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Tuesday, August 22, 2006

Veterans Issues: PTSD---WHEN WAR NEVER ENDS

New study estimates about one in five combat veterans experiences it

The Orange County Register
By: Blythe Bernhard
August 2006

COMBAT STRESS BY THE NUMBERS

20-30% Vietnam veterans who experience post-traumatic stress disorder

19% Iraq veterans believed to be experiencing the disorder

8% Americans who may have the disorder

11.5% Vietnam veterans with the disorder convicted of a felony

The psychological toll of combat can be overlooked as death and casualty counts climb. But a recent study has renewed the debate surrounding the mental-health problems of veterans.

Post-traumatic stress disorder may not affect as many Vietnam veterans as previously thought, according to a study published last week in the journal Science. The count is significant, both because of funding levels for veterans' mental-health programs and as an early indicator of the diagnosis in Iraq veterans.

A previous federal survey counted one in three Vietnam veterans are suffering from the stress disorder. New analysis of the same data lowered that number to one in five. Still, the numbers are significant---an estimated 630,000 Americans have experienced the stress disorder since their service in Vietnam.

The 1988 study surveyed 1,200 Vietnam veterans around the country for symptoms of psychological distress---nightmares, flashbacks and easy irritability. The study concluded that 30% of the veterans experienced symptoms at any point after the war.

The new report "re-evaluated" 260 of the veterans from the original study. The researchers corrected for other possible causes of PTSD and found that 19% of the veterans developed it from the war.

Some veterans question the science behind the lower figures, calling it a political ploy engineered by lawmakers leery of the Department of Veterans Affairs' yearly $3B budget for mental health.

Others said the study further legitimatizes the disorder and establishes the need for continued treatment.

"We can't quibble about the numbers, but the point is that it's a lot of people," said Dr. Matthew J. Friedman, executive director of the National Center for PTSD for the Department of Veterans Affairs.

Q: What is post-traumatic stress disorder?

A: It's a mental disorder that occurs in some people who experience a life-threatening event such as combat, natural disasters, rape or even serious car accidents. Symptoms can include flashbacks, nightmares, insomnia and depression. Sufferers may have trouble keeping jobs and relationships and often abuse alcohol or drugs. The disorder can only manifest through high blood pressure, night sweats, anxiety, phobias and headaches.



Q: What causes it?

A: It is thought that stress hormones or adrenaline released by the body during an emotionally traumatic event can, sear those memories into the brain.

"The bottom line is once you know you're going to die and then you don't, at that moment you lost your personal sense of safety," said Sharon Simrin, a mental-health nurse practitioner with the Veterans Affairs Long Beach health-care system, which treats about 400 local veterans for the disorder. "They never feel safe so they can never trust anybody, can never get close to anybody."

Q: How many people in the general population have the disorder?

A: About 8% of the adult U.S. population has experienced PTSD. Women are twice as likely as men to develop the disorder. The most common triggers include rape, molestation and abuse.

Q: Why do some people get the disorder and others don't?

A: That remains a mystery. PTSD develops over time. Some experts feel that a person's coping skills can play a role in whether they develop it.

Q: Can you block it from happening?

A: Researchers at UC Irvine have found that the formation of strong memories from emotional experiences might be prevented with medication.

"They'll still remember the rape, the mugging, but the memory is not going to be so strong that it is overpowering," said UCI neurobiologist James McGaugh. "The social and economic benefits would be just wonderful if the research of the clinicians pans out in the way we hope it will."

Q: Is the disorder permanent?

A: Most cases of post-traumatic stress will subside. However, about 20% of people with the disorder will have it for the rest of their lives, experts said.

Q: What does this all mean for Iraq veterans?

A: Early data show that the number of Iraq veterans affected by post-traumatic stress resembles that of Vietnam veterans. Nearly one out of five Americans serving in Iraq report mental-health problems, according to a March report in the Journal of the American Medical Association.

Exposure to combat increases the risk of post-traumatic stress. Nine out of ten Army soldiers in one combat unit reported experiencing enemy fire in Iraq, according to a 2004 report in the New England Journal of medicine.

"I think the Iraq vets are going to end up worse off," said Bobby Muller, director of Veterans for America in Washington. "Because of the shortages in military manpower, they've already got multiple deployments."

"There really is no end in sight."

Exposures to the horrors of war---fearing, killing, death---renders soldiers emotionally vulnerable. And though only formally recognized as a mental illness in the second half of the last century, trauma-related mental-health issues have long been talked up in popular culture. Here's a look at some of that history:

A SHORT HISTORY OF COMBAT STRESS

1860s: Phrases such as soldier's heart and longing are used to describe the mood of some Civil War veterans returning home after battle.

"People were...trying to understand why they had been changed, because there was a general recognition that they had been changed, and that many of those changes were not for the good," said Dr. Matthew Firedman, director of the National Center for PTSD, in a recent interview with the PBS show "Frontline." The Civil War vets' problems are linked to geographical displacement---time away from home amd family---as much as battle. Physicians note long-term physical changes in some veterans, including higher blood pressure and heart rate. Others note higher suicide rates and unemployment among some veterans.

1920s: Shell shock enters the daily language when Americans see news accounts of soldiers incapacitated by trench warfare. In the late 1920s, the issue becomes a topic of popular discussion. Some Americans---though not all---are sympathetic to the plight of the battle-scarred soldiers.

1940s: The Army adds psychiatrists to each division in World War II, the first official recognition that battle can cause mental-health issues. When Gen. George S. Patton slaps a soldier suffering from what was then known as combat fatigue, he is both lionized and vilified in the American press.

1970s: The Vietnam War brings first widespread acceptance of post-traumatic stress syndrome. Movies, novels and news accounts start to show soldiers with PTSD in a sympathetic light. In 1980, the American Psychiatric Asssociation adds PTSD to the third edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-III). Critically, the condition is seen as being caused by outside factors, not a failing by the individual.

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