Advocates see trouble for misdiagnosed soldiers

By ANNE FLAHERTY, Associated Press Writer Anne Flaherty, Associated Press Writer – 

WASHINGTON – At the height of the Iraq war, the Army routinely dismissed hundreds of soldiers for having a personality disorder when they were more likely suffering from the traumatic stresses of war, discharge data suggests.
Under pressure from Congress and the public, the Army later acknowledged the problem and drastically cut the number of soldiers given the designation. But advocates for veterans say an unknown number of troops still unfairly bear the stigma of a personality disorder, making them ineligible for military health care and other benefits.
"We really have an obligation to go back and make sure troops weren't misdiagnosed," said Dr. Barbara Van Dahlen, a clinical psychologist whose nonprofit "Give an Hour" connects troops with volunteer mental health professionals.
The Army denies that any soldier was misdiagnosed before 2008, when it drastically cut the number of discharges due to personality disorders and diagnoses of post-traumatic stress disorders skyrocketed.
Unlike PTSD, which the Army regards as a treatable mental disability caused by the acute stresses of war, the military designation of a personality disorder can have devastating consequences for soldiers.
Defined as a "deeply ingrained maladaptive pattern of behavior," a personality disorder is considered a "pre-existing condition" that relieves the military of its duty to pay for the person's health care or combat-related disability pay.
According to figures provided by the Army, the service discharged about a 1,000 soldiers a year between 2005 and 2007 for having a personality disorder.
But after an article in The Nation magazine exposed the practice, the Defense Department changed its policy and began requiring a top-level review of each case to ensure post-traumatic stress or a brain injury wasn't the underlying cause.
After that, the annual number of personality disorder cases dropped by 75 percent. Only 260 soldiers were discharged on those grounds in 2009.
At the same time, the number of post-traumatic stress disorder cases has soared. By 2008, more than 14,000 soldiers had been diagnosed with PTSD — twice as many as two years before.
The Army attributes the sudden and sharp reduction in personality disorders to its policy change. Yet Army officials deny that soldiers were discharged unfairly, saying they reviewed the paperwork of all deployed soldiers dismissed with a personality disorder between 2001 and 2006.
"We did not find evidence that soldiers with PTSD had been inappropriately discharged with personality disorder," wrote Maria Tolleson, a spokeswoman at the U.S. Army Medical Command, which oversees the health care of soldiers, in an e-mail.
Command officials declined to be interviewed.
Advocates for veterans are skeptical of the Army's claim that it didn't make any mistakes. They say symptoms of PTSD — anger, irritability, anxiety and depression — can easily be confused for the Army's description of a personality disorder.
They also point out that during its review of past cases, the Army never interviewed soldiers or their families, who can often provide evidence of a shift in behavior that occurred after someone was sent into a war zone.
"There's no reason to believe personality discharges would go down so quickly" unless the Army had misdiagnosed hundreds of soldiers each year in the first place, said Bart Stichman, co-director of the National Veterans Legal Services Program.
Stichman's organization is working through a backlog of 130 individual cases of wounded service members who feel they were wrongly denied benefits.
Among those cases is Chuck Luther, who decided to rejoin the Army after the Sept. 11 attacks. He had previously served eight years before being honorably discharged.
"I knew what combat was going to take," he said.
Luther, who lives near Fort Hood, Texas, said throughout his time in the Army, he received eight mental health evaluations from the Army, each clearing him as "fit for duty."
Luther was seven months into his deployment as a reconnaissance scout in Iraq's violent Sunni Triangle in 2007 when he says a mortar shell slammed him to the ground. He later complained of stabbing eye pain and crippling migraines, but was told by a military doctor that he was faking his symptoms to avoid combat duty.
Luther says that he was confined for a month in a 6-by-8 foot room without treatment. At one point, Luther acknowledges, he snapped — biting a guard and spitting in the face of a military chaplain.
After that episode, Luther says, the Army told him he could return home and keep his benefits if he signed papers admitting he had a personality disorder. If he didn't sign, he said, he was told he would be kicked out eventually anyway.
Luther, whose account was first detailed by The Nation, signed the papers.
His case highlights the irony in many personality discharges. A person is screened mentally and physically before joining the military. But upon returning from combat, that same person is told he or she had a serious mental disorder that predated military service.
As in the civilian world, where many insurance companies deny coverage for illnesses that develop before a policy is issued, the government can deny a service member veteran health care benefits and combat-related disability pay for pre-existing ailments.
Despite the Defense Department's reforms, groups such as the National Veterans Legal Services Program say they don't have enough manpower to help all the veterans who believe they were wrongly denied benefits.
Stichman says his organization has more than 60 law firms across the country willing to take on the legal cases of wounded veterans for free. But even with that help, the group doesn't know when it would be able to take on even one new case.
A congressional inquiry is under way to determine whether the Army is relying on a different designation — referred to as an "adjustment disorder" — to dismiss soldiers.
Sen. Kit Bond, a Missouri Republican, wants the Pentagon to explain why the number of these discharges doubled between 2006 and 2009 and how many of those qualified to retain their benefits.
As for Luther, he got lucky. After about a year, he says the Veterans Administration agreed to reevaluate him and decided that he suffers from post-traumatic stress syndrome coupled by traumatic brain injury. The ruling gives him access to a psychologist and psychiatrist every two weeks, despite his discharge status, he said.
But Luther acknowledges that he still struggles. In June, he received word that the Army had turned down his appeal to correct his record, which means he could never return to the service or retire with full benefits.
A week later, he says, he lost his job delivering potato chips because a superior felt threatened by him. Luther says he misses the Army.
"When I was in uniform, that defined me," he said. "It's what made me, me."
___
Online:
U.S. Army Medical Command: http://www.armymedicine.army.mil
Department of Veterans Affairs: http://www.va.gov/
"Give an Hour": http://www.giveanhour.org
National Veterans Legal Services Program: http://www.nvlsp.org/

