Effects of PTSD with Family Members of Veterans. Dr. Barbara Anderson, DSW, MSW, BCD, MAC, LICSW

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1 Effects of PTSD with Family Members of Veterans Dr. Barbara Anderson, DSW, MSW, BCD, MAC, LICSW

2 Learning Objectives: 1) Increased knowledge about Post-Traumatic Stress Disorder and the effects of Post-Traumatic Stress Disorder with the family members of veterans. 2) Increased awareness of the need of treatment for the family members of veterans that are diagnosed with Post- Traumatic Stress Disorder. 3) Increased knowledge about the available resources for veterans and their family members.

3 What is Post-Traumatic Stress Disorder? The diagnostic criteria for PTSD in the DSM-5 identifies the cause of PTSD as exposure to actual or threatened death, serious injury or sexual violation. The exposure must result from one or more of the following scenarios: 1) where the individual either directly experiences the traumatic event 2) witnesses the traumatic event in person 3) learns that the traumatic event occurred to a close family member or close friend (with the actual or threatened death being violent or accidental) 4) experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television or movies, unless work-related) (American Psychiatric Association, 2013).

4 Symptoms of PTSD fall into four categories: Specific symptoms can vary in severity. Intrusive thoughts Avoiding reminders of the traumatic event Negative thoughts and feelings Arousal and reactive symptoms (APA, 2013)

5 Prevalence of PTSD with Veterans According to the National Institute of Mental Health (2009), the U.S. Department of Veterans Affairs estimates that PTSD affects 31% of Vietnam veterans 10% of Gulf War (Desert Storm) veterans 11% of veterans of the war in Afghanistan 20% of Iraqi war veterans. The prevalence rates of PTSD among veterans are higher than those in the U.S. civilian population (Brancu et al., 2014). 50% of those veterans with PTSD do not seek treatment for PTSD.

6 So, how does this affect the family members? Research and clinical observations have suggested that when a veteran has PTSD, the symptoms of this disorder affect all immediate family members, such as the spouse/partner and children (Dekel and Monson, 2010). Empirical investigations have shown that combat veterans with PTSD have hyper-arousal symptoms and engage in verbal aggression toward family members (Evans, Cowlishaw, Forbes, Parslow, & Lewis, 2010). Higher anxiety (arousal) symptoms were linked with higher anger arousal in veterans with PTSD (Evans et al., 2010).

7 Spouse/ Partner Relationships Research showed elevated risk of relationship abuse with veterans that are diagnosed with PTSD. Evans et al. (2010) study showed that hyper-arousal symptoms were associated with physical and verbal aggression toward partners, thus lowering relationship quality. The inability to express and experience intimacy may be greatly limited among those with the symptoms of emotional numbing. Research has shown that emotional withdrawal is particularly harmful for relationship adjustment (Erbes, Meis, Polusny, & Compton, 2011).

8 How does PTSD affect the spouse/partner? Wives are primarily focused on their husbands PTSD. Coping with the veteran's problems; loneliness and social isolation; feeling confused, overwhelmed, and responsible; feeling a loss of identity and a loss of control over one's life; and self-blame (Jordan et. al, 2005). Dekel et al. (2005) found that the wives lived in constant fear of what their husbands PTSD may cause and the fear of suicidal attempts. This affected the spouse every day and caused the mirroring images of the same PTSD symptoms.

9 How does PTSD affect the children? The majority of research on children of veterans with PTSD has been done with children of Vietnam veterans. So, more research is needed in this area. National Vietnam Veterans Readjustment Study (NVVRS) (Kulka et al., 1990) Children often worry about the parent with PTSD. The parent with PTSD will often isolate, which affects the relationship with the children. They may feel that the parent has no interest in them or loves them.

10 How does PTSD affect the children? Children of Veterans with PTSD are at higher risk for behavioral, academic, and interpersonal problems. Children are more depressed, anxious, aggressive, hyperactive, and delinquent compared to children of non-combat Vietnam era Veterans who do not have PTSD. In addition, the children are perceived as having difficulty establishing and maintaining friendships. Chaotic family experiences can make it difficult to establish positive attachments to parents, which can make it difficult for children to create healthy relationships outside the family. (National Center for PTSD, 2017)

11 How do children respond? A parent's PTSD symptoms can be directly linked to their child's responses. Children can respond in different ways: The "over-identified" child The "rescuer" child The "emotionally uninvolved" child (National Center for PTSD, 2017)

12 What should we do to help families of veterans with PTSD? First and foremost, include the entire family in treatment. Individual Treatment for the Veteran, Spouse, and Children Family Therapy Remember, each family is unique and the treatment modality needs to focus on the needs for that specific family.

