Running Head: VIGNETTE ANALYSIS I 1 VIGNETTE ANALYSIS I 6 Psychology of Trauma-Vignette Analysis I Laura Kay Utgard Cal Southern University PSY: 87519 Dr. Barbara Lackey August 1, 2018 Vignette Analysis I Anxiety, depression and anger Reactions The present post-traumatic stress diagnostic is applying to one event which lasts for a short duration, nevertheless, there is an increase in the number of professionals who are pushing for a new diagnosis in describing the long-lasting psychological events after the long term trauma. Even though it is unofficial diagnosis in the DSM-5, the complex post-traumatic stress disorder is affecting people who have undergone through chronic unpreventable traumas it is slightly possible to control over the ongoing months or years (Jonathan, Sarah, Catrin, & Neil, 2015). Relate to Roni People with post-traumatic stress disorder usually struggle with occasional and intense symptoms of anxiety. The stronger symptoms of anxiety make these individuals depend on unhealthy ways of coping like the use of the drugs and alcohol thus making their situation to be worse as they risk having more complications such as cancers. The anxiety disorder caused by the post-traumatic stress disorder sometimes gets worse over time and this is likely to contribute to the development of other psychological disorder known as the anxiety disorder. Anxiety is a worry and an issue of concern because it may also result in physical symptoms such as fast heart rate and shakiness. Other disorders that might be experienced by the post-traumatic stress disorder patients include phobia, social anxiety disorder, separation anxiety disorder, panic disorder, and the selective mutism (Abigail, Negar, Sierra, Dorthie, Marylene, & Bekh, 2017).Relate to Roni According to the DSM-5, depression is described as having depressed moods on a daily basis, losing the interest or pleasure of engaging in other activities, loss in the weight or gaining of the weight, finding it hard to fall asleep or having too much sleeps, feeling restless and worthless, finding it hard to concentrate, and suicidal thoughts. Depression is making the traumatic experiences to worsen and this reduces the chances of healing the post-traumatic stress disorder. The signs of the post-traumatic stress disorder can be distressing and debilitating and this leads to the development of the depression. This makes the affected individuals feel detached from the families or friends. It is also becoming hard for the affected victim to experience positive emotions such as joy and happiness and when not addressed immediately, people with the post-traumatic disorder will forever be sad, lonely, and depressed (Abigail, Negar, Sierra, Dorthie, Marylene, & Bekh, 2017). Same Various ranges of negative internal states increase the possibility of an angry response. People with post-traumatic stress disorder develop anger to assists them in coping with life stresses by providing ...

1. Running Head: VIGNETTE ANALYSIS I
1
VIGNETTE ANALYSIS I 6
Psychology of Trauma-Vignette Analysis I
Laura Kay Utgard
Cal Southern University
PSY: 87519
Dr. Barbara Lackey
August 1, 2018
Vignette Analysis I
Anxiety, depression and anger Reactions
The present post-traumatic stress diagnostic is applying to
one event which lasts for a short duration, nevertheless, there is
an increase in the number of professionals who are pushing for
a new diagnosis in describing the long-lasting psychological
events after the long term trauma. Even though it is unofficial
diagnosis in the DSM-5, the complex post-traumatic stress
disorder is affecting people who have undergone through
chronic unpreventable traumas it is slightly possible to control

2. over the ongoing months or years (Jonathan, Sarah, Catrin, &
Neil, 2015). Relate to Roni
People with post-traumatic stress disorder usually struggle
with occasional and intense symptoms of anxiety. The stronger
symptoms of anxiety make these individuals depend on
unhealthy ways of coping like the use of the drugs and alcohol
thus making their situation to be worse as they risk having more
complications such as cancers. The anxiety disorder caused by
the post-traumatic stress disorder sometimes gets worse over
time and this is likely to contribute to the development of other
psychological disorder known as the anxiety disorder. Anxiety
is a worry and an issue of concern because it may also result in
physical symptoms such as fast heart rate and shakiness. Other
disorders that might be experienced by the post-traumatic stress
disorder patients include phobia, social anxiety disorder,
separation anxiety disorder, panic disorder, and the selective
mutism (Abigail, Negar, Sierra, Dorthie, Marylene, & Bekh,
2017).Relate to Roni
According to the DSM-5, depression is described as having
depressed moods on a daily basis, losing the interest or pleasure
of engaging in other activities, loss in the weight or gaining of
the weight, finding it hard to fall asleep or having too much
sleeps, feeling restless and worthless, finding it hard to
concentrate, and suicidal thoughts. Depression is making the
traumatic experiences to worsen and this reduces the chances of
healing the post-traumatic stress disorder. The signs of the post-
traumatic stress disorder can be distressing and debilitating and
this leads to the development of the depression. This makes the
affected individuals feel detached from the families or friends.
It is also becoming hard for the affected victim to experience
positive emotions such as joy and happiness and when not
addressed immediately, people with the post-traumatic disorder
will forever be sad, lonely, and depressed (Abigail, Negar,
Sierra, Dorthie, Marylene, & Bekh, 2017). Same
Various ranges of negative internal states increase the
possibility of an angry response. People with post-traumatic

