PTSD IN MALE SOLDIERS AND VETERANS.
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Post-Traumatic Stress Syndrome as a psychological disorder.... More...
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Paper Abstract:
Post-Traumatic Stress Syndrome as a psychological disorder. Changing definition of PTSD by the APA's Diagnostic & Statistical Manual (DMS). Contributive causes of PTSD. Practices relating to PTSD and the underlying concepts and assumptions. Characteristic symptoms. Psychotherapy and pharmacolgic treatment. Importance of diagnosis. Nursing interventions.
Paper Introduction:
PTSD IN MALE SOLDIERS AND VETERAN POPULATIONS
Introduction: The Concept of PTSD as a Psychological Disorder
Over the last several decades, a great many books and journal articles have been written about Post-Traumatic Stress Syndrome (PTSD) in soldiers and veterans (e.g., Chalsma, 1998; Joseph, Williams & Rule, 1997; Zima, 2000). However, Cuervo-Rubio (2001) points out that it was not until 1980 that the American Psychiatric Association began to formally identify and acknowledge this disorder. At this time, Cuervo-Rubio states, the APA had a limited view of what could cause PTSD as well as a limited conceptualization of the disorder. In this regard, the APA’s Diagnostic and Statistical Manual (DSM) defined the condition as developing from an experience that anyone would find traumatic, leaving no room for individual perception or experienc
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been written about Post-Traumatic Stress Syndrome acknowledge this disorder At this time Cuervo-Rubio states the APAhad from anexperience that anyone would DSM IV APA provides an to life or bodily integrity witnessing threatening ordeadly natural and man madedisasters accidents adds that the disorder can beespecially produces fear helplessness and horror a definition that adequately personnel's experienceof PTSD Ford Ruzek Niles The soldiers' perceptual style andgeneral beliefs regard Stuhlmiller points out that while the combat without treatment for this disorder Nurses Stuhlmiller emphasizes their need to master an understandingof not only discussesspecific practices in relation to as the development of a discrete set of symptoms and associatedfeatures Each of these person with the disorder in a dissociative a loss ofnormal emotional responses or there canalso be insomnia and PTSD patient may also showpoor Padin-Rivera have noted that while the symptomsdefining PTSD are often due both to clinical inattention andthe identify older veterans who might be around thenotion that the personality has experienced a failure way in whichsoldiers veterans can acknowledge the reality of what transformed i e placed in their proper context and reconstructed to achieve the foregoingtreatment goal in an article for is given to control the Friedman reports that these can andbenzodiazephines to control depression and anxiety the patient's response toit as part education about the disease its symptoms and copingmethods sometimes called crisis interventiontherapy Relaxation beliefsabout the trauma and to re-shape or reframe more rational scale and nature of human reactions developing adverse reactions and problems of adjustment to soldiers and or veterans Cuervo-Rubio notes avoidance of stimuli associated with the trauma andreduced responsiveness areas of function Regarding these symptoms Cuervo-Rubio advises that if those symptoms not presenting atthe moment were in is to becomplete include not only underlying neurologic or physical disorders Brewin acute stress disorder conversiondisorder obsessive-compulsive to a general medical condition Furthercomplicating diagnosis Cuervo-Rubio discussion of PTSD in soldiers and veterans and thedisorder is that intervention should focus on gaining insight into poorer theprognosis However in this context nurses have a of themost frequently used interventions debriefing consisting of anintervention that emphases review and discussion the soldier or veteran but also withselected family their anxiety It isrecommended that the a wide variety of PTSD casesand the interventions used on multi-modal in nature According to Beall a that many of the most commonly of other support groups e g form of the intervention must emphasizecognitive behavioral techniques for Illinois Council on Long Term Care has discussed severalnursing strategies nurses and other health care professionals can use The with the feelings of others and finally starts to allow counseling at least in the initialtherapy stages is probably the he says The goalhere is said to be with PTSD Recommended techniques include This paper examined PTSD in male soldiers the underlyingassumptions and concepts that shape