Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment
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Prior to the military conflicts in Iraq and Afghanistan, wars and conflicts have been characterized by such injuries as infectious diseases and catastrophic gunshot wounds. However, the signature injuries sustained by United States military personnel in these most recent conflicts are blast wounds and the psychiatric consequences to combat, particularly posttraumatic stress disorder (PTSD), which affects an estimated 13 to 20 percent of U.S. service members who have fought in Iraq or Afghanistan since 2001. PTSD is triggered by a specific traumatic event - including combat - which leads to symptoms such as persistent re-experiencing of the event; emotional numbing or avoidance of thoughts, feelings, conversations, or places associated with the trauma; and hyperarousal, such as exaggerated startle responses or difficulty concentrating.
As the U.S. reduces its military involvement in the Middle East, the Departments of Defense (DoD) and Veterans Affairs (VA) anticipate that increasing numbers of returning veterans will need PTSD services. As a result, Congress asked the DoD, in consultation with the VA, to sponsor an IOM study to assess both departments' PTSD treatment programs and services. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment is the first of two mandated reports examines some of the available programs to prevent, diagnose, treat, and rehabilitate those who have PTSD and encourages further research that can help to improve PTSD care.
and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), can be found in Box 2-1 (APA, 2000). The Department of Defense (DoD) and the Department of Veterans Affairs Copyright © National Academy of Sciences. All rights reserved. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment HISTORY, DIAGNOSTIC CRITERIA, AND EPIDEMIOLOGY 27 BOX 2-1 DSM-IV-TR Diagnostic Criteria for Posttraumatic Stress Disorder A1. The person
odds of PTSD (MacGregor et al., 2012). With the conflict in Iraq having ended and the conflict in Afghanistan expected to wind down, more service members will be returning home; as a result, the number seeking treatment for psychologic issues is expected to increase. In addition to the many stressors encountered by service members while serving in the military, there are protective factors specific to military service that should not be overlooked. Unit cohesion, the close bond and culture
prevalence of military sexual assault among female Veterans Administration outpatients. Journal of Interpersonal Violence 15(3):291-310. Smith, T. C., M. A. Ryan, D. L. Wingard, D. J. Slymen, J. F. Sallis, D. Kritz-Silverstein, and The Millennium Cohort Study. 2008. New onset and persistent symptoms of post-traumatic stress disorder self-reported after deployment and combat exposures: Prospective population based U.S. military cohort study. British Medical Journal 336(7640):366-371. Stecker, T.,
observed in reconsolidation or extinction. These factors may include the amount of time between re-exposure and the previously conditioned cue, protein synthesis in the amygdala and the medial prefrontal cortex, the strength of the conditioned fear memory, and the possibility that Copyright © National Academy of Sciences. All rights reserved. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment 66 PTSD IN MILITARY AND VETERAN POPULATIONS the
investigate the physical and psychologic effects of traumatic events. The work has since grown beyond service members to research on the impact of war, deployments, and injuries on children and families (Center for the Study of Traumatic Stress, 2012). The Army and the DoD have supported the work of the Walter Reed Army Institute of Research for over 100 years (U.S. Army, 2012d). The institute aims to be at the forefront of biomedical research, including deployment psychology and the psychologic