IRAQ WAR CLINICIAN GUIDE
2nd EDITION
Written and Compiled by
National Center for Post-Traumatic Stress Disorder
Contributing authors include (in alphabetical order): Eve B. Carlson, Ph.D., Erika Curran, L.C.S.W.,
Matthew J. Friedman, M.D., Ph.D., Fred Gusman, M.S.W., Jessica Hamblen, Ph.D., Rachel
Kimerling, Ph.D., Gregory Leskin, Ph.D., Brett Litz, Ph.D., M.S.W., Barbara L. Niles, Ph.D., Susan
M. Orsillo, Ph.D., Ilona Pivar, Ph.D., Annabel Prins, Ph.D., Robert Rosenheck, M.D., Josef I.
Ruzek, Ph.D., Paula P. Schnurr, Ph.D., Steve Southwick, M.D., Jane Stafford, Ph.D., Amy Street,
Ph.D., Pamela J. Swales, Ph.D., Casey T. Taft, Ph.D., Robyn D. Walser, Ph.D., Patricia J. Watson,
Ph.D., Julia Whealin, Ph.D.; and Harold Kudler, M.D., from the Durham VA Medical Center.
Editorial Assistant: Sherry E. Wilcox.
Walter Reed Army Medical Center
Contributing authors include (in alphabetical order): LTC John C. Bradley, MC, USA, LTC David
M. Benedek, MC, USA, COL Ryo Sook Chun, MC, USA, COL Dermot M. Cotter, COL Stephen J.
Cozza, MC, USA, Catherine M. DeBoer, MAJ Geoffrey G. Grammer, CAPT Thomas A. Grieger,
MC, USN, Rosalie M. Kogan, L.C.S.W., COL (Ret) R. Gregory Lande, DO FACN, Barbara A. Marin,
Ph.D., COL (Ret) Patricia E. Martinez, MAJ Erin C. McLaughlin, Corina M. Miller, L.C.S.W., COL
Theodore S. Nam, MC, USA, COL (Ret) Marvin A. Oleshansky, M.D., MAJ Mark F. Owens, LTC
(Ret) Harold J. Wain, Ph.D., COL Douglas A. Waldrep, MC, USA.
June 2004
DEPARTMENT OF VETERANS AFFAIRS
NATIONAL CENTER FOR PTSD
Iraq War Clinician Guide
ii
Table of Contents
IRAQ WAR CLINICIAN GUIDE
Table of Contents
I.
Executive Summary ........................................................................................1
Key Topics
II.
III.
IV.
Topics Specific to the Psychiatric Treatment of Military Personnel ....................4
The Returning Veteran of the Iraq War: Background Issues and
Assessment Guidelines .................................................................................21
Treatment of the Returning Iraq War Veteran .................................................33
Special Topics
V.
VI.
VII.
VIII.
IX.
X.
XI.
XII.
XIII.
Treatment of Medical Casualty Evacuees .......................................................46
Treating the Traumatized Amputee ...............................................................50
PTSD in Iraq War Veterans: Implications for Primary Care..............................58
Caring for the Clinicians Who Care for Traumatically Injured Patients ............62
Military Sexual Trauma: Issues in Caring for Veterans.....................................66
Assessment and Treatment of Anger in Combat-Related PTSD ........................70
Traumatic Grief: Symptomatology and Treatment for the
Iraq War Veteran..........................................................................................75
Substance Abuse in the Deployment Environment .........................................79
The Impact of Deployment on the Military Family .........................................83
Appendices
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Case Examples from Operation Iraqi Freedom ...............................................87
VA/DoD PTSD Practice Guideline ................................................................92
VA Documents on Service Provision .............................................................93
Assessment of Iraq War Veterans: Selecting Assessment Instruments
and Interpreting Results .............................................................................. 108
Program Evaluation .................................................................................... 126
Litz, B. T., Gray, M. J., Bryant, R. A., & Adler, A. B. (2002). Early
interventions for trauma: Current status and future directions. Clinical
Psychology: Science and Practice, 9, 112-134. ............................................ 128
Keane, T. M., Street, A. E., & Orcutt, H. K. (2000). Posttraumatic stress
disorder. In M. Hersen & M. Biaggio (Eds.), Effective brief therapies: A
clinician’s guide (pp. 140-155). New York: Academic Press.......................... 151
Friedman, M. J., Donnelly, C. L., & Mellman, T. A. (2003).
Pharmacotherapy for PTSD. Psychiatric Annals, 33, 57-62. .......................... 169
Friedman, M. J., Schnurr, P. P., & McDonagh-Coyle, A. (1994). Posttraumatic stress disorder in the military veteran. Psychiatric Clinics of
North America, 17, 265-277....................................................................... 175
Educational Handouts for Iraq War Veterans and Their Families ................... 188
DEPARTMENT OF VETERANS AFFAIRS
NATIONAL CENTER FOR PTSD