The role of the military is such that they and their loved ones are at extremely high exposure for stress and traumatic events. Of the men and women who have spent time in a war zone as military, contracted civilian, reporter, or aid worker many, around a third, go on to later experience PTSD.13
Studies find that the number of Veterans eventually diagnosed with PTSD varies by service era13, 14,15:
| Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF): |
- About 11-20 out of every 100 Veterans (or between 11-20%) who served in OIF or OEF were experiencing PTSD during each measured year.
Gulf War (Desert Storm):
- About 12 out of every 100 Gulf War Veterans (or 12%) were experiencing PTSD during each measured year.
- About 15 out of every 100 Vietnam Veterans (or 15%) were diagnosed with PTSD at the time of the most recent comprehensive study (the late 1980s), the National Vietnam Veterans Readjustment Study (NVVRS).
- It is estimated that about 30 out of every 100 (or 30%) of Vietnam Veterans have had PTSD in their lifetime.
| A National Institute of Health (NIH) study found that military spouses were not immune from stress. 21.6% of spouses showed arrays of symptoms significant enough to qualify them for a diagnosis of PTSD.16|
Stress disorders as a category have been described as complex somatic, cognitive, affective, and behavioral consequences of psychological trauma. Stress disorders are caused by experiencing, witnessing, or being confronted with an event/events involving serious injury, death, or threat to the physical integrity of that person or someone close to them. These are accompanied by a response involving helplessness, intense fear, or horror.
Intrusive thoughts and feelings characterize post-traumatic stress disorder, nightmares and flashbacks of past traumatic events, desires to avoid reminders of the trauma, and the presence of hypervigilance and sleep disturbances. All of which leads to considerable occupational, social, and interpersonal dysfunction, particularly with those who know them best.
It has been shown in various studies that a direct relationship can be observed between the severity of a traumatic event and the risk of developing a stress disorder. Prior exposure to repeated traumatic events as well as such factors as the duration, severity, and proximity of the event may also contribute to the degree of stress that the individual experiences.
Events Often Associated with PTSD Onset15
- Military combat
- Terrorist attacks
- Violent physical assault
- Severe physical injury
- Life-threatening illness
- Severe motor vehicle accidents
- Negative media saturation
- Natural Disasters
- Serious accidents
- Sexual assault
- Childhood sexual abuse
- Observing or learning about a traumatic event
The initiating events associated with PTSD are generally the same as in ASD, acute stress disorder. PTSD may be thought of as being an extension of ASD and has subtypes that are acute, chronic, or delayed in nature.
Acute PTSD typically has symptoms lasting three months or less, while chronic PTSD symptoms last longer than three months. In delayed-onset PTSD, the symptoms that characterize the condition tend to be unnoticeable for at least the first six months following the traumatic event, creating a time-lapse which may make linking the symptoms with an initiating event at times tricky to isolate.17
Definition Time: CPTSD is DESNOS18
| “Complex” PTSD or CPTSD is a newer term used interchangeably for both delayed-onset PTSD (symptoms taking longer than six months to manifest), and the all-to-common ‘hard to diagnose’ disorders that spew a spread of symptomatology across the spectrum of emotional/behavioral/cognitive functioning.|
Be aware - CPTSD is not in the DSM-5. The term was developed in the 1990s during research for “Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM-IV Field Trial for Post-traumatic Stress Disorder.” A 1997 publication in the Journal of Traumatic Stress. Whether CPTSD simply arrived too late to make the DSM-5 revision, or it failed to gain enough support during the cavalcade of expert-led committees delegated to determine version fives contents is unknown. What is important is that the undefined term of Complex PTSD is commonly used, so be aware of it.
CPTSD, Complex PTSD, can be argued as being used incorrectly, or at least unnecessarily, for both of its primary uses – Delayed and Complicated – forms of PTSD.