DoD Studies PTSD, TBI Methods

A recent study funded by the Department of Defense compared methods of assessing and diagnosing traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). The study found that current practices for assessment and diagnosis of these mental health conditions are hindered by biases and complications, but they remain the most effective tools to study and assess brain injuries. The study was conducted in part by researchers from the Defense and Veterans Brain Injury Center (DVBIC) and was published in the journal Rehabilitation Psychology. An abstract of the study is available on the APA PsycNET website.

Study to Seek Clues to Soldier Suicides

By Steve Vogel

Washington Post Staff Writer
Monday, August 10, 2009

Doctors leading the largest study ever of suicide and mental health in the military are developing intensive soldier surveys that they hope will provide clues as to why suicide rates among Army personnel have grown dramatically in recent years.

The study, a collaboration between the National Institute of Mental Health and the Army, will seek data from every soldier recruited into the Army over the next three years as well as from about 90,000 soldiers already in the service, and the project could eventually involve half a million participants.

The soldiers will be asked on a volunteer basis for personal information that can be used to make psychological assessments. Family members might be contacted for further information. In some cases, saliva and blood samples will be collected for genetic and neurobiological studies.

The information will serve as an "ongoing natural laboratory," officials said, as researchers follow these soldiers for years, looking for common strands as to which individuals are more likely to commit suicide.

"We're looking at suicide as the culmination of a long chain of events," said Robert K. Heinssen, the NIMH study director.

In 2008, 143 soldiers committed suicide, the highest number in the three decades that the Army has kept records.

"The most frustrating thing is trying to find a cause," Gen. Peter W. Chiarelli, the Army's vice chief of staff, told the Senate Armed Services Committee on July 30.

The five-year, $50 million study, which stems from an agreement in October between the Army and NIMH, is an ambitious attempt to solve the mystery.

Last month, Robert J. Ursano, chairman of the psychiatry department at Uniformed Services University of the Health Sciences in Bethesda, was named to lead an interdisciplinary team of four research institutions involved in the project.

The study will be "complex in its design, and it's looking at a rare phenomenon," Ursano said.

A number of factors may play roles in suicide, according to Ursano, including post-traumatic stress disorder, family issues, alcohol abuse and neurobiological factors.

Repeated deployment to Iraq, Afghanistan and elsewhere since 2001 is another factor, but one that does not by itself account for the increases in suicide, Ursano said.