3. stress disorder develop anger to assists them in coping with life
stresses by providing them with the energy to carry on in the
face of problem. Even though it might be of help to them, anger
creates major problems in the personal lives of the individuals
experiencing post-traumatic stress disorder. When these patients
are faced with a threat, they respond with anger. Anger helps
them survive by shifting their focus. However, anger leads to an
outburst of extreme emotions (Jonathan, Sarah, Catrin, & Neil,
2015). Same
In this case study (Vignette one), Roni has developed a
sensation that she is being stalked and is having the fear that
her child might be hurt. She is having terrifying and this makes
to be worried about the safety of her daughter. Roni is having
depression and this makes her have negative thoughts which
make her be worried that a similar situation might occur to her
2-year-old daughter. Expand and relato to course conepts
Physical and Somatic Problems
Phased based approaches are important for a more complex
presentation of the post-traumatic stress disorder. The phase-
based approaches involve targeting problems dysregulation,
dissociation, and the somatic symptoms to help in the promotion
of the adaptive coping, sense of wellbeing, and the stabilization
prior to undertaking traumatic focused intervention (Grupta,
2013). Somatic problems are issues which are related to the
physical sensation and movements. Individuals with post-
traumatic stress disorder always suffer from the physical issues.
The post-traumatic stress disorder's persistent emotional arousal
contributes to the dysregulation of the biological systems and
this increases the risks of having a biological abnormality which
could result in numerous somatic complaints. The somatic
complaints include fatigue, pain, tension, and the related
biological adaptation which is promoted by the never-ending
states of the stress (Jonathan, Sarah, Catrin, & Neil, 2015).
Same
The tension within Roni makes her not to forget the
incidence of which occurred when she was 17 years old. Due to

4. the tension which makes her have fleeting memories of the
gunshots, screaming of the people and incidence when the
children were being pushed into a car into an unknown place
makes her be fearful. She cannot be alone and when she
remembers the incidence, she becomes tense thus feels insecure
to the extent that she cannot leave her daughter alone to play in
the neighborhood playground. See Syllabus - ?Type 1,2,3
Trauma
Emotional Dysregulation
Emotional dysregulation involves the process of being
unable to control or regulate the emotional responses to the
proactive stimuli. Each individual is exposed to events such as
conflict or the perceived abandonment. Individuals with post-
traumatic stress disorder usually experience emotional
dysregulation and they tend to react in an emotionally
exaggerated manner to the interpersonal challenges by
overreacting such as the burst of anger, intense effort to avoid
the perceived abandonment. Emotional dysregulation tends to be
rational and this implies that it is triggered by a close personal
contact such as family, child or the loved one who is having the
power to control over that person.
The symptoms of the post-traumatic stress disorder such as
the emotional dysregulation act as a risk factor and it leads to
the development of difficulty or the interference with the daily
functions. Therefore, in the process of treatment, it is always
important to target this symptom because it will help in
promoting the greater treatment success. Through teaching the
act of accepting the situation or the forbearance of the adverse
emotions is crucial in the treatment of the people with the
emotion dysregulation (Abigail, Negar, Sierra, Dorthie,
Marylene, & Bekh, 2017). Sane as above Some theory does not
seem to app
In this case study, Roni who is suffering from the post-
traumatic disorder is having emotional dysregulation. She is
having excessive fear as she tries to react to the past severe and
the life-threatening traumatic event by running to take her child

