KATHRYN J. KOTRLA, M.D.
VICE DEAN
TEXAS A&M
HEALTH SCIENCE CENTER
COLLEGE OF MEDICINE – ROUND ROCK
 OIF/OEF
 PTSD
 TBI
 Understanding Their
Experience
 Linking to Available
Resources
“No one
comes home
from war
unchanged.”
• Iraq and Afghanistan Veterans of America,
January 2008
~1.6
Million
Soldiers
have
served
449,000
deployed
> 1 tour
20%
Female
Soldiers
As of January
23, 2006, DoD
reports 505,366
OIF/OEF
Veterans
eligible for VA
services
43% separated
Active Duty
troops
57%
Reserve/National
Guard members
Survey of 894
OIF Soldiers
95% observed
dead bodies
or human
remains
93% were
shot at;
89% were
ambushed
68% saw
dead or
injured
Americans
48% killed
an enemy
combatant
 NOT Knowledgeable about MH warning
signs
 49% Military Service Members
 52% Military Spouses
 Insufficient Information about Treatment
options for MH
 59% Military Service Members
 66% Military Spouses
 10% have sought treatment; STIGMA
prevents MH Care
 30-40% Iraq Veterans will face depression,
anxiety, or PTSD
 Multiple tours and prolonged deployments
increase combat stress by 50%
 National Guard and Reserve at increased risk
for MH issues and Suicide
 Amount of TBI: Unknown
 Interaction between PTSD and TBI: Unknown
 Individuals may RE-EXPERIENCE the event in
a variety of ways:
May experience intrusive thoughts of the event
 May have distressing dreams or nightmares
of the event
 May feel very uncomfortable when confronted
with a reminder of the event
 May act or feel as if the traumatic event were
recurring (“flashback”)
 Individuals may experience INCREASED
AROUSAL:
May be irritable and/or have angry outbursts
 May experience insomnia
(problems falling or staying asleep)
 May be hypervigilant
 May have difficulty concentrating
 May startle easily and excessively
Individuals may AVOID certain triggers or
reminders of the trauma and may experience
EMOTIONAL NUMBING (and/or distance
themselves from others).
• They may try to avoid:
•
ACTIVITIES
•
PLACES
•
THOUGHTS
•
PEOPLE
External force applied to the head
Disruption of brain function
Alteration of consciousness
 incomplete memory of the event
 “dazed” or confused
 loss of consciousness
Adapted from ACRM Special Task Force on TBI
Blast Induced Injury
MAJOR DEPRESSION
JOB LOSS
 ~25% jobless
VIOLENCE TOWARD OTHERS
HOMELESSNESS
 ~30%
DOMESTIC VIOLENCE
 Up 177%
DIVORCE
 2/3 marriages
ALCOHOL ABUSE
NARCOTIC ADDICTION
INCARCERATION
MILITARY SEXUAL TRAUMA
SHADOW WARRIORS
SUICIDE
 18/Day
 950 attempts/month
CHILD ABUSE
 30% increase with each 1% deployment
 Children’s academic, physiological,
and psychological issues
Psychological
Health
Family
Caregiver
Needs
Medical Care
Benefits
&
Compensation
Military
Considerations
SERVICE
MEMBER/
VETERAN &
FAMILY
Transportation
Spirituality
Assistive
Devices
Technology
Education/
Training
Housing
Career
Employment
“The journey home marks the beginning of an
internal war for the Marines. Give them the
space they require to slowly turn the switch.
The switch from violence to gentle. The switch
from tension to relaxation. The switch from
suspicion to trust. The switch from anger to
peace. The switch from hate to love...”
LT. Col. Mark Smith, WISHTV
Feb 18, 2005
Down Range to Iraq and Back (Cantrell & Dean)
 Traumatic events that can be challenging to process
and talk about.
 Identification and closeness with their military unit and
comrades who have shared similar experiences.
 Regimentation in the form of highly structured and
efficient routines.
 Heightened sensory experiences including sights,
sounds and smells.
 Expanded self-importance and identity shaped by war.
Create an organized repository
of all needed Federal, State,
and Local services for Military
Service Members, Veterans, and
their Families: TexVet
www.TexVet.org







Warrior-Mentor Programs
Student Veteran Associations
Veterans County Service Officers
Bring Everyone In the Zone
Community groups (Austin, San Antonio,
Houston)
Vet Centers
VHA
 Listen to what Warriors need, not what we
think they need
 Educate yourself about their experiences to
build trust
 Achilles in Viet Nam; Odysseus in
America by Jonathon Shay
 A Warrior’s Guide to Insanity; A Warrior’s
Guide to World’s at War by SGT. (Ret)
Andrew Brandi
 Prove that you’ve got their backs
 Prepare for the long haul
 Watch for and respect secondary
traumatization
 Build relationships across silos
 Remember you have the expertise
to shape the future for our Warriors
and for Texas