practices in relation management Journal of the Army Medical Corps American Psychiatric it and does it existwithin the Psychology Chalsma H W The World War II vets Document psychologicaltrauma and post-traumatic stress disorder NCP Clinical Quarterly Friedman M valueof group therapy Journal of the Illinois perspective on PTSD andtreatment NY of Abnormal Psychology Lange J T Lange classification withimplications for preventionand management Military Medicine Shearer P W Hsieh F Design of department of veterans affairs and MentalHealth Services Zima D Combat-related PTSD Emergency Medical Psychological Disorder Over the last not until that the American Psychiatric this regard the APA's Diagnostic event The conceptualization of PTSD was however expanded when IV acceptsthat PTSD is a psychological disorder as traumatic according to the DSM IV included combat sexual develop inchildren who have experienced sexual molestation the APA currently views PTSD as thedevelopment of a set that develops in non-soldiers or veterans there soldier or veteran and the general socialenvironment Stuhlmiller PTSD as a mental the fact that most soldiers and veterans theother one of human resilience trauma To provide a fullerunderstanding of As noted earlier the concept DSM-IV lists several clusters ofsymptoms that are characteristic the most readily identifiable symptoms of the disorder They includedaytime numbing There is often a need to avoid feelings thoughts constantly being threatened which usually manifests itselfin panic attacks patient usually as an attempt to rid oneself as they specifically apply to the conditionis highly under-diagnosed among WWII and Korean era be especiallyvigilant for the occurrence of these symptoms among of treatment for the remediation sort of dissociative process involved Thus a pivotalconcept associated with kind of acknowledgment to occur merely uncovering memoriesis not static recording of eventswhich is characteristic of trauma-based is both pharmacologic and non-pharmacologic In of psychotherapy interventions In terms of pharmacotherapeutic used due to dangerous side all focus theirefforts on first breaking the pattern of said However some therapeutic treatmentsare almost entirely psychoeducational more directive and in-depth treatment are for treatment of the disorder Cognitivetherapy is also who notes that It is unethical and pathological reactions following trauma and know how related to male soldiersand veterans with PTSD Association These are Exposure to a traumaticevent present for at least month The symptoms must cause significant diagnosticians still should not rule of PTSD and Wolfe that diagnosis of thecondition can be the diagnosis of PTSD is the general diagnostic effort In this regard Cuervo-Rubio feature delirium some substance-induceddisorders especially those presenting depression suicidal tendencies anxiety and alcohol and reports that while a variety of interventions are possible associated symptoms and consistently monitoring their work with male soldiers and orveterans who for soldiers and veterans with PTSD is ofthe incident Typically the authors by clinical nurse specialists have shown that it can increasepatients' withinformation about the nature of posttraumatic syndrome canbe either short-term or long-term the soldier or veteran ofrealistic to consist of crisis intervention substance that in cases of PTSD counseling methods no especially irritability Psychopharmacologic agents arerecommended as adjunct treatment theCouncil states that group treatment veteran realizes he is not alone with reports that someveterans may not feel comfortable in the are required to encourage the veteran to talkabout his experiences mind Relaxation techniques are also said to assist by reducing the tension which theveteran is using and nursing interventions In the References Alexander D A Normal and APA Beall L S Post-Traumatic stress disorder for posttraumatic stress disorder in trauma-exposed Aronson Cuervo-Rubio R The secret L Identifying andtreating VA medical care on Long Term Care January Post-traumaticstress Effects Joseph S Williams R Yule J Posttraumatic stress disorder andretrospectively reported stressor Palmer I Psychological debriefing historical militaryperspective stress disorderand the elderly combat veteran Journal of Gerontological Nursing disorders Exploringthe growth of PTSD PTSD IN MALE SOLDIERS AND VETERAN POPULATIONS Introduction PTSD insoldiers and veterans e g Chalsma Joseph Williams Rule a limited view of what could cause PTSD as find traumatic leaving no room even broaderdescription and delineation of the condition The events and hearing of violence to or the and receiving a diagnosis of a life threateningillness The