Post traumatic Stress Disorder (PTSD)

Medical Author: Roxanne Dryden-Edwards, MD
Medical Editor: Melissa Conrad Stöppler, MD

Disaster Survivors Face PTSD Risk

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor:
William C. Shiel Jr., MD, FACP, FACR

Post-traumatic stress disorder (PTSD) is a psychiatric condition that can develop following any traumatic, catastrophic life experience. Recognition of this condition increased dramatically following the war in Viet Nam, when many returning U.S. veterans developed disturbing psychological symptoms and impaired functioning. More recently, the 9/11 tragedy, the Asian tsunami, the London bombings, and Hurricane Katrina and its aftermath have left thousands of people at risk for this potentially debilitating condition.

PTSD symptoms can develop weeks or months, or sometimes even years, following a catastrophic event. Along with survivors of natural disasters, wars, and acts of terrorism, people who have been the victims of violent crime or torture often develop symptoms of PTSD.

PTSD symptoms vary among individuals and also vary in severity from mild to disabling. PTSD Symptoms can include one or more of the following:

  • "flashbacks" about the traumatic event
  • feelings of estrangement or detachment
  • nightmares
  • sleep disturbances
  • impaired functioning
  • occupational instability
  • memory disturbances
  • family discord
  • parenting or marital difficulties

What is posttraumatic stress disorder?


Posttraumatic stress disorder (PTSD) is an emotional illness that develops as a result of a terribly frightening, life-threatening, or otherwise highly unsafe experience. PTSD sufferers re-experience the traumatic event or events in some way, tend to avoid places, people, or other things that remind them of the event (avoidance), and are exquisitely sensitive to normal life experiences (hyperarousal). Although this condition has likely existed since human beings have endured trauma, PTSD has only been recognized as a formal diagnosis since 1980. However, it was called by different names as early as the American Civil War, when combat veterans were referred to as suffering from "soldier's heart." In World War I, symptoms that were generally consistent with PTSD were referred to as "combat fatigue." Soldiers who developed such symptoms in World War II were said to be suffering from "gross stress reaction," and many who fought in Vietnam who had symptoms of what is now called PTSD were assessed as having "post-Vietnam syndrome." PTSD has also been called "battle fatigue" and "shell shock." Complex posttraumatic stress disorder (C-PTSD) usually results from prolonged exposure to a traumatic event or series thereof and is characterized by long-lasting problems with many aspects of emotional and social functioning.

Approximately 7%-8% of people in the United States will likely develop PTSD in their lifetime, with the lifetime occurrence (prevalence) in combat veterans and rape victims ranging from 10% to as high as 30%. Somewhat higher rates of this disorder have been found to occur in African Americans, Hispanics, and Native Americans compared to Caucasians in the United States. Some of that difference is thought to be due to higher rates of dissociation soon before and after the traumatic event (peritraumatic); a tendency for individuals from minority ethnic groups to blame themselves, have less social support, and an increased perception of racism for those ethnic groups; as well as differences between how ethnic groups may express distress. Other important facts about PTSD include the estimate of 5 million people who suffer from PTSD at any one time in the United States and the fact that women are twice as likely to develop PTSD as men.

Almost half of individuals who use outpatient mental-health services have been found to suffer from PTSD. As evidenced by the occurrence of stress in many individuals in the United States in the days following the 2001 terrorist attacks, not being physically present at a traumatic event does not guarantee that one cannot suffer from traumatic stress that can lead to the development of PTSD.

PTSD statistics in children and teens reveal that up to more than 40% have endured at least one traumatic event, resulting in the development of PTSD in up to 15% of girls and 6% of boys. On average, 3%-6% of high school students in the United States and as many as 30%-60% of children who have survived specific disasters have PTSD. Up to 100% of children who have seen a parent killed or endured sexual assault or abuse tend to develop PTSD, and more than one-third of youths who are exposed to community violence will suffer from the disorder.

What are the effects of PTSD?


Untreated PTSD can have devastating, far-reaching consequences for sufferers' functioning and relationships, their families, and for society. Women who were sexually abused at earlier ages are more likely to develop complex PTSD and borderline personality disorder. Babies that are born to mothers that suffer from this illness during pregnancy are more likely to experience a change in at least one chemical in their body that makes it more likely (predisposes) the baby to develop PTSD later in life. Individuals who suffer from this illness are at risk of having more medical problems, as well as trouble reproducing. Emotionally, PTSD sufferers may struggle more to achieve as good an outcome from mental-health treatment as that of people with other emotional problems. In children and teens, PTSD can have significantly negative effects on their social and emotional development, as well as on their ability to learn.


What causes PTSD?


Virtually any event that is life-threatening or that severely compromises the emotional well-being of an individual may cause PTSD. Such events often include either experiencing or witnessing a severe accident or physical injury, receiving a life-threatening medical diagnosis, being the victim of kidnapping or torture, exposure to combat or to a natural disaster, other disaster (for example, plane crash) or terrorist attack, being the victim of rape, mugging, robbery or assault; enduring physical, sexual, emotional or other forms of abuse, as well as involvement in civil conflict.


What are the risk factors and protective factors for PTSD?


Issues that tend to put people at higher risk for developing PTSD include increased duration of a traumatic event, higher severity of the trauma experienced, having an emotional condition prior to the event, or having little social support in the form of family or friends. In addition to those risk factors, children and adolescents, females, and people with learning disabilities or violence in the home have a greater risk of developing PTSD  after a traumatic event.

While disaster-preparedness training is generally seen as a good idea in terms of improving the immediate physical safety and logistical issues involved with a traumatic event, such training may also provide important protective factors against developing PTSD. That is as evidenced by the fact that those with more professional-level training and experience (for example, police, firefighters, mental-health professionals, paramedics, and other medical professionals) tend to develop PTSD less often when coping with disaster than those without the benefit of such training or experience.

Some medications have been found to help prevent the development of PTSD. Some medicines that treat depression, decrease the heart rate, or increase the action of other body chemicals are thought to be effective tools in the prevention of PTSD when given in the days immediately after an individual experiences a traumatic event.


What are the signs and symptoms of PTSD?


The three groups of symptoms that are required to assign the diagnosis of PTSD are

  • recurrent re-experiencing of the trauma (for example, troublesome memories, flashbacks that are usually caused by reminders of the traumatic events, recurring nightmares about the trauma and/or dissociative reliving of the trauma),
  • avoidance to the point of having a phobia of places, people, and experiences that remind the sufferer of the trauma and a general numbing of emotional responsiveness, and
  • chronic physical signs of hyperarousal, including sleep problems, trouble concentrating, irritability, anger, poor concentration, blackouts or difficulty remembering things, increased tendency and reaction to being startled, and hypervigilance to threat.

The emotional numbing of PTSD may present as a lack of interest in activities that used to be enjoyed (anhedonia), emotional deadness, distancing oneself from people, and/or a sense of a foreshortened future (for example, not being able to think about the future or make future plans, not believing one will live much longer). At least one re-experiencing symptom, three avoidance/numbing symptoms, and two hyperarousal symptoms must be present for at least one month and must cause significant distress or functional impairment in order for the diagnosis of PTSD to be assigned. PTSD is considered of chronic duration if it persists for three months or more.

A similar disorder in terms of symptom repertoire is acute stress disorder. The major differences between the two disorders are that acute stress disorder symptoms persist from two days to four weeks, and a fewer number of traumatic symptoms are required to make the diagnosis as compared to PTSD.

In children, re-experiencing the trauma may occur through repeated play that has trauma-related themes instead of through memories, and distressing dreams may have general content rather than of the traumatic event itself. As in adults, at least one re-experiencing symptom, three avoidance/numbing symptoms, and two hyperarousal symptoms must be present for at least one month and must cause significant distress or functional impairment in order for the diagnosis of PTSD to be assigned. When symptoms have been present for less than one month, a diagnosis of acute stress disorder (ASD) can be made.

Symptoms of PTSD that tend to be associated with C-PTSD include: problems regulating feelings, which can result in suicidal thoughts, explosive anger, or passive aggressive behaviors; a tendency to forget the trauma or feel detached from one's life (dissociation) or body (depersonalization); persistent feelings of helplessness, shame, guilt or being completely different from others; feeling the perpetrator of trauma is all-powerful and preoccupation with either revenge against or allegiance with the perpetrator; and severe change in those things that give the sufferer meaning, like a loss of spiritual faith or an ongoing sense of helplessness, hopelessness, or despair.

How is PTSD assessed?


For individuals who may be wondering if they should seek evaluation for PTSD by their medical or mental-health professional, self-tests may be useful. The National Institute of Mental Health and offers a self-test for PTSD. The assessment of PTSD can be difficult for practitioners to make since sufferers often come to the professional's office complaining of symptoms other than anxiety associated with a traumatic experience. Those symptoms tend to include body symptoms (somatization), depression, or substance abuse. Individuals with PTSD may present with a history of making suicide attempts. In addition to depression and substance abuse disorders, the diagnosis of PTSD often co-occurs (is comorbid with) bipolar disorder (manic depression), eating disorders, and other anxiety disorders like obsessive compulsive disorder, panic disorder, and generalized anxiety disorder.

Most practitioners who examine a child or teenager for PTSD will interview both the parent and the child, usually separately, in order to allow for each party to speak freely. Interviewing the child in addition to the adults in their life is quite important given that while the child or adolescent's parent or guardian may have a unique perspective, there are naturally things the young person may be feeling that the adult is not aware of. Another challenge for diagnosing PTSD in children, particularly in younger children, is that they may express their symptoms differently from adults. For example, they may go backward or regress in their development, become accident-prone, engage in risky behaviors, become clingy, or suffer from more physical complaints as compared to adults with PTSD. Traumatized younger children may also have trouble sitting still, focusing, or managing their impulses and therefore be mistaken as suffering from attention deficit hyperactivity disorder (ADHD).

