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IN HONOR AND MEMORY OF
2,709,965 Who served in Vietnam
1,870 POW/MIA'S
58,226 who were KIA
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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. |
Contents:
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What If ? What
if you think you might be among those who have PTSD from your combat
General Information about PTSD and Trauma Below is a list of information currently available from the National Center for PTSD about the nature of trauma, PTSD, and the consequences of trauma. 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 for the publicWhat is Posttraumatic Stress Disorder? Answers basic questions about the signs and symptoms of PTSD, who gets it, how common it is, and what treatments are available Effects of Traumatic Experiences Common primary and secondary effects of trauma Posttraumatic Stress Disorder: An Overview A revised version of an overview of the subject from the Encyclopedia of Psychology Epidemiological Facts about PTSD Information about rates of PTSD in the United States among different populations Answers to frequently asked questions about posttraumatic stress disorder Managing Stress and Recovering from Trauma A brief guide to recognizing the symptoms of stress and managing traumatic stress Ten common reactions to trauma are described
Below is a list of information currently available from the National Center for PTSD specific to PTSD and trauma-related disorders in veteran populations. 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 sheetsGeneral InformationHelp 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 How Terroristic Acts May Affect Veterans Information for veterans and caregivers on how veterans may be particularly sensitive to the effects of terroristic acts and war Managing Stress and Recovering from Trauma: Facts and Resources for Veterans and Families A brief guide to recognizing the symptoms of stress and managing traumatic stress PTSD and Older Veterans Information for veterans of World War II 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 Female VeteransTraumatic Stress in Female Veterans Some findings from a National Study of Women Vietnam Veterans Non-white VeteransThe Legacy of Psychological Trauma from the Vietnam War for American Indian Military Personnel Utilizing data gathered from the large-scale VA Matsunaga study, describes the effects of trauma on American Indian veterans Utilizing data gathered from the large-scale VA Matsunaga study, describes the effects of trauma on Native Hawaiian and Japanese American veterans.
Stress
and Trauma Fact
Sheets: All of these feelings and reactions are normal and natural even though they may seem unusual and even though some are very different from others. We are all individuals. We all respond in our own unique way. The incident cannot be erased. The memory will always be a part of your life. Everyone moves at their own pace through the stages of crisis and healing. Everyone has their own clock. For some people, there may be ongoing problems. Possible Reactions:
What To Expect As Recovery Continues
Post-Trauma
Debriefing:
Depending
on the post-trauma incident and consequences, these are examples of
coping skills for debriefing participants.
What To Do About Flashbacks?
Skill Building For Survivors
Coping With Bereavement The loss of someone close, especially as a casualty during deployment or war, is one of life's most stressful events. It can leave you so numb that you have difficulty recognizing the reality of death or coping with its impact on your life.Even so, you're forced to deal with ideas that cause a great deal of pain. We know, for example, that a refusal to acknowledge "the facts of death" is a disservice to the dying and the living alike, but doing so forces the acknowledgment of how real this situation is, and it hurts. This fact sheet was not created to make the pain go away--unfortunately, nothing can do that for you--but to help you understand the intense emotions you're experiencing or are going to soon feel.
Background Bereavement literally means "being deprived by death." It describes a process all people go through when someone close dies. Each person experiences this process differently, but there are some characteristics common to most instances of bereavement:It doesn't progress in an orderly fashion. You probably won't find yourself moving systematically from one well-defined stage to another. Instead, you'll probably drift back and forth from what might best be described as overlapping, fluid phases of anger, denial and acceptance. It involves emotions and behavior that wouldn't be described as normal under other circumstances. While some people benefit from professional help to cope with their grief, you shouldn't automatically interpret emotions or acts as a sign that you're losing your sanity. It's frequently complicated. The initial numbness makes the later physical and emotional upheaval all the more frightening, or seem a sign of weakness but it is not. Grieving is a healthy, necessary process, and refusing to grieve may postpone inevitable reactions that build up into later crises. By design, bereavement is self-centered. You need all your energy to cope with your emotions. Resist the inclination to put your own needs aside in an effort to meet those of your family; a healthier idea would be to secure outside support and guidance from a mental health professional. The Experience Of Normal Grief
Feelings
- sadness, anger, guilt, anxiety, loneliness, helplessness,
hopelessness, shock, yearning, relief, and numbness.
Physical Sensations - hollowness in stomach, tightness in the chest, tightness in the throat, oversensitivity to noise, a sense of depersonalization, feeling short of breath, weakness in the muscles, lack of energy, dry mouth, and fatigue. Cognitions - disbelief, confusion, preoccupation, sense of presence, hallucinations, and dreams about the deceased. Behavior - sleep disturbance, appetite disturbance, social withdrawal, absent-minded behavior, avoiding or seeking out reminders of the deceased, sighing, restlessness, crying, and visiting places or carrying objects that remind the survivor of the deceased. Phases:
What Helps?
Effective
coping with bereavement really depends on your ability to mourn
properly. When a loved one dies, there are many things which will help
you cope better with the pain. Some examples include:
People who care: Family, friends, neighbors, colleagues, and strangers in a mutual support group who have "been there" can all offer support. A lifetime habit of close, caring relationships is the best possible preparation for bereavement. Understand the "facts of death." This is a particularly important in time of war. Knowing what to expect and knowing your options helps. Express your feelings--talk, be angry, weep. You are not alone; all grieving people need such outlets. Reach out for help. Others cannot always make the first move. They may be afraid of intruding on your privacy. Make your needs known. Seeking out a mutual support group in your community is a great first step. Keep in touch with your physician. Following your physician's advice can help you deal with physical side effects. Accept the inevitable. Some things in life, and certainly in war, have no basis in logic; they just happen. Accepting this can prevent much bitterness and self-blame. Don't rush into major life changes. Moving, changing jobs, or remarrying are too important to rush. This is no time to make major decisions. Your judgement may be poor and the changes are only likely to add to your stress. Wait a year. Make big decisions then. Introduce new relationships gradually and carefully--let them grow. If you find yourself in need of more assistance than friends and family can provide, contact your clergyperson or your physician. Your local Mental Health Association can also help you find the support you need. How To Help Those You Care About
Family
Members & Friends
War-Zone-Related Stress Reactions: What Veterans Need to Know A
National Center for PTSD Fact Sheet Traumas
are events in which a person has the feeling that he
or she may die or be seriously injured or harmed, or events in which
he or she witnesses such things happening to others. Traumatic
events are of course common in the war zone, but they are common in
the civilian world too, so that in addition to war zone experiences,
many military personnel will have experienced one or more traumatic
events in their civilian lives. When
they are happening, traumas often create feelings of intense fear,
helplessness, or horror. Often in the days and weeks that follow
trauma, there are longer-lasting stress reactions that can be
surprising, distressing, and difficult to understand. By
understanding their traumatic stress reactions better, Iraq War
veterans can become less fearful of them and better able to cope with
them. While reviewing the list of effects of trauma below, keep in
mind several facts about trauma and its effects:
Traumatic
war experiences often cause
many of the following kinds of (often temporary) reactions in
veterans: 1.
