In the news media, Post-Traumatic Stress Disorder (PTSD) is more commonly associated with former members of the military or an abused children. Very little is discussed when attributed to the aging population and the foreshadowing of PTSD. Evidence has suggested that although there are comparable traits between a generally diagnosed PTSD individual and an elderly individual, there are distinct factors which deviates from their related symptoms. With the typical changes in hormones levels and brain function in the general population of PTSD individuals, it can be suggested that PTSD in the elderly only expedites aging.

An elderly woman. [illustrative]. (photo credit:REUTERS)

The classic example of Post-Traumatic Stress Disorder is “Battered Woman Syndrome” (BWS), where a woman is severely abused and emotionally traumatized due to the actions of an abusive partner. Generationally this term has been scrutinized for numerous reasons, usually casting blame upon the female victim. The comparison of the empathic support a military member may receive versus an abused woman is incomparable. Women generally suffer through PTSD silently, whether this is due to aging, health issues, domestic violence, or financial instability all of these difficulties escalate into advancing years.

In today's article, the focus will be on both the visible and invisible dangers of Post-Traumatic Stress Disorder in aging women. In addition, the contributing factors and relatable treatments for women, of all ages, struggling with this disorder.

In older people it is not uncommon to experience transitions with a broader spectrum of losses. Among these are: The loss of physical functioning (i.e. inability to climb stairs, take a shower alone or drive), loss of independence (i.e. financial instability, illness and/or loss of a spouse), or the loss of a loved one (i.e. spouse, parents, siblings, children, etc.). There are several different forms of Post-Traumatic Stress Disorders (PTSD) that can manifest from these losses in an older person’s life.

“First is de novo, due to a trauma experienced in old age. Second is chronic, where the trauma is experienced much earlier in life, and leads to PTSD that follows a chronic course with possible periods of ﬂuctuation with respect to symptom severity. Third, PTSD can manifest itself with delayed onset; after years of absent, low or well-controlled symptoms, full-blown PTSD surfaces in old age.” (Lapp, 2011, p. 859)

PTSD in recent years has gained more credibility as a mild to severe anxiety disorder associated with traumatic events. Regarding the delayed diagnosis of post-traumatic stress disorder for many, whether in the elderly or younger individuals, is that “Some maintain that PTSD with delayed onset is in fact a misnomer – the apparent absence of PTSD is actually due to under-reporting, delayed referral, exacerbation of subclinical PTSD, or misdiagnosis. (Lapp, 2011, p. 859)

To address most importantly from these findings is that PTSD can take shape from previous experiences from the individual’s life (i.e. - war related trials such as genocide or forced incarceration, physical abuse, loss of a loved one at a young age, etc.) In a time of aging, one loss may feel reminiscent of a previous. So the influence of PTSD can be re-experienced with each troubling event.

Often the most influential of aging losses can be the death of a spouse. “Spousal bereavement has a wide range of physical and psychological consequences for the bereaved person.” (O’Connor, 2010, p. 670) This event leaves the surviving party feeling distressed, helpless, disenfranchised.

The overwhelming waves of loss on the grieving can be a traumatic experience, thus leading to forms of Post-Traumatic Stress Disorder (PTSD). PTSD is characterized as “…a mental health condition that's triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.” (Mayo Clinic, 2015, Web)

When carefully reviewing statistics of widowed bereavement, it clearly produces a broader picture of the most effected by spousal loss. “Approximately 75% of married women will be widowed and will remain unmarried an average of 18 years, and about half of all women in this country older than 65 years are widows.” (Brady, 2004, p. 35) The risk for this group of widowed women is higher for physical illnesses, psychological illness, and mortality.

In addition to these symptoms, “…certain individuals experience a cluster of symptoms that are separate from depression and are often protracted. These symptoms include yearning and searching for the deceased, loneliness, numbness, preoccupation with the deceased, and disbelief regarding the loss. Overall, there appears to be a general anxious tone to the symptom picture, complemented by emotional numbing and an inability to accept the death of the spouse or loved one.” (Brady, 2004, p. 36)

PTSD can blend with these symptoms due to the traumatic loss of the survivor’s loved one, making it difficult at times to clarify how profound their traumatization is. Unfortunately “…the special needs of older women with PTSD have received almost no attention.”(Westrup, 2005. p. 114) Generally grief counseling and support groups are utilized for widowers, however with the effects of PTSD they may avoid receiving assistance. Their avoidance is not evidence of a lesser problem or dis-accreditation of their suffering. It is simply apprehension on the survivor’s part in seeking help or support.

