PTSD

Some information on Veterans and Post Traumatic Stress Disorder

(These statistics are taken from several websites – all are featured in the resource section of this article).

• 1 in 5 veterans of the Iraq and Afghanistan wars are diagnosed with ptsd.
• It is estimated that 30% of Vietnam vets have PTSD (all these years later, this is considered “chronic” in nature.
• More than 40 percent of Iraq and Afghanistan war veterans responding to a recent survey said they did not seek mental health care because of a perceived negative impact on their careers. (Iraq and Afghanistan Veterans of America, Member Survey 2012).
• Health Care for Veterans with PTSD costs 3.5 times more than for one without ptsd. ((facethefactsusa.org)
• 22 service members per day are committing suicide.
• In the general population, it is estimated that 7 or 8 people out of 100 develop ptsd at some point in their life. In contrast, when looking at our current troops serving in Operation enduring Freedom or Operation Iraqui Freedom, it is estimated that they will develop PTSD at a rate of 11-20 out of 100.
• For troops suffering from combat trauma, 2 out of 3 of their marriages are failing. That’s over 200,000 military divorces.
• 1/3 of our nation’s homeless are veterans. This needs to change! We have a responsibility to them! They served for us and we, as a nation, need to be prepared to help them.

What is PTSD?

For those that don’t know, Posttraumatic Stress Disorder is a formal diagnostic term in the medical/mental health field. It is s relatively new diagnosis, only being added in 1980 to our Diagnostic and Statistical Manual (DSM) – the book healthcare providers refer to for diagnostic criteria.

In it’s initial DSM-III formulation, a traumatic event was conceptualized as a “catastrophic stressor that was outside the range of usual human experience”. The original practitioners who decided on the criteria had events such as war, torture, rape, the Nazi Holocaust, the atomic bombings of Hiroshima and Nagasaki, natural disasters (such as earthquakes, hurricanes, and volcano eruptions), and human-made disasters (such as factory explosions, airplane crashes, and automobile accidents) as the catastrophic stressors in mind. It was the first time a diagnostic criteria had the suggestion of an experience as causing a mental condition. Prior to that, all mental conditions were thought to be organic/biological in nature. The advent of its addition to the DSM-III came at a much needed time as our country was dealing with almost a decade of Vietnam Veterans demonstrating similar clusters of symptoms in reaction to their experience at war.

3 very common symptoms of Post Traumatic Stress Disorder:
Triggers, hyper-vigilance and flashbacks (see below B(4), D(4), and B(1). The information given next is not meant for you to self- diagnose, but if you find that you relate to the criteria, or you know someone who fits that description, please seek out a consult with a local mental health provider who treats Posttraumatic Stress Disorder for further Assessment and treatment options.

The diagnostic criteria of Post Traumatic Stress Disorder as we know it today as listed in the DSM-IV-TR are as follows:

1. 1. The person has been exposed to a traumatic event in which both of the following have been present: the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others the person’s response involved intense fear, helplessness, or horror.
      Note: In children, this may be expressed instead by disorganized or agitated behavior.
   2. The traumatic event is persistently re-experienced in one (or more) of the following ways:
      * recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.
      Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
      * recurrent distressing dreams of the event.
      Note: In children, there may be frightening dreams without recognizable content.
      * acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
      * intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
      physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
   3. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:* efforts to avoid thoughts, feelings, or conversations associated with the trauma
      * efforts to avoid activities, places, or people that arouse recollections of the trauma
      * inability to recall an important aspect of the trauma
      * markedly diminished interest or participation in significant activities
      * feeling of detachment or estrangement from others
      * restricted range of affect (e.g., unable to have loving feelings)
      * sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
   4. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
      * difficulty falling or staying asleep* irritability or outbursts of anger
      * difficulty concentrating
      * hyper-vigilance
      * exaggerated startle response
   5. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month.
   6. occupational, or other important areas of functioning.Specify if:
      Acute: if duration of symptoms is less than 3 months
      Chronic: if duration of symptoms is 3 months or more
      With Delayed Onset: if onset of symptoms is at least 6 months after the stressor.per: DSM-IV TR Criteria for Post Traumatic Stress Disorder
      http://www.ncbi.nlm.nih.gov/books/NBK83241/

What’s new in identifying PTSD?

The DSM-5 is out and will officially be adopted by practitioners in the next few months. The criteria is the same except that a person does not have to actually experience the trauma, they can have heard of it – Instead of 3 clusters of symptoms as referenced above, there is a 4th cluster: Negative thoughts and mood or feelings — For example, feelings may vary from a persistent and distorted sense of blame of self or others, to estrangement from others or markedly diminished interest in activities, to an inability to remember key aspects of the event.

What do the changes mean?

1. -It means that a diagnosis may be easier to identify.

2. The changes allow for others who experience the symptoms after being exposed to others’ stories of trauma to seek treatment.

We know that therapists, medical doctors and combat medics can develop what we know as vicarious trauma. Vicarious Trauma is essentially experiencing all the symptoms necessary to substantiate a diagnosis of PTSD, but without having firsthand experienced the traumatic event. I think you can understand how, using the example of a therapist’s experience, listening to others’ stories of trauma day in and day out can start to wear on a person’s psyche. Self-care, including time off from clinical work is stressed by the profession in order to help stave off the vicarious trauma.

Once vicarious trauma presents itself, it looks like PTSD. The therapist may have the flashbacks, triggers, hyper-vigilance, lack of interest in others and any of the other symptoms, resulting in that therapist now in need of treatment of Posttraumatic Stress. The research that is completed thus far on combat medics also notes how their PTSD is thought of as more severe than the general population of helpers. This may be because of the fact that they are not only experiencing traumatic events (i.e. being on base when a bomb fires) but also they are then in the middle of treating the injuries of those traumatic events in real time, often not getting to even make sense of what they just experienced.

Controversy Regarding the Name Posttraumatic Stress Disorder and the Military
When the DSM-5 was being developed, there were attempts to have the name changed from Posttraumatic Stress Disorder to Posttraumatic Stress Injury. This was specifically in order to help decrease the stigma so that more troops in need would seek help for their symptoms without having to worry that they would get labeled with “a disorder”. This discussion happened in 2012 at the American Psychological Association’s (APA) annual meeting. There was some concern that the term “injury” would not be precise enough to constitute a medical diagnosis, so the change was denied.