Each and every day, people wake up, live their lives, go to bed, then do it all over again. However, it is vital to stop and think about why you’re able to (mostly) do what you want, when you want, where you want. This is all due to freedom. Freedom doesn’t come free, but rather it is fought for. Blood, sweat, tears and psychological disturbances can all stem to the surface when being deployed into combat and following afterwards, as well. The main psychological illness that can result from being deployed into combat is known as Post-Traumatic Stress Disorder, otherwise labeled, PTSD. A critical piece of information to understand is that PTSD is not only developed after deployment but can occur during deployment, as well (U.S Department of Veteran Affairs: What is PTSD, 2017).
To have a better understanding about PTSD resulting during and/or after combat, this paper will discover what PTSD is, what creates the label applied to combat veterans experiencing PTSD pertaining to different psychological perspectives, methods associated with these different psychological perspectives that can help treat PTSD, and how to improve the research regarding this topic as a whole. It is not the time that is the primary factor looked upon first, but rather it is if a veteran gets the treatment that they are in need of. This paper’s investigation will help unfold the mystery of whether veterans who experience post-traumatic stress disorder during or after combat receive the most beneficial method of treatments from different psychological perspectives.
To apprehend the course of actions that occur to veterans suffering from PTSD recover, knowing what PTSD is and what contributes as a diagnostic criterion to be diagnosed as having this mental illness is valuable. PTSD is considered to be anxiety disorder that develops after witnessing or experiencing a life-threatening event, where symptoms may start occurring soon after the event takes place or not until months or years after, that do not go away on their own (U.S. Department of Veteran Affairs: What is PTSD, 2017). To be diagnosed with a mental illness, the book of importance for mental health clinicians is called, The Diagnostic and Statistical Manual of Mental Disorders, or DSM, where self-reported checklists of symptoms associated with each disorder are presented and followed through with to help construct an overall diagnostic.
The latest DSM, which is the fifth edition, uses a checklist that is geared towards a specific event to evaluate the degree of PTSD being experienced. Before DSM-5 was published, DSM-IV provided three different checklists that could be used for rating PTSD symptoms; civilian, military, and specific. However, with the renovation into the next DSM, DSM-5, there has been no creation of military or civilian checklists that correspond with the checklists that were made prior (U.S. Department of Veteran Affairs: PTSD and DSM-5, 2017). This is an essential piece of information to account for due to the fact that in case studies conducted researching this topic, some studies have used the military checklists from DSM-IV, while others have used the checklist from the DSM-5, the specific checklist. Since there have been no corresponding checklist published with DSM-5 for the military and civilian checklists, the scoring of these checklists can be compared universally with the DSM-IV.
Considering a veteran has suspected PTSD, there are signs and symptoms that become present in the diagnosis of such. According to the U.S. Department of Veteran Affairs, which is the National Center for PTSD, reports that there are eight different criterion zones that become addressed while making a diagnosis; exposure, intrusion, avoidance, negative thoughts, alterations in arousal and activity, length of symptoms, cause of distress to oneself, and symptoms cannot be caused due to other factors, respectively (2017). For each criterion, certain things can shape the formation of the criteria being met.
For Criteria A, the exposure component, this can be checked as present through direct exposure of the traumatic event, witnessing the event or even learning about a loved-one being exposed to the event. For Criteria B, the intrusion component, can be presented in the most commonly known way of a flashback, where unwanted memories surface, nightmares are occurring, emotional distress and physical reactivity occurs after exposure from a reminder of the traumatic event. For Criteria C, the avoidance component, it is what it states; avoidance of traumatic provocations such as thoughts, feelings, and even places. For Criteria D, the negative thought component, this includes overly negative thoughts about themselves and the world around them, negative affect is present, feeling isolated, survivors’ guilt is expressed, and inability to recall important aspects of the trauma occurs. For Criteria E, alterations in arousal and activity component, such as being irritable, have difficulty sleeping and concentrating, an increase of startle reaction, and hypervigilance can transpire. For Criteria F, length of the symptoms lasting longer than at least one month; Criteria G, cause of functional deficiency or distress to oneself; and Criteria H, symptoms cannot occur due to other illnesses, medications, or substance abuse; are all required to start the process to see if a diagnosis of PTSD is present (Weathers et al, 2013).
