cutterx2202: Thank you for your clarification. We are entitled to our opinion. Here is the opinion of the American Psychiatric Assocication in regard to PTSD. This is the current revision. The first time PTSD was recognized was in DSM-III, it was then revised in DSM-III-R and finally in DSM-IV.

From the book DSM-IV, word for word.

309.81 DSM-IV Criteria for Posttraumatic Stress Disorder

A. The person has been exposed to a traumatic event in which both of the following have been present:

(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.

(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.

(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.

(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma

(2) efforts to avoid activities, places, or people that arouse recollections of the trauma

(3) inability to recall an important aspect of the trauma

(4) markedly diminished interest or participation in significant activities

(5) feeling of detachment or estrangement from others

(6) restricted range of affect (e.g., unable to have loving feelings)

(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hypervigilance
(5) exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month.

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:
Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more

Specify if:
With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

quote:

Originally posted by Schwanke:
Apples, the single IED might have done it, but from my perspective, it appears that driving that road the SECOND time, and again and again may contribute more, once the fear is realized. It has been a long time since Vietnam, but I really don't feel that any ONE of the incidents I was involved in created my PTSD as much as the CUMULATIVE effect of the entire war experience. For instance the VA considers a mortar or rocket attack against your base as a valid stressor. Again, it seems to me that any attack was not all that exciting, even including the one I got wounded in, but the almost nightly attacks for a year wore me down a lot, and in my opinion were the reason. Just letting my mind wander back, ignore or expound as y'all feel.

i would agree to some extent -- however, since i didn't drive down that road again, ever (i was sent home to military hospital in san antonio) once was enough.

but again, we spent almost a year, at a hyperivigilant -- paranoid even -- alert mentally for IEDs. we heard about them constantly, were briefed for them, etc, so you're already on pins and needles leaving the base and then one goes off -- and you're injured a few are killed, several more injured, you never look at a suspicious bump / rock / thing in the road again as safe... it's one of the reasons i can't drive.

but i'm sure it's not the only thing -- it probably is somewhat the cumulative effect of being necessarily hypervigilant for a year... a very ABNORMAL state for the human psyche, as it does create adreneline depletion and exaggerated stress responses.

think of ptsd this way -- you are twisting a pencil around a rubber band. for a long time, the rubber band will stretch, and the tension gets higher and higher, but the rubber band still holds, and the pencil is still within the confines of that rubberband, but one turn to manny, and the rubber band SNAPS, and the PENCIL GOES FLYING INTO OBLVION, and the rubberband is never the same again...

quote:

/..../once was enough.

And that's all it takes....

According to medical science and VA law, one traumatic incident can cause PTSD.

This message has been edited. Last edited by: Flash69,

Lest I be misunderstood, I am well aware that "once is enough", and was not insinuating that people with one stressor don't suffer from PTSD, far from it. As apples said, perhaps the events leading up to the event can be an accompanying force as well. We are all shaped by traumatic events and in rethinking it, I think apples is probably correct in that the PREVIOUS events simply wind us up to that breaking point. I don't know, still trying to figure it all out myself.

i got your drift schwanke.. i was just clarifying my point for others maybe who haven't been following our whole conversation!

i really do think that the previous setup of MAX OPS TEMPO **IS** an additive causal factor for so many developing ptsd. u're body no longer processes stress normally.

we see the same sort of thing (though it's rarely called ptsd) in air traffic controllers who work high traffic environments for long periods of time. the human mind and body was not designed to withstand prolonged stress with little to no reprieve, as we are now doing in this modern age.

Good example. Finally that aircraft that ignores a direction and causes the controller to revamp his whole plan, makes him go "postal".

Well, as long as you don't say all ATC is that stressful. Coming from an ATC unit, I fixed everything they worked on from radars, computers, radios, etc, so I was in the tower just as much as they were. From time to time it may be very stressful, but mostly it's just as stressful as other time-based jobs in the military like mine. Don't forget they follow FAA regs, so they are forced to get plenty of downtime, too. O'hare is way more stressful than ATC in Iraq. That coming from a unit that got a presidential unit citation, and national (civilian included) ATC award. The only places that really have it high stress are high volume civilian airports such as Chicago, NY, etc.

as a pilot -- following FAA regs doesn't mean less stress. one - two hours of consistant high stress states on a regular basis is the same concept, at times on a higher level, as being in a combat area for a year. we had to get rest 'over there' too. doesn't change the effect it has, nor the fact that a lot of ATCers don't complete a 20 year career due to burn out. that is a fact.

