Conforming to traditionally “masculine” traits worsens PTSD symptoms among veterans

By Sally Robertson, B.Sc.Jan 27 2020

Certain personality traits traditionally considered “masculine” that is encouraged during military training, are the very same traits that can worsen symptoms of post-traumatic stress disorder (PTSD) when veterans return home from the field, according to a study published by the American Psychological Association.

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Continuing to keep up traits such as self-reliance and emotional control can also make treatment more difficult to access and less effective when it is implemented, the study found.

The importance of certain traits traditionally thought of as “masculine” are often encouraged in the military as a way of helping service members perform confidently and develop skills in the field.

However, lead author Elizabeth Neilson of Morehead State University says the current findings suggest that “veterans with rigid adherence to traditional masculinity may be at increased risk for developing PTSD, may have more severe PTSD symptoms and may be less likely to seek mental health treatment for PTSD."

What did the study involve?

As reported in the journal Psychology of Men and Masculinities, Neilson and colleagues used qualitative and quantitative methods to assess data from 17 studies conducted over the last 25 years that included more than 3,500 military veterans.

All studies assessed the association between conforming to traditionally masculine traits and symptoms related to trauma.

The studies mainly focused on men, although one paper did include men and women. They were also mainly conducted in the US, but some studies from the UK, Israel, Vietnam, and Canada were also included.

The veterans think “they should be tough"

Overall, we found that strict adherence to masculine norms was associated with more severe PTSD symptoms in veterans, but more detailed analysis suggests that the association may specifically be caused by the veterans' belief that they should control and restrict their emotions…In other words, they should be tough."

Neilson

Although society members, in general, are exposed to aspects of traditional masculinity, these values are normalized and reinforced as part of training among military members, says Neilson:

"Previous research has found that military personnel reports high levels of conformity to traditionally masculine norms, such as emotional control, self-reliance and the importance of one's job."

The traits can contribute to the severity of PTSD symptoms

Although these traits can be useful for promoting self-confidence and building skills whilst on the field, they can also contribute to the severity of PTSD symptoms if a military member is faced with trauma.

Exposure to physical or mental trauma can cause a sense of hopelessness and loss of power, feelings that conflict with the traits traditionally associated with men such as being strong and in control.

This disparity between how military members feel and how society expects them to be can intensify symptoms of PTSD and almost one-quarter who return from Iraq and Afghanistan, already have the condition.

Conforming to the masculine traits can also stop veterans seeking treatment

Neilson says that adhering to the traditionally masculine traits can also impede access to necessary treatment. Previous studies have demonstrated that a certain pride taken in being self-reliant and able to handle mental trauma independently meant service members returning from Iraq and Afghanistan were reluctant to seek the help they needed.

Furthermore, when veterans did seek treatment, the importance placed on emotional stoicism and mental fortitude could make it more difficult to treat them, she adds.

The two most common treatment approaches to PTSD require patients to talk openly about any emotions, thoughts, and behaviors that they think might be related to exposure to trauma. One feature characterizing PTSD is the avoidance of certain stimuli such as places, emotions or scenarios that the patient associates with trauma. Part of successfully treating PTSD often involves encouraging patients to break this avoidance cycle and face stimuli that induce trauma.

"Both military culture and traditional masculine ideals lead to the avoidance of disclosure and speaking about traumatic experiences, which may interfere with appropriate treatment," explains Neilson.

The study also identified another important trend: veterans tend to reinstate their masculinity following trauma by adopting stereotypically male behaviors such as being aggressive or highly sexually active, as a way to counteract the impact the trauma has on their sense of self.

"In one study we reviewed, veterans reported engaging in frequent sex to avoid negative thoughts, because feeling sexually desirable temporarily suspended those negative thoughts about their self-worth," says Neilson.

APA recommends therapists consider talking about masculine ideology when treating veterans

In 2018, the American Psychological Association published recommendations advising therapists to consider talking about traditionally masculine ideals and the effects of society’s expectations on males when treating service members.

It would not surprise me if some clinicians are already considering how a veteran's masculinity ideology contributes to their PTSD symptomology and treatment engagement. Consistent with APA's recommendations, I suggest that clinicians discuss beliefs and adherence to traditional masculinity ideologies with the patients,”

Neilson.

“This information is important for conceptualizing patients' mental health and identifying specific behaviors to target in treatment,” she concludes.