Military Service Members

Transcription

1 Military Service Members Amanda Peterson, Sheridan Sylvester, Kirstie Leavitt

2 Table of Contents Post Traumatic Stress Disorder.. 3 Definition. 3 Diagnosis & Symptoms.. 3 Specific Needs. 5 Effective Treatment Options. 6 Military Sexual Trauma.. 7 Definition.. 7 Diagnosis. 8 Specific Needs. 9 Specific tests, equipment, medication. 9 Polytrauma.. 9 Definition.. 9 Diagnosis. 9 Specific Needs 10 Specific tests, equipment, medication 10 TR implications for Trauma. 11 Resources for Trauma...11 Amputees Definition.13 Diagnosis & Symptoms.14 Specific Needs 14 Specific tests, equipment, medication 15 TR Implications..15 Resources

3 Post Traumatic Stress Disorder Definition Post traumatic stress disorder, otherwise knowns as PTSD is an anxiety disorder that may develop after exposure to a terrifying event or ordeal in which severe physical harm occurred or was threatened. This event caused fear to overwhelm the individual which brings out the fight-or-flight response. This response is in us as a protection. When we enter a dangerous situation, we need to take care of ourselves; thus, fight or flight. This response was triggered in the individual and symptoms were left behind. Most individuals that have traumatic experiences like those in war recover naturally from these experiences. Some do not. These individuals who do not recover suffer. They may be diagnosed with PTSD in the future, but not all of them decide to be officially diagnosed and live their lives trying to overcome it themselves. PTSD has affected many people in the world. For those in the United States, statistics have been given: Those who serve in Operation Iraqi Freedom and Enduring Freedom, about of every 100 veterans have PTSD each year. Those who served in the Gulf War, about 12 of every 100 veterans is affected each year Those who served in the Vietnam War, about 30 of every 100 veterans were affected in their lifetime This is not a disorder that only affects some. It affects many people. The hardest part, is that sometimes it s hard to see it. Diagnosis & Symptoms PTSD used to be considered a type of anxiety disorder and the DSM-5 was moved into a new category: Trauma and Stress-related Disorders. This could help destigmatize PTSD since it is no longer an anxiety related mental illness, but a disorder connected to an external event. The criteria for PTSD include specifying qualifying experiences of traumatic events, four sets of symptom clusters, and two subtypes. There are also requirements around duration of symptoms, how it impacts one s functioning, and ruling out substance use and medical illnesses. Also, there is now a preschool diagnosis for PTSD, so the following description is for people ages 7 and older. Criterion A: Traumatic event Trauma survivors must have been exposed to actual or threatened: 3

4 death serious injury sexual violence The exposure can be: direct witnessed indirect, by hearing of a relative or close friend who has experienced the event indirectly experienced death must be accidental or violent repeated or extreme indirect exposure to qualifying events, usually by professionals non-professional exposure by media does not count Many professionals who work in trauma differentiate between big T-traumas, the ones listed above, and little-t traumas. Little-t traumas can include complicated grief, divorce, non-professional media exposure to trauma, or childhood emotional abuse, and clinicians recognize that these can result in post-traumatic stress, even if they don t qualify for the PTSD diagnosis. There is no longer a requirement that someone had to have an intense emotional response at the time of the event. This requirement excluded many veterans and sexual assault survivors in the past. Criterion B: Intrusion or Re-experiencing These symptoms envelope ways that someone re-experiences the event. This could look like: Intrusive thoughts or memories Nightmares related to the traumatic event Flashbacks, feeling like the event is happening again Psychological and physical reactivity to reminders of the traumatic event, such as an anniversary Criterion C: Avoidant symptoms Avoidant symptoms describe ways that someone may try to avoid any memory of the event, and must include one of the following: Avoiding thoughts or feelings connected to the traumatic event Avoiding people or situations connected to the traumatic event Criterion D: Negative alterations in mood or cognitions This criterion is new, but captures many symptoms that have long been observed by PTSD sufferers and clinicians. Basically, there is a decline in someone s mood or thought patterns, which can include: Memory problems that are exclusive to the event Negative thoughts or beliefs about one s self or the world Distorted sense of blame for one s self or others, related to the event Being stuck in severe emotions related to the trauma (e.g. horror, shame, sadness) Severely reduced interest in pre-trauma activities Feeling detached, isolated or disconnected from other people Criterion E: Increased arousal symptoms 4

