Post traumatic stress disorder


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Research on PTSD and veterans

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  • I am the Associate Director of the Tri-service Integrator of Outpatient Programming Systems (TrIOPS) and work with military programs throughout the country that provide behavioral health treatment for combat related stress conditions (i.e., PTSD, depression, anxiety, etc..). Please feel free to contact me if you have information or experiences you would like to share regarding this area of treatment. There is a much good work taking place with much more work to be done. I am dedicated to learning as much as I can about the system in which care is provided so that resources, products, and services can be developed and utilized by treatment programs working with our Warriors.
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Post traumatic stress disorder

  1. 1.
  2. 2.  Civil War › Soldier’s Heart WW1 › Shell Shock WW2 › Battle Fatigue Korean War › Gross Stress Reaction Formally diagnosed as a disorder (PTSD) in 1980
  3. 3.  Anxiety disorder that can occur after a person experiences or witnesses a violent or frightening event. Not everyone who experiences trauma develops PTSD. The essential feature of PTSD is the development of characteristic symptoms following exposure to traumatic events that arouse “intense fear, helplessness, or horror” (APA).
  4. 4.  Number of reported cases up 50% from 2006-2007 Nearly 40,000 from Iraq/Afghanistan from 2003-2007 diagnosed › Army-28,365 Marine-5,581 › Navy and Air Force < 1000 Up to 30% of deployed soldiers experience PTSD symptoms Roughly 50% don’t get treatment b/c fear of embarrassment or hurting career
  5. 5.  Self Reports - a study completed by › 2,275 Operation Iraqi Freedom soldiers › 1,814 Operation Enduring Freedom soldiers 44% clinically significant levels of depression and/or PTSD (LaPierre, 2007) Experts Estimate › 15% of Vietnam Vets currently, several years after war › 8-10% of Desert Storm › 6-11% of Enduring Freedom › 12-20% of Iraqi Freedom  Problems?  7-9% of general public suffers from PTSD (5.2 million 18-54)  30% of combat veterans develop PTSD  Strong link between PTSD and violence but violence alone does not cause PTSD (APA)
  6. 6.  121 Veterans have committed murder since their return to the States › Most victims were their spouses or children  1/3 were spouses, girlfriends, children or other relatives › Trauma and stress of deployment along with alcohol abuse, family discord and other problems set the stage › 75% were still in military when killed relative › 50% involved guns  Rest were stabbings, beatings, strangulation, and bathtub drownings › 25 face homicide charges for fatal crashes from drunken, reckless, or suicidal driving (Sontag, 2008) Felony El Paso county jail bookings for service members jumped from 295 in 2005 to 471 in 2006 Reports of theft and domestic violence for soldiers increased in 2006 Crime ring in Ft. Carson of Iraqi War Veterans were responsible for the deaths of two GIs
  7. 7.  May occur soon after trauma or can be delayed for more than 6 months after › When occurs right after trauma, usually gets better after 3 months › Some may have long term PTSD which can last for many years › Approximately 50% of cases remit within 1 year Psychological, genetic, physical and social factors involved but no exact cause › Changes the body’s response to stress › There may be a personal predisposition necessary for symptoms to develop after trauma
  8. 8.  Being female Having learning disability Physical and/or sexual abuse Existence of mental disorder prior to event Low education levels and poor SES Some ethnic differences due to how pain and anxiety are expressed (Hispanics, African Americans, Native Americans) Duration of traumatic event* Traumatic events inflicted by a person* Violence associated with trauma* Negative life events* › *most likely to effect soldiers*
  9. 9.  Disaster Preparedness training › Firefighters, police and paramedics receive this Strong support systems › Positive paternal relationship › Social support Positive life events Stress management training Psychological preparedness Older age at entry to war Higher level of education Higher SES
  10. 10.  Currently no tests to diagnose PTSD › The diagnosis is made based on a certain set of symptoms that continue after the trauma has occurred. › Psychiatric and physical exams performed to rule out other illnesses › Usually must have at least one re-experiencing symptom for diagnosis Mental Health Self-Assessment Program › Military personnel and their families › Online or over the phone test › Identify symptoms › Access assistance before problems becomes serious
  11. 11.  Repeatedly “reliving” of the event, which disturbs day-to-day activities › Flashbacks, recurring distressing memories › Repeated dreams › Physical reactions to situations that remind of event Avoidance › Emotional numbing, feelings of detachment › Inability to remember important parts of trauma › Lack of interest in normal activities › Less expression of moods › Staying away from anything that is a reminder › Sense of having no future Arousal › Difficulty concentrating, sleeping difficulties › Exaggerated response when startled › Hyper vigilance › Irritability or outbursts of anger
  12. 12.  Charles W Hoge (2004) 4 US Combat Infantry Units › 3 Army 1 Marine › Iraq-2530 Afghanistan-3671 Combat duty in Iraq and Afghanistan- Levels of PTSD › Before combat in Iraq 9.3% › After Iraq 15.6-17.1% › After Afghanistan 11.2% Only 23-40% sought mental health care 2x as likely to report concern about possible stigmatization and other barriers to seeking mental health care › Feared seeking treatment b/c would make them appear weak or cause their peers to treat them differently
  13. 13.  Michelle D. Sherman (2006) Veterans with PTSD have higher rates than the general population of abuse 17 couples seeking therapy were studied › PTSD and depression diagnosed Veterans perpetrated more violence  Much higher than found in previous research › 81% engaged in at least one act of violence toward their partner in a year  > than 6x the general population