Sometimes, professionals will use a structured psychiatric interview for children in its entirety or just the portion that assesses PTSD in order to test for PTSD. Examples of such tools include the Diagnostic Interview for Children and Adolescents-Revised (DICA-R), the Diagnostic Interview Schedule for Children-Version IV (DISC-IV), and the Schedule for Affective Disorders and Schizophrenia for School Age Children (K-SADS). There are also some PTSD-specific structured interviews, like the Clinician-Administered PTSD Scale-Child and Adolescent Version, the Child PTSD Checklist, and the Child PTSD Symptom Scale. For the assessment of the severity of PTSD symptoms in children, structured interviews like the Child Posttraumatic Stress Reaction Index, the Child and Adolescent Trauma Survey, and the Trauma Symptom Checklist for Children are sometimes used. The Child Trauma Screening Questionnaire has been found by some professionals to be useful in predicting which children who endure a traumatic event will go on to develop PTSD.

How is PTSD treated?


Treatments for PTSD usually include psychological and medical treatments. Providing information about the illness, helping the individual manage the trauma by talking about it directly, teaching the person ways to manage symptoms of PTSD, and exploration and modification of inaccurate ways of thinking about the trauma are the usual techniques used in psychotherapy for this illness. Education of PTSD sufferers usually involves teaching individuals about what PTSD is, that it is caused by extraordinary stress rather than weakness, how it is treated, and what to expect in treatment. This education thereby increases the likelihood that inaccurate ideas the person may have about the illness are dispelled, and any shame they may feel about having it is minimized. This may be particularly important in populations like military personnel that may feel particularly stigmatized by the idea of seeing a mental-health professional and therefore avoid doing so.

Teaching people with PTSD practical approaches to coping with what can be very intense and disturbing symptoms has been found to be another useful way to treat the illness. Specifically, helping sufferers learn how to manage their anger and anxiety, improve their communication skills, and use relaxation techniques can help individuals with PTSD gain a sense of mastery over their emotional and physical symptoms. Cognitive therapy can help people with PTSD recognize and adjust trauma-related thoughts and beliefs by educating sufferers about the relationships between thoughts and feelings, exploring common negative thoughts held by traumatized individuals, developing alternative interpretations, and by practicing new ways of looking at things. This treatment also involves practicing learned techniques in real-life situations.

Eye-movement desensitization and reprocessing (EMDR) is a form of cognitive therapy in which the practitioner guides the person with PTSD in talking about the trauma suffered and the negative feelings associated with the events, while focusing on the professional's rapidly moving finger. While some research indicates this treatment may be effective, it is unclear if this is any more effective than cognitive therapy that is done without the use of rapid eye movement.

Families of PTSD individuals, as well as the sufferer, may benefit from family counseling, couples' counseling, parenting classes, and conflict resolution education. Family members may also be able to provide relevant history about their loved one (for example, about emotions and behaviors, drug abuse, sleeping habits, and socialization) that people with the illness are unable or unwilling to share.

Directly addressing the sleep problems that can be part of PTSD has been found to not only help alleviate those problems but to thereby help decrease the symptoms of PTSD in general. Specifically, rehearsing adaptive ways of coping with nightmares (imagery rehearsal therapy), training in relaxation techniques, positive self-talk, and screening for other sleep problems have been found to be particularly helpful in decreasing the sleep problems associated with PTSD.

Medications that are usually used to help PTSD sufferers include serotonergic antidepressants (SSRIs) like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and medicines that help decrease the physical symptoms associated with illness, like clonidine (Catapres), guaneficine (Tenex), and propranolol. Individuals with PTSD are much less likely to experience a relapse of their illness if antidepressant treatment is continued for at least a year. SSRIs are the first group of medications that have achieved approval by the U.S. Food and Drug Administration (FDA) for the treatment of PTSD. These medicines have been found to help PTSD sufferers modify information that is taken in from the environment (stimuli) and to decrease fear. Research also shows that this group of medicines tends to decrease anxiety, depression, and panic. SSRIs may also help reduce aggression, impulsivity, and suicidal thoughts that can be associated with this disorder.

Other less directly effective but nevertheless potentially helpful medications for managing PTSD include mood stabilizers like lamotrigine (Lamictal), tiagabine (Gabitril), divalproex sodium (Depakote), as well as mood stabilizers that are also antipsychotics, like risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel). Antipsychotic medicines seem to be most useful in the treatment of PTSD in those who suffer from agitation, dissociation, hypervigilance, intense suspiciousness (paranoia), or brief breaks in being in touch with reality (brief psychotic reactions).

Benzodiazepines (tranquilizers) have unfortunately been associated with a number of problems, including withdrawal symptoms and the risk of overdose and have not been found to be significantly effective for helping individuals with PTSD.

How can people cope with PTSD?


Some ways that are often suggested for PTSD patients to cope with this illness include learning more about the disorder as well as talking to friends, family, professionals, and PTSD survivors for support. Joining a support group may be helpful. Other tips include reducing stress by using relaxation techniques (for example, breathing exercises, positive imagery), actively participating in treatment as recommended by professionals, increasing positive lifestyle practices (for example, exercise, healthy eating, distracting oneself through keeping a healthy work schedule if employed, volunteering whether employed or not) and minimizing negative lifestyle practices like substance abuse, social isolation, working to excess, and self-destructive or suicidal behaviors.


Where can people get help?


  • Air Force Palace HART
    Phone: 1-800-774-1361
  • American Love and Appreciation Fund (for veterans)
  • Army Wounded Warrior Program
    Phone: 1-800-237-1336 or 1-800-833-6622
  • DHSD Deployment Helpline
    Phone: 1-800-497-6261
  • Marine for Life
    Phone: 1-866-645-8762
    Email: i
  • Military One Source
    Phone: 1-800-342-9647
  • Military Severely Injured Center
    Phone: 1-800-774-1361
  • National Coalition Against Sexual Assault
    Phone: 1-717-728-9764
  • National Alliance for Mentally Ill
    Phone: 1-800-950-6264
  • National Mental Health Association
    Phone: 1-800-969-6642
  • Navy Safe Harbor
    Phone: 1-800-774-1361
  • Operation Comfort (for veterans and their families)
    Phone: 1-866-632-7868 (1-866-NEAR TO U)
  • PTSD Information Hotline
    Phone: 1-802-296-6300
  • PTSD Sanctuary
    Phone: 1-800-THERAPIST
  • Rape, Abuse and Incest National Network
    Phone: 1-800-656-HOPE

The future

As the use of the Internet continues to expand, so will internet psychiatry. This is particularly true given that it may be quite useful in specifically providing access to psychotherapy for individuals with PTSD. Other areas that researchers are targeting to improve recovery for PTSD sufferers include expanding research on EMDR, studying how PTSD can be more specifically treated in various ethnic groups, and discovering how to best prevent people from developing the illness.

PTSD At A Glance
  • Posttraumatic stress disorder (PTSD) is an emotional illness that was first formally diagnosed in soldiers and war veterans and is caused by terribly frightening, life-threatening, or otherwise highly unsafe experiences.
  • PTSD symptom types include re-experiencing the trauma, avoidance, and hyperarousal.
  • PTSD has a lifetime prevalence of seven up to 30%, with about 5 million people suffering from the illness in any one year. Girls, women, and ethnic minorities tend to develop PTSD more than boys, men, and Caucasians.
  • Complex posttraumatic stress disorder (C-PTSD) usually results from prolonged exposure to traumatic event(s) and is characterized by long-lasting problems that affect many aspects of emotional and social functioning.
  • Symptoms of C-PTSD include problems regulating feelings, dissociation or depersonalization; persistent depressive feelings, seeing the perpetrator of trauma as all-powerful, preoccupation with the perpetrator, and a severe change in what gives the sufferer meaning.
  • Untreated PTSD can have devastating, far-reaching consequences for sufferers' medical and emotional functioning and relationships, their families, and for society. Children with PTSD can experience significantly negative effects on their social and emotional development, as well as their ability to learn.
  • Although almost any event that is life-threatening or that severely compromises the emotional well-being of an individual may cause PTSD, such events usually include experiencing or witnessing a severe accident or physical injury, getting a frightening medical diagnosis, being the victim of a crime or torture, exposure to combat, disaster or terrorist attack, enduring any form of abuse, or involvement in civil conflict.
  • Issues that tend to put people at higher risk for developing PTSD include female gender, minority ethnicity, increased duration or severity of, as well as exposure to, the trauma experienced, having an emotional condition prior to the event, and having little social support. Risk factors for children and adolescents also include having any learning disability or experiencing violence in the home.
  • Disaster preparedness training may be a protective factor for PTSD.
  • Medicines that treat depression (for example, serotonergic antidepressants or SSRIs), decrease the heart rate (for example, propranolol) or increase the action of other body chemicals (for example, hydrocortisol) are thought to be effective tools in the prevention of PTSD when given in the days immediately after an individual experiences a traumatic event
  • Individuals who wonder if they may be suffering form PTSD may benefit from taking a self-test as they consider meeting with a practitioner.
  •  Professionals may used a clinical interview in either adults, children, or adolescents, or one of a number of structured tests with children or adolescents to assess for the presence of this illness.
  • Diagnosing PTSD can present a challenge for professionals since sufferers often come for evaluation of something that seems to be unrelated to that illness at first. Those symptoms tend to be physical complaints, depression, or substance abuse. Also, PTSD often co-occurs with manic depression, eating disorders, or other anxiety disorders.
  • Challenges for assessment of PTSD in children and adolescents include adult caretakers' tendency to be unaware of the extent of the young person's symptoms and the tendency for children and teens to express symptoms of the illness in ways that are quite different from adults.
  • Treatments for PTSD usually include psychological and medical treatments. Education about the illness, helping the individual talk about the trauma directly, exploration and modification of inaccurate ways of thinking about it, and teaching the person ways to manage symptoms and are the usual techniques used in psychotherapy. Family and couples' counseling, parenting classes, and education about conflict resolution are other useful psychotherapeutic interventions.
  • Directly addressing the sleep problems that are associated with PTSD has been found to help alleviate those problems, thereby decreasing the symptoms of PTSD in general.
  • Medications that are usually used to help PTSD sufferers include serotonergic antidepressants (SSRIs) and medicines that help decrease the physical symptoms associated with illness. Other potentially helpful medications for managing PTSD include mood stabilizers and antipsychotics. Tranquilizers have been associated with withdrawal symptoms and other problems and have not been found to be significantly effective for helping individuals with PTSD.
  • Some ways that are often suggested for PTSD patients to cope with this illness include learning more about the illness, talking to others for support, using relaxation techniques, participating in treatment, increasing positive lifestyle practices, and minimizing negative lifestyle practices.


