritual and existential struggles. Although this topic only provided a brief glimpse into the female veteran’s plight, it is hopeful that additional forums for discussion will continue to address the affects of combat deployment on women veterans who served on the front lines and the measures needed to ensure their continued physical and mental health.

References
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