Unwanted
remembering or re-experiencing
Almost all veterans experience difficulty controlling
distressing memories of war. Although these memories are upsetting, on
the positive side, the memories provide an opportunity for the person
to make sense of what happened and gain mastery over the event. The
experience of these memories can include: · Unwanted distressing memories as images or other thoughts · Feeling like it is happening again (flashbacks) · Dreams and nightmares · Distress and physical reactions (e.g., heart pounding, shaking) when reminded of the trauma 2.
Physical
activation or arousal
The body's fight-or-flight reaction to a life-threatening situation
continues long after the event is over. It is upsetting to feel like
your body is overreacting or out of control. However, on the positive
side, these fight-or-flight reactions help prepare a person in a
dangerous situation for quick response and emergency action. Signs of
continuing physical activation, common following participation in war,
can include: · Difficulty falling or staying asleep · Irritability, anger, and rage · Difficulty concentrating · Being constantly on the lookout for danger (hyper-vigilance) · Being startled easily for example, when hearing a loud noise (exaggerated startle response) · Anxiety and panic 3. Shutting down: Emotional numbing When
overwhelmed by strong emotions, the body and mind sometimes react by
shutting down and becoming numb. As a result, veterans may have
difficulty experiencing loving feelings or feeling some emotions,
especially when upset by traumatic memories. Like many of the other
reactions to trauma, this emotional numbing reaction is not something
the veteran is doing on purpose. 4. Active avoidance of trauma-related thoughts and feelings Painful
memories and physical sensations of fear can be frightening, so it is
only natural to try to find ways to prevent them from happening. One
way that most veterans do this is by avoiding anything people, places,
conversations, thoughts, emotions and feelings, physical sensations
that might act as a reminder of the trauma. This can be very helpful
if it is used once in a while (e.g., avoiding upsetting news or
television programs). But when avoidance is used too much, it can have
two big negative effects. First, it can reduce veterans abilities to
live their lives and enjoy themselves, because they can become
isolated and limited in where they go and what they do. Second,
avoiding thoughts and emotions connected with the trauma may reduce
veterans abilities to recover from it. It is through thinking about
what happened, and particularly through talking about it with trusted
others, that survivors may best deal with what has happened. By
constantly avoiding thoughts, feelings, and discussions about the
trauma, this potentially helpful process can be short-circuited. 5. Depression Most
persons who have been traumatized experience depression. Feelings of
depression then lead a person to think very negatively and feel
hopeless. There is a sense of having lost things: one's previous self
(I'm not the same person I was), a sense of optimism and hope,
self-esteem, and self-confidence. With time, and sometimes with the
help of counseling, the trauma survivor can regain self-esteem,
self-confidence, and hope. It is important to let others know about
feelings of depression and, of course, about any suicidal thoughts and
feelings, which are sometimes a part of feeling depressed. 6. Self-blame, guilt, and shame Many
veterans, in trying to make sense of their traumatic war experiences,
blame themselves or feel guilty in some way. They may feel bad about
some thing(s) they did or didn't do in the war zone. Feelings of guilt
or self-blame cause much distress and can prevent a person from
reaching out for help. Therefore, even thought it is hard, it is very
important to talk about guilt feelings with a counselor or doctor. 7. Interpersonal problems Not
surprisingly, the many changes noted above can affect relationships
with other people. Trauma may cause difficulties between a veteran and
his or her partner, family, friends, or co-workers. Particularly
in close relationships, the emotional numbing and feeling of
disconnection that are common after traumatic events may create
distress and drive a wedge between the survivor and his or her family
or close friends. The
survivor's avoidance of different kinds of social activities may
frustrate family members. Sometimes, this avoidance results in social
isolation that hurts relationships. Others
may respond in ways that worsen the problem rather than help recovery.
They may have difficulty understanding, become angry with the veteran,
communicate poorly, and fail to provide support. Partners and families
need to participate in treatment; by learning more about traumatic
stress, they can often become more understanding of the veteran and
feel more able to help. Some
kinds of traumatic experiences (e.g., sexual assault) can make it hard
to trust other people. These
problems in relationships are upsetting. Just as the veteran needs to
learn about trauma and its effects, people who are important to him or
her also need to learn more. As the survivor becomes more aware of
trauma reactions and how to cope with them, he or she will be able to
reduce the harm they cause to relationships. 8. Physical symptoms and health problems Because many traumas result in physical injury, pain is often part of the experience of survivors. This physical pain often causes emotional distress, because in addition to causing pain and discomfort, the injury also reminds them of their trauma. Because traumas stress the body, they can sometimes affect physical health, and survivors may experience stress-related physical symptoms such as headaches, nausea or other stomach problems, and skin problems. The veteran with PTSD will need to care for his or her health, seek medical care when appropriate, and inform the doctor or nurse about his or her traumas, in order to limit the effects of the trauma.