Often PTSD is associated with returning U.S. military or former military veterans, usually attributed to their service in the United States military. Their experiences of trauma so tragically consuming they may resort to drug use, self-harm (suicide), depression, and/or physical/emotional abuse of others around them.

{Illustrative} Stock Photo, User Created.

With consideration to the number of women serving in the armed forces, it is stated that “Female Iraq and Afghanistan veterans were more likely to be diagnosed with depression than their male counterparts, who were more likely to be diagnosed with post-traumatic stress disorder, a retrospective study of US. veterans has shown.” (Mechcatie, 2011, p. 8) As fore mentioned, PTSD can not only disguise itself within other symptoms but it can also be argued that there is an issue regarding under-reported PTSD related symptoms.

Addressing the U.S. military statistic in contrast to the greater population, there is a significant difference. “Approximately 10 % of male trauma survivors and 20 % of female trauma survivors develop post-traumatic stress disorder.” (Shipherd, 2014, p. 423)

In retrospect the number of PTSD in women significantly changes dependent on the age of the military servicewoman. Military women have a higher risk of developing depression past the age of thirty, if they are unmarried, were in the Reserves, National Guard, Navy, or Air Force and/or were an officer. However the greatest group at risk for PTSD are older women, characterized as women over the age of 30 years of age. These servicewomen are at “... greater risk for being diagnosed with PTSD and depression than younger women.” (Mechcatie, 2011, p. 8)

When considering PTSD in older women, it is necessary to address the health related issues that are often associated with Post Trauma. “Physical health can also decline following traumatic events, with problems such as chronic pain, anemia, asthma, arthritis, diabetes, cancer and digestive disorders often developing post-trauma.” (Shipherd, 2014, p.423) The correlation of health problems and mental health symptoms highlight the importance of PTSD treatment.

These health related issues can often be contributed to changes in negative behavior such as substance abuse (drugs/alcohol), smoking and generally poor eating habits. Some “…theorists suggest that there is an additive and/or multiplicative effect of psychological and biological stressors that can result in breakdowns in the body’s ability to regulate its systems and ultimately result in disease states. Thus, suggesting that PTSD symptoms directly impact health through a cumulative dysregulatory effect of chronic stress.” (Shipherd, 2014, p. 424)

Interestingly when reviewing the health related effects of Post Trauma, cancer appears to be a prevalent consequence of PTSD patients. For women this is an especially relevant factor because it has been found that cancer patients, “…with PTSD were more likely to be women (47%) than men (13%)…” (Foley, 2006, p. 22)

Many individuals who have opted to seek treatment have seen a decline in some of their health related issues, this is associated with better health-related quality of life decisions on the individual’s part. Despite the successes of PTSD treatments, there is still an inconsistency of findings as to how the treatment effectively resolves PTSD past a 24 month period of treatment. Unfortunately the studies long term have not been completely reviewed.

Post PTSD treatment varies in technique however as a general approach to PTSD Pharmacological treatments are often prescribed to the individual. In addition to therapy sessions, support groups/activities and healthcare resources (i.e. nutritional plans, exercise regiments, physical therapy).

Despite the association of PTSD to military service members, it has also been linked to domestic violence and abuse. For women this has been a cautionary tale for most of their lives, where in some modern countries today there are no laws protecting them from harm or spousal abuse.

