Addressing the Unique Challenges and Experiences of Female Service Members and Veterans Tracy Hejmanowski, Ph.D. Clinical Psychologist Deployment Health Center Naval Hospital Jacksonville

The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or the United States Government.

Female service members 12-14% of OIF/OEF/OND troops Support v. forward deployed Camaraderie / security Utilization of services PTSD risk Photo courtesy of U.S. Navy

Unique Life Experience Challenges Leadership Communication Discipline Respect Self-confidence Photo courtesy of U.S. Army Photo courtesy of U.S. Navy

Characteristics of Female Veterans Achievement-oriented (out to prove self) Determined (stubborn) High expectations (relentless) Stoic (cold) Photos Courtesy of U.S. Navy Photos courtesy of U.S. Army

Pre-deployment Considerations Relationship/Marriage Nuclear Family role Extended Family role (allaying fears) Procreation timeline Child care Resentment Fear of injury Disapproval Two masters, Photos courtesy of U.S. Navy

Peri-deployment Considerations Guilt Camaraderie Isolation/privacy Practicalities Sanitizing communication Danger (on/off FOB) Homefront distractions Photos courtesy of U.S. Navy

Post-Deployment Considerations Invisibility Assumptions Stigma Role return 4 P’s Photos courtesy of U.S. Navy

Therapeutic Presentations Combat and Operational Stress / PTS Depression Anxiety Anger Dyscontrol SUD PPCS/mTBI Chronic pain Marital/family strain

Physical Injury Loss of limb functionality Loss of hearing, eyesight Chronic pain back, joints, burns Muscle tension mandibular, shoulders Fibromyalgia Headache/migraine Asthma Dyssomnias

Brain Injury Up to 40% may have exposure Many undiagnosed unrecognized, unavailable, pride first noticeable problems appear Cognitive difficulties (overlap with PTSD) Attention, concentration Working memory, short-term memory Learning deficit Information processing sluggish Impaired abstract reasoning, executive functioning (p/s, planning, sequencing, time mgmt, insight/awareness)

Continuum of PTS 3 conceptual models Subtypes Severity Medical Social Occupational Subtypes Depressive Anxious Angry Grieving Morally Injured Combination Severity Photo courtesy of Naval Hospital Jacksonville

Soul Injury Manifestations Grief, rage (both rooted in humanity), depression, suicidality Guilt, survivor shame, regret, fear, angst

Safety and Lethality Assessment Authenticity of a SM’s support network Access to lethal means of self/other harm History of impulsivity Substance use Adequacy of sleep Medication regimen Outlook on the near and distant future

What hinders help-seeking Stigma Cliché Guilt Shame Ethos Weakness Judgment

Discussion