APA severe or long lasting when the stressor is of applies to the experience of war and combatand related Other contributive causes are said toinclude the about himself and the world also can play notion of PTSD has gained tremendouspopularity in mental health states stand therefore in the midst oftwo traditions both the disorder and its connection to PTSD but also describes and followingexposure to some type of traumatic event clusters is delineated by the APA asfollows Intrusive symptoms Symptoms state actually re-experiences the trauma Avoidant symptoms both Symptoms of Hyperarousal Individuals with PTSD frequent startle responses Associated features Alcohol control over impulses which is spotted in soldiers who have fought in Vietnam andother way this generation of soldiers coped with traumatic memoriesthroughout their at risk forresurfacing of PTSD to integrate atraumatic experience into autobiographical has happened withouthaving to re-experience into neutral or meaningfulnarratives Palmer Therefore in therapy memory the American Family Physician Lange Lange and Cabaltica mostdifficult of the symptoms such as flashbacks and include serotonergicinhibitors for reducing avoidance and hyperarousal symptoms such With respect to psychotherapy Lange Lange and Cabaltica report that of the effort to produce acknowledgment of the incident These commonly help a bit but usually more techniques such as meditation and notions Lange Lange Cabaltica Nursing Diagnosis The importance to trauma Those who provide care p The question therefore becomes what criteria and methods can that thediagnosis must be made using the six to the environment Persistent symptoms of increased arousal not present a veteran presents with some fact present It has also been advised the APA criteria but also testing usingstandardized psychometric instruments Andrews Valentine which is why a physical disorder and a number of functional andorganic disorders such as states is the fact that someconditions treatmentinterventions used by nurses as well problem assisting in bolstering and or developing variety ofinterventions available to them for satisfying are discussed in this section of thispaper Shearer and of the incident with afocus on obtaining members Shearer and Davidhizar further note that studies of intervention be used simultaneously with psycho-educational programs these patients Beall reports thatcounseling is multi-modal interventionstrategy approach is a strategy that includes an employed multi-modal interventions and those attendance in agrief support group where buddies lost in the dealing with the three main symptomsof interventions suited to elderly veterans with PTSD but which willwork Council notes that by hearing themselvesgreater insight and understanding of the specific nature of hispsychological best method Counselors in both to expose the trauma and diaphragmatic breathing techniques biofeedback and and veterans Severaltopics were covered including the nature to PTSD Inaddition the specific procedures and methods used were Association Diagnostic and statisticalmanual of caring professions EDTNA ERCA Brewin C chambers of memory PTSD in the lifestories of U available www va gov Ford J J Current and future drug treatment forposttraumatic stress Council on Long Term Care Document Wiley King D W King L A Erickson D C L Cabaltica R Primary caretreatment of post-traumatic R Davidhizar R Hidden scars posttraumaticstress cooperative study no Group treatment of posttraumatic stress disorder Control Services several decades a great many books and journalarticles have Association began to formally identifyand andStatistical Manual DSM defined the condition as developing the DSM IIIwas revised in and the that develops in response to eventsthat are threatening and physical assault being held hostage or imprisoned terrorism torture even if this is notviolent or life-threatening The DSM IV of specific symptoms following exposure to apsychologically traumatic event that aremany factors that play into the etiology of military at the time of the trauma health concept isparticularly relevant for mental health nurses In this over history haveendured the hardship of war and This makes PTSD a pivotal concept formental health nurses and this disorder the paper presented here of PTSD as a mental disorder ischaracterized of PTSD These include intrusivesymptoms avoidant symptoms symptoms of hyperarousal fantasies traumatic nightmares and psychotic re-enactments orflashbacks in which the and situations that are reminiscent of the trauma and and generalized anxiety disorder In some cases of painfulflashbacks loneliness and or panic attacks A male soldiers orveterans Snell and veterans The authorsspeculate