“Although both men and women are victims of intimate partner violence (IPV), the vast majority of assaults between partners are perpetrated against women. Of the 1 million reported violent incidents involving partners in 1998, 85% of these crimes were committed against women. Nearly 1 in 4 women report being raped and/or physically assaulted by a current or former partner, and intimate partner violence is the leading cause of injury for women.” (Perez, 2008, p. 635-636)

Most victims of intimate partner violence (IPV) report not only physical abuses but psychological abuse, in turn the effects of such abuse result in psychological illnesses (easily relatable to PTSD). “Previous research has shown increased rates of anxiety, depression, hopelessness, low self-esteem, dissociation, sexual problems, somatization, substance abuse, and suicidality in women who have experienced violence from an intimate partner.” (Perez, 2008, p. 636)

With consideration as to how society has handled spousal abuse in the past, there have been several generations of women who have quietly suffered without support or reprieve of their abuses. At times they were subjected to forms of “victim blaming” from authoritarian figures (i.e. doctors, therapists, family, political leaders and/or church members). Victim blaming occurs when the victim of a crime is accusing of doing something to cause their own suffering.

In the United States the mistaken assumption by some is that sexism stopped when women received the right to vote in 1920. Despite acquiring this right, women have commonly been subjected to injustices over the span of centuries. Whether it was the inability to own property, hold a job for equal pay, vote or simply go to college; women continually struggled for rights and freedoms that were unavailable to them. Fast forwarding into the 21st century, women have gained many rights and freedoms, however there are still obstacles in what freedoms we are allowed to exercise (i.e. abortion, birth control methods, equal pay, etc.).

Still there are injustices that plague the modern Westernized world, misogyny finds itself into the daily lives of many women. Whether it be rape allegations: “she was asking for it, look at what she is wearing” to freedom of choice: “abortion is wrong, we need laws to control her choice.” These mere opinions become factual over time, this leaves women who are judged well before they even had a moment to rebuttal. On a lesser level of injustice, there are common assumptions made regarding women that can influence their ability to communicate the need for help. As an example, a common stereotype of women is that they are not good at mathematics or science.

Image: Sluts and sweethearts, The Guardian 2010, http://tinyurl.com/mdlefm3 — Image: Sluts and sweethearts, *The Guardian* 2010, **http://tinyurl.com/mdlefm3**

Today we refer to these varied injustices as gender microaggressions, which is defined as “…brief and commonplace daily verbal, behavioral, and environmental indignities that communicate hostile, derogatory, or negative sexist slights and insults toward women.” (Haynes, 2011) If an older woman is told repeatedly she is unworthy and disposable, whether this is in daily life transgressions or more hostile abuse, she will simply embrace the opinion of majority to avoid further traumatization. Acceptance of trauma can appear less painful at the time of its issuance.

Over time women began to speak up regarding their abuse, seek support or sought help to evade further abuses. In the United States, this formerly silenced abuse has been called Battered Woman Syndrome (BWS). At times this syndrome has been pleaded in U.S. courts to defend women who either injured or killed their abusive spouses. Although criticized by many, the psychological effects of traumatic abuse can lead to a fight or flight mode by the victim.

Most troubling of the struggle of abused women and the link to PTSD, is the heightened likelihood that they will be subjected to re-occurrences of abuse. “PTSD is linked with a history of interpersonal violence and a heightened risk for revictimization.” (Westrup, 2005, p. 114)

As a form of trauma, the feelings of guilt and fear can weigh on the victim resulting in the victim blaming themselves for their own abuse. In some cases the victim may rationalize their trauma, in one such case an abused woman surmised that these were “just things that happen to women.”(Westrup, 2005, p. 116) in an attempt to justify the abuse.

For older women the long term effects of assault related PTSD are continuous in relationship history. The effects of PTSD on a victim of abuse can play a key role in the individual’s ability to establish future stability and safety. “PTSD symptoms may actually inhibit battered women’s ability to make full use of the resources available to them.” (Perez, 2008, p. 648) This left unattended could lead to greater implications for women as they age, leaving them incapable of making self-preserving decisions.

Effective treatments for assault related PTSD are similar to methods utilized for former military members. However, the most prioritized component is rebuilding the survivor’s confidence, independence and defusing the plausibility of a re-victimization scenario.

As an example, a non-traditional treatment for PTSD would be self-defense training. Specifically targeting assault related PTSD in women. The benefits of such a treatment could be “…tackling the negative symptoms of PTSD and improving quality of life, and for addressing issues of personal safety and risk of re-victimization.”(Westrup, 2005, p. 114)

If a woman elects to attend therapy for PTSD, she is less likely to carry PTSD symptoms into older age. However, despite this theory “…women are more likely than men to have a history of affective or anxiety disorders that may put them at greater risk for exposure to trauma and PTSD during their lifetimes and in old age.” (Benninghouse, 2009, p. 414) As fore mentioned regarding servicewomen, although they were not diagnosed with PTSD as quickly as the servicemen, there is a more than likely chance they will develop PTSD as they age. The amount of counseling and support they seek will also determine what additional disorders may come into effect over time.