5. from the neighbors' playground. She has been exposed to events
of conflict or the perceived abandonment and she is having an
intense effort to avoid the perceived abandonment. According to
her situation, she complains of being overwhelmingly fearful of
abandonment and is terrified of being alone. This fear is also
making her lose trust in her neighbors and she fears to leave
them alone with her 2-year-old child due to fear of being hurt
by people. All these behaviors are reactions to the previous
severe and often life-threatening traumatic event which
happened to her when she was 17 years old and they are being
reinitiated by the memories she is having and this makes her not
to be able to control these emotional responses. Due to her love
for her daughter and the fear of being hurt, she is powerfully
being controlled by her daughter. Better analysis according to
course theory, Laura
To overcome this situation, it is always important to
include the safety of the patient, education, and the engagement.
These treatment mechanisms require the involvement of the
relational psychotherapy accompanied with the mentalization-
based therapies, dialectical behavioral therapy, and the somatic
experiencing therapy. The management of the anger sleep;
psychoeducation, and the neuro-feedback are important in
improving the client experience. Relate to Roni
Loss of Self-Integrity
Exposure to the extreme interpersonal stress caused by the
mental illnesses such as the post-traumatic stress disorder which
is exemplified by the experience of torture is causing a threat to
the psychological integrity of the affected individual. Such
experiences lead to the mental death due to the loss of the pre-
trauma identity of the victim. The mental death results in the
loss of the key beliefs and values, distrust, and alienation from
other people, sham or guilt or having a sense of being
permanently damaged. The events of the post-traumatic stress
disorder are a threat to the life or to the physical integrity of
oneself. The results of these threats are the intense fear,
helplessness, and horror.

6. DSM-5 is highlighting that the traumatic stressors caused
by the post-traumatic stress disorder involved the perceived
threat to the life of the individual or the physical integrity.
These stressors affect the physical condition of the victim
because they interfere with the integrity of the victim's social
network of the broad system of the social support (Abigail,
Negar, Sierra, Dorthie, Marylene, & Bekh, 2017). In this case
study (Vignette One), Roni is no longer believing or trusting her
neighbors due to the event which she experienced and this
interfered with the self-integrity thus she can no longer trust
people around her. This situation has made her be helpless and
is having intense fear. She cannot concentrate on whatever she
is doing and is worried that the same experience might re-occur
again. She fears to leave her 2-year-old daughter in the
neighbor's playground due to the development of the distrust.
This is not her wish but the situation or her condition as forced
her to behave this way. She does not have any feeling or
connection with her neighbors and feels like she is alone.
According to her, life is fulfilling and meaningful but
sometimes she is finding herself numb for no reason and feels
like her life in a movie. How does this relate to self integrity
Safety and Therapeutic Relationship
There are several well-known and evidence-based
categories of the psychological therapies for the post-traumatic
stress disorder. Most treatment forms are focused on the
cognitive behavioral therapy which has been proven to be
suitable in treating the post-traumatic stress disorder. It is
always important to address the key intrapersonal and the
interpersonal factors which are occasionally disrupting the
responses to the exposure to the trauma. Most of the evidenced-
based therapies involve the use of the prolonged exposure,
cognitive processing therapy, brief eclectic psychotherapy, and
the cognitive therapy.
These trauma-focused therapies involve the inclusion of a
number of types of the guided exposition to traumatic memory.
A good case is that which involve requesting the affected victim

7. to relieve the trauma imaginable. This is carried out through
developing exhaustive present-tense description of precisely
what occurred throughout the traumatic incidence while creating
an audio record of the narration and asking the victim to
frequently pay attention to that video (Roberts, Roberts, Jones,
& Bisson, 2016).
In this case study, it is important to optimize treatment for
the clients by addressing the complicated issues of the trauma
through the sound utilization of the multi-theoretical strategies.
For Roni to benefit from the therapeutic approach applied, it is
important to consider her safety, educating her, and engaging
her in every aspect and process of the treatment. Education, in
this case, involve providing Roni with the necessary skills
which are important the management of the stress, depression
and the conflict which makes her to distrust her close friends
such as the neighbors (Courtois & Ford, 2015).Yes, I would
recommend that you do this, Laura
References
Abigail, P., Negar, F., Sierra, C., Dorthie, C., Marylene, C., &
Bekh, B. (2017). Differential predictors of DSM-5 PTSD and
ICD-11 complex PTSD among African American women.
European Journal of Psychotraumatology, 8 (1).
Courtois, C. A., & Ford, J. D. (2015). Treatment of complex
trauma: a sequenced, relationship-based approach. The
Guildford Express.
Grupta, M. (2013). Review of somatic symptoms in post-
traumatic stress disorder. International Review Psychiatry, 25,
86-99.
Jonathan, I. B., Sarah, C., Catrin, L., & Neil, P. R. (2015). Post-
traumatic stress disorder. BMJ, 351.
Roberts, N. P., Roberts, P. A., Jones, N., & Bisson, J. I. (2016).
Psychological therapies for post-traumatic stress disorder and