13 Helpful books for children with parents with PTSD. Why is Dad so Mad? Author Seth Kastle Why is Mom so Mad? Author s Seth and Julie Kastle My Daddy has PTSD Author Regina Burch

14 Tears of a Warrior by Dr. Janet Seahorn php/products/pts-book/

15 Whether you re a Veteran s spouse, child, parent, sibling, grandparent, friend, or caregiver, the Veterans Crisis Line is available. If you are concerned about the safety and well-being of a Veteran, stand by them. Family members, caregivers, and loved ones are often the first to realize a Veteran may be in crisis and need support. Responders at the Veterans Crisis Line are specially trained to help Veterans families and friends make sure their loved ones get connected to care.

16 Web Sites _ptsd.asp 5_Standard.pdf (PTSD CHECKLIST FOR DSM-5) ( )Coaching Into Care Resource

17 Conclusion Our veterans are willing to pay the ultimate sacrifice. Freedom is not FREE! It is our responsibility to provide treatment to them and their family members.

18 References Adler, D.A., Possemato, K., Mavandadi, S., Lerner, D., Chang, H., Klaus, J., Tew, J.D., Barrett, D., Ingram, E., Oslin, D.W. (2011). Psychiatric status and work performance of veterans of Operations Enduring Freedom and Iraqi Freedom. Psychiatry Service 62, American Psychiatric Association (2013). The Diagnostic and Statistical Manual (5th ed). Retrieved from American Psychological Association (1994). The Diagnostic and Statistical Manual (4th ed.). Beckham, J.C., Moore, S.D., Feldman, M.E., Hertzberg, M.A., Kirby, A.C., Fairbank, J.A., (2003). Health status, somatization, and severity of posttraumatic stress disorder in Vietnam combat veterans with posttraumatic stress disorder. American Journal of Psychiatry 155, Boscarino, J., (2006). PTSD and mortality among US Army veterans: a 30-year follow- up. Annals of Epidemiology 16, Brancu et al., (2014). The impact of social support on psychological distress for U.S. Afghanistan/Iraq era veterans with PTSD and other psychiatric diagnoses. Psychiatry Research 30, Calhoun, P.S., Bosworth, H.B., Grambow, S.C., Dudley, T.K., Beckham, J.C., (2002). Medical service utilization by veterans seeking help for posttraumatic stress disorder. American Journal of Psychiatry 159,

19 References Carrion, V. & Hull, K., (2009) Treatment manual for trauma-exposed youth: Case studies. Clinical Child psychology and psychiatry 15 (1), Dekel, R. Goldblatt, H., Keider, M., Solomon, Z., & Polliack, M. (2005). Being a Wife of a Veteran with Posttraumatic Stress Disorder, Family Relations, 54, Dekel,R. & Monson, C. (2010). Militaryrelated post-traumatic stress disorder and family relations: Current knowledge and future directions. Aggression and Violent Behavior, 15, Jordan et al., (1992) Problems in Families of Male Vietnam Veterans with Posttraumatic Stress Disorder. Journal of Consulting and Clinical Psychology, 60.6, Keane, T.M., Gerardi, R., Lyons, J., & Wolfe, J. (1988). The interrelationship of substance abuse and posttraumatic stress disorder: Epidemiological and clinical considerations. Recent Developments in Alcoholism, 6, Keane, T., Caddell, J. & Taylor, K. (1988). Mississippi scale for combat-related posttraumatic stress disorder: Three studies in reliability and validity. Journal of Consulting and Clinical Psychology, 56 (1), King, L., & King, D. (1988). Risk factors for male-perpetrated domestic violence in Vietnam veteran families in the United States. ICPSR version. Boston, MA: Veteran's Administration Boston Healthcare Center and Boston University School of Medicine [producers], Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor],

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