Dealing With PostTraumatic Stress Disorder PTSD and Returning Veterans

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Dealing With Post-Traumatic Stress Disorder
(PTSD) and Returning Veterans

• Dr. Stephen B. Springer, CPM, LPC
• Texas State University
• ss01_at_txstate.edu 512-245-2115

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Definition and Comments

• Although the concept of PTSD has been around
  for many years, there is a resurgence of the
  discussion due in part to both the Vietnam vets
  reaching middle and later ages as well as the
  large number of returning service members from
  Iraq and Afghanistan. Stateside military units
  and also business and professional organizations
  are dealing with individuals suffering from PTSD.

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Definitions Continued

• Battle fatigue and other terms have been
  discussed in literature for years. Many of you
  may have known a relative who had fought in WWII
  or Korea and who refused to discuss in detail any
  experiences during the war. Still others became
  visually upset when certain topics were
  discussed. Finally, some veterans took their
  stories to their grave due to many reasons, one
  of which was the gravity of the discussion about
  warfare.

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Definitions Continued

• Some discussions, names, areas, current
  events, smells and pictures may trigger a veteran
  to relive the horrific things seen in warfare.
  One POW I knew who had been a prisoner over five
  years had great difficulty when Jane Fondas name
  was mentioned. These responses to stimuli are
  some of the issues that must be addressed as we
  define PTSD in the current context of those who
  suffer from PTSD.

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Clinical Definition

• Post-traumatic stress disorder (PTSD) is a
  debilitating psychological condition triggered by
  a major traumatic event such as rape, war, a
  terrorist act, death of a loved one, a natural
  disaster, or catastrophic accident. It is marked
  by upsetting memories or thoughts of the ordeal,
  blunting of emotions, increased arousal, and
  sometimes severe personality change.
• (Gale Encyclopedia of Medicine, 3rd edition,
  2006)

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Rate Among Returning Veterans

• Dr. Evan Kanter, MD, PhD, staff psychiatrist
  in the VA health system reported in 2007 that
  there were a minimum of 300,000 psychiatric
  casualties from service in Iraq (to that point).
  Estimated lifetime cost of treatment is 660
  billionmore than the war cost until that time.

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Statistical Review

• Dr. Kanter also provided the comments that 25
  of the first 100,000 Iraq and Afghanistan
  veterans who were seen by the VA received a
  mental health diagnosis. In addition, of this
  25 it was found that 56 had 2 or more mental
  health issues diagnosed. These were most often
  PTSD, substance abuse and depression. This was
  also the most common among the younger veterans.

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Statistical Review Continued

• It is interesting to note that Dr. Kanter
  reported that directly upon return from
  deployment 5 of active duty and 6 of reserves
  had a significant mental health problem. When
  the assessment was redone 3-6 months later, 27
  of active duty and 42 of reserve personnel had
  that evaluation.

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Comments

• Dr. Kanter attributes two reasons for the rise
  in numbers
• Underreporting due to wanting to return to
  families,
• PTSD and other conditions have a delayed onset.

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Serious Strain on System

• Health Affairs, Volume 26, Number 6 for
  November and December 2007, reports a fivefold
  greater growth in number of veterans seeking
  treatment for PTSD and other mental health issues
  among those vets from other eras. Reasons for
  this are unclear. Military Medicine, Volume 173,
  Number 1 for 2008 also reported that military
  medical personal are at risk for developming
  psychological morbidity. In essence, the very
  caregivers are operating at risk.

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Advisor/Counselor and Coworker Response?

• The interviewing college counselor, VA
  counselor and/or civilian counterpart must find a
  method to deal with these veterans. However,
  these veterans through lack of self disclosure,
  lack of treatment, lack of progress or
  overwhelming manifestation of disorders will
  interact without us actually knowing about their
  problems. What must we know?

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What Must We Know?

• There are several areas we must know in
  relation to the problem in this discussion
• 1. Symptoms
• 2. Referral Sources
• 3. Methods to Cope
• 4. Emergency Actions

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Symptoms

• Michelle L. Van Etten, Department of
  Psychiatry at the University of Michigan and
  Steven Taylor, Department of Psychiatry at the
  University of British Columbia, provide
  information on three clusters of symptoms in
  their 1998 article in Clinical Psychology and
  Psychotherapy. These are 1.recurrent
  reexperiencing of the traumatic event, 2.
  avoidance of trauma-related stimuli and numbing
  of general responsiveness, 3. persistent
  hyperarousal.

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Symptoms Continued

• Dr. Kanter reports rate of suicide is the highest
  it has been since records have been kept. (26
  years)
• Family issueslikely to become divorced. (Vietnam
  cohort)
• Behavioral problems in children
• More family violence

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Referral Sources

• This is a key factor within our ability to deal
  with individuals suspected as having PTSD.
  Obviously we cannot conclusively diagnose an
  individual. However, within our organization we
  must be able to recognize the symptoms and have
  some specific places and personnel we know can
  address this problem. Mental Health personnel
  must operate only with areas they are able to
  deal with within their level of expertise. It is
  important that networks be created within the
  organization for referral to various levels of
  these individuals.

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Methods to Cope

• Dealing with individuals who exhibit some of
  these symptoms is difficult. Here are some
  suggestions
• Remain calm despite the situation. You can set
  the tone of the interaction.
• Remain positive that the issue can be addressed.
• Remain engaged with the person not detached due
  to their behavior.

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Methods to Cope Continued

• Remain attentive to what the person is saying
  reflect on what is said. Rephrase what is being
  said.
• These are skills that take time to develop
  and are ones that are useful in all types of
  situations. However, these are especially
  critical in the situations involving PTSD.

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Emergency Actions

• Some individuals may feel that since they are
  also veterans or have a strong understanding of
  what an individual is going through that they
  can deal with any action a suspected PTSD
  individual is going through. Although it is
  helpful in the conversation to have shared
  experience, it does not always mean that the
  individual will respond directly to you or curb
  anger outbursts.

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Emergency Action Continued

• Therefore, there are some safety measures all
  persons can take
• Always have desk heavy objects secured,
• Have a way out of the office if the need arises,
• Make certain meetings/counseling and advising
  does not occur when no others are within the
  office,
• Know how to be temporarily agreeable.

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Emergency Action Continued

• Be prepared for the unexpectedthings can trigger
  responses that you may not expect.
• Stand if they are standing, sit down if they are
  sitting down.
• Finally, let the individual know you care about
  them and their circumstances.

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Conclusion

• We are faced with a growing number of
  individuals returning or within our society who
  have experienced the abnormal and who experienced
  that as the normal for a length of time. There
  will be changes and difficulties that we must be
  aware of in order to assist these individuals.
  As we know about those who returned and those who
  did not, all gave some and some gave all.