VA Rating of PTSD

The following is from Title 38 USC Chapter One Part 4:

General Rating Formula for Mental Disorders:
        Total occupational and social impairment, due to             100
         such symptoms as: gross impairment in thought
         processes or communication; persistent delusions
         or hallucinations; grossly inappropriate behavior;
         persistent danger of hurting self or others;
         intermittent inability to perform activities of
         daily living (including maintenance of minimal
         personal hygiene); disorientation to time or
         place; memory loss for names of close relatives,
         own occupation, or own name.......................
        Occupational and social impairment, with                      70
         deficiencies in most areas, such as work, school,
         family relations, judgment, thinking, or mood, due
         to such symptoms as: suicidal ideation;
         obsessional rituals which interfere with routine
         activities; speech intermittently illogical,
         obscure, or irrelevant; near-continuous panic or
         depression affecting the ability to function
         independently, appropriately and effectively;
         impaired impulse control (such as unprovoked
         irritability with periods of violence); spatial
         disorientation; neglect of personal appearance and
         hygiene; difficulty in adapting to stressful
         circumstances (including work or a work like
         setting); inability to establish and maintain
         effective relationships...........................
        Occupational and social impairment with reduced               50
         reliability and productivity due to such symptoms
         as: flattened affect; circumstantial,
         circumlocutory, or stereotyped speech; panic
         attacks more than once a week; difficulty in
         understanding complex commands; impairment of
         short- and long-term memory (e.g., retention of
         only highly learned material, forgetting to
         complete tasks); impaired judgment; impaired
         abstract thinking; disturbances of motivation and
         mood; difficulty in establishing and maintaining
         effective work and social relationships...........
        Occupational and social impairment with occasional            30
         decrease in work efficiency and intermittent
         periods of inability to perform occupational tasks
         (although generally functioning satisfactorily,
         with routine behavior, self-care, and conversation
         normal), due to such symptoms as: depressed mood,
         anxiety, suspiciousness, panic attacks (weekly or
         less often), chronic sleep impairment, mild memory
         loss (such as forgetting names, directions, recent
        Occupational and social impairment due to mild or             10
         transient symptoms which decrease work efficiency
         and ability to perform occupational tasks only
         during periods of significant stress, or; symptoms
         controlled by continuous medication...............
        A mental condition has been formally diagnosed, but            0
         symptoms are not severe enough either to interfere
         with occupational and social functioning or to

         require continuous medication.....................

 Global Assessment of Functioning (GAF)


Axis 1:

Clinical disorders

Axis 2:

Personality/ developmental disorders

Axis 3:

Relevant physical disorders

Axis 4:

Psychosocial and Environmental problems

Axis 5:

Global Assessment of Functioning


· Anxiety disorders

· Mood disorders

· Dissociative disorders

· Substance-related disorders

· Schizophrenia

· Sexual & gender-identity disorders

· Eating disorders


· Paranoid personality disorder

· Antisocial personality disorder

· Narcissistic personality disorder

· Borderline personality disorder

· Dependent personality disorder


· Infectious & parasitic diseases

· Endocrine, nutrional, metabolic, immune diseases

· Diseases of nervous system & sense organs

· Congenital anomalies


· Problems with primary support group

· Problems related to social environment

· Educational problems

· Occupational problems

· Housing or economic problems


100 = Superior functioning in a wide range of activities

50 = Serious symptoms or impairment in social, occupational, or school functioning

10 = Persistent danger of severely hurting self or others



















The VA requires that a GAF score be given at least every 90 days, however, most mental health workers
will list a GAF with each visit. Both the US Court of Veteran Appeals and the Board of veterans' Appeals
consider a GAF of 50 to represent "Serious" symptoms.

Psychiatrists and Psychologists use a rating scale - the Global Assessment of Functioning (GAF) - scale to assess how well the individual is able to function in his/her environment.
persistent danger of hurting self; can't maintain standard of self-care
danger of hurting self; unable to maintain self-care; impairment in communication
delusions, hallucinations; major impairment in most areas; lack of judgement
some impairment in reality testing; major impairment in select areas
serious symptoms (suicidal ideation but low risk); serious impairment in one area
moderate symptoms in most areas
mild symptoms; able to function with some problems in relationships and work
slight impairment; transient symptoms
good functioning
happy. healthy, and content


VA Compensation and Pention Exam (PTSD)

Initial Evaluation for Post-Traumatic Stress Disorder (PTSD)

# 0910 Worksheet

Name: SSN:
Date of Exam: C-number:
Place of Exam:

A. Identifying Information:
  • age

  • ethnic background

  • era of military service

  • reason for referral (original exam to establish PTSD diagnosis and related psychosocial impairment; re-evaluation of status of existing service-connected PTSD condition)

B. Sources of Information:

  • records reviewed (C-file, DD-214, medical records, other documentation)

  • review of social-industrial survey completed by social worker

  • statements from collaterals

  • administration of psychometric tests and questionnaires (identify here)

C. Review of Medical Records:

  1. Past Medical History:

  1. Previous hospitalizations and outpatient care.

  2. Complete medical history is required, including history since discharge from military service.

  3. Review of Claims Folder is required on initial exams to establish or rule out the diagnosis.

  1. Present Medical History - over the past one year.

  1. Frequency, severity and duration of medical and psychiatric symptoms.

  2. Length of remissions, to include capacity for adjustment during periods of remissions.

D. Examination (Objective Findings):

Address each of the following and fully describe:

History (Subjective Complaints):
Comment on:

Premilitary History (refer to social-industrial survey if completed)

  • describe family structure and environment where raised (identify constellation of family members and quality of relationships)

  • quality of peer relationships and social adjustment (e.g., activities, achievements, athletic and/or extracurricular involvement, sexual involvements, etc.)

  • education obtained and performance in school · employment

  • legal infractions

  • delinquency or behavior conduct disturbances

  • substance use patterns

  • significant medical problems and treatments obtained

  • family psychiatric history

  • exposure to traumatic stressors (see CAPS trauma assessment checklist)

  • summary assessment of psychosocial adjustment and progression through developmental milestones (performance in employment or schooling, routine responsibilities of self-care, family role functioning, physical health, social/interpersonal relationships, recreation/leisure pursuits).

Military History

  • branch of service (enlisted or drafted)

  • dates of service

  • dates and location of war zone duty and number of months stationed in war zone

  • Military Occupational Specialty (describe nature and duration of job(s) in war zone

  • highest rank obtained during service (rank at discharge if different)

  • type of discharge from military

  • describe routine combat stressors veterans was exposed to (refer to Combat Scale)

  • combat wounds sustained (describe)

  • clearly describe specific stressor event(s) veteran considered particularly traumatic. Clearly describe the stressor. Particularly if the stressor is a type of personal assault, including sexual assault, provide information, with examples, if possible.

  • indicate overall level of traumatic stress exposure (high, moderate, low) based on frequency and severity of incident exposure (refer to trauma assessment scale scores described in Appendix B).

  • citations or medals received

  • disciplinary infractions or other adjustment problems during military

NOTE: Service connection for post-traumatic stress disorder (PTSD) requires medical evidence establishing a diagnosis of the condition that conforms to the diagnostic criteria of DSM-IV, credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. It is the responsibility of the examiner to indicate the traumatic stressor leading to PTSD, if he or she makes the diagnosis of PTSD. Crucial in this description are specific details of the stressor, with names, dates, and places linked to the stressor, so that the rating specialist can confirm that the cited stressor occurred during active duty.

A diagnosis of PTSD cannot be adequately documented or ruled out without obtaining a detailed military history and reviewing the claims folder. This means that initial review of the folder prior to examination, the history and examination itself, and the dictation for an examination initially establishing PTSD will often require more time than for examinations of other disorders. Ninety minutes to two hours on an initial exam is normal.