"It's a much more complex aggregate of factors," Ursano said. "Deployment increases the stress on a family, but it's clearly not the deciding factor."

The surveys are expected to begin early next year. The information gathered on individual soldiers will be subject to strict privacy safeguards, officials said.

In addition to the planned surveys, researchers are working with the Army to identify and collect relevant information from existing databases, Heinssen said. Data on soldiers who have committed suicide since 2004 will be analyzed.

While the study will continue for years, the researchers are expected to quickly identify and report on potential risk factors to help the Army prevent suicide.

"That's kind of a different way of doing business for us," Heinssen said.

NIMH will report to the Army on a quarterly basis beginning in November. Findings will be incorporated as quickly as possible into treatment programs, according to Chiarelli.

New PTSD Program Answers Nee

|by Capt. Bryan Lewis

LANDSTUHL REGIONAL MEDICAL CENTER, Germany - Symptoms of combat stress and post-traumatic stress disorder include continual nightmares, avoidance behaviors, denial, grief, anger and fear.

Some Soldiers, battling these and other symptoms, can be treated successfully as an outpatient while assuming their normal duties. For others, however, returning to work and becoming their old selves again were challenges recognized by several mental health professionals across the European theater.

"We were looking at how we can best meet the needs of our clientele, and we were identifying that a lot of the Soldiers needed more than once-a-week outpatient, individual therapy and probably needed more than once- or twice-a-week group therapy," said Joseph Pehm, chief of Medical Social Work at Landstuhl Regional Medical Center.

The solution came in the creation of an intensive eight-week therapeutic Post-Traumatic Stress Disorder Day Treatment Program called "evolution" that began in March 2009 at LRMC. During the eight-hour days, patients enrolled in the program participate in multiple disciplines and interests, including art therapy, yoga and meditation classes, substance abuse groups, anger and grief management, tobacco cessation, pain management and multiple PTSD evidence-based practice protocols.

"I am a great believer in the kitchen sink, meaning I throw everything, including the kitchen sink, and something will stick," said Dr. Daphne Brown, chief of the Division of Behavioral Health at LRMC. "And so we've come with all the evidence-based treatment for PTSD that we know about ... We've taken everything that we can think of that will be of use in redirecting symptoms for these folks and put it into an eight-week program."

Brown, Pehm and Sharon Stewart, a Red Cross volunteer who recently received a doctorate in psychology, said the program is designed from research into the effects of traumatic experience and mirrors successful PTSD programs at Walter Reed Army Medical Center and the Department of Veterans Affairs, as well as programs run by psychologists in the U.S.

"We are building on the groundbreaking work that some of our peers and colleagues have done and just expanding it out," said Brown.

During treatment, patients begin the day with a community meeting where they discuss how well they feel and any additional issues or concerns since their last meeting. The remainder of the day depends on the curriculum scheduled for that week.

The first few weeks focus on learning basic coping skills such as how to reduce anxiety and fight fear, as well as yoga and meditation for relaxation. Eye Movement Desensitization and Reprocessing, or EMDR, an evidence-based practice for treating PTSD, is also conducted during the early phases of the treatment program.

"The concept behind EMDR is that, essentially, memories become fixed in one part of our brain and they maintain their power and control over our emotions as long as they are fixed there," said Brown. "And if we can activate a different part of the brain while we're experiencing that memory, we can help to remove some of that emotional valence from it. So we use physiological maneuvers to activate both sides of the brain."

The goal at the beginning of the PTSD program is to provide patients with a number of tools they can use to help them calm down when feeling overwhelmed, especially before more intense therapy begins in the latter weeks. Cognitive processing therapy is used throughout the program. EMDR and prolonged exposure therapy are also available on an individual basis at the Soldier's request. All three techniques are research-based treatments.

When life-changing events occur, Brown said perceptions about the world may change. For example, before Soldiers experience combat trauma they may think the world is safe. Following combat, a Soldier's perceptions may change - a majority of the world may now seem unsafe. Cognitive processing therapy attempts to re-address experiences and reshift a Soldier's perceptions.