5 Increased arousal symptoms are used to describe the ways that the brain remains on edge, wary and watchful of further threats. Symptoms include the following: Difficulty concentrating Irritability, increased temper or anger Difficulty falling or staying asleep Hypervigilance Being easily startled Criteria F, G and H These criteria all describe the severity of the symptoms listed above. Basically, they have to have lasted at least a month, seriously affect one s ability to function and can t be due to substance use, medical illness or anything except the event itself. Subtype: Dissociation Dissociation has now been set apart from the symptom clusters, and now its presence can be specified. While there are several types of dissociation, only two are included in the DSM: Depersonalization, or feeling disconnected from oneself Derealization, a sense that one s surroundings aren t real Specific Needs People with PTSD often have many other problems that are connected to their PTSD. Common problems include avoidance, substance abuse, depression, sleep problems, and suicidal thoughts. Some people with PTSD may also have a Traumatic Brain Injury and/or chronic pain. To learn more about each of these common problems and how they relate to PTSD, follow the link below. Many soldiers return home and do not get the help and treatment they need because they are afraid of being seen differently or as weak by their friends, family, and fellow soldiers. Therefore, it is important that they are surrounded by people who are supportive and encourage them to get the help that they need. Family relationships also commonly struggle when a family member has PTSD. Some families with a family member with PTSD, participate in family therapy to help rebuild and strengthen their relationships. How people with PTSD can help themselves ml Importance of high quality care: Other resources for additional PTSD information 5

6 Effective Treatment Options There are many options available for treatment of PTSD. Often those experiencing PTSD have a difficult time telling others how they feel and keep their feelings bottled up. Talking with a therapist can help people with PTSD heal. Cognitive behavioral therapy (CBT) has been shown to be the most effective type of counseling for veterans with PTSD, specifically Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy. Eye movement desensitization and reprocessing (EDMR) has also been used for PTSD, although there is some controversy to its effectiveness and how it works. Lastly, there are medications available to treat PTSD. Cognitive Therapy In cognitive therapy, a therapist helps you understand and change how you think about trauma and its aftermath. The goal is to understand how certain thoughts about trauma cause you stress and make your symptoms worse. Patients learn to identify thoughts about the world and themselves that make them feel afraid or upset. With the help of the therapist, they learn to replace these thoughts with more accurate and less distressing thoughts. Patients also learn ways to cope with feelings such as anger, guilt, and fear. After a traumatic event, some might blame themselves for things they couldn't have changed. For example, a soldier may feel guilty about decisions he or she had to make during war. Cognitive therapy, a type of CBT, helps one understand that the traumatic event lived through was not their fault. Exposure Therapy In exposure therapy, the goal is to have less fear about memories. It is based on the idea that people learn to fear thoughts, feelings, and situations that remind them of a past traumatic event. By talking about trauma repeatedly with a therapist, patients learn to get control of their thoughts and feelings about the trauma. They will learn that they do not have to be afraid of their memories. This may be hard at first. But over time, patients will begin to feel less overwhelmed as they relive their trauma. Often, patients will begin talking about less upsetting things before talking about worse memories, called desensitization. This helps people deal with bad memories little by little. On the other hand, a therapist may use a technique called flooding which involves remembers a lot of bad memories all at once to help people learn not to feel overwhelmed. Therapists may also teach different relaxation skills to use when patients experience a stressful situation. 6