8. comorbid substance use disorder (Review). Cochrane Database
of Systematic Reviews (4), 1-125.
Laura, please review my welcome letter to you – I can
send you another copy ; Also please review syllabus directions
and Sample vignette Please take each experience, symptoms
and relate to those relevant areas
One area where you began to analyze and apply. Well
referenced. +15
Running head: VIGNETTE ANALYSIS 2 1
VIGNETTE ANALYSIS 2 8
Vignette Analysis 2
Laura Kay Utgard
PSY:87519 –Psychology of Trauma
Dr. Barbara Lackey
Cal Southern University
August, 2018
Vignette Analysis 2
Assessment and diagnosis
Anthony was exposed to traumatic events which has developed
to Posttraumatic Stress Disorder (PTSD). The condition can be
diagnosed after one month from the time a person is exposed to
traumatic event. The condition starts as ASD and it progresses

9. to PTSD. Based on Diagnostic and Statistical Manual of Mental
Disorder, (DSM-IV), the symptoms include what is expressed
by Anthony. It is evident that he has intrusive recollections of
traumatic occurrences through flashbacks, avoidance of moving
outside, increased efforts to avoid any association to trauma and
irritability. Part of your assessment?
Study show PTSD can differ in frequency and severity and can
make patients have disabilities from distress to severe
incapacitation (Swartz, 2014). Moreover, although onset
happens shortly after experience, the lag period linking
exposure and indication is dependent and in many cases it is
long. The condition of Anthony is a case of delayed onset
because it has been expressed six months after the war. The
PTSD can be recurrent and chronic; however, in many patients,
it occurs with major depressive disorder which comes after the
manifestation of PTSD. This paper focus of diagnosis and
assessment of PTSD from the point when Anthony accepted
diagnostic criteria for the condition as explained in DSM-IV.
Diagnostic criteria
The modern criteria of diagnosing the condition started with the
DSM-III. The criteria has not changed even with the
introduction of DSM-IV. The evidence-based diagnosis for the
patients based on DSM-IV factors in
Exposure to traumatic event (post war)
Intrusive re-experiencing of the event
Avoidance (He did not want move out of the house)
Hyperarousal
Distress which can lead to trauma
The person under study has shown signs of traumatic disorder in
which the ensuing happened
Anthony experienced and witnessed American war that involved
actual death and serious injury. Moreover, the war threated him
Survivor guilt?
The victim is in a state of constant avoidance of stimuli which
is associated with trauma. This is indicated by (Abdul-Hamid &
Hughes, 2014)

10. Efforts to avoid thought by taking alcohol frequently
Efforts to avoid places and people and this is expressed through
being indoor
He has marked diminished interest in important activities
Anthony detached from other
Persistent symptoms of increase arousal of Anthony are
indicated by exaggerated startle response and hypervigilance.
Excellent relevance of reported behavior to the case of Anthony
Clinical diagnosis
The story of Anthony present hint to a psychological health
profession who is familiar with analysis of PTSD. Despite this,
the symptoms and diagnostic process is variable and as
assessment based on the patient symptoms, mental health and
willingness to work with health professional. Normally,
Anthony should be evaluated in a confidential setting with one-
on-one consultation by health specialist. The consultation
should consider patient signs, account of the traumatic
happenings and find out if somebody meets DSM-IV standards
for PTSD (Courtois & Ford, 2015). The health professional
ought to determine severity of symptom, associated disability
and medical conditions. Specifics re Anthony
In the case of Anthony, he accepts that he has avoidance
on anything which relates to trauma. For clinical assessment
there is need to allocate enough time. Based on his case, the ex-
military readiness and ability to relate well with health expert,
the process of diagnosis takes about one hour. A simple factor
of PTSD is determination if a person faced disturbing event. A
war environment give an opportunities for exposure to trauma
events. It is clear that Anthony experiences stressors which
include injuries and death, see military personnel being killed
or injured or torture. Self-report questionnaires are used to
veterans to enhance professional to examine exposure to
traumatic events.Which ones would you suggest for Anthony?
Assessment
Besides official diagnostic procedure, there is more
inclusive review of patient by determining comorbidity,

