PTSD Women Veterans’ Prevalence of PTSD Care Nancy Lutwak, MD VA New York Harbor Healthcare System, NYU School of Medicine, New York, NY, USA. J Gen Intern Med DOI: 10.1007/s11606-013-2489-y © Society of General Internal Medicine 2013 To the Editor:—Posttraumatic stress disorder (PTSD) among women who have experienced assaultive violence is being studied and better understood. Women veterans who have PTSD commonly have fair or poor health, depression, anxiety and disability. This problem is also associated with higher rates of reproductive and substance use disorders. 1 A recent publication by Washington, et al. discusses the incidence of PTSD among women Veterans and that a significant segment of this group does not receive mental health care. The majority of women Veterans receive care outside of the US Department of Veterans Affairs (VA) and their healthcare providers may be unaware of the increased risk of PTSD among this patient population. The authors feel that the patients and their providers should be made more aware so that appropriate treatment may be offered. 1 Other informative recent articles have explored PTSD in women. Betts, et al. have described a female-specific risk to partial and full PTSD following physical assault. These author postulate that traumatic events affect males and females differently, with females at increased risk for PTSD when controlling for trauma type. 2 Inslicht et al. have written about enhanced acquisition of conditioned fear in women with PTSD. They state that stress hormones and neuromodulators may enhance fear conditioning during traumatic stress exposure. Inslicht et al. suggest a sex specific vulnerability to increased fear conditioning from heightened levels of pituitary adenylate cyclase-activating polypeptide, which is modulated by estrogen. 3 Physiological changes have been demonstrated by Liberzon et al. They state that PTSD patients have altered regional cerebral blood flow in multiple areas that regulate the hypothalmis-pituitary-adrenal axis, have exaggerated emo- tional responses and changes in sensitivity to glucocorticoids. 4 These important publications focus on the increased incidence of PTSD following assaultive violence, the specific risk to women as well as physiological changes that occur in the patients affected. If physicians are made aware of these facts, they will provide improved care for the patients suffering from this serious problem. 1–4 Corresponding Author: Nancy Lutwak, MD; VA New York Harbor Healthcare System, NYU School of Medicine, 423 East 23rd Street, New York, NY 10010, USA (e-mail: [email protected]). REFERENCES 1. Washington DL, Davis TD, Der-Martirosian C, Yano EM. PTSD Risk and Mental Health Care Engagement in a Multi-War Era Community Sample of Women Veterans. J Gen Intern Med. 2013. doi:10.1007/s11606-012-2303-2. 2. Betts KS, Williams GM, Najman JM, Alati R. Exploring the Female Specific Risk to Partial and Full PTSD Following Physical Assault. J Trauma Stress. 2013;26:86–93. 3. Inslicht SS, Metzler TJ, Gaarcia NM, Pineles SL, Milad MR, Orr SP, Marmar CR, Neylan TC. Sex differences in fear conditioning in posttraumatic stress disorder. J Psychiatr Res. 2013;4:64–71. 4. Liberzon I, King PA, Britton JC, Phan L, Abelson JL, Taylor SF. Paralimbic and Medial Prefrontal Cortical Involvement in Neuroendocrine Responses to Traumatic Stimuli. Am J Psychiatry. 2007;164:1250–1258. doi:10.1176/appi.ajp.2007.0608136.

PTSD Women Veterans’ Prevalence of PTSD Care

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PTSD Women Veterans’ Prevalence of PTSD Care

Nancy Lutwak, MD

VA New York Harbor Healthcare System, NYU School of Medicine, New York, NY, USA.

J Gen Intern Med

DOI: 10.1007/s11606-013-2489-y

To the Editor:—Posttraumatic stress disorder (PTSD)among women who have experienced assaultive violence isbeing studied and better understood. Women veterans whohave PTSD commonly have fair or poor health, depression,anxiety and disability. This problem is also associated withhigher rates of reproductive and substance use disorders.1

A recent publication by Washington, et al. discusses theincidence of PTSD among women Veterans and that asignificant segment of this group does not receive mentalhealth care. The majority of women Veterans receive careoutside of the US Department of Veterans Affairs (VA) andtheir healthcare providers may be unaware of the increasedrisk of PTSD among this patient population. The authorsfeel that the patients and their providers should be mademore aware so that appropriate treatment may be offered.1

Other informative recent articles have explored PTSD inwomen. Betts, et al. have described a female-specific risk topartial and full PTSD following physical assault. Theseauthor postulate that traumatic events affect males andfemales differently, with females at increased risk for PTSDwhen controlling for trauma type.2 Inslicht et al. havewritten about enhanced acquisition of conditioned fear inwomen with PTSD. They state that stress hormones andneuromodulators may enhance fear conditioning duringtraumatic stress exposure. Inslicht et al. suggest a sex specificvulnerability to increased fear conditioning from heightened

levels of pituitary adenylate cyclase-activating polypeptide,which is modulated by estrogen.3

Physiological changes have been demonstrated byLiberzon et al. They state that PTSD patients have alteredregional cerebral blood flow in multiple areas that regulate thehypothalmis-pituitary-adrenal axis, have exaggerated emo-tional responses and changes in sensitivity to glucocorticoids.4

These important publications focus on the increasedincidence of PTSD following assaultive violence, thespecific risk to women as well as physiological changesthat occur in the patients affected. If physicians are madeaware of these facts, they will provide improved care for thepatients suffering from this serious problem.1–4

Corresponding Author: Nancy Lutwak, MD; VA New York HarborHealthcare System, NYU School of Medicine, 423 East 23rd Street,New York, NY 10010, USA (e-mail: [email protected]).

REFERENCES1. Washington DL, Davis TD, Der-Martirosian C, Yano EM. PTSD Risk and

Mental Health Care Engagement in a Multi-War Era Community Sample ofWomenVeterans. JGen InternMed.2013. doi:10.1007/s11606-012-2303-2.

2. Betts KS, Williams GM, Najman JM, Alati R. Exploring the FemaleSpecific Risk to Partial and Full PTSD Following Physical Assault. JTrauma Stress. 2013;26:86–93.

3. Inslicht SS, Metzler TJ, Gaarcia NM, Pineles SL, Milad MR, Orr SP,Marmar CR, Neylan TC. Sex differences in fear conditioning inposttraumatic stress disorder. J Psychiatr Res. 2013;4:64–71.

4. Liberzon I, King PA, Britton JC, Phan L, Abelson JL, Taylor SF.Paralimbic and Medial Prefrontal Cortical Involvement in NeuroendocrineResponses to Traumatic Stimuli. Am J Psychiatry. 2007;164:1250–1258.doi:10.1176/appi.ajp.2007.0608136.

http://dx.doi.org/10.1007/s11606-012-2303-2

http://dx.doi.org/10.1176/appi.ajp.2007.0608136