PTSD & Veteran Issues

1. PTSD & Veteran Issues David J Dietz, PhD NADE National Conference Columbus, Ohio September 11, 2012

2. Who am I Completed Internship at Walter Reed Army Medical Center Aeromedical Psychological Training Program Chief, Psychology Fort Carson Colorado NADE National Conference Columbus, Ohio September 11, 2012

3. The “History” of PTSD • Ancient Greeks • Charles Dickens • Shell shock • Combat fatigue • Battlefield neurosis • PTSD NADE National Conference Columbus, Ohio September 11, 2012

4. “An abnormal response to an abnormal situation is normal behavior” Victor Frankel, MD Man’s Search for Meaning NADE National Conference Columbus, Ohio September 11, 2012

5. Sources of PTSD in the Veteran • Combat • Training accidents • Civilian accidents • Sexual Assault NADE National Conference Columbus, Ohio September 11, 2012

6. Definition of Trauma • PTSD diagnosis requires having experienced a traumatic experience • Cultural values • Changes of over time • Individual differences NADE National Conference Columbus, Ohio September 11, 2012

7. NADE National Conference Columbus, Ohio September 11, 2012

8. The PTSD Diagnosis A. The person has been exposed to a traumatic event in which both of the following were 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. NADE National Conference Columbus, Ohio September 11, 2012

9. The PTSD Diagnosis B. The traumatic event is persistently re-experienced 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. 3. acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). 4. intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event 5. physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event NADE National Conference Columbus, Ohio September 11, 2012

10. The PTSD Diagnosis C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by 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 (e.g., unable to have loving feelings) 7. sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span) NADE National Conference Columbus, Ohio September 11, 2012

11. The PTSD Diagnosis D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by 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 NADE National Conference Columbus, Ohio September 11, 2012

12. The PTSD Diagnosis E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month. F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. NADE National Conference Columbus, Ohio September 11, 2012

13. Problems facing the soldier With current technology many soldiers remain in frequent contact with home Spouse sees return as time for soldier to take over home responsibilities Active Duty vs. Reserves / National Guard Leaving their unit/comrades behind – sent home before deployment is over NADE National Conference Columbus, Ohio September 11, 2012

14. Incidence rates • 70% of all adults have experienced a traumatic lifetime event (220 Million people) • 20% go on to develop PTSD (31 million people) • 10% of women develop PTSD (twice as many as men) • 20% of Iraq and Afghanistan veterans (over 300,000) • Over 2/3rds of female military personnel develop PTSD due to sexual assault NADE National Conference Columbus, Ohio September 11, 2012

15. Navigating the System • “Wounds” are not obvious • “Warrior mentality” • Don’t want to be seen as “broken” • Survivor guilt NADE National Conference Columbus, Ohio September 11, 2012

16. Complicating Factors • Alcoholism • Other forms of disability • Suicide NADE National Conference Columbus, Ohio September 11, 2012

17. Questions NADE National Conference Columbus, Ohio September 11, 2012