Anniversary ReactionsMany people with PTSD notice that their symptoms seem to get worse at certain times of the year. Often these times of the year are anniversaries of particularly traumatic experiences - getting wounded, being shot down, or the death of a friend for example. During these times, feelings about the trauma can come up and be almost as strong as they were right after the event. Depression, anxiety, guilt, anger, intrusive thoughts, nightmares and other symptoms may all get worse, which can be particularly discouraging if your PTSD seemed to be improving. This is called an "anniversary reaction" and is very common in people who have been traumatized. You may notice that your symptoms seem to come and go but may not notice that there is a yearly or monthly pattern to this. Or, you may notice that your symptoms get worse at certain times of the year but not understand why. Often veterans with PTSD are not aware of connections between changes in their symptoms and traumatic events in their past. This can often worry people and cause them to feel out of control of their PTSD and hopeless about their recovery. It can be helpful to keep track of times when your symptoms seem to get worse and notice if there is any pattern to these changes. Do you tend to feel more depressed and have more nightmares around the end of the month, for example, or do you have more panic attacks and intrusive thoughts in the summer? If so, think back over your trauma and see if there are any connections. Were you wounded, attacked, or assaulted on the 28th of the month? Was a friend killed in July? If there are any connections there, you may be experiencing anniversary reactions. If you are someone who has anniversary reactions, there are things you can do to cope. Simply establishing the relationship between your trauma and your current symptoms can be a relief because you can then better understand your PTSD, predict when your symptoms are likely to get worse, and prepare for this in whatever ways work for you. Some suggestions for preparing for anniversary reactions are:
In
general, by recognizing anniversary reactions and taking steps to
cope, you can feel more in control of your PTSD rather than feeling
like your symptoms are controlling you. Below is a list of information currently available from the National Center for PTSD on anniversary reactions. 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 sheetsPublished Information by National Center for PTSD staffMorgan,
Charles Andrew; Hill, Susan; Fox, Patrick; Kingham, Peter; Southwick,
Steven M
Other Resources 9-11 ANNIVERSARY REACTIONS: An interview with Dr. Frank OchbergWebsite links: www.ptsdinfo.org
Techniques for Handling the Memories By
Sean Bennick, What Are Your Options?When dealing with flashbacks, there are actually three possible options. At the first sign of an oncoming flashback, you need to quickly determine which option you are choosing. The techniques used for each of these options are the same, but how you combine these techniques and the intensity with which you use them will vary to bring about each of the three. It is important to note that not all flashbacks can or will be Controlled or Escaped. If the triggering event is strong enough, the flashback may overwhelm every attempt made at Control or Escape. During these times, get yourself to the safest place you can and keep using the techniques to manage the Acceptance of the flashback. AcceptThe first option is to Accept the flashback at full intensity, and everything that comes with it. At first glance this looks like a ridiculous choice, but one of the reasons you have flashbacks in the first place is to help your mind process the information contained in the flashback. There are times that this is the best option because the information is going to come forward at some time anyway. So if the time and place are right, prepare yourself and try to control the flashback only enough to keep yourself safe. How do you know if the time and place are right? Well, there are several factors that may help indicate when it is safe enough to Accept a flashback at full force. The first of these is a safe environment, by safe I mean comfortable and comforting. This may be your bedroom, living room, or even your therapist's office. The second is the existence of a support person, or someone you can talk to afterwards if you need to. This could be a significant other, close friend or therapist. I have found that limiting the times I Accept a flashback at full force can significantly improve how I deal with the more devastating memories. ControlThe second option is to Control the flashback, or rather to make an attempt to diminish the effects of the flashback. In order to Control the flashback, you need to increase the effort you put into the coping techniques you have (or those listed at the bottom of this article). I find it useful to also continue to remind myself that I am safe and that I cannot be hurt. Controlling and Escaping flashbacks work by interrupting the thought processes involved in the flashback. Since flashbacks are basically electrical impulses within the brain, I look at this as short-circuiting the flashback process. When you have a song you don't particularly like stuck in your head, the only way to get rid of it is to hear a song you like and replace the thought that is keeping that song in your head. Short-circuiting a flashback is the same thing you are attempting to replace one thought process with another. Controlling is not the full replacement of a flashback but a redirection of the flashback onto a different and safer circuit. To do this, you will be using your coping tools to interrupt the thought process. You may need to interrupt the flashback several times to Control the impact, and it may take several efforts to cause a single interruption. Mixing your coping methods around and using them in combination are ways of intensifying the attempt at interruption. If your environment is familiar and you can feel safe, or if you are with someone who can give you a measure of safety, then Controlling the flashback may be the best option. EscapeThe final option is the Escape of the flashback. Again, remember that this may not always be possible, but never give up your attempts. Mix up your coping methods and combine them, try the more intense methods and try new methods. Escape is both tiring and difficult for me, but it can be done. One thing that you need to be aware of is that Escape is not permanent. By Escaping the flashback, you are simply putting it off until it is safe to process the information. You won't get to select when that reprocessing happens either. Once you Escape, get yourself to a safer place and calm yourself down. Taking NotesWhether you simply make mental notes or write down every detail about the flashback and what you did to cope, this is an important part of the process. The more information you have about your flashbacks, the better.