In spite of the preceding information regarding PTSD and aging women, this population has not been thoroughly researched enough.

However, “…the aging of the baby boomers will inflate the proportion of the total population that is aged 65-74 from 6% to 10% between 2005 and 2030. Those persons over 75 years of age will comprise 9% of the population in 2030 and are expected to increase to 12% in 2050. Additionally, because women live longer than men, we can expect that a greater percentage of the population aged 65 years and older will be female, both now and in the future” (Benninghouse, 2009, p. 412- 413)

With baby boomers retiring, the expectation is that of the longer life span of the majority of women than men. At this point in time, “…older women are the fastest growing demographic group in the United States population.” (Benninghouse, 2009, p.412)

Post-traumatic stress disorder was acknowledged as early as World War 1 (“shell shock”), but often the focus of such a disorder has only been placed on military members or veterans. However, the effects of trauma effect every individual. Women particularly are at the highest risk for PTSD, whether directly effecting their mental health or indirectly influencing their physical health. The road to recovery from PTSD can only be accomplished with the proper support and therapy clearly directed at women. Just as with most therapies, we cannot standardize the care of women. The obstacles of a diluted past of transgressions and misconceptions must be taken apart one block at a time. However, the necessity is understanding the road traveled not dismissing it as myth.

References
Benninghouse, H. T., & Rosset, A. G. (Eds.). (2009). Women and Aging : New Research. Hauppauge, NY, USA: Nova Science Publishers, Inc.. Retrieved February 1, 2015.

Brady, K. L., Acierno, R. E., Resnick, H. S., Kilpatrick, D. G., & Saunders, B. E. (2004). PTSD SYMPTOMS IN WIDOWED WOMEN WITH LIFETIME TRAUMA EXPERIENCES. Journal Of Loss & Trauma, 9(1), 35-43. doi:10.1080/15325020490255296, Retrieved January 31, 2015.

Foley, K. (2006, March 1). Women are at higher risk for PTSD after cancer diagnosis. Internal Medicine News, 39(5), 22. Retrieved January 1, 2015.

Haynes, K. and Nadal, K. (2011). The effects of sexism, gender microaggressions, and other forms of discrimination on women's mental health and development. Women's psychology: Women and mental disorders. Santa Barbara, CA: Praeger. Retrieved January 2, 2015.

Lapp, L. K., Agbokou, C., & Ferreri, F. (2011). PTSD in the elderly: The interaction between trauma and aging. International Psychogeriatrics, 23(6), 858-68. doi:http://dx.doi.org/10.1017/S1041610211000366

Mayo Clinic, Definition in Diseases and Conditions: Post-traumatic stress disorder (PTSD). (2015). Retrieved February 5, 2015, from http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/basics/definition/con-20022540

Mechcatie, E. (2011, February). Vets: gender drives depression, PTSD diagnoses. Clinical Psychiatry News, 39(2), 8. Retrieved February 1, 2015.

O'Connor, M. (2010). PTSD in older bereaved people. Aging & Mental Health, 14(6), 670-678. doi:10.1080/13607860903311725, Retrieved January 31, 2015.

Perez, S., & Johnson, D. M. (2008). PTSD compromises battered women's future safety. Journal of Interpersonal Violence, 23(5), 635-651. doi:http://dx.doi.org/10.1177/0886260507313528, Retrieved January 31, 2015.

Shipherd, J., Clum, G., Suvak, M., & Resick, P. (2014). Treatment-related reductions in PTSD and changes in physical health symptoms in women. Journal of Behavioral Medicine, 37(3), 423-433. Retrieved February 1, 2015, from Springer International Publishing AG.

Westrup, D., Weitlauf, J., & Keller, J. (2005). I got my life back! Making a case for self-defense training for older women with PTSD. Clinical Gerontologist, 28(3), 113-118. Retrieved January 31, 2015.

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