  14. 14.  Cynthia A Leardmann (2009) If baseline functional health status can predict PTSD after combat › 5410 participants  Baseline and follow-up questionnaires  7.3% had new onset symptoms of PTSD  Those whose baseline mental component summary scores were below the 15th centile had 2-3x the risk of symptoms of PTSD by follow-up compared to those in the 15th-85th centile. › Low mental or physical health prior to combat significantly increased risk of PTSD
  15. 15.  Traditional Treatments (Last 3-6months up to 1-2yrs+) › CBT  Behavioral therapy can be used to treat avoidance symptoms › Supportive patient education  Support groups with people who had experienced similar traumas › Psychopharmacology  Antidepressants (SSRIs) can be effective in treating PTSD  Sedatives for sleep disturbances Immersion Therapy Video Game › Simulates sights, sounds & smells of combat › Gradually re-enter a traumatic event › “Virtual Iraq” Side Issues › May need to treat side symptoms such as depression and alcohol/drug abuse before addressing the PTSD
  16. 16.  8 phases of treatment › 1: History taking and treatment plan › 2: Does client have adequate methods developing good coping skills and dealing with emotional distress-self calming exercises › 3-6: Client identifies most vivid memories from event, intensity of negative emotions and positive personal beliefs › 7: Closure-client keeps a journal during the week to document any related material › 8: Re-evaluation of the previous session After EMDR clients typically report that the emotional distress related to the memories is significantly decreased or gone
  17. 17.  Research into how to prevent PTSD is currently ongoing Possibilities › Trauma debriefing immediately after event › Early intervention › Injection of Cortisol shortly after exposure  (currently in animal testing phase)  (Navert, 2008)
  18. 18.  Fort Carson Units › Every soldier and hundreds of family members are trained to spot signs of PTSD and brain injury › Every returning soldier is screened repeatedly and those who need help get it quickly since the earlier they find something, the easier it is to treat Training program › Soldiers learn how to deal with people who have PTSD issues › Use verbal judo to take person down so no harm is caused
  19. 19.  Difficulty fitting into the society they went to war to defend Hard to turn off some of the reactions that saved life in combat › May lead to grief in bar No drug addictions, alcoholism, or criminal behavior until after war War assignments basically 14months of testosterone build-up
  20. 20.  Abuse Tension Marital strain Violence Secondary PTSD for wives
  21. 21.  Increased crime rates Lost lives › Risk of suicide and/or homicide High medical costs › Costs of untreated trauma, related alcohol/drug abuse about $160 Billion/yr Legal woes › Criminal Behavior Poor work performance › Lost jobs-US loses $3 Billion every year due to work place problems caused by PTSD Family troubles  (Kedem, 2007)
  22. 22.  Relationships of soldiers and prisoners of war before and after combat experience Ways to assess PTSD properly so it is not misdiagnosed Studies of long term treatment effectiveness
  23. 23.  The National Center for PTSD › › 802-296-6300 PTSD Self Test ›
  24. 24.  Anxiety/Stress News, (2008, May 29). Reported cases of PTSD in soldiers up 50%, according to defense officials. Retrieved June 15, 2009, from Medical News Today: APA, (2009). PTSD facts and statistics. Retrieved June 15, 2009, from APA help Center Barrish, I.S. (2008). Military Veterans PTSD Reference Manual. Bryn Mawr, PA: Infinity. Basoglo, M. (1997). Psychological preparedness for traumas a protective factor in survivors of torture. Psychological Medicine 27: 1421- 1433 Goulston, Mark (2008). PTSD for Dummies. Hoboken, NJ: Wiley. Hoge, C.W. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine 351: 13-22 LaPierre, C.B. (2007). Posttraumatic stress and depression symptoms in soldiers returning from combat operations in Iraq and Afghanistan. Journal of Traumatic Stress 20: 933-943 LeardMann, C. A. (2009). Baseline self reported functional health and vulnerability to post-traumatic stress disorder after combat deployment: prospective US military cohort study. BMJ 338: 1273-1273 Lilly, David (2000). Preventing PTSD. Retrieved June 15, 2009, from Sonnet Psychology MHSAP, (2009). Mental Health self-assessment program. Retrieved June 15, 2009, from Screening for Mental Health military/ index.aspx Navert, Rick (2008, Dec 2). New treatment may prevent PTSD. Retrieved June 15, 2009, from Psych Central prevent-ptsd/3428.html NCPTSD, (2007, Aug 2). PTSD Information Center. Retrieved June 15, 2009, from National Center for PTSD
  25. 25.  Psychiatric Disorders, (2009). PTSD. Retrieved June 15, 2009, from MoreFocus Groups: http://www.psychiatric- Reeves, R. R. (2007). Diagnosis and Management of Posttraumatic Stress Disorder in Returning Veterans. Journal of the American Osteopathic Association 107: 181-189 Ridder, K. (2007, December 25). War stresses linked to soldiers crimes . Retrieved June 15, 2009, from,13319, 158912,00.html Rogge, T. A. (2008, May 21). PTSD Health. Retrieved June 15, 2009, from Healthline ADAM: utm_medium=ask&utm_source=smart&utm_campaign=article_toc&utm_term=Post-traumatic+stress+disorder+risk+factor Shapiro, F (2004). A brief description of EMDR. Retrieved June 18, 2009, from EMDR Institute Sherman, M.D. (2006). Domestic Violence in veterans with PTSD who seek couples therapy. Journal of Marital and Family Therapy 32: 479-490 Solomon, Zahava. (1990). Life events and combat related PTSD; the intervening role of locus of control and social support. Military Psychology 2: 241-256 Solomon, Zahava. (1988). Negative life events, coping response and combat-related psychopathology: A prospective study. Journal of Abnormal Psychology 97: 302-307 Sontag, Deborah (2008, Jan 13). Across America, Deadly echoes of foreign battles. New York Times, War Torn Part 1.