Having these notes can help create a better plan for flashback management. They can also help your therapist in helping you. Coping TechniquesNearly anything you can do to help cope with your flashbacks is a good thing. I say nearly everything because anything that does harm to yourself or another person is simply inexcusable in my opinion. I feel I have a right to say this because like many out there with PTSD, I resorted to self-injury in an attempt to deal with some of the memory I recovered. Not only was self-injury ineffective, it put me in a very dangerous position. Resorting to causing yourself pain to cover other pain simply amplifies your agony. You may temporarily feel what you believe to be relief but once things return to normal and the flashback is gone, there is additional pain to deal with and at times, serious injury as well. I view Alcohol and Drugs the same way (with the exception of drugs prescribed by my own doctor or therapist). They may not do visible harm like cutting yourself, but the damage is done and the problems are compounded. Having said that, remember that if something works to help you cope and it is not harmful, then use it as often as you can. If this means that you need to hum the theme from Gilligan's Island over and over in public (which was surprisingly effective because I was attempting to recall the words as I was humming), then do so. Keep in mind that my explanations about why the techniques below work for me are based on my own understanding and may not be accurate. I can tell you that each of the ideas I suggest have worked for me and helped me cope with my own flashbacks for the past 5 years. When You Are AloneMemory Games One of the easiest ways to cope or manage a flashback is by distraction. Try to remember something challenging such as the lyrics to a particular song, or a favorite poem. This can help interrupt the flashback by redirecting the activity in your brain. For some reason, memory games work well when I am having flashbacks that involved my hearing and balance. Some of the more effective memory games I have used are:
Ice Cube This has been my most important tool in dealing with physically oriented flashbacks. The technique was actually taught to me by a Viet Nam Veteran who said he used it for every single flashback, adding "usually it helps, but sometimes it can't." I have found it to be effective to some degree almost every time I have tried it. The idea is simple, take a fairly large ice cube and hold it tight in one of your hands throughout the flashback. The cold feeling keeps that part of you grounded to some degree and the physical sensation gives you something solid to focus on besides the memory you are reliving. It is important to hold the ice cube fairly tight and in the same hand for the duration of the flashback. I experimented with switching hands and holding it lightly and the technique lost much of its effectiveness. I always use this technique in addition to some of the others when attempting to Escape or Control. Wall Spotting This technique involves selecting 4 or 5 brightly colored items in the room that are easily within vision and moving your focus between them. Make sure to vary the order and allow yourself to lock onto the items briefly before shifting to the next item. Keep this up throughout the flashback and continue for a short time afterwards. Following the same pattern can actually cause you to become more involved in the flashback because your mind becomes used to the pattern and builds on it. By varying the pattern, you disrupt the thought processes involved in the flashback. I suggest continuing the eye movements for a while after the flashback ends to allow yourself to get more focused on the present since I use this technique mostly for flashbacks with a visual element. Cold Water on Your Face This one is simple and can help with any type of flashback. This idea is one of the first ones any of us find that helps. Remember that it can continue to help. Try and use water cold enough to give yourself a good shock. There is a bit more evidence on why this works, it is called the "Mammalian Diving Reflex" or simply the "Diving Reflex" and relies on the fact that our bodies want to survive. Sudden immersion in very cold water (below 70 degrees) triggers the Diving Reflex. The body reacts by lowering the heart rate, increasing blood pressure, and shutting down circulation to all but the body's core. The result is a lowered metabolism that conserves energy, which helps cold water survival. This is also why near-drowning victims in cold water have a much higher survival rate. The effect on a flashback is fairly drastic. In short, the brain is shocked and interrupts the flashback to survive what may be a life-threatening immersion in freezing water. For this reason, make sure you use the coldest water available and use a good amount of it. When A Friend Is AvailableCounting This is a technique I came up with while assisting a friend with a panic attack. I call this Counting for lack of a better term. The idea, like most of the techniques above, is to confuse the mind and disrupt the thought processes. To do this, remember that random is good. Basically, your friend would make you repeat whatever they are saying and would start by following a predictable pattern. Throwing in random words breaks the pattern up and causes a brief disruption in the flashback. This can be very powerful against the more intense flashbacks and I tend to use it only when I am in great need. The sample below is meant to illustrate both why I call it counting and how it can work.
I am unsure why this has been effective, but I do know it will not work alone. If you are selecting the order, than the order is not random, there are no surprises. The surprises catch us off guard and our reaction of "One, Two, Three, Eight?" is often enough to lessen the impact of fairly intense flashbacks. ©
2001-2003 Sean Bennick. All Rights Reserved.
BiologyBelow is a list of information currently available from the National Center for PTSD about the psychophysiological and biological aspects of PTSD and trauma-related disorders. 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 for the publicPTSD and the Brain: What's New in Basic Research An interview with Ronald Duman, Ph.D., who is Director of the Laboratory of Molecular Pathogenesis and Treatment Mechanisms within the Clinical Neurosciences Division of the National Center for PTSD in West Haven, CT. PTSD Research at Fort Bragg: Prediction and Prevention An interview with Charles A. (Andy) Morgan III, M.D., who is Director of the Stress and Resilience Laboratory within the Clinical Neurosciences Division in West Haven, CT. The Problem of Dual Disorders: PTSD and Substance Abuse An interview with Ismene Petrakis, M.D., who is Director of the Dual Diagnosis (Substance Abuse) Laboratory of the Clinical Neursosciences Division in West Haven, CT. Other Related Topics
PTSD Information for Women's Medical Providers A fact sheet for medical providers working with women who have a history of sexual trauma Trauma, PTSD, and the Primary Care Provider What primary care providers should know about the effects of PTSD and trauma on mental and physical health Discussing Trauma and PTSD with Your Doctor A checklist to help one discuss traumatic stress symptoms with primary care physicians What is Posttraumatic Stress Disorder? Answers basic questions about the signs and symptoms of PTSD, who gets it, how common it is, and what treatments are available. 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.
For more information call the PTSD Information Line at (802) 296-6300 or send email to ncptsd@ncptsd.org. This page was last updated on Fri Oct 31 08:10:30 2003.