Prolonged exposure therapy is behaviorally based and addresses a Soldier's fears, which are seen as reflex reactions to a stimulus. To decondition the reactions, a patient is continually exposed to the stimulus by retelling the story repeatedly, minus the negative outcome. Brown compared it to riding a roller coaster over and over again to overcome a fear of roller coasters.

"So they're getting EMDR, they're getting cognitive processing therapy, they're getting individual therapy, they're getting group therapy, they're getting education, anger management, self-esteem, relationship issues, grief and loss, yoga, meditation exercise, skill building -- a little bit of everything across the board," said Brown. "Not everything's going to resonate with everyone who comes through, but something's going to resonate for everyone who comes through."

In addition to the overall core curriculum, Brown and her staff have programs such as pain management, relationship enrichment and tobacco cessation to help individualize treatment.

"The core of the group and individual education is consistent for everyone," said Brown. "But we recognize that every patient is different, and we have to tailor-make it to give an individualized treatment plan. We don't keep people in pain management if they're not in pain. We don't give them tobacco cessation if they're not smoking. So we do try and tailor as much of it as we can."

Spirituality, relationship enrichment and gender-specific issues are also areas of focus.
"The program is holistic," said Pehm. "It looks at people from different spheres, not just the medical model, because everything is impacted when someone has combat stress or PTSD - not just the individual Soldier, but everybody who comes in contact with them."

The intensity, length and "kitchen sink" qualities are not the only aspects that make this program unique, said Brown. It is a joint military and civilian effort accomplished entirely by volunteers. The staff is as diverse as the therapy options, and includes chaplains, social workers, Red Cross volunteers, psychiatrists, a nurse practitioner, enlisted psychiatric technicians, and graduate students. Brown said having a sundry of personnel keeps the program fresh and the staff excited.

"The patients get perspectives from people from a number of different backgrounds," said Brown.

Thus far, the staff outnumbers the program's participants.

"By design we started out small, and we were able to establish a really good working relationship with the local Warrior Transition Unit people ... It's been a wonderful working relationship with them," said Pehm.

Evolution is currently on it second eight-week course, with five patients enrolled. The first class had four. The goal is to keep the class size small in order to benefit from the program's intensity. Thinking small also helps keep the impact large by successfully returning Soldiers to their units, while also expanding access outside the WTUs. However, Pehm said they would like to expand the program to include patients from throughout the European Command.

"Ideally, we'd like to max it at about 10 because it is so intensive," said Brown. "These are folks we hope to remediate and return to the Army to be functional members again. Also, if they go back to their communities and their providers or spouses see the changes that have come about, that will increase the willingness or desire of more people to be here."

Though few have completed this young program, signs of success have already started to surface.

"With the last group, the shift from 'I have to be here' to 'I'm so glad I came' was really phenomenal," said Pehm.

"One of them said that he didn't think he was getting anything out of the program," Brown said. "It was about week six until he saw himself react differently to a situation that came up, and watched himself do it differently using skills that he didn't know he learned. He went 'Wow,' maybe I am getting something out of this."

It is too early, and the numbers are too small, to generalize the early trends, but self-completed PTSD checklists showed a significant decrease in reported symptoms for three of the four patients in the first cohort. Additionally, anxiety and depression symptom measures decreased.

"The whole idea is that we know all the changes aren't going to take place here," said Brown. "But we hope we give them enough learning to send them in a different direction. My hope is that we can build a program to provide valid, effective treatment to folks who have put themselves in harm's way at the request of their country, and help them live happier and better lives."

Many Veterans Need Mental Health Care

Those returning from Iraq may not show sign of problems right away, study notes

By Steven Reinberg
HealthDay Reporter

(HealthDay News) -- More than 40 percent of the U.S. soldiers from the Iraq and Afghanistan wars seen at VA hospitals suffer from mental health disorders or psychosocial behavioral problems, a new study shows.

Curiously, the researchers from the San Francisco VA Medical Center found that most mental health diagnoses were not made in the first year that a veteran entered the VA health-care system, but several years after. This finding supports the recent move to extend VA benefits to five years of free health care, which allows VA doctors the time to detect and treat more mental illness in returning combat veterans, the researchers noted.