The scoring rubric for the checklist concerning PTSD according to the DSM-5 criteria, notes that any question, numbers one through twenty, scoring a two (2) or higher, is what would be considered noting as a symptom in the form of PTSD being presented. The severity of the PTSD symptoms can be obtained by summing the twenty questions scores; whereas, an overall score of a 33 out of 80 would be considered as needing some sort of psychometric intervention to treat PTSD (Weathers et al., 2013). A DSM-5 PTSD checklist that a clinician may use as a diagnostic tool is attached at the end of the paper (pg. __).
Epidemiology; the study of the causes and distribution of any given disease, or in this case a disorder, in a (certain) population (U.S Department of Veteran Affairs: Epidemiology, 2016). The proportion of people within a population that have any given disorder and any given time can be referred to as that disorder’s prevalence rate. There are many different factors that are attributed to creating a disorder’s prevalence rate, such as, demographic features (like age, gender, location), the duration of a disorder (if individuals are living longer with the disorder, the rate can then increase), as well as disorder occurrence (if another disorder arises, the rate can then increase). However, it is vital to also keep in mind that prevalence rates are active, meaning that they can change over time, people, and places. Assessing the prevalence of individual’s involved in combat suffering from PTSD is important. In a study conducted with a total of one hundred and sixty-one veterans who had filled out a diagnostic checklist to screen for PTSD being present from World War II, Korea, and Vietnam, results showed the prevalence rate to be 24%, with most apparent psychiatric disturbances among Vietnam veterans (Dudley et al., 1990).
Another study conducted by the Department of Veteran Affairs, did an analysis pertaining to the utilization of the veteran affairs health care option available to veterans of Operation Enduring Freedom (OEF) (which relates to Afghanistan), Operation Iraqi Freedom (OIF) (which relates to Iraq), and Operation New Dawn (OND) (which relates to Iraq as well). The data collected from this study was from the first quarter fiscal year of October 1st, 2001 through the fourth quarter fiscal year of September 30th, 2014. Results from this study showed that from a possible 572,569 veterans suffering from a mental disorder, 311,688 accounted for PTSD within the first quarter, from a possible 593,583 veterans suffering from a mental disorder, 324,204 accounted for PTSD within the second quarter, from a possible 615,922 veterans suffering from a mental disorder, 337,285 accounted for PTSD within the third quarter, and lastly from a possible 640,537 veterans suffering from a mental disorder, 351,422 accounted for PTSD within the fourth quarter (U.S. Department of Veteran Affairs, 2015). When looking back at the data that the Veteran Affairs has compiled, during any given quarter, one through four, results indicate that at least 54% of combat veterans are suffering from PTSD. As the quarters progressed, the percentage increased a tenth of a percent. This shows that the prevalence rate of combat veterans suffering from PTSD has increased over the years of combat and is something to focus upon for future research.
Unfortunately, sometimes there is an occurrence of two (or more) disorders present within an individual, labeling this as comorbidity. Pertaining to PTSD and combat veterans, the comorbidity that I would like to focus on is suicidal ideations and alcohol use disorder. In a previous research study that explored PTSD as a risk factor for suicidal ideations among veterans from the Iraq and Afghanistan wars, data that was gathered found that the veterans who screened positive for PTSD were more than four times more likely to encounter suicidal ideations in comparison to veterans who did not have PTSD (Jakupcak et al., 2009).