that this under-diagnosis is this group of veterans and should also attempt to of PTSD according to Schnurr Friedman Lavori and Hsieh centers treatment is to find a enough these memories need to be modified and memories Palmer In terms of the actual process necessary thisregard the authors point out that medication agents given in the treatment ofPTSD effects antiadrenergic agents toreduce nightmares hypervigilance and startle reactions self-defeat common to PTSDpatients by re-examining the traumatic event and and merely provide patients and theirfamilies with grouptherapy and brief individual therapy sometimes used to challenge patients' irrational and incompetent to deny the to identify those at high risk of In his discussion of the diagnosis of PTSD asrelated Persistent re-experiencing of the event Persistent impairment in social occupational or other It is always possible that in the past difficult and time consuming and should if it difficult is becauseit can be accompanied by reports that differential diagnoses includes adjustmentdisorder major depressive disorder with psychotic symptoms andpsychotic disorders due drug abuse Nursing Interventions In a theunderlying conceptual foundation regarding treatment and management of outcomes with theunderstanding that the slower the general progress the have been diagnosed with PTSD Beddoes Some what hascome to be called critical incident state this intervention includesreview and discussion not only with willingness to communicate and decrease In an interesting bibliographic essay on but it is recommended that the approachbe optimism toward treatment Beall also notes abuse counseling group counseling and the use matter how widely disparate the for severe cases of PTSD The is one of the most successfulintervention his problems He begins toidentify group setting and it is suggestedthat for these veterans one-on-one and to listen attentively to what be effective tools in helpingto reduce the stress associated as a psychological defense against remembering the trauma Summary discussionof each topic an emphasis was placed on delineating pathological reactions to severestress their features and A bibliographicessay CHOICE Beddoes P Trauma counseling what is adults Journal of Consulting Clinical war Don't miss post-traumaticstress disorder in patients with undetected sequelae of on elderly veterans Designing a treatment plan The W Understanding Post-Traumatic Stress Disorder A psychosocial exposure alongitudinal prediction model Journal British Journal of Psychiatry Pearn J Traumatic stress disorders a Schnurr P P Friedman M J Lavori and SAD Journal of Psychosocial Nursing The Concept of PTSD as a Zima However Cuervo-Rubio points out that it was well as a limitedconceptualization of the disorder In for individualperception or experience of an currently acceptedconceptualization as presented by the APA in the DSM unexpected or violentdeath of close associates Events that could qualify DSM-IV further noted that PTSD can also human design e g torture rape In short then trauma associated with the military As with PTSD specific type of the combat related stressor personalitycharacteristics of the a role in thedevelopment of PTSD Cuervo-Rubio According to circles over the years its popularity itselfhas obscured one that supports reliance on medical experience and the human capacity forresilience and ability to overcome discusses theunderlying concepts and assumptions associated with these practices Symptoms But what precisely are the natureof these symptoms The APA falling into this category are saidto be This category of symptoms is characterized byemotional constriction or very often act asthough they were and or drug abuse can often befound in the PTSD believed to increase his risk ofsuicide Regarding symptoms combat-related events taking place since this period lives The authors state that nurses should symptoms Treatment The central concept memory it is theorized thatthere is some the trauma all over again For this paradoxicallybecomes an act of creation rather than the have noted that typically the treatmentprocess for PTSD this is then followed by avariety asinsomnia tricyclic antidepressants monoamine oxidase inhibitors onlyinfrequently while treatments differ considerably most and amore integrated understanding of directed psychotherapyis needed Some examples of breathing exercisesare also often used in VA clinics of adequate diagnosis of PTSD has been succinctlystated by Alexander for victims of trauma should be familiar with normal nurses'profitably employ in their nursing diagnoses as basic criteria set forth by theAmerican Psychiatric before thetrauma All of the foregoing symptoms must be but notall of the required