"After the start of the Iraq War, there is a growing burden of mental illness, particularly post-traumatic stress disorder (PTSD), that will require increased allocation of resources for better detection and early intervention to prevent chronic mental illness, which threatens individual veterans, their families and communities," said lead researcher Dr. Karen Seal, an assistant professor of medicine and psychiatry at the University of California, San Francisco.

The report is published in the July 16 online edition of the American Journal of Public Health.

For the study, Seal's team collected data on 289,328 Iraq and Afghanistan veterans who sought health care at VA medical centers from 2002 to 2008.

Among these returning vets, 106,726 were given mental health care. These included 62,929 diagnosed with PTSD and 50,432 diagnosed with depression. That's nearly 37 percent of veterans, the authors noted.

"When the definition is expanded to include diagnoses of mental health disorders or psychosocial behavioral problems such as homelessness, or both, 43 percent of these veterans received these diagnoses," Seal added.

The diagnoses included 22 percent with PTSD, 17 percent with depression, 7 percent with alcohol use disorder, and 3 percent with drug use disorder. Many vets had several of these problems. In fact, 29 percent of veterans with mental health problems were diagnosed with two different conditions, and 33 percent were diagnosed with three or more, Seal said.

In addition, women had a higher risk for depression, but men had more than twice the risk for drug use problems, the researchers found.

Since the start of the Iraq war, mental health problems increased more than fourfold among active-duty personnel and sevenfold for members of the National Guard or Reserve, Seal said.

Age also played a role in the risk for PTSD, Seal said. While younger active-duty veterans had a higher risk for PTSD, "among Guard and Reserve members, those over 40 were at significantly higher risk for PTSD than their colleagues under 25," she said.

Moreover, active-duty enlisted veterans in the Army rather than other service branches, or who had multiple tours of duty, thus more combat exposure, were at greater risk for PTSD, Seal said. This was not seen in National Guard and Reserve personnel, she noted.

Mark Kaplan, a professor of community health at the School of Community Health at Portland State University in Oregon, noted that the study only covers vets who have received care at the VA, but there are many more with serious mental health problems that are either seeking care privately or not at all, he said.

"This study adds to what we know about this population, however, that's the veterans who seek care at the VA system. But if you look at the total population of veterans from all wars, there are one-third of all veterans who have these problems," Kaplan said.

Doctors who are not connected with the VA but who see veterans need to ask them about any mental health issues they have, Kaplan said. "They need to be aware of the risks associated with veteran status, and in particular those who served in Iraq and Afghanistan," he said.

Kaplan added that it is not uncommon for problems such as PTSD to arise years, even decades, after service. "We don't know the full emotional toll of the wars in Iraq and Afghanistan," he said.

Simon A. Rego, associate director of psychology training at Montefiore Medical Center in New York City, says that "while the results may be somewhat inflated due to the researchers' inability to assess data on clinical outcomes, potential treatment outside of the VA system, or even subsequent deployments, they are nevertheless, stunning."

The authors found a much higher percentage of veterans enrolling in the VA now than at any other time in history: 41 percent since 2002 versus 10 percent of Vietnam veterans. And, Rego noted, new mental health diagnoses in 2008 were six times higher than in 2002 -- 37 percent versus 6.4 percent.

"An important and often overlooked finding here was that a lack of social support -- being separated, divorced, widowed, etc.-- may pose a serious risk for new post-deployment mental health problems," Rego said.

This underscores the need for ancillary social support services for returning veterans who are unmarried and/or without social support, he said. "All too often we focus on treating the symptoms but fail to address the individual's social context. Based on the data here, a failure to do so could lead to increased risk in developing new mental health problems."

More information

For more information on the mental health toll on soldiers of the war in Iraq and Afghanistan, visit the U.S. National Center for PTSD .

SOURCES: Karen Seal, M.D., M.P.H., assistant professor, medicine and psychiatry, University of California, San Francisco; Mark Kaplan, Dr.PH., professor, community health, School of Community Health, Portland State University, Oregon; Simon A. Rego, Psy.D., associate director, psychology training, Montefiore Medical Center, New York City; July 16, 2009, American Journal of Public Health, online

PTSD and Problems with Alcohol Use

PTSD does not automatically cause problems with alcohol use; there are many people with PTSD who do not have problems with alcohol. However, PTSD and alcohol together can be serious trouble for the trauma survivor and his or her family.

