Military Works to Improve Personality Disorder-Based Discharge Process

By John J. Kruzel
American Forces Press Service

Dec. 20, 2007 - The military is working to improve the way it implements a policy of discharging troops based on pre-existing personality disorders, Defense Department health officials said today. Several articles in summer 2007 claimed that some 22,500 troops had been discharged -- in some instances, wrongly discharged -- after being diagnosed as having personality disorders. In response, the Defense Department launched a "secondary review."

In the ongoing investigation thus far, officials have reconfirmed that 85 percent of servicemembers initially determined to have personality disorders were correctly diagnosed. Roughly 1.5 percent, however, were misdiagnosed, officials said.

"We have looked at most of them, and some, on review, have been incorrect diagnoses," Dr. S. Ward Casscells, assistant secretary of defense for health affairs, told reporters at the Pentagon today.

Casscells denied the most inflammatory claim made in the articles: that the military was shirking its responsibility to those affected. "When the articles first came out, the tenor was, 'Military is labeling people (with) personality disorders so they don't have to pay benefits,'" he said. "We did not find any evidence of that."

Echoing Casscells' comments, Air Force Col. Joyce Adkins, director of psychological health and strategic operations, defended the policy, but acknowledged possible flaws in implementation.

Adkins clarified that a personality disorder does not necessarily bar an individual from serving in the armed forces. "Certainly there are many people who have personality traits that we would characterize as a disorder who have stayed in the military," she said. "It's only when their personality doesn't fit well with the job that they are separated."

Moreover, Adkins said a "separation," or discharge, on the basis of a personality disorder can benefit the discharged servicemember because it serves as a "safety valve," freeing the servicemember from further obligation to military service.

"If you have a job and you don't fit well with that job, you can quit," she said. "In the military, you can't just quit that easily. This is a way to say that this person doesn't fit well with this job and to allow them to pursue other employments."

Adkins added that the "large majority" of such discharges occur within the first two years of military service.

The difficulty of assessing a dormant personality disorder underscores the complexity of the issue highlighted by media attention and subsequent hearings on Capitol Hill.

In most cases, no psychological evaluation can determine whether a personality disorder is apparent at the time of enlistment, as many signs of a latent disorder are undetectable. But despite difficulties in detecting pre-existing personality disorders, Adkins said, the military could improve the way it evaluates servicemembers returning from combat who are suspecting of suffering from such disorders.

"We are really stepping up on specifying the clinical criteria for what that evaluation should include," she said. "We want to make sure that (misdiagnoses) do not happen, that when a person is supposed to get a thorough evaluation, they do get a thorough evaluation.

"If you have a clinical condition, such as (post-traumatic stress disorder), major depressive disorder, an anxiety disorder, that certainly is treatable," she continued. "And we want to know if the problems with your behavior are related to one of these treatable conditions ... or if it is related to a personality disorder, which is not easily treated."

With regard to inaccurate evaluations, Adkins called it "disturbing to think that that might not be implemented in the way that it was intended." She added that in large systems, like military health care, there are bound to be some issues with "quality control."

Adkins said that $900 million appropriated by Congress to increase the number of mental health personnel will help efforts to improve the current process.

Casscells lamented troops whose personality disorders become manifest during the course of military service, and emphasized a continuing obligation to these individuals.

"The military doesn't bring out the best in them, like it does in most people. In their case, it uncovered something else," he said. "There are some people who want to serve but shouldn't serve because it's not the right culture for them.

"I feel our responsibility is to not blame them for the fact that they wanted to serve," he said.