7 EMDR Eye movement desensitization and reprocessing (EMDR) is another type of therapy for PTSD. Like other kinds of counseling, it can help change how people react to memories of trauma. During EMDR, the patient will think or talk about their memories while focusing on other stimuli like eye movements, hand taps, and sounds. For example, the therapist will move his or her hand, and the patient will follow this movement with your eyes. Experts are still learning how EMDR works, and there is disagreement about whether eye movements are a necessary part of the treatment. Medication Although several medications are available, SSRIs have been found to be most common and most effective with the treatment of PTSD. Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant medicine. These help people feel less sad and worried. They appear to be helpful, and for some people they are very effective. SSRIs include citalopram (Celexa), fluoxetine (such as Prozac), paroxetine (Paxil), and sertraline (Zoloft). Chemicals in the brain affect the way people feel. For example, when you have depression you may not have enough of a chemical called serotonin. SSRIs raise the level of serotonin in your brain. Military Sexual Trauma Definition Military Sexual Trauma (MST) is a psychological trauma resulting from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the Veteran was serving on active duty, active duty for training, or inactive duty training. On a more basic level, it is sexual activity against one s will that leaves a psychological trauma behind. These individuals are Pressured into activities To receive promotions Threats of negative consequences Promise of better treatment When intoxicated Physically forced The receiving end of offensive sexual remarks Both women and men 7

8 1 in 4 women are affected 1 in 100 men are affected These are only the people that have chosen to speak out Something interesting about MTS is that it is an experience, not a diagnosis or a mental health condition. Thus, it is treated differently than mental health conditions. Mentalhealth.va.gov/msthome.asp Diagnosis Individuals who experience MTS show many things that could be qualified as part of a diagnosis. Strong Emotions depression; intense, sudden emotional responses; feelings or anger; irritable all the time Numbness emotionally numb, have a hard time feeling love and happiness Trouble sleeping hard time falling and staying asleep, nightmares Attention, concentration and Memory difficulties hard time staying focused, mind wandering, difficulty remembering things Alcohol and drugs daily drinking or drug use, intoxication or high to cope with memories and emotional reactions, drinking to fall asleep Difficulty feeling safe, going out of their way to avoid reminders of MST experience Difficulties with relationships feelings of isolation and disconnectedness, abusive relationships, hard time with employers or authority figures Physical health problems sexual difficulties, chronic pain, weight and eating problems, gastrointestinal problems Panic Attacks STDS Sexual dysfunction Transfer requests when on active duty All of these symptoms show that MTS might be an experience that this individual has faced. However, many may show some of these symptoms that have not suffered a MTS experience. Aside from these symptoms, the most common symptoms that are related to MTS are PTSD, depression, mood disorders, and substance abuse. The difficulty in diagnosing MTS is that all these symptoms can also come from a traumatic experience causing PTSD and other things. MTS is hard to diagnose because most individuals do not want to talk about it or are embarrassed to mention the experience. 8

9 ptsd.va.gov/public/types/violence/military-sexual-trauma-general.asp Specific Needs The needs of a victim of a MST experience vary based on every case and every individual. Many different Individuals suffer from different experiences based on their past experiences. Different reactions are based on: If there is prior trauma history How others reacted at the time or the responses they received from others during the MST experience Whether it happened only once or was repeated. Based on these different experiences, needs change. Many need therapy, medicine for depression or other help. It depends on the person and the difficulty they are having with the situation. Specific tests, equipment, medication, etc. Like mentioned in the specific needs section, each individual is different. If they suffer from depression, they need depression medication. If they suffer from PTSD, there are certain therapies that are especially for them. Since MST is an experience, different things will happen with each individual, so their medication or needs will be different. Definition Polytrauma Polytrauma occurs when a person experiences injuries to multiple body parts and organ systems often, but not always, as a result of blast-related events. TBI frequently occurs in polytrauma in combination with other disabling conditions, such as amputation, burns, spinal cord injury, auditory and visual damage, spinal cord injury (SCI), post-traumatic stress disorder (PTSD), and other medical conditions. Due to the severity and complexity of their injuries, Veterans and Service Members with polytrauma require a high level of integration and coordination of clinical care and other support services. Diagnosis Diagnosis of polytrauma depends greatly on the individual and their circumstances because there are a variety of injuries that can result from a traumatic 9