Post-Military Trauma History (refer to social-industrial survey if completed)

  • describe post-military traumatic events (see CAPS trauma assessment checklist)

  • describe psychosocial consequences of post-military trauma exposure(s) (treatment received, disruption to work, adverse health consequences)

Post-Military Psychosocial Adjustment (refer to social-industrial survey if completed) · legal history (DWIs, arrests, time spent in jail)

  • educational accomplishment

  • employment history (describe periods of employment and reasons)

  • marital and family relationships (including quality of relationships with children)

  • degree and quality of social relationships

  • activities and leisure pursuits

  • problematic substance abuse (lifetime and current)

  • significant medical disorders (resulting pain or disability; current medications)

  • treatment history for significant medical conditions, including hospitalizations

  • history of inpatient and/or outpatient psychiatric care (dates and conditions treated)

  • history of assaultiveness

  • history of suicide attempts

  • summary statement of current psychosocial functional status (performance in employment or schooling, routine responsibilities of self care, family role functioning, physical health, social/interpersonal relationships, recreation/leisure pursuits)

E. Mental Status Examination

Conduct a brief mental status examination aimed at screening for DSM-IV mental disorders. Describe and fully explain the existence, frequency and extent of the following signs and symptoms, or any others present, and relate how they interfere with employment and social functioning:

  • Impairment of thought process or communication.

  • Delusions, hallucinations and their persistence.

  • Eye Contact, interaction in session, and inappropriate behavior cited with examples.

  • Suicidal or homicidal thoughts, ideations or plans or intent.

  • Ability to maintain minimal personal hygiene and other basic activities of daily living.

  • Orientation to person, place and time.

  • Memory loss, or impairment (both short and long-term).

  • Obsessive or ritualistic behavior which interferes with routine activities and describe any found.

  • Rate and flow of speech and note any irrelevant, illogical, or obscure speech patterns and whether constant or intermittent.

  • Panic attacks noting the severity, duration, frequency and effect on independent functioning and whether clinically observed or good evidence of prior clinical or equivalent observation is shown.

  • Depression, depressed mood or anxiety.

  • Impaired impulse control and its effect on motivation or mood.

  • Sleep impairment and describe extent it interferes with daytime activities.

  • Other disorders or symptoms and the extent they interfere with activities, particularly:

  • mood disorders (especially major depression and dysthymia)

  • substance use disorders (especially alcohol use disorders)

  • anxiety disorders (especially panic disorder, obsessive-compulsive disorder, generalized anxiety disorder)

  • somatoform disorders

  • personality disorders (especially antisocial personality disorder and borderline personality disorder)

Specify onset and duration of symptoms as acute, chronic, or with delayed onset.

F. Assessment of PTSD

  • state whether or not the veteran meets the DSM-IV stressor criterion

  • identify behavioral, cognitive, social, affective, or somatic change veteran attributes to stress exposure

  • describe specific PTSD symptoms present (symptoms of trauma re-experiencing, avoidance/numbing, heightened physiological arousal, and associated features [e.g., disillusionment and demoralization])

  • specify onset, duration, typical frequency, and severity of symptoms

G. Psychometric Testing Results

  • provide psychological testing if deemed necessary

  • provide specific evaluation information required by the rating board or on a BVA Remand.

  • comment on validity of psychological test results

  • provide scores for PTSD psychometric assessments administered

  • state whether PTSD psychometric measures are consistent or inconsistent with a diagnosis of PTSD, based on normative data and established "cutting scores" (cutting scores that are consistent with or supportive of a PTSD diagnosis are as follows: PCL > 50; Mississippi Scale > 107; MMPI PTSD subscale a score > 28; MMPI code type: 2-8 or 2-7-8)

  • state degree of severity of PTSD symptoms based on psychometric data (mild, moderate, or severe)

  • describe findings from psychological tests measuring problems other than PTSD (MMPI, etc.)

H. Diagnosis:

  1. The Diagnosis must conform to DSM-IV and be supported by the findings on the examination report.

  2. If there are multiple mental disorders, delineate to the extent possible the symptoms associated with each and a discussion of relationship.

  3. Evaluation is based on the effects of the signs and symptoms on occupational and social functioning.

NOTE: VA is prohibited by statute, 38 U.S.C. 1110, from paying compensation for a disability that is a result of the veteran's own ALCOHOL OR DRUG ABUSE. However, when a veteran's alcohol or drug abuse disability is secondary to or is caused or aggravated by a primary service-connected disorder, the veteran may be entitled to compensation. See Allen v. Principi, 237 F.3d 1368, 1381 (Fed. Cir. 2001). Therefore, it is important to determine the relationship, if any, between a service-connected disorder and a disability resulting from the veteran's alcohol or drug abuse. Unless alcohol or drug abuse is secondary to or is caused or aggravated by another mental disorder, you should separate, to the extent possible, the effects of the alcohol or drug abuse from the effects of the other mental disorder(s). If it is not possible to separate the effects in such cases, please explain why.

I. Diagnostic Status

  • Axis I disorders

  • Axis II disorders

  • Axis III disorders

  • Axis IV (psychosocial and environmental problems)

  • Axis V (GAF score - current)

J. Global Assessment of Functioning (GAF):

NOTE: The complete multi-axial format as specified by DSM-IV may be required by BVA REMAND or specifically requested by the rating specialist. If so, include the GAF score and note whether it refers to current functioning. A BVA REMAND may also request, in addition to an overall GAF score, that a separate GAF score be provided for each mental disorder present when there are multiple Axis I or Axis II diagnoses and not all are service-connected. If separate GAF scores can be given, an explanation and discussion of the rationale is needed. If it is not possible, an explanation as to why not is needed. (See the above note pertaining to alcohol or drug abuse, the effects of which cannot be used to assess the effects of a service-connected condition.)

DSM-IV is only for application from 11/7/96 on. Therefore, when applicable note whether the diagnosis of PTSD was supportable under DSM-III-R prior to that date. The prior criteria under DSM-III-R are provided as an attachment.

K. Capacity to Manage Financial Affairs: Mental competency, for VA benefits purposes, refers only to the ability of the veteran to manage VA benefit payments in his or her own best interest, and not to any other subject. Mental incompetency, for VA benefits purposes, means that the veteran, because of injury or disease, is not capable of managing benefit payments in his or her best interest. In order to assist raters in making a legal determination as to competency, please address the following:

What is the impact of injury or disease on the veteran's ability to manage his or her financial affairs, including consideration of such things as knowing the amount of his or her VA benefit payment, knowing the amounts and types of bills owed monthly, and handling the payment prudently? Does the veteran handle the money and pay the bills himself or herself?

Based on your examination, do you believe that the veteran is capable of managing his or her financial affairs? Please provide examples to support your conclusion.

If you believe a Social Work Service assessment is needed before you can give your opinion on the veteran's ability to manage his or her financial affairs, please explain why.

L. Other Opinion: Furnish any other specific opinion requested by the rating board or BVA remand (furnish the complete rationale and citation of medical texts or treatise supporting opinion, if medical literature review was undertaken). If the requested opinion is medically not ascertainable on exam or testing please state why. If the requested opinion can not be expressed without resorting to speculation or making improbable assumptions say so, and explain why. If the opinion asks " ... is it at least as likely as not ... ", fully explain the clinical findings and rationale for the opinion. M. Integrated Summary and Conclusions

  • Describe changes in psychosocial functional status and quality of life following trauma exposure (performance in employment or schooling, routine responsibilities of self care, family role functioning, physical health, social/interpersonal relationships, recreation/leisure pursuits)

  • Describe linkage between PTSD symptoms and aforementioned changes in impairment in functional status and quality of life. Particularly in cases where a veteran is unemployed, specific details about the effects of PTSD and its symptoms on employment are especially important.

  • If possible, describe extent to which disorders other than PTSD (e.g., substance use disorders) are independently responsible for impairment in psychosocial adjustment and quality of life. If this is not possible, explain why (e.g., substance use had onset after PTSD and clearly is a means of coping with PTSD symptoms).

  • If possible, describe pre-trauma risk factors or characteristics than may have rendered the veteran vulnerable to developing PTSD subsequent to trauma exposure.

  • If possible, state prognosis for improvement of psychiatric condition and impairments in functional status.

  • Comment on whether veteran is capable of managing his or her financial affairs.



Writting Your Stressor Letter

Please contact one the individuals listed at the end of the page for more information and any questions you have There are two basic steps to receive a disability from the Veterans Administration for PTSD. The first step is filing a claim with the VA for PTSD. The second, and most Important, is submitting a stressor letter. Most combat veterans do not trust the government or the VA. This is understandable considering the treatment most veterans received during and after the Vietnam War. But the VA has improved in most places, and the benefits are there for the combat veterans. The VA does not go looking for the combat veteran with PTSD. You mush push aside any bad feelings and make the effort to receive the earned benefits. 

As ridiculous at it may seem, all combat veterans must not only prove that they were in combat, they must also prove that they were in the military. This process screens out the phony combat veterans. It is surprising how many combat veterans have surfaced who were on top secret missions, and of course, there is no record of their even being in the military because their missions were so secret. 

You can file a claim on your own, but there are several veteran’s organizations who will represent you on a disability claim. You will need to sign a power of attorney. You sign this paper and send it back through the mail. This gives the Service Officer your permission to represent you in your claim. Please be aware that there are many poor Service Officers. If you are not offered immediate help, with eagerness, move on until you find a Service Officer who is eager to help you. All Veterans Groups have Service Officers, so shop alll of them until you find a person your are comfortable with or contact us and we will try to help you. 

This is the single most important factor in obtaining disability for the combat veteran. After your claim has been filed, usually within 30 to 60 days, you will receive a letter from the VA stating that they have received your claim for PTSD. Then you will be asked to submit a stressor letter. This is a written record of combat experiences which you felt were life threatening or have caused you to display symptoms of PTSD. They will also note that they understand how difficult this can be for some veterans (thinking about war experiences and writing them down). And for many this is difficult. Some can't write well. Some are too terrified to think in detail about their war experience. 