11. functional status, symptom severity, malingering and
neuropsychologic impairments (Courtois & Ford, 2015).Relate
to Anthony The process of determining comorbidity is important
in assessing patient with PTSD. ?PTSD and depression,
alcoholism, etdThe condition of PTSD is manifested by high
rate of comorbidity. Reports show that people with PTSD have
depressive disorder. It is also argued that 22% of war veterans
who suffer from PTSD have alcohol abuse or dependence
(Rytwinski & Scur, 2013). Anthony who has high inclination to
alcohol abuse has high PTSD. Found it
There is need to do comprehensive evaluation to determine
severity of the symptom. Severity is measured using a self-
report questionnaire and these questionnaires are used to
adjunct diagnostic interview. Yes, which ones?As noted with
case of Anthony, he has impair ability to engage in social role
such as being a husband and this could be the main reason his
wife wants to live him. Functional ability is assessed
independently. Once it is ascertained that Anthony has PTSD,
test should be done to characterize neurocognitive and
neurobehavioral impairments (Courtois & Ford, 2015).
However, the neuropsychologic analysis should be sourced to
validate report of some patients because they might confuse, as
delay recall, working memory and other impairments are not
only related to PTSD. Some test which can be done to Anthony
include “Rey Auditory Verbal Test, continuous Visual Memory
Test and the Verbal and Non Verbal Tests.”I don’t think these
are relevant. See text re standardized assessment instuments
Some people like Anthony may present signs of PTSD but
might be suspected of faking the condition or even exaggerating
the condition. According to DSM, people can malinger the
PTSD and it is recommended that health professionals should
assess a patient in medicolegal context. This involve checking
important shortcoming in patient report of clinical finding and
Anthony symptoms. Based on presentation of symptoms, this is
definitely inaccurate and not applicable, InaOther instances of
malingering involves lack of cooperation in diagnostic process

12. and presence of antisocial personality disorder (Richardson,
Frueh, & Acierno, 2010). Malingering in PTSD might be shown
by MMPI-2. Indicators to check malingering include
incapacitating injuries, repetitive dreams, and antisocial
character, poor work record and unvarying. To assessment if
Anthony is truly facing PTSD, clinician should check if he
demonstrates falsification of documentation, a tendency to
focus blame of the situation and overemphasis on flashback
moments. ????What info did you get from
observation,interview, standardized assessment? Specifics
needed How do you evaluate his paranoia, his vocationalissues,
etd, etc.
Treatment
As noted in the case of Anthony, the main clinical feature and
diagnostic approach of PTSD are defined and they are used to
assess and diagnosis the patients. The maximum assessment of
patient involve face-to-face interview observation standardized
assessment . It is important to have sufficient time to do
assessment. After assessment of Anthony the next phase is
therapy. It is helpful to remember that the condition is
reversible through psychotherapy and medications. The PTSD
therapy has three important goals and these include restore the
patient self-esteem, improve Anthony symptoms and teach him
skills on how to cope with the condition (Courtois & Ford,
2015). Many of these PTSD therapies are cognitive behavioral
therapy and the main idea is to transform the thought pattern
(Hamblen & Kivlahan, 2016). This involve talking about the
trauma and source of fear.
Goals?Missing
Eg to improve vocational functioning, decrease agoraphobic
behavior, etcCognitive Processing TherapyThe CPT take 12
weeks for a complete treatment. This process involves talking
about the trauma to therapist and expressing how the thoughts
relate to the trauma affect personal life. The process assists in
assessing thought pattern in relation to trauma and devising new
ways to live with it. The therapist helps patients to handle