working on the scopes, radar and electronic equipment in a tower, or atc facility is NOT the same, as being the one managing the traffic. yes, some areas are much slower than others, but some of the highest stress (other than major hubs such as o'hare) is in the airspace above 18,000 feet on the airways that are used by all the airlines, sometimes several hundred flights on the same airway at one time.

talk to a few ATC guys who don't work at the landing / approach phase, and they will tell you -- there's a reason these people burn out more frequently, than other professions.

quote:

Originally posted by boughtwaprice:
Hopefully they won't get labeled as being weak or overly emotional. I do have to say, when I saw this picture, it looked like a little kid holding the gun

Do not confuse PTSD in our fellow sodier women with GAD (Generalized Anxiety Disorder) They are the same thing PTSD = GAD If PTSD can be brought under control within one year it can be controlled for life. Otherwise, it turns into GAD. It however cannot be controlled in all people just some. One thing though it is a disorder that will last you a life time of treatments. It also gets worse over long periods of time.

quote:

Originally posted by applesandonions:
as a pilot -- following FAA regs doesn't mean less stress. one - two hours of consistant high stress states on a regular basis is the same concept, at times on a higher level, as being in a combat area for a year. we had to get rest 'over there' too. doesn't change the effect it has, nor the fact that a lot of ATCers don't complete a 20 year career due to burn out. that is a fact.

working on the scopes, radar and electronic equipment in a tower, or atc facility is NOT the same, as being the one managing the traffic. yes, some areas are much slower than others, but some of the highest stress (other than major hubs such as o'hare) is in the airspace above 18,000 feet on the airways that are used by all the airlines, sometimes several hundred flights on the same airway at one time.

talk to a few ATC guys who don't work at the landing / approach phase, and they will tell you -- there's a reason these people burn out more frequently, than other professions.

Now you're assuming a lot, belittling my experience in that exact field and didn't hear what I said. We have all types of controllers.

*poof* I'm gone, out.

Stressors are a funny thing, I think. Apparently for me there is a mix...a single incident involving great bodily harm and potential death, resultant TBI, an ongoing or chronic situation involving MST. People used to tell me I was a very strong person (psychologically), and come to me for a shoulder or someone to lean on. Now it's almost impossible to be a shoulder for anyone except in rare situations. I get royally twitchy. I can't handle being in a situation that puts me under some guy's thumb, even a situation with no sexual connotation whatsoever. And I go into that hyperalert adrenaline rush reaction whenever it appears someone's around that shouldn't be --like the day one of my housemates had a guy stay overnight without saying anything about it, and I met this male stranger when he walked into the kitchen unexpectedly the next morning. I think my housemate is a nutball; she had him over without saying anything and left the building for some hours with him still there.

quote:

she had him over without saying anything and left the building for some hours with him still there.

That would be a MAJOR trigger. I hope you have discussed this with your housemate and arrived at an agreement that it will never happen again.

quote:

Originally posted by cutterx2202:

quote:

Originally posted by applesandonions:
as a pilot -- following FAA regs doesn't mean less stress. one - two hours of consistant high stress states on a regular basis is the same concept, at times on a higher level, as being in a combat area for a year. we had to get rest 'over there' too. doesn't change the effect it has, nor the fact that a lot of ATCers don't complete a 20 year career due to burn out. that is a fact.

working on the scopes, radar and electronic equipment in a tower, or atc facility is NOT the same, as being the one managing the traffic. yes, some areas are much slower than others, but some of the highest stress (other than major hubs such as o'hare) is in the airspace above 18,000 feet on the airways that are used by all the airlines, sometimes several hundred flights on the same airway at one time.

talk to a few ATC guys who don't work at the landing / approach phase, and they will tell you -- there's a reason these people burn out more frequently, than other professions.

Now you're assuming a lot, belittling my experience in that exact field and didn't hear what I said. We have all types of controllers.

*poof* I'm gone, out.

i heard EXACTLY what you said -- you said you used to WORK on (repair) equipment. not that you were a controller, or ever did the job yourself... i didn't 'assume' that.

you do know the mandatory retirment age of controllers (from tower, to center) is 56 -- not because it's such a pretty number, but because of DOCUMENTED effects of stress on the air traffic control professional.