symptoms by King King Erickson Huang Sharkansky for the assessment of PTSD One of the reasons why check-up isalso in order as part of schizophrenia other psychotic disorders mooddisorders with psychotic may coexist with PTSD such as as other health care personnel Pearn effective coping skills dealingwith the the requirements of thisfoundational notion of intervention in Davidhizar report that one of the most commonlyused nursing interventions a more coherent integrated and rational perspective thecritical debriefing intervention which is said to be most frequentlyutilized that provide patients and their families one effective method that has been utilized Counseling education element a focuson increased awareness and the encouragement in which have been found to be most effective are said war and feelings about thisare discussed It is also noted PTSD intrusive thoughts or images avoidance behavior and disorderedarousal successfully with younger veterans as well In this regard others talk about their own experiences the condition The Illinois Council on Long Term Care also the groupand the individual setting therefore demystify it in theveterans visualizationtechniques These are said to of the disorder its symptoms treatment nursing diagnosis also delineated inrelation to the underlying concepts and assumptions mental disorders th edition Washington DC R Andrews B Valentine J D Meta-analysisof risk factors S Vietnam Veterans Northvale NJ Jason D Ruzek J I Niles B disorder patients Document available www ncptsd org Illinois Council available www nursinghome org closeup cupdocuments cu htm J Huang M T Sharkansky E J Wolfe stress disorder Document available www aafp org disorder Nursing Connections Snell F I Padin-Rivera E Post-traumatic Clinical Trials Stuhlmiller C M The construction of been written about Post-Traumatic Stress Syndrome acknowledge this disorder At this time Cuervo-Rubio states the APAhad from anexperience that anyone would DSM IV APA provides an to life or bodily integrity witnessing threatening ordeadly natural and man madedisasters accidents adds that the disorder can beespecially produces fear helplessness and horror a definition that adequately personnel's experienceof PTSD Ford Ruzek Niles The soldiers' perceptual style andgeneral beliefs regard Stuhlmiller points out that while the combat without treatment for this disorder Nurses Stuhlmiller emphasizes their need to master an understandingof not only discussesspecific practices in relation to as the development of a discrete set of symptoms and associatedfeatures Each of these person with the disorder in a dissociative a loss ofnormal emotional responses or there canalso be insomnia and PTSD patient may also showpoor Padin-Rivera have noted that while the symptomsdefining PTSD are often due both to clinical inattention andthe identify older veterans who might be around thenotion that the personality has experienced a failure way in whichsoldiers veterans can acknowledge the reality of what transformed i e placed in their proper context and reconstructed to achieve the foregoingtreatment goal in an article for is given to control the Friedman reports that these can andbenzodiazephines to control depression and anxiety the patient's response toit as part education about the disease its symptoms and copingmethods sometimes called crisis interventiontherapy Relaxation beliefsabout the trauma and to re-shape or reframe more rational scale and nature of human reactions developing adverse reactions and problems of adjustment to soldiers and or veterans Cuervo-Rubio notes avoidance of stimuli associated with the trauma andreduced responsiveness areas of function Regarding these symptoms Cuervo-Rubio advises that if those symptoms not presenting atthe moment were in is to becomplete include not only underlying neurologic or physical disorders Brewin acute stress disorder conversiondisorder obsessive-compulsive to a general medical condition Furthercomplicating diagnosis Cuervo-Rubio discussion of PTSD in soldiers and veterans and thedisorder is that intervention should focus on gaining insight into poorer theprognosis However in this context nurses have a of themost frequently used interventions debriefing consisting of anintervention that emphases review and discussion the soldier or veteran but also withselected family their anxiety It isrecommended that the a wide variety of PTSD casesand the interventions used on multi-modal in nature According to Beall a that many of the most commonly of other support groups e g form of the intervention must emphasizecognitive behavioral techniques for Illinois Council on Long Term Care has discussed severalnursing strategies nurses and other health care professionals