PTSD and Physical HealthA National Center for PTSD Fact SheetBy Kay Jankowsi, Ph.D.Exposure to traumatic events such as military combat, physical and sexual abuse, and natural disaster, can be related to poor physical health. Posttraumatic Stress Disorder (PTSD) is also related to health problems. This fact sheet provides information on the relationships between trauma, PTSD, and physical health; specific health problems associated with PTSD; health-risk behaviors and PTSD; mechanisms that help explain how PTSD and physical health could be related; and a clinical agenda to address PTSD and health. Before addressing these topics, it is necessary to provide some basic information about how existing studies have measured physical health. The most common way to measure physical health is by having people report about their own health conditions, symptoms, and overall physical health. Self-report measures of physical health can be valid indicators of actual illness, but they should be interpreted with caution because they may be influenced by psychological health. The most reliable measure of physical health involves a physician’s diagnosis or laboratory tests. Is psychological trauma related to physical health?A considerable amount of research has found that trauma has negative effects on physical health. The relationship is clearest when examining self-report of physical health problems and trauma experienced as a result of time in the military, sexual assault, childhood abuse, and motor vehicle accidents. Greater self-report of military trauma, sexual assault, childhood abuse, and motor vehicle accidents is related to greater self-report of health problems. However, when health status is measured by physician diagnosis, associations are not as consistent for military trauma and sexual assault in adulthood. There is, however, a probable association for survivors of natural disaster. Two recent studies found that reports of childhood abuse and neglect were related to an increase in physician diagnosed disorders including cancer, ischemic heart disease, and chronic lung disease. It is also likely that a relationship exists between the experience of a trauma and an increase in utilization of medical services for physical health problems. In addition, health care costs have been found to be higher among women who report a history of childhood abuse or neglect than among women who report no history of maltreatment as a child. What is the relationship between physical health and PTSD?A growing body of literature has found a link between PTSD and physical health. Some studies have found that PTSD explains the association between exposure to trauma and poor physical health. In other words, trauma may lead to poor health outcomes because of PTSD. When health problems are measured by self-report, there is a clear association with PTSD for veterans and active duty personnel, civilian men and women, firefighters, and adolescents. Those who report that they have PTSD symptoms are more likely to have a greater number of physical health problems than those who do not have PTSD. Similar results are found when physical health is measured by physician report or by laboratory tests. PTSD also has been found to be associated with greater medical service utilization for physical health problems. At present, however, an association between PTSD and illness via physician diagnosis and medical service utilization has only been examined in veteran populations. Further research is indicated to examine PTSD, physical illness, and medical service utilization in both veteran and other traumatized populations. Existing research has not been able to determine conclusively that PTSD causes poor health. Thus, caution is warranted in making a causal interpretation of what is presented here. It may be the case that something associated with PTSD is actually the cause of greater health problems. For example, it could be that a factor associated with PTSD, such as smoking, is the actual cause of the increased health problems. This is not likely, however, given that we know that PTSD is associated with poor physical health even when behavioral factors such as smoking are controlled. PTSD may promote poor health through a complex interaction between biological and psychological mechanisms. The National Center for PTSD and other laboratories around the world are studying these mechanisms. Current thinking is that the experience of trauma brings about neurochemical changes in the brain. These changes may have biological, as well as psychological and behavioral, effects on one’s health. For example, these neurochemical changes may create a vulnerability to hypertension and atherosclerotic heart disease that could explain in part the association with cardiovascular disorders. Research also shows that these neurochemical changes may relate to abnormalities in thyroid and other hormone functions, and to increased susceptibility to infections and immunologic disorders associated with PTSD. The psychological and behavioral effects of PTSD on health may be accounted for in part by comorbid depressive and anxiety disorders. Many people with PTSD also experience depressive disorders or other disorders. Depressed individuals report a greater number of physical symptoms and use more medical treatment than do individuals who are not depressed. Depression also has been linked to cardiovascular disease in previously healthy populations and to additional illness and mortality among patients with serious medical illness. PTSD also may be related to poor health through symptoms of comorbid anxiety or panic. The evidence linking anxiety to cardiovascular morbidity and mortality is quite strong, but the mechanisms are largely unknown. Hostility, or anger, is another possible mediator of the relationship between PTSD and physical health. It is commonly associated with PTSD and decades of research on the health risks associated with the Type A behavior pattern have isolated hostility as a crucial factor in cardiovascular disease. PTSD and poor health also may be mediated in part by behavioral risk factors for disease such as smoking, substance abuse, diet, and lack of exercise. Little is known about how coping and social support relate to health in PTSD, but it is likely that both play important roles. Further research is needed to better understand these potential protective factors. What specific health problems are related to PTSD?There is not a lot of information about what specific health problems are associated with PTSD. Many studies have not looked at specific health problems but instead report only the number of overall health problems associated with PTSD. Some studies have examined specific health problems, but these problems have been primarily self-reported. However, there is some evidence to indicate PTSD is related to cardiovascular, gastrointestinal, and musculoskeletal disorders. There is also one study with similar findings that evaluated physician diagnosed disorders and PTSD in relation to specific body systems. A number of studies have found an association between PTSD and poor cardiovascular health. These studies found that self-report of circulatory disorders and symptoms of cardiovascular trouble were each associated with PTSD in veteran populations, civilian men and women, and male firefighters. Among studies that have examined PTSD in relation to cardiovascular illness via physician diagnosis or laboratory findings, PTSD has been consistently associated with a greater likelihood of cardiovascular morbidity. In a recent study, researchers used electrocardiogram (ECG) findings to compare the cardiovascular function of Vietnam veterans with PTSD to the cardiovascular function of veterans without PTSD. After controlling for risk factors such as alcohol consumption, weight, current substance abuse, and smoking, in addition to controlling for current medication use, PTSD was found to be associated with nonspecific ECG abnormalities, atrioventricular conduction defects, and infarctions. Because the PTSD group in this study included only those veterans with severe PTSD, it is important to interpret this study with caution. It is unknown whether men with less severe PTSD would show the same ECG abnormalities. It is also important to be cautious about generalizing the findings in this study since there have been no studies specifically evaluating cardiovascular morbidity and PTSD in women. The gastrointestinal and musculoskeletal systems have also been shown to be associated with PTSD, but the relationship of PTSD to these two systems has not been as extensively researched as the relationship between PTSD and the cardiovascular system. The majority of the studies that have been conducted have gathered information about veterans, but a study of civilian young men and women found that there is a relationship between gastrointestinal symptoms and PTSD. Similarly, researchers found that PTSD was related to musculoskeletal symptoms among male firefighters. Additional research is needed to learn more about how these and other bodily system troubles may be related to PTSD. What is the agenda for clinical practice?One agenda for clinical practice is for mental-health workers to increase collaboration with primary and specialty medical care professionals in order to better address this relationship between PTSD and health problems. Medical personnel need to become more aware of the potential harmful effects trauma and PTSD can have on health. Specifically, it is important to screen for PTSD in medical settings. Studies of patients seeking physical-health care show that many have been exposed to trauma and experience posttraumatic stress but have not received appropriate mental-health care. In answer to this problem, it might be useful to integrate PTSD treatment services with medical care services. http://www.ncptsd.org/facts/specific/fs_physical_health.html