Chances are the average veteran cannot write a stressor letter that will pass the rating board. Once a stressor letter has been rejected by the rating board, the process to receive disability can be long and discouraging. Many veterans give up and never receive the disability they deserve. The VA will tell-you how to write the letter or what details to include. If the letter is rejected, many combat veterans will give up before appealing the rating board decision. So a veteran must submit a solid stressor letter to pass the rating board. This is my area of expertise. I know what to put in the letter and how to present it so that the rating board will grant any where from 10% to 50% disability just from your stressor letter without rejection and VA appeal hearings. It will be impossible to receive a 100% rating from a stressor letter, but once the VA agrees you are disabled, you can appeal for a higher percentage. 


At some point after you file for disability, either before or after you have submitted your stressor letter, you will receive a letter asking you to come to the nearest VA Hospital in your area for a Compensation Examination. This just means that you are going to speak to a VA psychiatrist. The psychiatrist will ask you many questions about your background (including your childhood and current social life) and your war service. The meeting with the doctor will probably last anywhere from 20 to 45 minutes. The VA will also reimburse you with a small travel allowance for coming. 

You must show up for this comp exam. If for some reason you can't make it, then call the VA and they will schedule you again. Most of all, relax. This psychiatrist is not your enemy, and it is his or her job to send a report to the VA regional office as to whether you show symptoms of PTSD. The psychiatrist Is Impartial. If you show symptoms of PTSD, it will be reported without any favor toward the VA. So relax and answer questions to the best of your knowledge. Always stress the negative side of your life...never the positive. Just like at the close of the stressor letter. You can do this and still tell the truth just by avoiding the positive. 

Here are some things not to say at a Comp Exam 

1. My life is okay. It's not or you wouldn't be there. 

2. I sometimes hear voices. Hearing voices can lead to a diagnosis of schizophrenia, and your PTSD claim may be rejected. 

3. I am happily married. It has often been decided that having PTSD automatically means an unhappy marriage. It can but not always. 

4. I love my job. I have been there twenty years. If you have managed to keep one job, it may be determined that you interact normally and do not have PTSD. You can have one job and still be miserable. It's a matter of survival. 

5. I have lots of friends. Never admit you have lots of friends. Chances are you don't anyway. At least, not like the friends you made in combat situations who you can trust with your life.

6. Don't threaten the doctor. Some veterans scream, yell, and threaten to kill the doctor in an attempt to show symptoms of PTSD. 99% of the time this is an act and won't help your claim. The main thing is to stress the negative side of your life, just as in the end of the stressor letter. If you have had a substance abuse problem since before your war service, it would be best not to mention it. Stress the fact that you are depressed and have nightmares and feel that the war has altered your life. Just remember to stress the negative instead of anything positive in your life. 

For additional information and help with writing a stressor letter please go to:   

Coping with PTSD and Recommended Lifestyle Changes for PTSD Patients

A National Center for PTSD Fact Sheet
By Joe Ruzek, Ph.D.

Coping with PTSD

Because PTSD symptoms seldom disappear completely, it is usually a continuing challenge for survivors of trauma to cope with PTSD symptoms and the problems they cause. Survivors often learn through treatment how to cope more effectively.

Recovery from PTSD is an ongoing, daily, gradual process. It doesn't happen through sudden insight or "cure." Healing doesn't mean that a survivor will forget war experiences or have no emotional pain when remembering them. Some level of continuing reaction to memories is normal and reflects a normal body and mind. Recovery may lead to fewer reactions and reactions that are less intense. It may also lead to a greater ability to manage trauma-related emotions and to greater confidence in one's ability to cope.

When a trauma survivor takes direct action to cope with problems, he or she often gains a sense of personal power and control. Active coping means recognizing and accepting the impact of traumatic experiences and then taking concrete action to improve things.

Positive coping actions are those that help to reduce anxiety and lessen other distressing reactions. Positive coping actions also improve the situation in a way that does not harm the survivor further and in a way that lasts into the future. Positive coping methods include:

Learning about trauma and PTSD-It is useful for trauma survivors to learn more about PTSD and how it affects them. By learning that PTSD is common and that their problems are shared by hundreds of thousands of others, survivors recognize that they are not alone, weak, or crazy. When a survivor seeks treatment and learns to recognize and understand what upsets him or her, he or she is in a better position to cope with the symptoms of PTSD.

Talking to another person for support-When survivors are able to talk about their problems with others, something helpful often results. Of course, survivors must choose their support people carefully and clearly ask for what they need. With support from others, survivors may feel less alone, feel supported or understood, or receive concrete help with a problem situation. Often, it is best to talk to professional counselors about issues related to the traumatic experience itself; they are more likely than friends or family to understand trauma and its effects. It is also helpful to seek support from a support group. Being in a group with others who have PTSD may help reduce one's sense of isolation, rebuild trust in others, and provide an important opportunity to contribute to the recovery of other survivors of trauma.

Talking to your doctor about trauma and PTSD-Part of taking care of yourself means mobilizing the helping resources around you. Your doctor can take care of your physical health better if he or she knows about your PTSD, and doctors can often refer you to more specialized and expert help.

Practicing relaxation methods-These can include muscular relaxation exercises, breathing exercises, meditation, swimming, stretching, yoga, prayer, listening to quiet music, spending time in nature, and so on. While relaxation techniques can be helpful, they can sometimes increase distress by focusing attention on disturbing physical sensations or by reducing contact with the external environment. Be aware that while uncomfortable physical sensations may become more apparent when you are relaxed, in the long run, continuing with relaxation in a way that is tolerable (i.e., interspersed with music, walking, or other activities) helps reduce negative reactions to thoughts, feelings, and perceptions.

Increasing positive distracting activities-Positive recreational or work activities help distract a person from his or her memories and reactions. Artistic endeavors have also been a way for many trauma survivors to express their feelings in a positive, creative way. This can improve your mood, limit the harm caused by PTSD, and help you rebuild your life. It is important to emphasize that distraction alone is unlikely to facilitate recovery; active, direct coping with traumatic events and their impact is also important.

Calling a counselor for help-Sometimes PTSD symptoms worsen and ordinary efforts at coping don't seem to work. Survivors may feel fearful or depressed. At these times, it is important to reach out and telephone a counselor, who can help turn things around.

Taking prescribed medications to tackle PTSD-One tool that many with PTSD have found helpful is medication treatment. By taking medications, some survivors of trauma are able to improve their sleep, anxiety, irritability, anger, and urges to drink or use drugs.

Negative coping actions help to perpetuate problems. They may reduce distress immediately but short-circuit more permanent change. Some actions that may be immediately effective may also cause later problems, like smoking or drug use. These habits can become difficult to change. Negative coping methods can include isolation, use of drugs or alcohol, workaholism, violent behavior, angry intimidation of others, unhealthy eating, and different types of self-destructive behavior (e.g., attempting suicide). Before learning more effective and healthy coping methods, most people with PTSD try to cope with their distress and other reactions in ways that lead to more problems. The following are negative coping actions:

Use of alcohol or drugs-This may help wash away memories, increase social confidence, or induce sleep, but it causes more problems than it cures. Using alcohol or drugs can create a dependence on alcohol, harm one's judgment, harm one's mental abilities, cause problems in relationships with family and friends, and sometimes place a person at risk for suicide, violence, or accidents.

Social isolation-By reducing contact with the outside world, a trauma survivor may avoid many situations that cause him or her to feel afraid, irritable, or angry. However, isolation will also cause major problems. It will result in the loss of social support, friendships, and intimacy. It may breed further depression and fear. Less participation in positive activities leads to fewer opportunities for positive emotions and achievements.

Anger-Like isolation, anger can get rid of many upsetting situations by keeping people away. However, it also keeps away positive connections and help, and it can gradually drive away the important people in a person's life. It may lead to job problems, marital or relationship problems, and the loss of friendships.

Continuous avoidance-If you avoid thinking about the trauma or if you avoid seeking help, you may keep distress at bay, but this behavior also prevents you from making progress in how you cope with trauma and its consequences.

Recommended Lifestyle Changes – Taking Control

Those with PTSD need to take active steps to deal with their PTSD symptoms. Often, these steps involve making a series of thoughtful changes in one's lifestyle to reduce symptoms and improve quality of life. Positive lifestyle changes include:

Calling about treatment and joining a PTSD support group-It may be difficult to take the first step and join a PTSD treatment group. Survivors say to themselves, "What will happen there? Nobody can help me anyway." In addition, people with PTSD find it hard to meet new people and trust them enough to open up. However, it can also be a great relief to feel that you have taken positive action. You may also be able to eventually develop a friendship with another survivor.

Increasing contact with other survivors of trauma-Other survivors of trauma are probably the best source of understanding and support. By joining a survivors organization (e.g., veterans may want to join a veteran's organization) or by otherwise increasing contact with other survivors, it is possible to reverse the process of isolation and distrust of others.

Reinvesting in personal relationships with family and friends-Most survivors of trauma have some kind of a relationship with a son or daughter, a wife or partner, or an old friend or work acquaintance. If you make the effort to reestablish or increase contact with that person, it can help you reconnect with others.

Changing neighborhoods-Survivors with PTSD usually feel that the world is a very dangerous place and that it is likely that they will be harmed again. It is not a good idea for people with PTSD to live in a high-crime area because it only makes those feelings worse and confirms their beliefs. If it is possible to move to a safer neighborhood, it is likely that fewer things will set off traumatic memories. This will allow the person to reconsider his or her personal beliefs about danger.

