CHICAGO – The nightmares didn't start until months after Alicia Flores returned home. The images were stark and disturbing: In one dream, a dying Iraqi man desperately grabbed her arm. In another, she was lost in a blinding sandstorm.
Sometimes, Flores awakened to discover her mouth was dust-dry — as if she were really stumbling through the scorching, 120-degree desert.
The nightmares bring Flores back to Iraq, and her service in the Army's 92nd Chemical Company. She was just 19 when her unit arrived there. Now 23, she's left with memories of women and children being killed, of hauling bodies, of shooting a teenage Iraqi fighter. ("It was him or me," she says.)
"I'm fine with what I did over there ...," Flores says. "In my eyes, I did a good thing. It really doesn't bother me. The only thing that bothers me is I just want to sleep more."
Flores is one of a new generation of women who have returned from war to cope with emotional stress or physical wounds that linger long after the sounds of mortar and gunfire have faded. Studies of Vietnam and Gulf War veterans have documented post-traumatic stress in females — with higher rates than men, in some cases.
But the war in Iraq and Afghanistan has seen a far larger deployment of women — more than 155,000 — with far more females exposed to ambushes, roadside bombs, rocket-propelled grenades and other deadly hazards. And they have been left with an increased risk of combat-like stress.
Flores says she's not alarmed by her diagnosis of post-traumatic stress; she's getting help for her sleeping problems. It wasn't the war, but the adjustment to the civilian world that she found difficult.
"It was OK — now what?" she says. "You have nobody to talk to. Your family can't relate to what you and your soldiers had and it's just really hard. ... I felt lost. ... I didn't know what to do with my time."
That anxiety — along with depression, irritability and feelings of isolation — also are common symptoms for men with post-traumatic stress, but some mental health experts believe there are distinct pressures for women veterans.
Some come from military service itself — where some women feel they need to prove themselves — while others come from the transition from vigilant soldier to caring wife or mother.
"Women are pulled in different directions," says Darrah Westrup, lead psychologist at the Veteran Affairs' Women's Trauma Recovery Program in Menlo Park, Calif. "They want to be a good partner. They want to be a good mother. ... They want to be a good solider."
Returning home can be especially stressful for women who may find themselves running a household, taking care of children, going to work and dealing with insomnia or other war-related problems, says Diane Shearod, women veterans program manager at the Hines VA Hospital in Chicago.
"They get frustrated with themselves not being able to manage like they did before," she says. "They have to run the kids to school. They have to take them to different functions. Can you imagine what that's like with just two to three hours sleep? You're wondering, 'Am I going to be like this forever?'"
Though it's too soon to gauge the toll on women veterans, some early studies have offered a few clues.
For example, the VA reports that slightly more than a third of 23,635 women veterans from Iraq and Afghanistan evaluated from 2002 to last August had a preliminary diagnosis of a mental disorder.
Those numbers provide just a partial glimpse into the problem: Many women veterans, like men, don't go to VA hospitals or prefer to seek private help.
A second study released early this year also found that of more than 220,000 Iraq veterans, 23.6 percent of women had a mental health concern — compared with 18.6 percent for men (an insignificant difference, according to Col. Dr. Charles Hoge, one of the study's authors).
Mental health experts say one of the biggest contributors to psychological problems for women in uniform is military sexual trauma — a term that covers verbal harassment and physical assault, which is a strong risk factor for PTSD.
Studies conducted by the VA health system vary, but generally about 20 percent of women report a physical assault during their service, Westrup says. "Unfortunately, a huge aspect of that experience is guilt and self-blame and shame on top of stress," she adds.
Last year, the Pentagon announced a new policy of confidentiality, so sexual assault victims can report the incident and get help but law enforcement and senior commanders are not immediately notified.
Compounding the emotional turmoil for women are wounds and ailments that range from life-changing — the loss of limbs and brain injuries — to temporary, such as infections and rashes.
Some of the short-term health problems are likely tied to the harsh realities of war, where women can go weeks without a shower and spend months hauling gear and lifting heavy weapons in triple-digit heat.
The VA found 29 percent of the women veterans it evaluated returned with genital or urinary system problems, 33 percent had digestive illnesses and 42 percent had back troubles, arthritis and other muscular ailments.