Spiritual Healing And PTSDBy Philip G. Salois, M.S.NCP Clinical Quarterly 5(1): Winter 1995Twenty-five years ago, I was drafted and sent to Fort Ord to train as a combat infantry soldier. It certainly was no mystery to me or anyone else that I would end up in the jungles of Viet Nam. I served with a Light Infantry Brigade experiencing combat, the loss of a few friends, and the earning of a Silver Star for leading a rescue mission. I never sustained physical injury, but the war impacted my psyche and my soul. As a result of a battlefield promise made to God on March 1, 1970, I am an ordained Priest. Curiously, I had forgotten that promise made during intense battle, until two years into my seminary training four years later. And though I went into the seminary on my own free will and not under the obligation of fulfilling a promise, I have come to believe that God rescued me from the war for some special work or mission. This realization has not made the on-going work any easier, but it did provide the quiet strength I needed to begin my own long and painful pilgrimage of healing. I have been ordained 10 years now and as I hoped, I have had the opportunity to work with veterans. After five years of working with Vietnam veterans, I increasingly understand spirituality's significant role in the holistic picture of healing. The majority of Vietnam veterans were raised in Judeo-Christian families with a view of God as a father-image, that is, the strong, stern disciplinarian capable of inflicting severe punishment. In these families, the difference between right and wrong was clearly defined for children and it was defined within religious parameters. Adolescents going to war brought with them their adolescent concept of God. For many young soldiers, their concept of God was tested, challenged and potentially destroyed by the magnitude of evil all around them. In Vietnam, soldiers discovered that their concept of God did not provide answers or explanations for what they were going through. For many, the experience of the war shattered their religious concept of right and wrong. For many, the exposure to evil resulted in deep feelings of guilt and shame. The approach to spiritual healing with Vietnam veterans requires much care, and even caution, as many of these veterans view God as a helpless, non-caring outsider watching it all from His heavenly throne. Refounding Of The Sacred StoryMy work is to help the veteran to refound his or her sacred story. I make deliberate use of that word re-founding because for many their sacred story was lost on the battlefield. The process of re-founding of one's sacred story is one of a journey away from an adolescent view of God toward a more mature understanding of faith and God's role in the course of humanity. It begins with helping the veteran to discover where and when the connection was lost. This encounter is pre-requisite to any authentic reconciliation with God as knowledge and understanding must precede forgiveness and reconciliation. To help the process of reconnection, I have developed two interfaith healing services: one for male Vietnam veterans entitled "WELCOME HOME SERVICE," and one for women. The women' service, entitled "WOMEN OF FAITH/ WOMEN OF VALOR" has included veteran and civilian women who served in Vietnam, Vietnamese women, as well as wives, widows, and mothers of veterans. In each service the altar holds various artifacts to reflect aspects of the Vietnam experience. In the past I have used The Book of Names (on The Wall), a replica of the The Wall; a replica of the Three Service Men Statue; an actual piece of the Hanoi Hilton, framed pictures of the Eight Viet Nam Nurses whose names are on The Wall and other religious and patriotic symbols as well. Combining the power of ritual and symbol, there are many activities that can aid veterans spiritual healing process. My own personal healing has included visits to the Vietnam Veterans Memorial "The Wall' in Washington, DC bringing flowers, letters and taking a rubbing of a name; a return to Vietnam with other veterans for the purpose of healing; a visit to the parents and grave of my buddy who was killed in 'Nam (recounting the events of his death proved healing for his parents as well). I am not recommending that other veterans pursue this same path. There are hundreds of creative ways for veterans to receive healing from writing to participating in Sweat Lodges. Every veteran must find the form of healing appropriate to their experience and ability. My role is to help them discover the options available to them. It is crucial that something in the form of a spiritual healing take place. Disillusioned veterans need to regain the capacity to hope- - HOPE IN THEMSELVES - IN LIFE - IN OTHERS - IN GOD. As someone said - we might have to hope for the Vet until he or she can begin to hope for himself. FATHER PHILIP G. SALOIS, M.S. is the Chief, Chaplain Service at Boston VAMC. President, National Conference of Vietnam Veteran Ministers, National Chaplain, Vietnam Veterans of America. Fr. Salois served in the US Army in Vietnam from 1969-1970 as a combat infantryman with the 199th Light Infantry Brigade-earning many decorations including the Silver Star.
Trauma
And Dissociation
Recent empirical studies have supported a strong relationship among trauma, dissociation, and per-sonality disturbances. Herman and colleagues (1989) found a high prevalence of traumatic histories in patients with borderline personality disorder. A pro-found relationship has been reported for childhood trauma and multiple personality disorder (MPD). Kluft (1993) proposes that the dissociative processes that underlie multiple personality development con-tinue to serve a defense function for individuals who have neither the external nor internal resources to cope with traumatic experiences. Coons and Milstein (1986) reported that 85% of a series of 20 MPD patients had documented allegations of childhood abuse. Simi-lar observations have been made by Frischholz (1985) and Putnam and colleagues (1986), who reported rates of severe childhood abuse as high as 90% in patients with MPD. The nature of the childhood trauma in many of these cases is notable for its severity, multiple elements of physical and sexual abuse, threats to life, bizarre elements, and profound rupture of the sense of safety and trust when the perpetrator is a primary caretaker or other close relationship. Peritraumatic Dissociation. The studies reviewed clearly demonstrate the relationship between trau-matic life experience and general dissociative response. One fundamental aspect of the dissociative response to trauma concerns immediate dissociation at the time the traumatic event is unfolding. Trauma victims not uncommonly will report alterations in the experience of time, place, and person, which confers a sense of unreality of the event as it is occurring. Dissociation during trauma may take the form of altered time sense, with time being experienced as slowing down or rapidly accelerated; profound feelings of unreality that the event is occurring, or that the individual is the victim of the event; experiences of depersonalization; out-of-body experiences; bewilderment, confusion, and disorientation; altered pain perception; altered body image or feelings of disconnection from one¹s body; tunnel vision; and other experiences reflecting immediate dissociative responses to trauma. We have designated these acute dissociative responses to trauma as peritraumatic dissociation. Although actual clinical reports of peritraumatic dissociation date back nearly a century, systematic investigation has occurred more recently. Wilkinson (1983) investigated the psychological reponses of sur-vivors of the Hyatt Regency Hotel skywalk collapse in which 114 people died and 200 were injured. Survi-vors commonly reported depersonalization and derealization experiences at the time of the structural collapse. Holen (1993), in a long-term prospective study of survivors of a North Sea oil rig disaster, found that the level of reported dissociation during the trauma was a predictor of subsequent PTSD. Koopman and colleagues (1994) investigated predic-tors of posttraumatic stress symptoms among survi-vors of the 1991 Oakland Hills firestorm. In a study of 187 participants, dissociative symptoms at the time the firestorm was occurring more strongly predicted subsequent posttraumatic symptoms than did anxi-ety and the subjective experience of loss of personal autonomy. Peritraumatic
Dissociative Experiences Questionnaire. Based on the important
clinical and early research observations on peritraumatic dissociation
as a risk factor for chronic PTSD, we embarked on a series of studies
to develop a reliable and valid measure of peritraumatic dissociation.