Refraining from alcohol and drug abuse-Many trauma survivors turn to alcohol and drugs to help them cope with PTSD. Although these substances may distract a person from his or her painful feelings and, therefore, may appear to help deal with symptoms, relying on alcohol and drugs always makes things worse in the end. These substances often hinder PTSD treatment and recovery. Rather than trying to beat an addiction by yourself, it is often easier to deal with addictions by joining a treatment program where you can be around others who are working on similar issues.

Starting an exercise program-It is important to see a doctor before starting to exercise. However, if the physician gives the OK, exercise in moderation can benefit those with PTSD. Walking, jogging, swimming, weight lifting, and other forms of exercise may reduce physical tension. They may distract the person from painful memories or worries and give him or her a break from difficult emotions. Perhaps most important, exercise can improve self-esteem and create feelings of personal control.

Starting to volunteer in the community-It is important to feel as though you are contributing to your community. When you are not working, you may not feel you have anything to offer others. One way survivors can reconnect with their communities is to volunteer. You can help with youth programs, medical services, literacy programs, community sporting activities, etc.

The information on this Web site is presented for educational purposes only. It is not a substitute for informed medical advice or training. Do not use this information to diagnose or treat a mental health problem without consulting a qualified health or mental health care provider.

All information contained on these pages is in the public domain unless explicit notice is given to the contrary, and may be copied and distributed without restriction


If And How To Tell Others About PTSD

If you've been in treatment for PTSD, you'll know by now that talking to counselors and doctors about your PTSD is essential to self-care. But if you haven't ever sought care for PTSD, we recommend that you do so. Talking about PTSD to a professional counselor in your VA or local Vet Center has meant the beginning of a better life for many, many veterans.


But here we're focusing on talking to other people - your partner, family members, friends, work or volunteer colleagues.

There are many possible benefits to telling others that you have PTSD. They can come to understand you better and support you more. They may realize that when you're angry or need to leave a situation, it's not because you dislike them but more about your symptoms and struggles. They can come to be more accepting of your fears, irritability, withdrawal, or other PTSD symptoms.

Partners and family members have a special need to learn about PTSD. In fact, good care for you will often mean that those close to you need to become better educated about PTSD: what it is, how it can result from traumas like combat or sexual assault, what happens in treatment, what happens in the process of recovery, what things trigger your symptoms, and what they can do to help support your recovery.

On a case-by-case basis, it may also be important to tell people you work, volunteer, or socialize with about your PTSD. If they know about PTSD, they will be more likely to react in a helpful way when your PTSD worsens or you have problems related to PTSD.

Here are some things to consider as you decide if, when, and how to tell another person about your PTSD:

  1. Talk about this with your counselor before telling others and think together about the pro's and con's of talking.

  2. Choose carefully whom you tell. There should be a good reason to tell them, and there are times when it will not be necessary or wise to tell a particular person.

  3. Think about their possible reactions. Will they be understanding; will they listen?

  4. Think about and prepare what you are going to say.

  5. Test the water a little. Try a brief conversation and see how they react.

  6. When doing this for the first or second time, choose someone that you are confident will be understanding and supportive.

  7. Don't tell them about your traumatic experiences, unless you and your counselor decide there is some reason to do so. Other people need to understand what your experience is now, not what happened to you. You can tell them, briefly and generally, what happened, if you choose ("I saw people die" or "I almost died" or "I saw terrible things"). But there is no reason to go into the details.

  8. Tell them why you are explaining about your PTSD: that part of your recovery means letting people important to you know what's going on with you, discussing what problems you might occasionally experience, and making some plans for how to deal with problems if they arise.

Very occasionally, someone might react badly when you tell them about your PTSD. They might be scared of you ("crazy Vietnam vet") or they might appear uncomfortable. Usually, this will be due to ignorance, a lack of understanding of war and other trauma, and of trauma reactions. Commonly, they will not know what to say. Most people don't know much about the impact of trauma on human beings, and they have not had the opportunity to talk about emotional problems with someone who is experiencing them.

What do you want to tell them about your PTSD? It may be especially helpful to tell them about the parts of your PTSD reactions that might affect them: your difficulty in expressing positive feelings, your difficulty in getting close to another person, your irritability or anger, your difficulty in going into busy or crowded places, your occasional social isolation, your difficulties in being in social situations, and so on. Also tell them about the basic symptoms of PTSD.

You can explain things in a positive and prideful way. You can say (in your own words, expanding on what you want) that war (or other trauma) affects many people in very powerful ways that continue long past the trauma itself, that you are actively working at self-care by learning coping tools and getting counseling and other forms of regular support, and that part of your self-care action is to talk to people that are important to you about what PTSD is and how it can affect you.

As you strengthen your recovery and become more skilled in using your coping tools, you will gradually become more comfortable in talking to others about what is going on with you.

 This information is from the VA's National Treatment Center for PTSD at Menl Park, CA, part of the VA's Palo Alto Health Care System

The information on this Web site is presented for educational purposes only. It is not a substitute for informed medical advice or training. Do not use this information to diagnose or treat a mental health problem without consulting a qualified health or mental health care provider. All information contained on these pages is in the public domain unless explicit notice is given to the contrary, and may be copied and distributed without restriction.




                                         ePluribus Media


Post Traumatic Stress Disorder (PTSD) became part of the American vocabulary after the Vietnam War as its affects on veterans became widely publicized. Now, a new generation of American veterans are again victims of PTSD. This series explores the impact of politics on the funding, diagnosis and treatment of veterans suffering from PTSD. It examines the propaganda used to justify a reduction in benefits to veterans with PTSD and the effort to redirect blame for the ravages of war to the soldiers themselves.

Part I: Stacking the Deck - With trillion dollar estimates for the Iraq war, the Administration looks to cut costs, eyeing treatment for the returning PTSD wounded veterans.

Part II: Ration & Redefine - Redefining PTSD and substance abuse as moral/spiritual failings opens the door to cheaper unregulated, unlicensed faith-based "treatments."

Part III: Malign & Slime - Propaganda is used to stigmatize veterans seeking help, reduce benefits to veterans with PTSD and to blame the soldiers for their own illness.

PTSD Resources | About the Authors



Specialized PTSD Treatment Programs in the U.S. Department of Veterans Affairs

A National Center for PTSD Fact Sheet

The Department of Veterans Affairs Medical Centers provides a network of more than 100 specialized programs for veterans with PTSD and works closely with the Vet Centers operated by VA's Readjustment Counseling Service.

Each specialized PTSD program offers veterans education, evaluation, and treatment conducted by mental-health professionals from a variety of disciplines (such as psychiatry, psychology, social work, counseling, and nursing).

Outpatient PTSD Programs include three basic types of clinics in which veterans meet with a PTSD specialist for regularly scheduled appointments. PTSD Clinical Teams (PCTs) provide group and one-to-one evaluation, education, counseling, and psychotherapy. Substance Use PTSD Teams (SUPTs) offer outpatient education, evaluation, and counseling for the combined problems of PTSD and substance abuse. Women's Stress Disorder Treatment Teams (WSDTTs) provide women veterans group and one-to-one evaluation, counseling, and psychotherapy.

Day Hospital PTSD Programs include two basic approaches to providing a "therapeutic community." Veterans with PTSD can attend these community programs several times weekly for social, recreational, and vocational activities as well as for counseling. Day Treatment PTSD Units provide one-to-one case management and counseling, group therapy, education, and activities in order to help clients live successfully with PTSD. Treatment and socialization activities are scheduled for several hours each day during the day and evening hours. Residential (Lodger) PTSD Units also offer one-to-one case management and counseling, group therapy, education, and activities for several hours each day. While enrolled in daytime and evening PTSD treatment, lodger clients may live temporarily in secure quarters that do not have 24-hour nursing supervision.

Inpatient PTSD Programs include four basic types of service and are conducted while veterans reside in hospital units that provide 24-hour nursing and psychiatric care. Specialized Inpatient PTSD Units (SIPUs) provide trauma-focused evaluation, education, and psychotherapy for a period of 28 to 90 days of hospital admission. Evaluation and Brief Treatment of PTSD Units (EBTPUs) provide PTSD evaluation, education, and psychotherapy for a briefer period ranging from 14 to 28 days. PTSD Residential Rehabilitation Programs (PRRPs) provide PTSD evaluation, education, counseling, and case management that focuses on helping the survivor resume a productive involvement in community life. PRRP admissions tend to be 28 to 90 days. PTSD Substance Use Programs (PSUs) provide combined evaluation, education, and counseling for substance use problems and PTSD. PSU admissions range from 14 to 90 days.

For more information about these treatment programs, including locations and contact information, go to the United States Department of Veterans Affairs website. The website provides a wide range of information on veterans' benefits and treatment facilities.