ATC personnel have high incidence of stress related health issues, directly related to their work. there are several reports, and studies within the ATC organizations themselves that verify this -- i don't feel it necessary to list them here.

it is an extremely flippant remark to assert that atc is NOT a particularly stressful job.

yes, there are down times, every job has that. some places are extremely slow, duh, not all airports and victor airways, and jet routes are as busy as others, but it IS also one of the most diverse jobs there is. takes multi-tasking to a whole new level.

but then i forgot, you know everything about atc, because you worked on the equipment... you never stated you were a controller... so since it was not stated, but you stated you repaired the equipment, it's not an illogical assumption to ASSUME you aren't a controller yourself.

The updated version of the DSM series is the DSM-IV TR which can be found here: www.psych.org. This is the current version of the diagnostic manual which is used by the VA.

When DSM-IV TR came out it made many of we VSO's very happy. However it was a couple of years before many of rating specialists actually started rating completly on the new criteria. The DSM-IV was more liberal in the diagnosis of PTSD.

There are supposed improvements in the making. Here is the APA report:

DSM-V: The Future Manual

The process for revising the Diagnostic and Statistical Manual of Mental Disorders (DSM) began with a brief discussion between Steven Hyman, M.D., (then-Director of the National Institute of Mental Health), Steven M. Mirin, M.D., (then-Medical Director of the American Psychiatric Association) and David J. Kupfer, M.D., (then-Chair of the American Psychiatric Association Committee on Psychiatric Diagnosis and Assessment) at the National Institute of Mental Health (NIMH) in 1999. They believed it was important for the American Psychiatric Association (APA) and NIMH to work together on an agenda to expand the scientific basis for psychiatric diagnosis and classification.



The initial DSM-V Research Planning Conference in 1999 was under the joint sponsorship of the two organizations to set research priorities. Participants included experts in family and twin studies, molecular genetics, basic and clinical neuroscience, cognitive and behavioral science, development throughout the life-span, and disability. To encourage thinking beyond the current DSM-IV framework, many participants closely involved in the development of DSM-IV were not included at this conference. Through this process, participants recognized the need for a series of white papers that could guide future research and promote further discussion, covering over-arching topic areas that cut across many psychiatric disorders. Planning work groups were created, including developmental issues, gaps in the current system, disability and impairment, neuroscience, nomenclature and cross-cultural.



In early 2000, Darrel A. Regier, M.D., M.P.H., was recruited from the NIMH to serve as the research director for the APA and to coordinate the development of DSM-V. Additional conferences to set the DSM-V research agenda were held later in July and October of 2000 to propose planning work group members and to hold the first face-to-face meetings. These groups, which included liaisons from the National Institutes of Health (NIH) and the international psychiatric community, developed the series of white papers, published in A Research Agenda for DSM-V (2002, American Psychiatric Association). A second series of cross-cutting white papers entitled, Age and Gender Considerations in Psychiatric Diagnosis, was subsequently commissioned and published by APA in 2007.



Leaders from the APA, the World Health Organization (WHO) and World Psychiatric Association (WPA) determined that additional information and research planning was needed related to specific diagnostic areas. Hence, in 2002, the American Psychiatric Institute for Research and Education (APIRE), with Executive Director Darrel A. Regier, M.D., M.P.H., as the Principal Investigator, applied for a grant from the NIMH to implement a series of research planning conferences that would focus on the research evidence for revisions of specific diagnostic areas. A $1.1 million cooperative agreement grant was approved with support provided by NIMH, the National Institute on Drug Abuse (NIDA) and the National Institute on Alcoholism and Alcohol Abuse (NIAAA).



Under the guidance of a steering committee comprised of representatives from APIRE, the three NIH institutes and the WHO, 13 conferences were held from 2004 to 2008, with expertise that spanned the globe – each conference had co-chairs from both the U.S. and another nation, and approximately half of the participants were from outside the U.S. In each conference, participants wrote papers addressing specific diagnostic questions, based on a review of the literature, and from these papers and the conference proceedings, a research agenda was developed on the topic. The results of seven of these conferences have been published to date in peer-reviewed journals or American Psychiatric Publishing, Inc. (APPI) monographs, with the remainder of the publications anticipated in 2008. Findings from all 13 conferences are immediately available to serve as a substantial contribution to the research base for the DSM-V Task Force and Work Groups, and for the WHO as it develops revisions of the International Classification of Diseases.