We designated this measure the Peritraumatic Dissociative Experiences
Questionnaire (Marmar et al., 1996).In a first study with the PDEQ,
the relationship of peritraumatic dissociation and posttraumatic
stress was investigated in male Vietnam theater veterans (Marmar et
al.1994). In a first replication of this finding, the relationship of
peritraumatic dissociation with symptomatic distress was determined in
emergency services personnel exposed to traumatic critical incidents
(Weiss et al., 1995; Marmar et al., 1996). In a second replication,
the relationship of peritraumatic dissociation and posttraumatic
stress was investigated in female Vietnam theater veterans (Tichenor
et al., 1994). Across the four studies, the PDEQ has been demonstrated
to be internally consistent, strongly associated with measures of
traumatic stress response, strongly associated with a measure of
general dissociative tendencies, strongly associated with level of
stress exposure, and unassociated with measures of general
psychopathology. These studies support the reliability and convergent,
discriminant, and predictive validity of the PDEQ. Strengthening these
findings are two independent studies utilizing the PDEQ by
investigators in other PTSD research programs. Bremner and colleagues
(1992), utilizing selective items from the PDEQ as part of a measure
of peritraumatic dissociation, reported a strong relationship of
peritraumatic dissociation with posttraumatic stress response in an
independent sample of Vietnam War veterans. In the first prospective
study with the PDEQ, Shalev and colleagues (1996) examined the
relationship of PDEQ ratings gathered in the first week following
trauma exposure to posttraumatic stress symptomatology at 5 months. In
this study of acute-physical-trauma victims admitted to an Israeli
teaching hospital emergency room, PDEQ ratings at 1 week predicted
stress symptomatology at 5 months, over and above exposure levels,
social supports, and Impact of Event scores in the first week. This
study is noteworthy in that it is the first finding with the PDEQ in
which ratings were gathered prospectively. Mechanisms
for Peritraumatic Dissociation. The strong replicated
findings relating peritraumatic dissociation to subsequent PTSD raise
theoretically important questions concerning the mechanisms that
underlie peritraumatic dissociation. Speculation concerning
psychological factors underlying trauma-related dissociation date back
to the early contributions of Breuer and Freud (1895/1955). In their
formulation,traumatic events are actively split off from conscious
experience but return in the disguised form of symptoms. The
dissociated complexes have an underground psychological life, causing
hysterics to "suffer mainly from reminiscences." Janet
(1889) proposed that trauma-related dissociation occurred in
individuals with a fundamental constitutional defect in psychological
functioning, which he designated la misere
psychologique. Janet proposed that normal individuals have
sufficient psychological energy to bind together their
The purpose of this glossary is to provide definitions for the frequently used terms in the field of traumatic stress disorders. The anticipated audience is diverse, ranging from mental health professionals to consumers of mental health services and their families. Because of this diversity, we have included general mental health terms for those unfamiliar with psychological literature. The goal is to provide a common vocabulary and common meanings for both general psychiatric and trauma disorder terms
The
Sidran Institute, a leader in traumatic stress education and advocacy,
is a nationally-focused nonprofit organization devoted to helping
people who have experienced traumatic life events.
Compassion Treatments for Abuse. http://www.compassionpower.com/ is where you can find out about compassion treatments for abuse. the usual shaming and blaming treatment for abusive men is 28% effective, and that is based on the man not getting arrested again in the same precinct in the next yr, which is pathetic. Dr. Stosny's compassion treatment for abusive guys is 87% effective by VICTIM report on court ordered batterers. Anyone who lashes out can use it. I use his HEALS technique myself on bad feelings so that I don't lash out or get superior. It hurts to be put down, but the way to heal it is to develop compassion for myself, and then for others. It is empowering to feel compassion, and it helps me not be a victim. Here is my article on HEALS from Vol 2, No 1 (Issue 7) of the Post Traumatic Gazette (Solace for the Self) copyright 1996 by Patience H C Mason reprinted with permission: Please visit www.patiencepress.com HEALS: A Useful Acronym for Self-Soothing by Patience Mason Steven Stosny’s HEALS acronym is a valuable resource for anyone who has been traumatized. Developed to help violent men replace the temporary high of violence with something that feels better: compassion, it was first used it in a maximum security prison with men who had each killed more that four people. It is currently used in programs for batterers. People who go through this program are 87% violence free after a year by victim report. It is also very helpful to victims who are not good at having compassion for themselves. He’s given me permission to use it in the newsletter, so here goes: "H" is for HEALING. Visualize this word in flashing neon letters as a thought stopper when you start to feel the first prickles of painful emotional arousal whether it is anger or another emotion. Stosny developed this with anger in mind, but it can also work for paralyzing waves of shame and despair. I’ve flashed HEALING many times in the last month when I realized the March/April issue would come out in May! Late again. The image of the word stimulates the natural healing capacity of the body and is “incompatible...[with] shame, anxiety, anger, hostility, and aggression. Since the brain cannot think ‘healing’ while hurting, it must switch programs to respond to your command to heal.” "E" stands for Explain to yourself. Here you acknowledge the lowest of the painful feelings you are experiencing using a list Dr. Stosny developed: disregarded unimportant accused: guilty or mistrusted devalued rejected powerless unlovable Say “I feel disregarded (or whatever).” Say it slowly and feel it for about 20 seconds. If you don’t feel it, you can’t heal it! Each time you feel this feeling, your sensitivity to its pain will go down and your tolerance for it will go up. It is like a vaccination against the power of painful feelings. Instead of controlling you, you can deal with them. "A" stands for Applying self compassion to change the meaning of having that feeling. This is the most important part because you train yourself to change patterns which you have internalized over a lifetime, patterns that tell you you really are no good unless you feel good, that you are no good unless someone else validates you. This is false information. Nothing someone else does or doesn’t do makes you unimportant, unlovable, unacceptable, or unworthy. This is particularly important for trauma survivors because they tend to assume responsibility for what happened to them, whether it’s a veteran saying I should have known about the ambush or an incest survivor believing s/he caused the abuse. [or a wife thinking she caused or deserves verbal abuse--(new addition to the article for this post. P.M.)