June 16, 2004

Last modified June 16, 2004 - 12:26 am

By Katherine Spitz
Knight Ridder News

AKRON, Ohio - After the Gulf War ended, Pam Pelle's battle continued.

Pelle, a nurse and Army Reserve staff sergeant with the Akron-based 2291st Army Hospital, was called for active duty during the late fall of 1990. For six months, she worked at Walter Reed Army Medical Center in Washington, nursing returning troops who had severe orthopedic injuries. Day after day, she tended to soldiers who had lost arms or legs and listened to their battlefield stories.

After she returned home to Copley, Ohio, Pelle had nightmares and lost weight. A year later, hours after delivering her first baby, she started to hallucinate in her room at Akron City Hospital.

"I started screaming," she recalls. "I was under overhead fire. I could see Scud missiles. Then, one by one, I could see every amputee I had taken care of during the war."

Shell shock. Combat fatigue. Post-traumatic stress disorder. For generations, such terms have described the way combat can batter the psyche, as well as the body. Typically, the image of a troubled veteran was that of a man.

But in the past two decades, an increasing number of women have put on military uniforms, and many of them now fill combat roles. Currently, the United States has about 216,000 women on active duty worldwide, with another 151,000 in the Reserves and National Guard.

In the ongoing fighting in Iraq, female soldiers have been killed, captured and gravely wounded.

Experts have long known that men and women react differently to stress. For example, women are more at risk for post-traumatic stress disorder, or PTSD, a debilitating mental health condition that can be triggered by various life-threatening situations such as assault or natural disaster, as well as combat.

Now, the Department of Veterans Affairs has launched a $5 million study to determine what type of psychotherapy works best for women suffering from PTSD. Continuing through 2005, the study is the largest ever to focus on psychotherapy for PTSD.

"About 20 to 25 percent of the women who served in the Vietnam War and the Gulf War developed PTSD," said Paula Schnurr, deputy executive director of the VA's National Center for PTSD in White River Junction, Vt., and the study's co-director. "We'd expect the figures for women serving in Iraq to be at least as high."

Lucy Bland is a 53-year-old nurse-anesthetist at Cuyahoga Falls General Hospital in Ohio. She's also a lieutenant colonel in the Army Reserves who was stationed at Al Asad, Iraq, last fall.

Although she is coping well, since returning home to Cuyahoga Falls in January after three months' duty, she believes that a great many returning soldiers will suffer from stress-related problems.

"It's not like there is a front line," Bland said, "so anyone can be a victim."

And women veterans, she believes, may be especially affected by the war.

"I think women are different than men," she explains. "I think women take things more seriously, and are more intensely feeling."

Indeed, when it comes to mental health, women and men are put together differently, said Dr. Patricia Resick, a psychologist and director of the Women's Health Sciences Division in Boston, a research and education center run by the VA.

Resick and her colleagues study not only PTSD, but other mental-health problems, such as marital difficulties, that veterans can experience after combat.

"Women generally are definitely at higher risk for mood disorders, (such as depression and anxiety)," Resick said. "Men are at higher risk for substance abuse and aggression. So there are some sex differences on how people deal with their stressors."

Experts don't exactly know why men and women react to stress differently. It's unclear how much of the difference is due to genetics and how much is due to environmental factors.

Consider post-traumatic stress disorder: This condition brings with it both biological and psychological symptoms, such as sleep disturbances, anxiety, altered brain-wave activity and relationship problems.

PTSD can occur when a person experiences or witnesses life-threatening situations. However, most people exposed to these situations don't get PTSD.

One risk factor for the condition is having undergone a previous trauma.

Resick said that by the time a woman reaches adulthood, she is much more likely to have been a victim of abuse than a man, particularly when it involves childhood sexual molestation or domestic violence, which are especially devastating to the psyche.

Today, nearly 15 years out of the Reserves, Pelle, 40, said that when she finally told her family doctor about her nightmares and other problems, he told her that she needed "to just get over it."

"It was the wrong thing to say to anyone who has come back from active duty," Pelle said. "Because you know what? It doesn't work that way.

"You don't just get over it."