  Rev. Amy L. Snow, M.A... -

Rev. Amy L. Snow, M.A., author
The Endless Tour: Vietnam, PTSD, and the Spiritual Void





Additional Links

What is P.T.S.D  United Kingdom Site (excellent)

 The Ex-Services Mental Welfare Society, COMBAT STRESS, exists to serve ex service personnel. For over 80 years, they have been the only services charity specializing in helping those of all ranks from the Armed Forces and the Merchant Navy suffering from psychological disability as a result of their service. Through their national network of welfare officers, they visit clients at home in order to establish how best we can improve their quality of life. Through out their three treatment centers, we provide rehabilitative treatment which aims to help the victim cope with his or her disabilities and to enjoy a better quality of life. In over 80 years of operation, the society has provided some 75,000 veterans of the two World Wars and the many conflicts since with a unique lifeline. Currently, the Society takes about 600 veterans onto its
books each year, the youngest in their early twenties, the oldest in their seventies. There are people in receipt of help who between them represent service in every campaign which the British Armed services has been engaged from the start of World War 2 to the present day. Should you wish to contact Combat Stress please speak to Keith Hudson (NIVA Welfare Officer) on Tel: 07880535314. Or alternativly contact Combat Stress directly:-
Head Office
Tyrwhitt House, Oaklawn Road
Leatherhead, Surrey KT22 0BX
Telephone Number: 01372 841600
Email Address:
Notes taken from Combat Stress




Active Duty Military

Below is a list of information currently available from the National Center for PTSD about active duty military. For more information, click on the related links and/or search the PILOTS database for a more complete listing of articles available on this topic.

Fact sheets

Other Related Topics

Help for Veterans with PTSD and Their Families

Answers to some questions about PTSD and service-connected disability that are frequently asked by veterans and their families

Specialized PTSD Treatment Programs in the U.S. Department of Veterans Affairs

Brief information about the Department of Veterans Affairs' network of more than 100 specialized programs for veterans with PTSD, including the Vet Centers operated by VA's Readjustment Counseling Service

Published Information by National Center for PTSD staff

=Iowa Persian Gulf Study Group
Self-reported illness and health status among Gulf War veterans: a population-based study [download ] [view]
Journal of the American Medical Association, January 15, 1997, vol 277, iss 3, pg 238-245

Bolton, Elisa Esthera; Litz, Brett T; Adler, Amy B; Roemer, Lizabeth
Reports of prior exposure to potentially traumatic events and PTSD in troops poised for deployment [download] [view]
Journal of Traumatic Stress, January 2001, vol 14, iss 1, pg 249-256

Erickson, Darin J; Wolfe, Jessica; King, Daniel W; King, Lynda A; Sharkansky, Erica J
Posttraumatic stress disorder and depression symptomatology in a sample of Gulf War Veterans: a prospective analysis [ddownloa] [view]
Journal of Consulting and Clinical Psychology , February 2001, vol 69, iss 1, pg 41-49

Fontana, Alan; Litz, Brett T; Rosenheck, Robert A
Impact of combat and sexual harassment on the severity of posttraumatic stress disorder among men and women peacekeepers in Somalia [download] [view]
Journal of Nervous and Mental Disease , March 2000, vol 188, iss 3, pg 163-169

Ford, Julian D; Chandler, Patricia; Thacker, Barbara G; Greaves, David; Shaw, David; Sennhauser, Shirley; Schwartz, Lawrence
Family systems therapy after Operation Desert Storm with European-theater veterans [download] [view]
Journal of Marital and Family Therapy, April 1998, vol 24, iss 2, pg 243-250

Friedman, Matthew J; Southwick, Steven M; Charney, Dennis S
Pharmacotherapy for recently evacuated military casualties [download] [view]
Military Medicine, July 1993, vol 158, iss 7, pg 493-497

King, Daniel W; King, Lynda A; Erickson, Darin J; Huang, Mina T; Sharkansky, Erica J; Wolfe, Jessica
Posttraumatic stress disorder and retrospectively reported stressor exposure: a longitudinal prediction model [download] [view]
Journal of Abnormal Psychology , November 2000, vol 109, iss 4, pg 624-633

Litz, Brett T
The psychological demands of peacekeeping for military personnel [download]
National Center for PTSD Clinical Quarterly, Winter 1996, vol 6, iss 1, pg 1, 3-8

Litz, Brett T; King, Lynda A; King, Daniel W; Orsillo, Susan Marie; Friedman, Matthew J
Warriors as peacekeepers: features of the Somalia experience and PTSD [download] [view]
Journal of Consulting and Clinical Psychology, December 1997, vol 65, iss 6, pg 1001-1010

Litz, Brett T; Orsillo, Susan Marie; Friedman, Matthew J; Ehlich, Peter J; Batres, Alfonso R
Posttraumatic stress disorder associated with peacekeeping duty in Somalia for U.S. military personnel [download] [view]
American Journal of Psychiatry, February 1997, vol 154, iss 2, pg 178-184

Lundin, Tom
Collision at sea between two Navy vessels [download] [view]
Military Medicine, July 1995, vol 160, iss 7, pg 323-325

Lundin, Tom; Otto, Ulf
Swedish soldiers in peacekeeping operations: stress reactions following missions in Congo, Lebanon, Cyprus, and Bosnia [download]
National Center for PTSD Clinical Quarterly, Winter 1996, vol 6, iss 1, pg 9-11

Morgan, Charles Andrew; Hazlett, Gary; Wang, Sheila; Richardson, E Greer; Schnurr, Paula P; Southwick, Steven M
Symptoms of dissociation in humans experiencing acute, uncontrollable stress: a prospective investigation [download] [view]
American Journal of Psychiatry, August 2001, vol 158, iss 8, pg 1239-1247

Morgan, Charles Andrew; Kingham, Peter; Nicolaou, Andreas L; Southwick, Steven M
Anniversary reactions in Gulf War veterans: a naturalistic inquiry 2 years after the Gulf War [download] [view]
Journal of Traumatic Stress, January 1998, vol 11, iss 1, pg 165-171

Morgan, Charles Andrew; Wang, Sheila; Mason, John W; Southwick, Steven M; Fox, Patrick; Hazlett, Gary; Charney, Dennis S; Greenfield, Gary
Hormone profiles in humans experiencing military survival training [download] [view]
Biological Psychiatry , May 15, 2000, vol 47, iss 10, pg 891-901

Morgan, Charles Andrew; Wang, Sheila; Rasmusson, Ann M; Hazlett, Gary; Anderson, George; Charney, Dennis S
Relationship among plasma cortisol, catecholamines, neuropeptide Y, and human performance during exposure to uncontrollable stress [download] [view]
Psychosomatic Medicine , May-June 2001, vol 63, iss 3, pg 412-422

Morgan, Charles Andrew; Wang, Sheila; Southwick, Steven M; Rasmusson, Ann M; Hazlett, Gary; Hauger, Richard L; Charney, Dennis S
Plasma neuropeptide-Y concentrations in humans exposed to military survival training [download] [view]
Biological Psychiatry , May 15, 2000, vol 47, iss 10, pg 902-909

Orsillo, Susan Marie; Roemer, Lizabeth; Litz, Brett T; Ehlich, Peter J; Friedman, Matthew J
Psychiatric symptomatology associated with contemporary peacekeeping: an examination of post-mission functioning among peacekeepers in Somalia [download] [view]
Journal of Traumatic Stress, October 1998, vol 11, iss 4, pg 611-625

Polis, B David ; Polis, Edith; DeCani, John; Schwarz, H P; Dreisbach, Lorraine
Effect of physical and psychic stress on phosphatidyl glycerol and related phospholipids [download] [view]

Pontius, Edward B
Acute traumatic stress: guidelines for treating mass-casualty survivors from the Persian Gulf War [download]
National Center for PTSD Clinical Newsletter, Winter 1993, vol 3, iss 1, pg 1, 4-5

Schwartz, Linda Spoonster
Women in the military and women veterans [download]
National Center for PTSD Clinical Quarterly, Summer/Fall 1994, vol 4, iss 3/4, pg 14-15

Sharkansky, Erica J; King, Daniel W; King, Lynda A; Wolfe, Jessica; Erickson, Darin J; Stokes, Lynissa R
Coping with Gulf War combat stress: Mediating and moderating effects [download] [view]
Journal of Abnormal Psychology , May 2000, vol 109, iss 2, pg 188-197

Sloan, Patrick; Arsenault, Linda; McCormick, William A; Dunn, Stephen; Scalf, Laurene
Early intervention with Appalachian reservists in Operation Desert Storm [download]
National Center for PTSD Clinical Newsletter, Winter 1993, vol 3, iss 1, pg 6-7, 12

Southwick, Steven M; Morgan, Charles Andrew; Darnell, Adam; Bremner, J Douglas; Nicolaou, Andreas L; Nagy, Linda M; Charney, Dennis S
Trauma-related symptoms in veterans of Operation Desert Storm: a 2-year follow-up [download] [view]
American Journal of Psychiatry , August 1995, vol 152, iss 8, pg 1150-1155

Southwick, Steven M; Morgan, Charles Andrew; Nagy, Linda M; Bremner, J Douglas; Nicolaou, Andreas L; Johnson, David Read; Rosenheck, Robert A; Charney, Dennis S
Trauma-related symptoms in veterans of Operation Desert Storm: a preliminary report [download] [view]
American Journal of Psychiatry, October 1993, vol 150, iss 10, pg 1524-1528

Southwick, Steven M; Morgan, Charles Andrew; Nicolaou, Andreas L; Charney, Dennis S
Consistency of memory for combat-related traumatic events in veterans of Operation Desert Storm [download] [view]
American Journal of Psychiatry , February 1997, vol 154, iss 2, pg 173-177

Southwick, Steven M; Morgan, Charles Andrew; Rosenberg, Roberta
ocial sharing of Gulf War experiences: association with trauma-related psychological symptoms [download] [view]
Journal of Nervous and Mental Disease , October 2000, vol 188, iss 10, pg 695-700

Weisæth, Lars; Mehlum, Lars; Mortensen, Mauritz S
Peacekeeper stress: new and different? [download]
National Center for PTSD Clinical Quarterly, Winter 1996, vol 6, iss 1, pg 12-15