13. events which happened and they were beyond the victim control
(Curran, Bauer, & Mittman, 2012). Prolonged Exposure
TherapyFor the case of Anthony, he has been avoiding events in
life which remind him of traumatic happens and this means that
PE can assist him fight them. This therapy involves 8-15
sessions and each session takes 90 minutes. At the start of the
process, therapist educate patient on breathing techniques which
make him lose anxiety when he imagines what transpired. Eye
movement desensitizationThis therapy is a manual treatment
which assist patients in processing and assessing traumatic
occurrences while making the adaptive. The patient should
access disturbing events linked with trauma, identify paining
self-referring habits and replace it with positive image. PTSD
patient hold the painful image and negative thoughts in mind
while tracking the movement of clinician finger for about 20
seconds. The process is repeated until the patient loss
association with the traumatic event. Study show (Curran,
Bauer, & Mittman, 2012) that Eye movement desensitization is
efficacious treatment for post trauma disorder. Some researcher
argue the result realized through EMDR as similar to those
noticed in CBT. In comparison, PE is more useful than Eye
movement desensitization and relaxation approach.
Group therapy
There are numerous group-based therapies for PTSD which use
individual therapy to improve symptoms. Group treatment helps
in increasing efficiency of treatment and give patient social
support needed to improve the condition. In group therapy,
patients are educated about coping mechanism, cognitive
restructuring and relapse prevention. During which phase would
these therapies happen Specifics to Anthony
Treatment phase I
This phase is referred to safety and stabilization. People with
PTSD are unsafe and have affected relationship with others
(Foa, Hembree, & Rothbaum, 2007). To regain safety, they take
few weeks. The act of knowing which part of life need to
stabilize is important in achieving recovery. People with trauma

14. have issues in soothing challenging emotions. In case Anthony
is diagnosed with PTSD he need to learn how to manage
overwhelming emotions. Lack of safety, poor comnication , etc
Specifics to Anthonyy
Phase II
This is remembrance and mourning phase. The therapy move
from processing trauma and giving it some meaning. The
process is undertaken with help of therapist in individual or in a
group therapy. During this process, it is important to continue
with safety and stability phase because it allows person affected
to move in a manner which integrates trauma instead of reacting
in a fight response. Timing and pace are important in this phase.
The phase further involves exploring the losses linked to trauma
and providing space to grieve.Specific to Anthony, eg process
“survivor guilt,” family of origin issues, etc.
Phase III
This is integration and reconnection stage of the therapy. The
phase involve creation of new sense of future and self. This
final task redefine oneself in a way which is meaningful to
relationships (Foa, Hembree, & Rothbaum, 2007). Through the
process, trauma is lose in patient life and it is integrated in
person life story but not the narrative which defines them.
Moreover, in this stage, person affected by trauma appreciate
effect of victimization but are willing to make efforts towards
empowering themselves. A person with PTSD finds a way to
continue healing and growing like peer mentoring and talking to
youth.Specifics. return to work, feel competent, reduce alcohol
consumption
The main experience of a person suffering from PTSD is
isolation, helplessness and failure of power to control. The
pointing concept of disturbance recovery is rebuilding of
personal safety and enablement. Therapy given to victims of
traumatic events does not mean full freedom from Post
Traumatic effect; however, it is capacity to deal with the state
in default of being overpowered by feelings of the

15. past.Specifics
Many, most symptoms were not addressed; goals missing;
assessment unclear
Treatment phases need to be specifically related to Anthony
You can redo and resubmit if you would like, Laura. Again,
reeview my welcome letter to you and the syllabus directions. -
35
Very well referenced and formatted Some relevant theory +105
References
Abdul-Hamid, W., & Hughes, J. (2014). Nothing new under the
sun: post-traumatic stress disorders in the ancient world. Early
Science Medicine, 19, 549–557.
Courtois, C., & Ford, J. (2015). Treatment of Complex Trauma:
A Sequenced, Relationship-Based Approach. The Guilford
Press.
Curran, G., Bauer, M., & Mittman, B. (2012). Effectiveness-
implementation hybrid designs: Combining elements of clinical
effectiveness and implementation research to enhance public
health impact. Medical Care, 50(3), 217–226.
Foa, E., Hembree, E., & Rothbaum, B. (2007). Prolonged
exposure therapy for PTSD: Emotional processing of traumatic
experiences: Therapist guide. New York: Oxford University
Press.
Hamblen, J., & Kivlahan, D. (2016). PTSD and substance use
disorders in veterans. U.S. Department of Veterans Affairs.
Retrieved August 07, 2018, from
www.ptsd.va.gov/professional/co-
occurring/ptsd_sud_veterans.asp.

16. Richardson, L., Frueh, B., & Acierno, R. (2010). Prevalence
estimates of combat-related post-traumatic stress disorder:
critical review. jounal of Psychiatry, 44, 4–19.
Rytwinski, N., & Scur, M. (2013). The co-occurrence of major
depressive disorder among individuals with posttraumatic stress
disorder: a meta-analysis. Journal of Trauma Stress, 26, 299–
309.
Swartz, M. (2014). Textbook of Physical Diagnosis: History and
Examination. Philadelphia, Pennsylvania: Elsevier;.