http://www.youtube.com/watch?v=TN3MR18uCoU
http://www.mentalhealthscreening.org/military/index.aspx
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Civil War
› Soldier’s Heart
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WW1
› Shell Shock
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WW2
› Battle Fatigue
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Korean War
› Gross Stress Reaction
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Formally diagnosed as a disorder (PTSD) in
1980
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).

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
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Self Reports - a study completed by
› 2,275 Operation Iraqi Freedom soldiers
› 1,814 Operation Enduring Freedom soldiers
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44% clinically significant levels of depression and/or
PTSD (LaPierre, 2007)
Experts Estimate
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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)

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)
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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

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
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*
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› *most likely to effect soldiers*
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Disaster Preparedness training
› Firefighters, police and paramedics receive this

Strong support systems
› Positive paternal relationship
› Social support
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Positive life events
Stress management training
Psychological preparedness
Older age at entry to war
Higher level of education
Higher SES

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
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Mental Health Self-Assessment Program
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Military personnel and their families
Online or over the phone test
Identify symptoms
Access assistance before problems becomes serious

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
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Avoidance
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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
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Difficulty concentrating, sleeping difficulties
Exaggerated response when startled
Hyper vigilance
Irritability or outbursts of anger
Arousal
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
Charles W Hoge (2004)
4 US Combat Infantry Units
› 3 Army
› Iraq-2530

1 Marine
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%
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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
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
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

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
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Immersion Therapy Video Game
› Simulates sights, sounds & smells of combat
› Gradually re-enter a traumatic event
› “Virtual Iraq”
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Side Issues
› May need to treat side symptoms such as depression and
alcohol/drug abuse before addressing the PTSD
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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
Research into how to prevent PTSD is
currently ongoing
 Possibilities
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› Trauma debriefing immediately after event
› Early intervention
› Injection of Cortisol shortly after exposure
 (currently in animal testing phase)
 (Navert, 2008)

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
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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
Difficulty fitting into the society they went
to war to defend
 Hard to turn off some of the reactions
that saved life in combat
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› May lead to grief in bar
No drug addictions, alcoholism, or
criminal behavior until after war
 War assignments basically 14months of
testosterone build-up
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Abuse
 Tension
 Marital strain
 Violence
 Secondary PTSD for wives
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Increased crime rates
Lost lives
› Risk of suicide and/or homicide
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High medical costs
› Costs of untreated trauma, related alcohol/drug
abuse about $160 Billion/yr
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Legal woes
› Criminal Behavior
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Poor work performance
› Lost jobs-US loses $3 Billion every year due to work
place problems caused by PTSD
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Family troubles
 (Kedem, 2007)
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
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The National Center for PTSD
› http://ncptsd.va.gov/ncmain/index.jsp
› 802-296-6300
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PTSD Self Test
› http://www.patss.com

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
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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.
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Basoglo, M. (1997). Psychological preparedness for traumas a protective factor in survivors of torture. Psychological Medicine 27: 14211433
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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
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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
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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
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Lilly, David (2000). Preventing PTSD. Retrieved June 15, 2009, from Sonnet Psychology
http://www.sonnetpsych.com/Sonnet_Psychological_Freeport_Maine_psychology_preventing_ptsd.htm
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MHSAP, (2009). Mental Health self-assessment program. Retrieved June 15, 2009, from Screening for Mental Health
http://www.mentalhealthscreening.org/ military/ index.aspx
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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
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NCPTSD, (2007, Aug 2). PTSD Information Center. Retrieved June 15, 2009, from National Center for PTSD
http://ncptsd.va.gov/ncmain/index.jsp
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Psychiatric Disorders, (2009). PTSD. Retrieved June 15, 2009, from MoreFocus Groups: http://www.psychiatricdisorders.com/articles/ptsd/overview/common-ptsd-sufferers.php
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Reeves, R. R. (2007). Diagnosis and Management of Posttraumatic Stress Disorder in Returning Veterans. Journal of the
American Osteopathic Association 107: 181-189
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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
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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
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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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Sherman, M.D. (2006). Domestic Violence in veterans with PTSD who seek couples therapy. Journal of Marital and
Family Therapy 32: 479-490
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Solomon, Zahava. (1990). Life events and combat related PTSD; the intervening role of locus of control and social support.
Military Psychology 2: 241-256
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Solomon, Zahava. (1988). Negative life events, coping response and combat-related psychopathology: A prospective study.
Journal of Abnormal Psychology 97: 302-307
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Sontag, Deborah (2008, Jan 13). Across America, Deadly echoes of foreign battles. New York Times, War Torn Part 1.