10 event, including a TBI (traumatic brain injury). It is important that victims of polytrauma are assessed thoroughly by a number of medical professionals. Specific Needs Victims of polytrauma require an extensive plan and care team to help them recover and to be able to be a part of society again following their injuries. The U.S. Department of Veteran Affairs has implemented a very thorough program to help veterans with polytrauma. Optimal care for TBI and polytrauma is delivered by compassionate, experienced, interdisciplinary teams of specialty clinicians with a holistic approach and an emphasis on patient and family engagement. Dedicated interdisciplinary teams (IDT) of rehabilitation specialists participate in the assessment, planning, and implementing the plan of care for each Veteran and Service Member enrolled in rehabilitation care in the PSC. Depending on the needs of the person served, the IDT may include physiatry, nursing, social work, psychology, physical therapy, occupational therapy, speech-language pathology, recreation therapy, and vocational counseling. Other medical and support services may participate as active members of the IDT and contribute their expertise to the overall plan of care. After initial recovery, the VA s Polytrauma System of Care has veterans go through the Individualized Rehabilitation and Community Reintegration (IRCR) Plan of Care. The Plan of Care documents physical, cognitive, mental health and vocational problems that may affect the Veteran s progress toward successful community reintegration and outlines Veteran s goals and priorities for rehabilitation. The Plan of Care provides information about the treatments recommended, their intensity and duration. Rehabilitation treatments for TBI may include physical and cognitive therapy, interventions that promote independence with activities of daily living, counseling, vocational rehabilitation, and prescription and training with prosthetics and adaptive devices. Specific tests, equipment, medication, etc. Because polytrauma varies depending on the individual, the tests, equipment, and medication will differ. Victims of polytrauma can experience burns, loss of limbs, traumatic brain injuries, spinal injuries, etc. They may also suffer from numerous psychological disorders such as depression, anxiety, ptsd, or others. This is why a plan of care is crucial to the healing of veterans with polytrauma. 10

11 TR Implications for Trauma Although many therapies exist to help people that suffer from PTSD, studies have shown that therapeutic recreation makes a big difference. These individuals need recreation and leisure in their lives to provide additional coping mechanisms that relate to stress and intense emotions. This happens because TR helps Lower levels of anxiety Provide social opportunities Create a sense of community Provide cohesion and engagement among other veterans All of these things come about because TR enables people to break down walls and barriers that they themselves have put up. There are many activities that TRS individuals can implement: Fun runs Triathlons Bike races Hiking Whitewater rafting Swimming rock/ice climbing Skiing Art therapy Gardening Pretty much all activities that encourage physical activity and improve mental health. Therapeutic Recreation can really make a difference in the lives of individuals that suffer from PTSD. It breaks down walls, teaches coping mechanisms, and teaches the individual that they are not alone. Resources for Trauma 11

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13 Definition Amputation Amputation is the surgical removal of all or part of a limb or extremity such as an arm, leg, foot, hand, toe, or finger. About 1.8 million Americans are living with amputations. Amputation of the leg -- either above or below the knee -- is the most common amputation surgery. An amputation refers to removal of the entire extremity without replacing it. There are several different types of amputations. The name given to the type of amputation depends upon how much of the limb is removed. Some special names given to amputations are as follows: Transmetatarsal amputation: removing the forefoot by cutting through the metatarsals Chopart amputation: amputation through the midfoot closer to the ankle Ankle disarticulation: amputation through the ankle joint (between the tibia/fibula and the talus) 13