Wolfe, Jessica; Erickson, Darin J; Sharkansky, Erica J; King, Daniel W; King, Lynda A
Course and predictors of posttraumatic stress disorder among Gulf War veterans: a prospective analysis [download] [view]
Journal of Consulting and Clinical Psychology, August 1999, vol 67, iss 4, pg 520-528

Wolfe, Jessica; Kelley, John M
Following Desert Storm: the impact on men and women [download]
National Center for PTSD Clinical Newsletter, Winter 1993, vol 3, iss 1, pg 8-9, 12

Wolfe, Jessica; Kelley, John M; Bucsela, Maria L; Mark, William R
Fort Devens Reunion Survey: report of Phase I [download] [view]
Returning Persian Gulf troops: first year findings, Northeast Program Evaluation Center, 1992, pg 19-44

Wolfe, Jessica; Proctor, Susan P; Davis, Jennifer Duncan; Borgos, Marlana Sullivan; Friedman, Matthew J
Health symptoms reported by Persian Gulf War veterans two years after return [download] [view]
American Journal of Industrial Medicine, 1998, vol 33, iss , pg 104-113

Wolfe, Jessica; Sharkansky, Erica J; Read, Jennifer P; Dawson, Ree; Martin, James A; Ouimette, Paige Crosby
Sexual harassment and assault as predictors of PTSD symptomatology among U.S. female Persian Gulf War military personnel [download] [view]
Journal of Interpersonal Violence, February 1998, vol 13, iss 1, pg 40-57

Wood, Dennis Patrick; Sexton, John L
Self-hypnosis training and captivity survival [download] [view]
American Journal of Clinical Hypnosis, January 1997, vol 39, iss 3, pg 201-211


Andreasen, N. C. Acute and delayed posttraumatic stress disorders: a history and some issues. American Journal of Psychiatry 161:1321-1323, August 2004.

American Academy of Child and Adolescent Psychiatry. Child and adolescent mental health statistics Resources for Families, 2007.

American Psychiatric Association. Diagnostic Criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition, Treatment Revision, Washington, D.C., 2000.

Beals, J., Novins, D. K., Whitesell, N. R., Spicer, P., Mitchell, C. M., Manson, S. M. American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project Team. Prevalence of mental disorders and utilization of mental health Services in two American Indian reservation populations: mental health disparities in a national context. American Journal of Psychiatry 162: 1723-1732, September 2005.

Bryant, R. A., Harvey, A. G. Gender differences in the relationship between acute stress disorder and posttraumatic stress disorder following motor vehicle accidents. Australian and New Zealand Journal of Psychiatry 37(2): 226-229, April 2003.

Cahill, S. P. Counterpoint: evaluating EMDR in treating PTSD. Psychiatric Times 17(7), July 2000.

Davidson, J. R. T. Effective Management Strategies for Posttraumatic Stress Disorder. Focus 1: 239-243, 2003.

Davidson, J. R. T, Stein, D. J., Shalev, A. Y., Yehuda, R. Posttraumatic stress disorder: acquisition, recognition, course and treatment. Journal of Neuropsychiatry 16: 135-147, May 2004.

Davidson, J. R. T. Surviving disaster: what comes after the trauma? The British Journal of Psychiatry 181: 366-368, 2002.

Department of Mental Health and Developmental Disabilities. Initiatives promoting mental health, 2007.

Ferenc, M., Brown, E. B., Zhang, H., Koke, S. C., Prakash, A. Fluoxetine v. placebo in prevention of relapse in post-traumatic stress disorder. The British Journal of Psychiatry 181: 315-320, 2002.

Friedman, M. J. Acknowledging the psychiatric cost of war New England Journal of Medicine 351(1): 75-77, 7/1/04.

Friedman, M. J. Posttraumatic stress disorder among military returnees from Afghanistan and Iraq American Journal Psychiatry 163: 586-593, April 2006.

Holtzheimer, P. E., Russo, J., Zatzick, D., Bundy, C., Roy-Byrne, P. P. The impact of comorbid posttraumatic stress disorder on short-term clinical outcome in hospitalized patients with depression. American Journal of Psychiatry 162: 970-976, May 2005.

Kaminer, D., Seedat, S., Stein, D. J. Post-traumatic stress disorder in children. World Psychiatry 4(2): 121-125, June 2005.

Keane, T. M., Marshall, A. D., Taft, C. T. Posttraumatic stress disorder: etiology, epidemiology and treatment outcome. Annual Review of Clinical Psychology 2: 161-197, April 2006.

Kenardy, J. A., Spence, S. H., Macleod, A. C. Screening for posttraumatic stress disorder in children after accidental injury. Pediatrics 118: 1002-1009. 2006.

Knaevelsrud, C., Maercker, A. Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: a randomized controlled clinical trial. BioMed Central Psychiatry 7: 13, 4/19/07.

Lamarche, L. J., De Koninck, J. Sleep disturbance in adults with posttraumatic stress disorder: a review. Journal of Clinical Psychiatry 68(8): 1257-1270. August 2007.

Loo, C. M. PTSD among ethnic minority veterans. National Center for PTSD, 2007. Post traumatic stress disorder (PTSD). April 12, 2007.

Meiser-Stedman, R., Smith, P., Glucksman, W. Y., Dalgleish, T. parent and child agreement for acute stress disorder, post-traumatic stress disorder and other psychopathology in a prospective study of children and adolescents exposed to single-event trauma. Journal of Abnormal Child Psychology 35(2): 191-201. April 2007.

Mental Health News. Prevalence and Correlates of Post Traumatic Stress Disorder and Chronic Severe Pain in Psychiatric Outpatients. June 1, 2007.

McLean, L. M., Gallop, R. Implications of childhood sexual abuse for adult borderline personality disorder and complex posttraumatic stress disorder. American Journal of Psychiatry 160: 369-371, April 2003.

NARSAD. Post-traumatic stress disorder can damage children's brain development., 11/20/07.

NIMH. Post traumatic stress disorder: a real illness., 11/19/07.

Perilla, J. L., Norris, F. H., Lavizzo. Ethnicity, culture and disaster response: identifying and explaining ethnic differences in PTSD six months after hurricane Andrew. Journal of Social and Clinical Psychology 21(1): 20-45, March 2002.

Perrin, M. A., DiGrande, L., Wheeler, K., Thorpe, L., Farfel, M., Brackbill, R. Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers. American Journal of Psychiatry 164(9): 1385-1394, September 2007.

Pole, N., Best, S. R., Metzer, T., Marmar, C. R. Why are Hispanics at greater risk for PTSD? Cultural, Diversity and Ethnic Minority Psychology 11(2): 144-161, 2005.

Reeves, R. R. Diagnosis and management of posttraumatic stress disorder in returning veterans. Journal of the American Osteopathic Association 107(5): 181-189, May 2007.

Ruchkin, V., Schwab-Stone, M., Jones, S., Cicchetti, D. V., Koposov, R., Vermeiren. R. Is posttraumatic stress in youth a culture-bound phenomenon? A comparison of symptom trends in selected U.S. and Russian communities. American Journal of Psychiatry 162: 538-544, March 2005.

Ruzek, J. Coping with PTSD and recommended lifestyle changes for PTSD patients. National Center for Post Traumatic Stress Disorder, 5/22/07.

Schuster, M. A., Stein, B. D., Jaycox, L. H., Collins, R. L., Marshall, G. N., Elliott, M. N., Zhou, A. J., Kanouse, D. E., Morrison, J. L., Berry, S. H. A national survey of stress reactions after the September 11, 2001 terrorist attacks. New England Journal of Medicine 345(20): 1507-1512, 11/15/01.

Schoenfeld, F. B., Marmar, C. R., Neylan, T. C. Current concepts in pharmacotherapy for post traumatic stress disorder. Psychiatric Services 55: 519-531 May 2004.

Seng, J. S., Graham-Bermann, S. A., Clark, M. K., McCarthy, A. M., Ronis, D. L. Posttraumatic stress disorder and physical comorbidity among female children and adolescents: results form service-use data. Pediatrics 116(6): 767-776, December 2005.

Udwin, O., Boyle, S., Yule, W., Bolton, D., O'Ryan, D. Risk factors for long-term psychological effects of a disaster experienced in adolescence: predictors of post traumatic stress disorder. The Journal of Child Psychology and Psychiatry and Allied Disciplines 41: 969-979, 2000.

Wikipedia. Combat stress reaction., 11/13/07.

Wikipedia. Complex post traumatic stress disorder., 11/1/07.

Wu, P., Duarte, C. S., Mandell, D. J., Fan, B., Liu, X., Fuller, C. J., Musa, G., Cohen, M., Cohen, P., Hoven, C. W. Exposure to the World Trade Center attack and the use of cigarettes and alcohol among New York City public high-school students. American Journal of Public Health 96(5): 804-807, 2006.

Yehunda, R., Engel, S. M., Brand, S. R., Seckl, J., Marcus, S. M., Berkowitz, G. S. Transgenerational effects of post traumatic stress disorder in babies of mothers exposed to the World Trade Center attacks during pregnancy. The Journal of Clinical Endocrinology and Metabolism 90(7): 4115-4118, 2005


Access information on how to use and search the PILOTS Database, the largest interdisciplinary index to the worldwide literature on traumatic stress, which contains over 22,000 abstracts.


The information on this Web site is presented for educational purposes only. It is not a substitute for informed medical advice or training. Do not use this information to diagnose or treat a mental health problem without consulting a qualified health or mental health care provider.