Shell shock. Combat fatigue. Post Traumatic Stress Disorder (PTSD) is the latest name and diagnostic formulation for a malady that is probably as old as warfare itself. One soldier described her experience as follows: "It took me nearly 10 years to calm down after coming home. I had a lot of trouble staying at jobs, including the one I returned to. I loved it before I left on military leave but hated it when I returned. I hated everyone. I was unable to stay anywhere for very long, often simply walking out of a job for no reason. Also had trouble staying where I lived, wanting to sell our home and move a lot. Couldn't stand having a paperboy because I couldn't tolerate a stranger walking across my lawn. Hated the mailman for coming too close to the house and actually touching my mailbox. If it suddenly thundered I'd drop and roll underneath the closest piece of furniture and draw a weapon. Major trust issues too. My husband once yanked his belt out preparing to change his pants and I took him down in an instant without even thinking about it. Scared the crap out of both of us!" Laura P. Staff Sergeant, US Army, 1983 \u2013 1989 PTSD is a unique mental illness in that in order to diagnose it, the sufferer must have experienced a traumatic life event and then develop a certain set of symptoms. Exposure to trauma isn't sufficient, and flashbacks without an identifiable trauma would also be insufficient to make the diagnosis. For servicemen and women, the traumatic event is often obvious and identifiable; in fact, PTSD can be difficult to treat in some cases because the number of traumatic events for a combat veteran can number in the hundreds. While both male and female soldiers are receiving this diagnosis at record rates, the experience of women in the military is somewhat different from their male counterparts. What tends to differentiate female soldiers' experience of trauma compared to male soldiers' experience includes: \tPre-military life and the likelihood of experiencing trauma as a civilian \tSexual harassment and discrimination while serving \tGender specific treatment by military and Veteran's Administration medical and psychiatric staff The Symptoms: PTSD may be diagnosed if the person presenting for treatment meets the following criteria: firstly, there must have been a traumatic event that the person witnessed or experienced first hand. This traumatic event must be sufficiently serious to be perceived as life threatening. Secondly, the person's response to this event must include overwhelming emotions such as shock, horror, fear, or helplessness. For soldiers to meet these criteria could be problematic, as responding to trauma with paralyzing fear, shock and\/or horror would not be functional for them. Military training includes learning to manage the emotions that accompany combat so that soldiers may function as soldiers. While this may make PTSD difficult to diagnose, due to the apparent absence of a key symptom, it doesn't change the experience of many soldiers-that upon coming home, re-entry to civilian life is fraught with struggle to unlearn that training. In addition, whether meeting diagnostic criteria or not, intrusive memories, flashbacks, and episodes of re-experiencing seem to occur despite the lack of an emotional reaction at the time of the incident. If those first two conditions are satisfied, the person must also report several key symptoms. They must re-experience the trauma in some way or ways. These re-experiencing episodes are not memories, but better understood as flashbacks. They can involve strong sensory hallucinations, such as smelling grenades or hearing artillery fire, and are truly re-experiences-for the former soldier, they feel that they are back in that moment, having that experience again, as Laura describes so clearly above. Further, to earn the diagnosis, avoiding this re-experiencing in an attempt to prevent it is required. Avoidance can look like an anxiety disorder or agoraphobia in severe cases, and can lead to socially "odd" behavior in other cases (for example, refusing to walk across a parking lot and instead walking the perimeter because this is "safer"). Finally, evidence of arousal is also required-this can be in the form of insomnia, hypervigilance, or other symptoms of increased watchfulness. Having a quick reaction to stimuli, which can also appear as increased irritability or anger, is also included as an arousal symptom. Stacking Trauma Upon Trauma Research has indicated that repeated exposure to trauma can increase the likelihood of developing PTSD. Prior to military service, women are more likely than men to have been the victim of a sexual crime-rape, incest, sexual harassment, or any other sexual assault. In fact, it has been hypothesized that some women seek to get away from these types of traumatizing situations by joining the service. Often these traumatic experiences are buried deep within the psyche, due to shame, blame, or any of the myriad accompanying fears-the fear of not being believed, fears of repercussions such as getting fired, or being physically abused, etc. Exposure to subsequent traumatic events can erode the defense mechanisms used to keep a "lid" on the initial response to trauma, as these defense mechanisms are on overload due to the overwhelming nature of military service, and especially of combat. In addition, women in the armed services often face sexual harassment from their male counterparts and superiors. This can occur in many forms, including a certain sense of isolation, due to being a "minority" and\/or a male bias regarding the diagnosis of PTSD itself. Elizabeth W., a veteran of the Iraq war, explains: "I also think the PTSD statistics are probably pretty skewed, partly due to stereotyping of females. When I returned from Iraq, the Army's Case Manager kept trying to shoehorn me into a PTSD diagnosis when in fact it was a TBI from an explosion. I think there's probably a fair number of misdiagnosed soldiers of both genders. The sooner the military can discharge a soldier and dump them into the VA medical system, the better it is for their budget." Laura J., Lieutenant, US Army adds: "It's frustrating, a lot of civilians don't understand. They think that as women we just did a few push-ups, etc. and were nurses. They don't realize we had to regularly qualify with hand grenades, the gas chamber, an M-16 rifle, and run MILES every day, among many other things. We slept outside in bitter winter for weeks at a time for training exercises after marching 50 miles to get to the site. We still felt that the males saw us as women first and foremost, and we always had to do more to prove ourselves. Then when we did, they didn't like it. We had THAT to deal with as well as the regular military shit. We didn't share the brotherhood the guys had in the military. When studying minorities, this parallels what African Americans have dealt with for so long. We had many terrorist threats on our barracks, at work, served the same guard duties, etc., and it was frightening. Men's fears were "realistic" while women were "whining" or Borderlines." Thus it would seems as if the deck is stacked against women in terms of their relative vulnerability with regard to trauma. Women serving alongside men may experience traumas stacked upon traumas before, during, and after their service. While the demands of the job as a soldier are the same for women and men, the rewards and the consequences appear to be quite different. The Future? According to recent statistics, women have made up 15 percent of the armed forces in Iraq, and are participating in combat duty in many, if not all, cases. Due to the greater participation of women in combat and the increasing numbers of women soldiers being diagnosed with PTSD, more research is being conducted regarding both how PTSD develops and which treatment modalities are effective. Hopefully, as women increase their role, their visibility, and their advocacy for themselves and each other, the avoidable traumas of sexual harassment and discrimination within the military can end.