How do PTSD and alcohol use affect each other and make problems worse?

PTSD and alcohol problems often occur together.

People with PTSD are more likely than others with similar backgrounds to have alcohol use disorders both before and after being diagnosed with PTSD, and people with alcohol use disorders often also have PTSD.

Being diagnosed with PTSD increases the risk of developing an alcohol use disorder.

Women exposed to trauma show an increased risk for an alcohol use disorder even if they are not experiencing PTSD. Women with problematic alcohol use are more likely than other women to have been sexually abused at some point in their lives.

Men and women reporting sexual abuse have higher rates of alcohol and drug use disorders than other men and women.

Twenty-five to seventy-five percent of those who have survived abusive or violent trauma also report problems with alcohol use.

Ten to thirty-three percent of survivors of accidental, illness, or disaster trauma report problematic alcohol use, especially if they are troubled by persistent health problems or pain.

Sixty to eighty percent of Vietnam veterans seeking PTSD treatment have alcohol use disorders. Veterans over the age of 65 with PTSD are at increased risk for attempted suicide if they also experience problematic alcohol use or depression. War veterans diagnosed with PTSD and alcohol use tend to be binge drinkers. Binges may be in reaction to memories or reminders of trauma.

Alcohol problems often lead to trauma and disrupt relationships.

Persons with alcohol use disorders are more likely than others with similar backgrounds to experience psychological trauma. They also experience problems with conflict and intimacy in relationships.

Problematic alcohol use is associated with a chaotic lifestyle, which reduces family emotional closeness, increases family conflict, and reduces parenting abilities.

PTSD symptoms often are worsened by alcohol use.

Although alcohol can provide a temporary feeling of distraction and relief, it also reduces the ability to concentrate, enjoy life, and be productive.

Excessive alcohol use can impair one's ability to sleep restfully and to cope with trauma memories and stress.

Alcohol use and intoxication also increase emotional numbing, social isolation, anger and irritability, depression, and the feeling of needing to be on guard (hyper-vigilance).

Alcohol use disorders reduce the effectiveness of PTSD treatment.

Many individuals with PTSD experience sleep disturbances (trouble falling asleep or problems with waking up frequently after falling asleep). When a person with PTSD experiences sleep disturbances, using alcohol as a way to self-medicate becomes a double-edged sword. Alcohol use may appear to help symptoms of PTSD because the alcohol may decrease the severity and number of frightening nightmares commonly experienced in PTSD. However, alcohol use may, on the other hand, continue the cycle of avoidance found in PTSD, making it ultimately much more difficult to treat PTSD because the client's avoidance behavior prolongs the problems being addressed in treatment. Also, when a person withdraws from alcohol, nightmares often increase.

Additional Mental Health Issues

Individuals with a combination of PTSD and alcohol use problems often have additional mental or physical health problems. As many as 10-50% of adults with alcohol use disorders and PTSD also have one or more of the following serious disorders:

• Anxiety disorders (such as panic attacks, phobias, incapacitating worry, or compulsions)
• Mood disorders (such as major depression or a dysthymic disorder)
• Disruptive behavior disorders (such as attention deficit or antisocial personality disorder)
• Addictive disorders (such as addiction to or abuse of street or prescription drugs)
• Chronic physical illness (such as diabetes, heart disease, or liver disease)
• Chronic physical pain due to physical injury/illness or due to no clear physical cause

What are the most effective treatment patterns?

Because the existence of both PTSD and an alcohol use disorder in an individual makes both problems worse, alcohol use problems often must be addressed in PTSD treatment. When alcohol use is (or has been) a problem in addition to PTSD, it is best to seek treatment from a PTSD specialist who also has expertise in treating alcohol (addictive) disorders. In any PTSD treatment, several precautions related to alcohol use and alcohol disorders are advised:

The initial interview and questionnaire assessment should include questions that sensitively and thoroughly identify patterns of past and current alcohol and drug use.

Treatment planning should include a discussion between the professional and the client about the possible effects of alcohol use problems on PTSD, sleep, anger and irritability, anxiety, depression, and work or relationship difficulties.

