Military PTSD: What is It How Is It Diagnosed

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Military PTSD What is It? How Is It Diagnosed
Treated?

• Jerry E Wesch, PhD
• Assistant OIC
• Warrior Combat Stress Reset Program
• CR Darnall Army Medical Center, Ft. Hood, TX

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PTSD Defined

• Post-Traumatic Stress Disorder
• After-affects of a traumatic event such as
• military combat
• natural disasters
• terrorist incidents
• serious accidents
• personal assaults such as rape
• Over-whelming mental/emotional impact
• Individualized unpredictable responses
• Can be Acute, Chronic or Delayed Reaction
• Can be one time event or repeated over time

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PTSD Defined

• PTSD event
• Actual, perceived or threatened death or serious
  injury
• Causing over-whelming emotional reaction
  involving
• intense fear, helplessness, hopelessness or
  horror
• PTSD 3 kinds of after-effects / experiences
• After the event is over individual is safe
• Re-experiencing
• Avoidance / Hyper-vigilance
• Hyper-Arousal

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COMBAT STRESS / PTSD

• Military Combat
• Unique environment
• Life / Death
• Longer time frames (12 15 months)
• Repeated deployments (3-6 common)
• History all wars, all times
• Native People Soul Loss
• Civil War Soldiers Heart
• WW1 Shell Shock
• WWII - Viet Nam Combat Fatigue
• 1/3 of combat soldiers (PTSD, TBI, Major
  Depression)

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PTSD Checklist, Military (PCL-M)
Note Score gt 40 Possible PTSD
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Combat PTSD Details

• 3 Potential Sources of After-effects
• Facts (Immediate stimuli)
• Feelings (Often afterwards)
• Judgments / Interpretations / After-action
• Hidden Aspects Dreams / Nightmares
• Flashbacks unique re-experiencing
• Reality changes and merges with current
• Triggers
• anxiety, memories or flashbacks

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Evolution of PTSD Symptoms

• May be mild or denied at first
• May be translated to anger or alcohol
• Excuses / redirection / hidden / No insight
• Often has a turning point
• After that I was not the same
• Insomnia, Nightmares, Anger, Triggers,
  Avoidance, Attention, Memory loss, Emotional
  Numbness, Loss of motivation, Anhedonia,
  Depression, Withdrawal, Relationship problems

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Disorders Of Extreme Stress

• New Proposal From Dr. Van der Kolk
• Emphasizes Complex PTSD / Extreme Events
• Adds characteristics including Disorders of
• Regulation of Affect Impulses
• Attention / Consciousness / Dissociation /
  Amnesia
• Self-Perception
• Relationships
• Somatization
• Systems of Meaning

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Resistence Stigma

• Soldiers with moderate to severe PTSD or mental
  health (MH) disorders often avoid seeking help
  for a variety of reasons
• Soldiers screened for moderate to severe MH
  disorders,
• 78 acknowledged MH symptoms,
• 42 expressed an interest in receiving help,
• 40 received some help, and
• only 20 actually received specialty care
• It is likely that many Soldiers Vets have PTSD
  symptoms or a PTSD disorder and are not seeking
  care

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Stigma

• Stigma of having a mental illness
• Weak or "damaged," feelings of shame and/or
  embarrassment.
• 61 strongly agreed that PTSD would harm career
• 43 would avoid them
• Old School Military Attitudes
• No such thing as PTSD weak, fakers (remember
  Gen Patton)
• Sometimes treated badly by command
• Changes in military culture are beginning
• Public image Homeless disabled Viet Nam Veteran
• Never get over it
• Dangerous, violent, unreliable, crazy
• Portrayal in movies

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mTBI Traumatic Brain Injury

• Impact Injury vs. Explosive blast wave
• Blast not the same as car wreck, ball bat or
  motorcycle
• Impact and contra-coup injuries
• Destruction of cells
• Long axonal shearing from compression / vibration
  effects
• Disconnection of connections between brain areas
• Loss of speed of cognition, decreased attention
• Symptoms of TBI immediately occurring following
  the event
• Dazed, seeing stars, disorientation, confusion,
  disorientation
• Ringing in ears (got your bell rung), blurred
  vision
• Loss of consciousnesslt30 min / memory confusion /
  amnesia
• Acute headache, dizziness, nausea/vomiting,
  balance disturbance
• Symptoms still persisting
• Headaches / coordination problems
• Short-term memory loss / Cognitive problems
• Concentration problems / loss of motivation
• Emotional labiality / impulsivity / irritability

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Traumatic Brain Injury (TBI)

• gt20 of combat soldiers with TBI sx (gt3 mil in
  USA)
• Treatments
• Medication
• Coping skills
• Cognitive rehabilitation
• Neurofeedback
• Complementary / Alternative Therapies
• Associated with increased PTSD
• Emotional impact of almost being killed
• Sights sounds
• Impact on others
• Potential repeat 24/7

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PTSD TBI Diagnosis

• Combat PTSD Assessment
• Psychological Interview
• Personality Testing / Symptoms
• Standard PTSD Questionnaires
• Collateral Evidence (Peers, Spouse, Commanders)
• mTBI Assessment
• Immediate on-going medical history (concussion)
• Neurological exam Imaging
• Neuropsychological Assessment
• Collateral Evidence (Peers, Spouse, Commanders)

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PTSD Treatments

• Time Recovery
• Medications
• Sleep
• Anxiety
• Depression
• Cognitive Therapy
• Exposure Therapy
• Individual Therapy
• Support Groups
• Mind / Body Relaxation

• Alternative Therapies
• Massage
• Bio-energy Therapies
• Yoga / Meditation
• EMDR / EFT
• Tai Chi
• Aromatherapy
• Music / Sound
• Neurofeedback

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Questions?jerry.wesch_at_amedd.army.mil(254)
288-4746