This research study also found that it was 5.7 times greater for the veterans who screened positive for PTSD to be a victim of comorbidity of two or more disorders (Jakupcak et al., 2009). Another research study analyzed the comorbidity of suicidal ideations among combat veterans. Within this survey, out of 272 OEF and OIF veterans that completed a survey concerning psychopathology, social support, and resilience, 34 participants that represented 12.5% of the participant pool reported that they had contemplated suicide within the two weeks prior to filling out the survey, indicating a positive association that suicide was contemplated more so by the veterans who screen positive for PTSD (Pietrzak, 2010). Generally speaking, one thing leads to another and so on and so forth. This is the case for combat veterans suffering from PTSD as well; with having PTSD, instead of focusing on suicidal ideations co-occurring, the comorbidity risk of alcohol use disorders, or otherwise labeled as AUD, exists too.
Seal et al (2011) found that, 9.9% received AUD diagnoses (pg. 95), which means of the 456,502 veterans in their study, roughly 10% have an alcohol use disorder. The commonality of the veterans returning from Iraqi and Afghanistan see the co-occurrence of the two disorders being experienced personally. It is unfortunate that comorbidity occurs, however findings as such indicate an identifying risk that suicidal ideations are among one of the many other disorders that can coincide with veterans suffering from PTSD. It is essential to keep this in mind and to not be blinded or limit yourself to thinking more than one disorder cannot be present; one may have more prominence over the over, however the co-occurrence can still exist.
When seeking out treatment for PTSD, there are multiple routes that one can take to lessen the severity of the symptoms being experienced, such as therapy and medications. A few different types of treatment that mental health clinicians recommend are categorized into two subsets: strongly recommended and conditionally recommended. The strongly recommended therapies are different variations of cognitive behavioral therapy, or CBT. Cognitive behavioral therapy is a technique that draws relationships between one’s emotions, behaviors, and thoughts, and how they impact one another, resulting in a change of one of the three areas to another (PTSD Treatments, 2018). These different variations of CBT include: cognitive behavioral therapy with cognitive processing therapy, cognitive therapy, and prolonged exposure therapy.
These serve as specialized treatment forms regarding certain properties of CBT. For the conditionally recommended therapies, these are interventions that can be used, however, they don’t provide much evidence giving credit that thy are as useful and helpful as the strongly recommended forms of therapy listed previously. The different therapies labeled conditionally recommended include: brief electric psychotherapy, eye movement desensitization and reprocessing therapy (EMDR), narrative exposure therapy, and four different medications. Regarding these different medications, the first three serve as selective serotonin reuptake inhibitors (SSRIs), and the last one serves as an antidepressant medication, respectively; Fluoxetine (commonly knowns as Prozac), Paroxetine (commonly known as Paxil), Sertraline (commonly known as Zoloft), and Venlafaxine (commonly known as Effexor) (PTSD Treatments, 2018).
Regarding the strongly recommended types of cognitive behavioral therapy, it is important to generate a basic understanding of what each therapy consists of. From the American Psychological Association, all four types are explained. The first type, CBT itself, is the focus on emotions, behaviors and thoughts, with the current problems and symptoms that are persisting are targeted in changing the focus and patterns of these different factors that lead to the difficulty in functioning to begin with; the second type, cognitive processing therapy, is a particular type of CBT that aids in assistance to patients with learning how to modify their beliefs related to the event, along with challenging these beliefs as to why they are incorrect; the third therapy type, cognitive-only therapy, which includes the method of changing the negative memories associated to the traumatic event, with the end goal achieved by interrupting these disturbing thought or behavior arrangements that interfere with the individuals life; lastly, with the fourth type, prolonged exposure therapy, that is again a particular type of CBT, where gradually approaching memories, situations, and thoughts that are triggered due to the traumatic event can be approached, with the result of facing what was avoided once and understanding that it is no longer holding any negative meaning that constitutes as being dangerous, which can be achieved through a subtype of therapy called virtual reality exposure therapy (PTSD Treatments, 2018).
These different forms of CBT are used throughout the studies integrated into this research paper, as well the medicinal approaches, as well. These different forms of treatments will be discussed further within this paper, categorized into their appropriate psychological perspective areas, along with the etiology of these perspective areas as well.
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