PTSD and the Combat Veteran Greg Tribble, LCSW Rotary Club of Northwest Austin January 23, 2015
What is PTSD Posttraumatic Stress Disorder? Traumatic Events that you see, hear about, or happens to you: Combat exposure Child sexual or physical abuse Terrorist attack Sexual or physical assault Serious accidents, like a car wreck Natural disasters, like a fire, tornado, hurricane, flood, or earthquake
How does PTSD develop? Most people who go through a trauma have some symptoms at the beginning. Only some will develop PTSD over time. It s not completely clear why some people develop PTSD and others don't it depends on many things:
How does PTSD develop? How intense the trauma was or how long it lasted If you were injured or lost someone important to you How close you were to the event How strong your reaction was How much you felt in control of events How much help and support you got after the event Other vulnerability factors (genetic predisposition, childhood environment, past trauma)
Prevalence of PTSD About 7% lifetime prevalence across the general population Women are more than twice as likely as men to have PTSD at some point in their lives. Veterans Vietnam Vets lifetime prevalence: approximately 30%; 12% at time of study (1986 88) Gulf War prevalence at time of study: approximately 10% (1995 97) Conflicts in Afghanistan & Iraq prevalence at time of study: approximately 14% (2008)
Symptoms of PTSD 1. Reliving the event (also called re experiencing symptoms) Memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place. For example: You may have nightmares. You may feel like you are going through the event again. This is called a flashback. You may see, hear, or smell something that causes you to relive the event. This is called a trigger. News reports, seeing an accident, or hearing a car backfire are examples of triggers.
Symptoms of PTSD 2. Avoiding situations that remind you of the event You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event. For example: You may avoid crowds, because they feel dangerous. You may avoid driving if you were in a car accident or if your military convoy was bombed. If you were in an earthquake, you may avoid watching movies about earthquakes. You may keep very busy or avoid seeking help because it keeps you from having to think or talk about the event.
Symptoms of PTSD 3. Negative changes in beliefs and feelings The way you think about yourself and others changes because of the trauma. This symptom has many aspects, including the following: You may not have positive or loving feelings toward other people and may stay away from relationships. You may forget about parts of the traumatic event or not be able to talk about them. You may think the world is completely dangerous, and no one can be trusted.
Symptoms of PTSD 4. Feeling keyed up (also called hyperarousal) You may be jittery, or always alert and on the lookout for danger. You might suddenly become angry or irritable. This is known as hyperarousal. For example: You may have a hard time sleeping. You may have trouble concentrating. You may be startled by a loud noise or surprise. You might want to have your back to a wall in a restaurant or waiting room.
Symptoms of PTSD It is expected and normal for people to experience posttraumatic stress soon after a traumatic event that does NOT mean a person has the DISORDER. If you have symptoms that last longer than one month, cause you great distress, or disrupt your work or home life, you may have PTSD. You should seek professional help from a doctor or counselor.
Co occurring Issues 80% of those with PTSD have co occurring issues substance use issues mental health issues like depression, other anxiety issues traumatic brain injuries (TBI) 48% of those with PTSD in US Military from Afghan Iraq conflicts also have co occurring mild TBI
Co occurring Issues Texas Vets (Afghan Iraq) receiving VA benefits: More than 1 in 3 died from a drug overdose, a fatal combination of drugs or suicide. Their median age at death was 28. Nearly 1 in 5 died in a motor vehicle crash. Of those with a primary diagnosis of posttraumatic stress disorder, the numbers are even more disturbing: 80 percent died of overdose, suicide, or a single vehicle crash. Austin American Statesman (2012)
Suicide Epidemic
Suicide Epidemic Numbers show growing link between multiple deployments and self harm. Until 2012, the majority of individuals who killed themselves had seen no deployment at all, only 15% had ever experienced direct combat. Their problems tended to relate to marital or relationship breakdown or financial or legal worries back at base. More recent reports are expected to record a sea change. For the first time, the majority of the those who killed themselves had been deployed. That's a watershed that is causing deep concern within the services, a creeping up of suicides among those who have had multiple deployments and whose effects will more than likely last at least a decade or more.
Suicide Epidemic The concept of "moral injury" has been used to help understand the current wave of self harm. It has been defined as "damage to your deeply held beliefs about right and wrong. It might be caused by something that you do or fail to do, or by something that is done to you but either way it breaks that sense of moral certainty. Contrary to widely held assumptions, it is not the fear and the terror that service members endure in the battlefield that inflicts most psychological damage, but feelings of shame and guilt related to the moral injuries they suffer. Top of the list of such injuries, by a long shot, is when one of their own people is killed the most common source of anguish for them was failing to protect their 'brothers'. The significance of that is unfathomable, it's comparable to the feelings heard from parents who have lost a child. Dr. William Nash (retired Navy psychiatrist)
Barriers to Help Stigma Fear of effects on career if ask for help Believing you will get better on your own Not knowing or believing treatment works Problems getting care: finding psychiatrists, therapists, costs, wait time for appointments or VA Benefits Veterans Crisis Line: 1 800 273 8255, press 1
References U.S. Dept of Veteran Affairs, PTSD: National Center for PTSD; http://www.ptsd.va.gov/ The Guardian http://www.theguardian.com/world/2013/fe b/01/us military suicide epidemic veteran Austin American Statesman http://www.statesman.com/news/news/local military/texas war veteran deathsstudied/nspjs/
Thank you! Greg Tribble, LCSW Seton Behavioral Health Care 512 324 2039 seton.net/behavioral health care