Military training includes learning to suppress emotion and the development of self-reliance. These skills are believed to help service members perform better in the field. New research suggests that when veterans return home, strict adherence to these traits can become detrimental, leading to more severe post-traumatic stress disorder symptoms that are more difficult to treat.

Researchers at Morehead University discovered that veterans with rigid adherence to traditional masculinity may be at increased risk for developing post-traumatic stress disorder. Moreover, veterans “may have more severe PTSD symptoms and may be less likely to seek mental health treatment for PTSD,” said Elizabeth Neilson, Ph.D., the lead author on the study.

The research appears in the journal Psychology of Men and Masculinities.

Neilson and her co-authors analyzed data from 17 studies, comprising more than 3,500 military veterans. The data, obtained over the last 25 years involved, at least in part, measuring the relationship between adherence to traditional masculine ideals and trauma-related symptoms.

The studies primarily focused on men, but one included both male and female participants. While most studies were conducted in the United States, the researchers also included studies from Canada, the United Kingdom, Israel and Vietnam.

“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 said. This held true for both male and female veterans.

While all members of society are exposed to aspects of traditional masculinity, members of the military receive messages that normalize, reinforce and instill values of masculinity as part of their training, according to Neilson.

“Previous research has found that military personnel report high levels of conformity to traditional masculine norms, such as emotional control, self-reliance and the importance of one’s job,” she said.

“These values can promote self-confidence and skill-building in the field, but when a service member is confronted with physical or mental trauma, they can also contribute to more severe PTSD.”

Traumatic experiences, including combat and sexual trauma, can lead to feelings of powerlessness and hopelessness, both of which are in direct opposition to what society expects of men: That they should be strong and in control.

The discrepancy between reality and societal expectations can exacerbate PTSD symptoms. In fact, researchers estimate that as many as 23 percent of veterans returning from Iraq and Afghanistan experience PTSD.

In the current study, researchers found that adherence to masculine norms can also create barriers to getting necessary treatment. The finding is consistent with previous research that found veterans returning from the wars in Iraq and Afghanistan.

Prior research discovered veteran’s find pride in self-reliance and they have a belief that one should be able to handle mental health problems on their own. This belief has kept service members from seeking help when they needed it.

And even if veterans did seek treatment, the emphasis on stoicism and mental fortitude within both military culture and traditional masculinity could make treatment more difficult, explains Neilson.

The two most widely used, evidence-based therapies for PTSD require explicit discussions of emotions, thoughts and behaviors related to traumatic experiences. PTSD is perpetuated by avoiding stimuli associated with a traumatic experience, including emotions. Successful PTSD treatment involves breaking that cycle of avoidance and confronting those stimuli, she said.

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

Another trend the researchers found was that veterans often try to reaffirm their masculinity following trauma, engaging in exaggerated stereotypical male behavior, such as aggression and increased sexual behavior, to compensate for the injury the trauma had on their identity, according to Neilson.

“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,” she said.

In 2018, the American Psychological Association published guidelines recommending that therapists consider discussing masculine ideology and the effects of cultural expectations of men and boys when treating male veteran clients. Neilson hopes that future research will examine how clinicians already are addressing conformity to masculinity ideology in their treatment of PTSD.

Source: American Psychological Association