Treatment should include education, therapy, and support groups that help the client address alcohol use problems in a manner acceptable to the client.

Treatment for PTSD and alcohol use problems should be designed as a single consistent plan that addresses both sources of difficulty together. Although there may be separate meetings or clinicians devoted primarily to PTSD or to alcohol problems, PTSD issues should be included in alcohol treatment, and alcohol use ("addiction" or "sobriety") issues should be included in PTSD treatment.

Relapse prevention must prepare the newly sober individual to cope with PTSD symptoms, which often seem to worsen or become more pronounced with abstinence.

Where can you get help?

For a listing of professionals in the USA and Canada who treat alcohol disorders and PTSD, we suggest consulting the membership directories of the International Society for Traumatic Stress Studies or the Association of Traumatic Stress Specialists. For veterans experiencing problems with PTSD and alcohol use, the Department of Veterans Affairs has a network of specialized PTSD and substance use treatment programs. For information on these programs, contact the local VA Vet Center or the Psychiatry Service at a VA Medical Center. (For addresses and telephone numbers, look under the "United States Government" listings in the telephone directory.)

FOR MORE INFORMATION:
EMAIL - ncptsd@va.gov
CALL - THE PTSD Information Line at (802) 296-6300

Contrarian Approach for PTSD

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D.

A different approach to managing PTSD suggests that for some people repressing rather than exposing the traumatic memories may be better for an individual’s health.

Geisinger Health System senior investigator and U.S. Army veteran Joseph Boscarino, Ph.D., is proud of his military service, yet he doesn’t like to talk much about his combat experiences.

Before becoming a renowned researcher of psychological trauma, Dr. Boscarino served a tour of duty with an artillery unit in Vietnam from 1965-66, during which he witnessed heavy combat and its aftermath. To this day, he tries hard not to reflect on those battlefield memories.

The research by Dr. Boscarino and Tulane University investigator Charles Figley, Ph.D., shows that for some people exposed to traumatic events, repressing these memories may be less harmful in the long run.

“Going back to the days of Sigmund Freud, psychiatrists and mental health experts have suggested that repression of traumatic memories could lead to health problems,” Dr. Boscarino said. “Yet we have found little evidence that repression had an adverse health impact on combat veterans exposed to psychological trauma many years later.”

In a study that appears in the June issue of the research publication Journal of Nervous & Mental Diseases, Drs. Boscarino and Figley examined the long-term mortality rates of Vietnam veterans who were evaluated in 1985 with followup in 2000.

By studying the death certificates and records of a random sample of more than 4,000 veterans 30 years after military service, the researchers found that having PTSD along with a repressive personality trait does not necessarily lead to premature death.

The researchers say this is an important finding because exposure therapy is a prevailing practice in psychiatry, a technique that encourages patients to relive painful or traumatic events. Yet, for some patients, this therapy may inadvertently cause a resurfacing of PTSD symptoms and psychological distress, putting that patient at risk for health problems.

Previous research by Boscarino has shown that PTSD may cause premature death from heart disease, leads to elevated white blood cell counts and higher erythrocyte sedimentation rate levels (both of which indicates inflammation), and may cause other diseases such as rheumatoid arthritis.

“While the dominant therapy model for PTSD should not be abandoned at this point, emerging research suggests that it might need to be seriously re-evaluated, at least for some PTSD patients,” Dr. Boscarino said. “More research is clearly needed.”

Dr. Figley, another renowned trauma scholar who co-authored the 2007 book Combat Stress Injuries, said he was not surprised by the findings since they are consistent with a new theory of combat-related stress.

“Repression is a self-regulator and a method of memory management,” Dr. Figley said. “In other words, ‘keeping your stressful memories inside or it will kill you’ is a myth.”

Dr. Figley, who served in Vietnam as a Marine at the same time as Dr. Boscarino, believes this study is a wakeup call to all those who care about combat veterans.

“These men and women deserve our respect in recognizing that they often know better than we do in how to manage their stressful memories, in most cases,” Dr. Figley said.

Source: Geisinger Health System

Other Resources:

PTSD: Pathways Through the Secret Door by Timothy Kendrick

Wide Asleep, Slumber No More

Ptsd And Fast Phobia Relief Self-Help Audio Program