14 Syme amputation: removal through the lower tibia Below the Knee Amputation (BKA): amputation through the tibia and fibula (through the leg bones) usually approximately 6-8 inches below the knee Above the knee amputation (AKA): amputation through the thigh bone Hip disarticulation: Removal of the entire leg by cutting through the hip joint (between the femoral head and the acetabulum) Hemipelvectomy: removal of the entire lower extremity including the same side of the pelvis Extended hemipelvectomy: removal of the entire lower extremity including the same side of the pelvis and the sacrum on the same side. Ray amputation: removal of a digit including a portion of the hand Shoulder disarticulation: removal of the upper extremity (entire arm) by cutting through the shoulder joint (between the humeral head and the glenoid) Forequarter amputation: removal of the entire upper extremity including the shoulder and scapula. spx Diagnosis There are many reasons an amputation may be necessary. The most common is poor circulation because of damage or narrowing of the arteries, called peripheral arterial disease. Without adequate blood flow, the body's cells cannot get oxygen and nutrients they need from the bloodstream. As a result, the affected tissue begins to die and infection may set in. Other causes for amputation may include: Severe injury (from a vehicle accident or serious burn, for example) Cancerous tumor in the bone or muscle of the limb Serious infection that does not get better with antibiotics or other treatment Thickening of nerve tissue, called a neuroma Frostbite For information on the actual amputation procedure: Specific Needs/Treatment Immediately following the surgical removal of a limb, the doctor will prescribe pain medications to help with the pain from the surgery. There is swelling after the surgery, so a person can use a compression garment to help with the swelling and shaping of the limb. It can also help with phantom pains and supporting the limb. Physical rehabilitation is an important part of the recovery process. It can be a long, difficult and frustrating process, but it's important. 14

15 Rehabilitation programs will be tailored to individual needs and requirements, and will aim to allow the patient to carry out as many of their normal activities as possible. The patient will work closely with physiotherapists and occupational therapists who will set goals with them. The Rehabilitation program will usually start within a few days of surgery, beginning with some simple exercises the patient can do while lying down or sitting. If they ve had a leg amputation, they'll be encouraged to move around as soon as possible using a wheelchair. The patient will also be taught "transfer techniques" to help them move around more easily, such as how to get into a wheelchair from a bed. Once the wound has started to heal, the patient may start working on an exercise program with a physiotherapist in the hospital gym to help them maintain their mobility and muscle strength. Emotional Recovery is also a very important step to recovering from having a limb amputated. A patient who is struggling with the loss of a limb should consider talking to a counselor in group or individual therapy. Talking about emotional struggles with others can be very effective. Specific Tests, Equipment, Medication, etc. Many people who have had a limb amputated have a prosthetic, which is an artificial body part. There are many different kinds of prosthetics to meet the various needs and activity levels of individuals who have an amputated limb. The type of prosthesis depends on the location and length of lost limb. The prosthesis replaces some of the function and appearance of the missing body part. It is important that the patient shares the activities that they feel are most important with their surgeon and prosthetist, so an appropriate prosthesis can be chosen. Some patients may decide not to use a prosthesis. Here is a Frequently Asked Questions article about prosthetics that provides almost all of the basic information that one should know about prosthetics for people with an amputated limb. TR Implications Leisure education is very important when working with patients who have an amputated limb. When people have a limb amputated, they may think that their activities will be greatly limited and that they will no longer be able to participate in their favorite activities. Therapeutic Recreation, through leisure education, can help teach people with an amputated limb about all of the resources and ways that they can still enjoy their favorite physical activities. 15

16 Some organizations have recreational therapy programs just for amputees. These are a great way to learn and network with others who share the same concerns and interests. Special programs include scuba diving, bicycling, rock climbing, golf, tennis, hockey, and skiing. Here are a few of the organizations: Disabled Sports USA BlazeSports U.S. Paralympics National Amputee Golf Association Challenged Athletes Foundation Orthotic and Prosthetic Assistance Fund Article about Recreational activities for lower-limb amputees with prostheses. Resources

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