In 2006, APA President Dr. Steven Sharfstein announced Dr. Kupfer as chair and Dr. Regier as vice chair of the task force to oversee the development of DSM-V. They, along with other leaders at the APA, nominated additional members to the task force, which includes the chairs of the diagnostic work groups that will review the research and literature base to form the content for DSM-V. These task force nominees were reviewed for potential conflicts of interest, approved by the APA Board of Trustees, and announced in 2007. In turn, the work group chairs, together with the task force chair and vice-chair, recommended nominees, who are widely viewed to be the leading experts in their field, to the successive APA Presidents, Drs. Pedro Ruiz and Carolyn Robinowitz, who then formally nominated members of the work groups. All work group members were also reviewed for potential conflicts of interest, approved by the APA Board and were announced in 2008.



The work groups began meeting in late 2007. While the 13 work groups reflect the diagnostic categories of psychiatric disorders in the previous edition DSM-IV, it is expected that those categories will evolve to better reflect new scientific understanding. With the understanding that some continuity from DSM-IV to DSM-V is desirable to maintain order in the practice of psychiatry and continuity in research studies, there has been no pre-set limitation on the nature and degree of change that work groups can recommend for DSM-V.



Each work group meets regularly, in person and on conference calls. They begin by reviewing DSM-IV’s strengths and problems, from which research questions and hypotheses are first developed and then investigated through literature reviews and analyses of existing data. They will also develop research plans that can be further tested in DSM-V field trials involving direct data collection. In order to invite comments from the wider research, clinical, and consumer communities, the APA launched a DSM-V Prelude web site in 2004, on which these groups could submit questions, comments and research findings, which were then distributed to the relevant work groups.


Based on this comprehensive review of scientific advancements, targeted research analyses and clinical expertise, the work groups will develop draft DSM-V diagnostic criteria. A period of comment will follow, and the work group will review submitted questions, comments and concerns. The diagnostic criteria will be revised and the final draft of DSM-V will be submitted to the APA’s Council on Research, Assembly and Board of Trustees for their review and approval. A release of the final, approved DSM-V is expected in May, 2012.

The DSM V, as in previous versions, relies heavily on competent clinical input and field testing. Previous versions of the DSM series were developed without empirical data. The 2012 date will like drift as there is much to be done with the field studies.

quote:

I would also state that the women should get in the SAME exact line at the VA as the male infantry grunt who has this same problem. No special treatment or initiatives should be given based on gender b/c that only promotes an unhealthy resentment IMO and may actually discourage their male counterparts from seeking the help they need./

It is a big mistake IMO for the VA to push any initiative that even remotely correlates PTSD and gender. These articles are bad enough and I can almost bet that some men may get the notion that PTSD is for women which probably means just what it says to many men.

I tend to agree, and there are some special dispensations given to females by the VA that make me very wary and suspicious. (Of course, that may just be my PTSD-rlated paranoia talking :-/ )

Part of the problem with the "Get in the same line for the same services" idea is that my (male) rapist may well be in that same line for PTSD treatment that I'm in. He was in a war, too. He's also entitled to treatment. I don't begrudge him that. But being around him, and to a very significant degree, being around people who strongly *remind* me of him is not really so good for MY recovery, now is it?

I don't mind so much being in line with other rape victims. Even if they happen to be male. They and I would have "the same problem" to a certain degree.

But I'm pretty darned sure he and I don't want to be in the same therapy session swapping stories about our rapes! Male rape is psychologically a somewhat different can of worms from female rape. Raped women don't tend to be very comfy with other men around, and raped men don't much like for women to know that about them.

quote:

I think we all could agree that no veteran should ever HAVE to travel through life on edge, guilt ridden, insomnic, self-medicated, withdrawn, angry and depressed b/c there was no help. I've known a few to find certain items listed above to be therapeutic and I won't begrudge them their coping skills.

That part, we wholeheartedly agree on, though. I've spent 10 years trying to "just suck it up" and make my own way. But I can't do it anymore. I'm glad there's a VA to go to, I just wish it wasn't such a damned convoluted mess to get HELP there.



I lost track of where the post was, but someone mentioned that the burden should be on the GOv't to prove that a vet was NOT permanently damaged by their service. I kinda like that idea :-)

not holding my breath, though.

Any act of trauma is not sexual, but an act of violence.

Few people understand this and we must all be aware that is the case.