Aneta Urban had a bad back after two tours in Iraq — one in a Marine military police company. She says she hauled as much as 70 pounds of gear.
But the impact on her psyche was greater. When Urban, now 31, returned from active duty to suburban Chicago last year, she didn't want to socialize with friends, regarding it as a waste of time and money.
"I'd think, 'There are troops in Iraq and they're giving up so much and people are partying and not even thinking about that,' " she says. "I still feel like that sometimes. ... They worry about what Paris Hilton is wearing. But every day, people are dying, young troops."
Then there were those who annoyed her by asking if she'd killed anyone. "Why would you want to know that? It's such a personal question," she says. "I believe in God and whatever I did in Iraq, I will answer for later."
She was frustrated, too, that no one was rushing to hire her.
"People would say, 'Oh, you're a veteran, you've done two tours, you're golden. Everybody will want you.' " It didn't happen. "That," she says, "added to my depression."
The death of a beloved cousin sent her into a tailspin; one day she found it difficult to breathe, and she checked herself into a hospital for exhaustion and stress.
More than a year later, Urban says she's much better. She's in college, studying for a master's degree in accounting, working as a detention officer at a police department and thinking about an FBI career.
"When you're busy," she says, "you don't have a lot of time to sit around and think about things."
Urban's bumpy road back isn't unusual.
Some women veterans — including those without psychological problems — say it takes time to decompress and switch gears from hard-nosed soldier to nurturing mother.
Darcie Greuel, a VA nurse in Milwaukee, spent nearly a year at the 452nd Combat Support Hospital in Afghanistan, then rejoined her husband and their three children.
"I was trying to get back into being a wife and a mother," she says. "But it was 'Wow, they survived without me.' ... I really didn't know where my place was. I had to be really careful. I didn't want my husband to think I was not appreciative of what he did. I didn't want to come back and say, 'It's all going to be my way.' "
Greuel, now 40, also had to settle back into her job. She returned to nursing but missed the adrenaline rush. She became irritated when colleagues griped about being overworked and sensed that people no longer wanted to listen to — or would understand — her war stories.
Greuel now gets together with military friends a few times a year, and has decided to return to college to complete her bachelor's degree in nursing.
Greuel found her way back into her family and work life without professional help.
But mental health experts say women veterans who do need counseling tend to respond well to treatment — perhaps even better than men — because they're more open about their emotions.
The problem is many women — just like men — are reluctant to take that first step.
Some are so determined to re-establish that bond with their children that they'll ignore their own problems, says Katherine Dong, women veterans program manager at the North Chicago VA Medical Center.
"They want to make it up to their family for being gone, yet they have all these symptoms and all these thoughts that are still haunting them," she says. "Women tend to put their families' needs above their own. They're trying to push their bad stuff aside and focus on their families and unfortunately, it's not always successful."
Keri Christensen was one of those veterans who did turn to the VA for help after serving with the Wisconsin National Guard in Iraq.
She had agonized leaving behind two small daughters — the younger less than a year old. "There were very guilty feelings ... that I was just neglecting my children," she says. "I was a stay-at-home mom ... but it was my call to duty and I felt I needed to do that."
She tried to stay connected to her girls, ordering books online, having them shipped to her in the war zone, recording them and sending the tapes back home. Her husband, Brian, tried to fill the void, joining his elder daughter's Brownie troop and attending meetings with her.
But when Christensen returned last winter, she had a hard time negotiating her domestic life, she says, because she was so depressed.
One of her wartime duties had been working next to the mortuary in Kuwait where she routinely saw flag-draped coffins of dead soldiers. "You'd see their possessions in a packet, their date of birth," she says. "They were kids — 19, 20, 21 — that was hard."
"They send you home and expect you to live your life normally," she adds. "You can't. Well, maybe some people can. I wasn't able to."
Christensen says she had panic attacks and hated driving, fearing she'd run red lights — something done in convoys she was on in Iraq — with her daughters in the car.
"I just don't like to go places," she says. "I'd rather stay in my own house, which I know is safe."
Alicia Flores, meanwhile, is thinking of leaving her home in Chicago, where she has been working as dental assistant and living with her mother, biding her time in the two years since she left the Army but failed to leave Iraq behind.
She has joined the Army Reserve and may return to the war zone.
"I feel restless, just not secure," she says, "like I'm waiting for something."