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Dealing With PostTraumatic Stress Disorder PTSD and Returning Veterans


Dealing With Post-Traumatic Stress Disorder (PTSD) and Returning Veterans ... over five years had great difficulty when Jane Fonda's name was mentioned. ... – PowerPoint PPT presentation

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Title: Dealing With PostTraumatic Stress Disorder PTSD and Returning Veterans

Dealing With Post-Traumatic Stress Disorder
(PTSD) and Returning Veterans
  • Dr. Stephen B. Springer, CPM, LPC
  • Texas State University
  • 512-245-2115

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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