--which is caused by a veteran's efforts to avoid thoughts or feelings associated with the trauma, usually shame and guilt, by blaming her! It has a momentary effect, but it doesn't last.] Here you learn to question the validity of the negative meaning your mind habitually supplies you with. HEALS also strengthens your boundaries. Say to yourself, “Does this external event or the behavior of that person mean that I’m unimportant, not valuable, unlovable?” Don’t question the feeling which is valid, question the meaning that attaches itself to that feeling, question whether feeling bad means you are bad. Feelings are real, but they don’t necessarily reflect reality. ”As you heal these feelings by rejecting false meaning about yourself, you will no longer need anger, anxiety and obsessions to avoid them.” YES! Stosny says the worst an external event can mean about you is that you made a mistake. That doesn’t mean you are a mistake! [And someone calling you names means they are having a bad day and have no other resources to feel better, and isn't that pathetic...P M] "L" stands for LOVE YOURSELF. Give yourself compassion. Feel compassion for yourself and others. Stosny writes: “To make yourself invulnerable to the core hurts, make yourself feel compassion.” Say to yourself: “I feel disregarded, but I am regarding myself, so the fact that whoever is not regarding me is okay. I can give myself the attention I need, the importance I need, the acceptance I need, the love I need, [The respect I need--PM] whichever of the emotions in the list applies. I suggest going through the whole list at first because they all seem to apply to me. Stosny suggests finding the lowest one on the list that applies and that works for me, too. It’s a good way to learn about and experience feelings in small bursts. Experiencing bad feelings and changing what they mean about you is preferable to avoiding them (ie emotional numbing), because it is so empowering. Being able to tolerate the pain means you have a pause button and can choose how to act instead of reacting in old patterns. I think HEALS parallels what happens when an understanding parent comforts a small child and leads him or her through handling a feeling: H= There, there. E= Johnny hit you and it hurt. A=When someone hits you, you don’t deserve to be hit. You didn’t make him hit you. L=You are a good kid. S= Solution: we’ll go play somewhere else till Johnny can control himself. When a caregiver gives you compassion, you develop it yourself. When you get ‘shut up or I’ll give you something to cry about,’ you don’t learn how to handle feelings, you learn to stuff them. "S" stands for SOLVE THE PROBLEM. Stosny believes “the skill of using self-compassion to heal the hurt that causes anger and anxiety must be learned before you are able to employ your full potential to solve problems...your concerns, opinions, and desires about a problem are...valid and important, but you will not be able to communicate their validity and importance until you have regulated anger and anxiety. Otherwise you will tend to blame, accuse, and attack, which is the surest way to get people to disagree with you and disregard you, no matter how valid and important the content of your opinions.” Ironically, that’s exactly how batterers respond to victims and their advocates in the battered women’s movement. They dismiss valid concerns because of the way they are expressed. Would you rather be right or effective? Once you have learned HEALS, anyone can learn to make classic non-blaming I statements, calmly and compassionately, and work through problems. “With repetition and practice, connections between the core hurts and higher healing thought processes replaces [the earlier learned] connections to hurts, anger, guilt, shame, obsessions and depression.” Stosny recommends practicing this system every day, many times a day (twelve or more) till it is automatic. Don’t wait till you’re in a rage or in the depths of despair to practice it. It works like pushups or shooting baskets or any other skill. Practice makes it work.
Resolution Of Traumatic Grief In Combat Veterans By Jeffrey Brandsma, Ph.D. and Lee Hyer, Ph.D. NCP Clinical Quarterly 5(2/3): Summer 1995
The Role Of Comorbid Social Phoibia By Susan M. Orsillo, Ph.D. NCP Clinical Quarterly 7(3): Summer 1997
Suggestions For Treatment
Conclusions
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 events)........................................... 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
Global Assessment of Functioning (GAF) DSM-IV SUMMARY TABLE
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.
VA Compensation and Pention Exam (PTSD) Initial Evaluation for Post-Traumatic Stress Disorder (PTSD)# 0910 Worksheet
A. Identifying Information: B. Sources of Information: C. Review of Medical Records: D. Examination (Objective Findings): Address each of the following and fully describe: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:F. Assessment of PTSD G. Psychometric Testing Results H. Diagnosis: I. Diagnostic Status 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.)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?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
Writting
Your Stressor Letter
Coping with PTSD and Recommended Lifestyle Changes for PTSD PatientsA National Center for PTSD Fact SheetBy Joe Ruzek, Ph.D.Coping with PTSDBecause 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 ControlThose 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:
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.
Palo
Alto Health Care Systems' site has much useful information on
how to cope and live with PTSD
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.
Specialized PTSD Treatment Programs in the U.S. Department of Veterans AffairsA National Center for PTSD Fact SheetThe 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.
THE ENDLESS TOUR: VIETNAM, PTSD and the SPIRITUAL VOID By
Rev.
Amy L. Snow, M.A...
www.trafford.com/robots/02-0383.html - Rev. Amy L.
Snow, M.A., author
What is P.T.S.D United Kingdom Site (excellent) The Ex-Services Mental
WelfareSociety, COMBAT STRESS, exists toserve ex service personnel. For
over 80 years, they have been the only services charity specialising
inhelping those of all ranks from the
Active Duty MilitaryBelow 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 sheetsOther Related TopicsHelp 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 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.
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