Post-Traumatic Stress DisorderThe Increase in Violence by Soldiers
Wendy Seiber
http://www.youtube.com/watch?v=TN3MR18uCoU
http://www.mentalhealthscreening.org/military/index.aspx
Many Names for One Problem
Civil War› Soldier’s Heart
WW1› Shell Shock
WW2› Battle Fatigue
Korean War› Gross Stress Reaction
Formally diagnosed as a disorder (PTSD) in 1980
Posttraumatic Stress Disorder 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).
Current Trends 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
Trends cont. 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)
Violent Behaviors 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
Etiology 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
General Risk Factors 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*
Protective Factors 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
Assessment 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
Symptoms of PTSD 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
Current Research 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
Domestic Violence Study 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
Recently….. 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
Treatment 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
Eye Movement Desensitization & Reprocessing
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
Prevention 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)
Watching for Signs 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
Impact on Soldiers 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
Impact on Families of Soldiers
Abuse Tension Marital strain Violence Secondary PTSD for wives
Cost on Society 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)
Future Research 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
Important The National Center for PTSD
› http://ncptsd.va.gov/ncmain/index.jsp› 802-296-6300
PTSD Self Test› http://www.patss.com
References 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: http://www.medicalnewstoday.com/articles/109094.php
APA, (2009). PTSD facts and statistics. Retrieved June 15, 2009, from APA help Center http://www.apa.org/topics/topicsptsd/html 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
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http://www.sonnetpsych.com/Sonnet_Psychological_Freeport_Maine_psychology_preventing_ptsd.htm MHSAP, (2009). Mental Health self-assessment program. Retrieved June 15, 2009, from Screening for Mental Health
http://www.mentalhealthscreening.org/ military/ index.aspx
Navert, Rick (2008, Dec 2). New treatment may prevent PTSD. Retrieved June 15, 2009, from Psych Central http://psychcentral.com/news/2008/12/02/new-treatment-may- prevent-ptsd/3428.html
NCPTSD, (2007, Aug 2). PTSD Information Center. Retrieved June 15, 2009, from National Center for PTSD http://ncptsd.va.gov/ncmain/index.jsp
References cont… Psychiatric Disorders, (2009). PTSD. Retrieved June 15, 2009, from MoreFocus Groups: http://www.psychiatric-
disorders.com/articles/ptsd/overview/common-ptsd-sufferers.php 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 soldier's crimes . Retrieved June 15, 2009, from Military.com: http://www.military.com/NewsContent/0,13319, 158912,00.html
Rogge, T. A. (2008, May 21). PTSD Health. Retrieved June 15, 2009, from Healthline ADAM: http://www.healthline.com/adamcontent/post-traumatic-stress-disorder? 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 http://www.emdr.com/briefdes.htm
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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.