Understanding PTSD in war veterans
drjohnmundt@hotmail.com
www.drjohnmundt.com
TRAUMA
POST
TRAUMATIC
PTSD
STRESS
DISORDER
 RESILIENCE is the norm
POST-TRAUMATIC GROWTH is
common
RECOVERY is possible
Understanding “PTSD”:
 Re-experiencing of traumatic events
 Avoidance (of reminders, of emotion)
 Hyperarousal & hypervigilance
PTSD Criteria from DSM-IV:
A. Exposure to a traumatic event, with both of the following
present
(1) 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
(2) The person’s response involved intense fear, helplessness,
or horror
PTSD in OEF/OIF veterans
PTSD Criteria from DSM-IV:
B. Re-experiencing of the event (in one or more of the following
ways)
(1) recurrent and intrusive distressing recollections of the
event, including images, thoughts, or perceptions.
(2) recurrent distressing dreams of the event (in children,
frightening dreams without recognizable content)
(3) acting or feeling as if the traumatic event were recurring
(includes reliving the experience, illusions, hallucinations,
and dissociative flashback episodes, including those that
occur while intoxicated)
(4) intense psychological distress at exposure to cues
(5) physiological reactivity on exposure to cues
Understanding “TRIGGERS”

Think “full body” :
memories are laid down
in all sensory spheres
Terrain: desert, urban
Weather: heat, wind, humidity
Songs, sounds
Smells: olfactory memories
People: automatic responses to persons
who appear Middle Eastern; children
Understanding CUES or “TRIGGERS”:
SITUATIONAL TRIGGERS:
-Mimic feelings of helplessness, danger
-Invasive medical procedures
-Seclusion or restraint
Driving: “signature trigger” for OEF/OIF
veterans
 Nature of war in Iraq & Afghanistan
 Need for high speeds, evasive maneuvers
PTSD Criteria from DSM-IV:
C. Persistent Avoidance of stimuli associated with the trauma
and numbing of general responsiveness, with three or more
of the following:
(1) efforts to avoid thoughts, feelings, or conversations
associated with the trauma
(2) efforts to avoid activities, places, or people that arouse
recollections of the trauma
(3) inability to recall an important aspect of the trauma
(4) markedly diminished interest or participation in
significant activities
(5) feeling of detachment or estrangement from others
(6) restricted range of affect
(7) sense of a foreshortened future
PTSD Criteria from DSM-IV:
D. Persistent symptoms of Arousal, with two or more of the
following:
(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hypervigilance
(5) exaggerated startle response
PTSD Criteria from DSM-IV:
E. Duration of the symptoms more than one month
F. Clinically significant distress or impairment in social,
occupational or other areas of functioning
THINKING OUTSIDE THE “DSM Box”:
What does PTSD feel like?

Sense of immediacy (“happening right now”)
 Re-experiencing of original memories and
sensory impressions
 Involuntary
THINKING OUTSIDE THE “DSM Box”:
Other “symptoms”
GUILT:
 Rational or irrational
 Understanding
atrocities
 “survivor guilt” (also guilt
for leaving, being “intact”)
THINKING OUTSIDE THE “DSM Box”:
Other “symptoms”
GRIEF:
 Multiple losses without
time to grieve
 Affective numbing,
anger/revenge
 Impact of pre-war losses, post-war losses
 Deaths of loved ones during deployment
THINKING OUTSIDE THE “DSM Box”:
Other “symptoms”

Anger at Government
 Mistrust of Authority
 Desire to return to warzone
 Damage to spirituality
PTSD in OEF/OIF veterans
Duration of problems & DSM criteria:
< 2 days: no diagnosis (“COSR”)
>2 days, <4 weeks: Acute Stress Disorder
>4 weeks, <3 months: PTSD, acute
>3 months: PTSD, chronic
Deployment, Homecoming &
the Family
What happens?
 Displacement of veteran from prior role
 Family adapts in his/her absence
 Change in roles
 Change in lifestyle
 Change in family dynamics
 Homecoming:
veteran returns
 Loss of roles
 Efforts to re-establish and/or create roles
PTSD negatively impacts relationships:
Separation and divorce
Family violence
Impaired parenting
Sexual/Intimacy problems
Caregiver burden
“The Bind That Ties” - Ned Broderick
Deployment: Impact on Family
Spouse/partner
 “Where is the person I knew?”
 Has adapted/ changed
 Has unrealistic expectations
 Vicarious traumatization (“PTSD by proxy”)
Deployment: Impact on Family
Spouse/partner (continued)
 separation/ divorce
 stalking
Deployment: Impact on Family
Children
 “Who Is This?”
 “This is scary.”
 Regression
 Exposure to trauma
Deployment: Impact on Family
TEENAGERS
“Who are you to tell me what
to do?!?!?!”
Understanding “PTSD” & impact on kids:
 Re-experiencing of traumatic events:
symptoms can be scary, confusing
 Avoidance (of reminders, of emotion):
parent seems detached, uncaring
 Hyperarousal & hypervigilance:
parent acts grouchy, mean, impatient
Parent’s “PTSD”: Children’s Responses
 Growing up too fast: taking on the adult role
 Feeling & behaving like the parent in order




to connect
Learning to be silent about trauma
“Too much information!” : “Intergenerational
transmission of trauma”
Filling in the gaps
Secondary traumatization: family violence
Deployment: Impact on Family
PARENTS
 “What happened to my son/daughter?”
 “Can’t you shake this off?”
 “This reminds me of my
own service…”
Deployment: Impact on Family
SPECIAL CASE OF MOTHERS:
Early separation from newborns
Problems reattaching
Change in roles
drjohnmundt@hotmail.com
www.drjohnmundt.com