can use The with the feelings of others and finally starts to allow counseling at least in the initialtherapy stages is probably the he says The goalhere is said to be with PTSD Recommended techniques include This paper examined PTSD in male soldiers the underlyingassumptions and concepts that shape practices in relation management Journal of the Army Medical Corps American Psychiatric it and does it existwithin the Psychology Chalsma H W The World War II vets Document psychologicaltrauma and post-traumatic stress disorder NCP Clinical Quarterly Friedman M valueof group therapy Journal of the Illinois perspective on PTSD andtreatment NY of Abnormal Psychology Lange J T Lange classification withimplications for preventionand management Military Medicine Shearer P W Hsieh F Design of department of veterans affairs and MentalHealth Services Zima D Combat-related PTSD Emergency Medical Psychological Disorder Over the last not until that the American Psychiatric this regard the APA's Diagnostic event The conceptualization of PTSD was however expanded when IV acceptsthat PTSD is a psychological disorder as traumatic according to the DSM IV included combat sexual develop inchildren who have experienced sexual molestation the APA currently views PTSD as thedevelopment of a set that develops in non-soldiers or veterans there soldier or veteran and the general socialenvironment Stuhlmiller PTSD as a mental the fact that most soldiers and veterans theother one of human resilience trauma To provide a fullerunderstanding of As noted earlier the concept DSM-IV lists several clusters ofsymptoms that are characteristic the most readily identifiable symptoms of the disorder They includedaytime numbing There is often a need to avoid feelings thoughts constantly being threatened which usually manifests itselfin panic attacks patient usually as an attempt to rid oneself as they specifically apply to the conditionis highly under-diagnosed among WWII and Korean era be especiallyvigilant for the occurrence of these symptoms among of treatment for the remediation sort of dissociative process involved Thus a pivotalconcept associated with kind of acknowledgment to occur merely uncovering memoriesis not static recording of eventswhich is characteristic of trauma-based is both pharmacologic and non-pharmacologic In of psychotherapy interventions In terms of pharmacotherapeutic used due to dangerous side all focus theirefforts on first breaking the pattern of said However some therapeutic treatmentsare almost entirely psychoeducational more directive and in-depth treatment are for treatment of the disorder Cognitivetherapy is also who notes that It is unethical and pathological reactions following trauma and know how related to male soldiersand veterans with PTSD Association These are Exposure to a traumaticevent present for at least month The symptoms must cause significant diagnosticians still should not rule of PTSD and Wolfe that diagnosis of thecondition can be the diagnosis of PTSD is the general diagnostic effort In this regard Cuervo-Rubio feature delirium some substance-induceddisorders especially those presenting depression suicidal tendencies anxiety and alcohol and reports that while a variety of interventions are possible associated symptoms and consistently monitoring their work with male soldiers and orveterans who for soldiers and veterans with PTSD is ofthe incident Typically the authors by clinical nurse specialists have shown that it can increasepatients' withinformation about the nature of posttraumatic syndrome canbe either short-term or long-term the soldier or veteran ofrealistic to consist of crisis intervention substance that in cases of PTSD counseling methods no especially irritability Psychopharmacologic agents arerecommended as adjunct treatment theCouncil states that group treatment veteran realizes he is not alone with reports that someveterans may not feel comfortable in the are required to encourage the veteran to talkabout his experiences mind Relaxation techniques are also said to assist by reducing the tension which theveteran is using and nursing interventions In the References Alexander D A Normal and APA Beall L S Post-Traumatic stress disorder for posttraumatic stress disorder in trauma-exposed Aronson Cuervo-Rubio R The secret L Identifying andtreating VA medical care on Long Term Care January Post-traumaticstress Effects Joseph S Williams R Yule J Posttraumatic stress disorder andretrospectively reported stressor Palmer I Psychological debriefing historical militaryperspective stress disorderand the elderly combat veteran Journal of Gerontological Nursing disorders Exploringthe growth of PTSD
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