- PTSD, which onsets more than six months from the trigger incident(s), is known in the DSM-5 as Delayed Onset PTSD.
- PTSD with complicating factors is referred to by the DSM-5 term Disorder of Extreme Stress Not Otherwise Specified (DESNOS).19
One last word about DESNOS (and the term CPTSD when/if it is used for complex cases). DESNOS all too frequently is birthed from severe, protracted abuse, most notably childhood sexual abuse, victims of torture, or perhaps living in a war zone.20
Research into identifying and treating stress disorders has led to recent changes in diagnostic criteria. In the recently released Diagnostic and Statistics Manual of the American Psychiatric Association, fifth edition (DSM-5), greater focus is placed on the behaviors that accompany PTSD. Four distinct clusters or groupings of behaviors are proposed as significant indications for diagnosis.
Re-experiencing behaviors: For example, spontaneously occurring memories of a past traumatic event such as nightmares or recurrent dreams related to an incident or incidents, illusions or hallucinations, flashbacks – the sudden powerful re-experiencing of past events, or other intense, prolonged forms of psychological distress.
Avoidance behaviors: Take the form of abruptly shying away from or pre-planned evasion of situations which might bring distressing memories, thought reminders of past events, feelings associated with the initiating traumatic experience, or external reminders of the event.
Negative cognitions and mood-related behaviors: Include such items as persistent blame of themselves or others, distorted feelings or overpowering emotions related to events or persons associated with stressing events, estrangement from others, marked decrease in activities that formerly interested that person, or the inability to remember aspects of what occurred.
Arousal behaviors: Can be demonstrated by reckless, aggressive, self-destructive behaviors. Sleep disorders, hypervigilance, the formation of protective habits such as always sitting with a back to the wall, sleeping facing a locked door, etc. are all examples of arousal. Please note current diagnostics emphasize an element of avoidance or flight from traumatic reminders. A strong flight response or reaction is also typical of the arousal behaviors of stress disorders.
In addition to the presence of key behaviors are three conditions or criteria that aid in making a diagnosis of PTSD. These three criteria are:
- The duration of symptoms for the person has been longer than one month
- The disturbance causes significant distress or impairment in that individuals functioning
- The disturbance is not attributable to the effects of a substance or other medical conditions
While there are no physical diagnostic tests that can readily catch the presence of a stress disorder, there are physical signs to notice. The presence of poor hygiene or poor personal appearance, in general, can be a tip-off to poorly functioning cognitive processes. The presence of unexplained bruises or injuries, such as bruised or lacerated knuckles from punching inanimate objects, and indications of fatigue from poor sleep may indicate difficulties. Heightened startle responses to sudden noises or shadows may be clues as well.
Mental status checks can also be helpful, as an orientation to person and place can be affected by stress disorders. Not knowing the current time or date may offer clues as to where an individual’s internal attention is focused. Perhaps the area most affected by stress disorders such as PTSD is memory. Reports of forgetfulness, particularly in details associated with a specific traumatic event, are frequently reported. Poor concentration with pressured or abnormally slowed speech may also be an indicator. Mood changes are common with stress disorders, as are feelings of generalized nervousness, fear, anxiety, guilt, and depression.
Please be alert for suicidal thoughts or feelings when PTSD is suspected. Changes in mood and struggles with core beliefs brought about by an intense trauma can be difficult for an individual. A small percentage of stress disorder clients may also become homicidal during the difficulties of dealing with delusional feelings, new phobias, hallucinations, and reliving experiences such as flashbacks.18
Core Beliefs are “…unconditional beliefs that serve as a basis for screening, categorizing, and interpreting experiences.21”
|Core beliefs are the foundational bedrock of our minds. They are the fundamental beliefs about our world, ourselves, and everything around us by which we measure all experiences.|
Core beliefs form the rules by which we perceive and interpret what is happening all around us.
Core beliefs typically bypass conscious thought and operate outside of an individual’s perceptions.