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VA Claims: Disabled Veterans Community|Hadit.com

Veterans Suicide – An American Legion White Paper

Suicide prevention is a top priority of The American Legion.
Deeply concerned about the number of military veterans who take their own lives at rates higher than that of the general population, the nation’s largest organization of wartime veterans established a Suicide Prevention Program under the supervision of its TBI/PTSD standing committee, which reports to the national Veterans Affairs & Rehabilitation Commission.
The TBI/PTSD Committee reviews methods, programs and strategies that can be used to treat traumatic brain injuries (TBI) and post-traumatic stress disorder (PTSD). In order to reduce veteran suicide, this committee seeks to influence legislation and operational policies that can improve treatment and reduce suicide among veterans, regardless of their service eras.
This white paper report examines recent trends in veteran suicide and their potential causes and recommends steps to address this public health crisis.

Since 2001, the U.S. military has been actively engaged in combat operations on multiple continents in the Global War on Terror.More than 3 million Americans have served in Iraq or Afghanistan through the first 17 years of the war. Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) have become known as the “signature wounds” of the war, and in recent years, countless studies, articles and reports have documented an inordinately high suicide rate among those who have come home from the war, those of previous war eras and among active-duty personnel.

The American Legion is deeply concerned by the high suicide rate among service- members and veterans, which has increased substantially since 2001.1 The suicide rate among 18-24-year-old male Iraq and Afghanistan veterans is particularly troubling, having risen nearly fivefold to an all-time high of 124 per 100,000, 10 times the national average. A spike has also occurred in the suicide rate of 18-29-year-old female veterans, doubling from 5.7 per 100,000 to 11 per 100,000.2 These increases are startling when compared to rates of other demographics of veterans, whose suicide rates have stayed constant during the same time period.

Read the full report below:
American Legion White Paper on Veteran Suicide by Jared Keller

VA Clears The Air On Doctors Talking To Veterans About Marijuana Use

Do you trust the VA to discuss medical marijuana? Many veterans don’t, VA docs can’t prescribe, they can, it says, discuss how it might interact with other medications or how it might effect pain management or PTSD symptoms.
VA providers are still NOT permitted to refer veterans to state-approved medical marijuana programs, since the drug is illegal under federal law, with no accepted medical use.
So do you trust VA?
https://www.npr.org/sections/health-shots/2018/01/09/576577596/va-clears-the-air-on-doctors-talking-to-veterans-about-marijuana-use
Related
https://www.politico.com/magazine/story/2017/12/16/jeff-sessions-marijuana-216109

History of PTSD in Veterans: Civil War to DSM-5 by Matthew J. Friedman, MD, PhD Senior Advisor and former Executive Director, National Center for PTSD

[no_toc]Exposure to traumatic experiences has always been a part of the human condition. Attacks by saber tooth tigers or twenty-first century terrorists have likely led to similar psychological responses in survivors of such violence. Literary accounts offer the first descriptions of what we now call posttraumatic stress disorder (PTSD). For example, authors including Homer (The Iliad), William Shakespeare (Henry IV), and Charles Dickens (A Tale of Two Cities) wrote about traumatic experiences and the symptoms that followed such events.

The PTSD diagnosis has filled an important gap in psychiatry in that its cause was the result of an event the individual suffered, rather than a personal weakness. PTSD became a diagnosis with influence from a number of social movements, such as Veteran, feminist, and Holocaust survivor advocacy groups. Research about Veterans returning from combat was a critical piece to the creation of the diagnosis. War takes a physical and emotional toll on Servicemembers, families, and their communities. So, the history of what is now known as PTSD often references combat history.

Early attempts at a medical diagnosis

Accounts of psychological symptoms following military trauma date back to ancienttimes. The American Civil War (1861-1865) and the Franco-Prussian War (1870-1871) mark the start of formal medical attempts to address the problems of military Veterans exposed to combat. European descriptions of the psychological impact of railroad accidents also added to early understanding of trauma-related conditions.
 

Nostalgia, Soldier’s Heart, and Railway Spine

Prior to U.S. military efforts, Austrian physician Josef Leopold (1761) wrote about “nostalgia” among soldiers. Among those who were exposed to military trauma, some reported missing home, feeling sad, sleep problems, and anxiety. This description of PTSD-like symptoms was a model of psychological injury that existed into the Civil War.
 
A second model of this condition suggested a physical injury as the cause of symptoms. “Soldier’s heart” or “irritable heart” was marked by a rapid pulse, anxiety, and trouble breathing. U.S. doctor Jacob Mendez Da Costa studied Civil War soldiers with these “cardiac” symptoms and described it as overstimulation of the heart’s nervous system, or “Da Costa’s Syndrome.” Soldiers were often returned to battle after receiving drugs to control symptoms.
The thought that physical injury led to PTSD-like symptoms was supported by European reports of “railway spine.” As rail travel became more common, so did railway accidents. Injured passengers who died had autopsies that suggested injury to the central nervous system. Of note, Charles Dickens was involved in a rail accident in 1865 and wrote about symptoms of sleeplessness and anxiety as a result of the trauma.

Shell Shock

In 1919, President Wilson proclaimed November 11th as the first observance of Armistice Day, the day World War I ended. At that time, some symptoms of present-day PTSD were known as “shell shock” because they were seen as a reaction to the explosion of artillery shells. Symptoms included panic and sleep problems, among others. Shell shock was first thought to be the result of hidden damage to the brain caused by the impact of the big guns. Thinking changed when more soldiers who had not been near explosions had similar symptoms. “War neuroses” was also a name given to the condition during this time.
During World War I, treatment was varied. Soldiers often received only a few days’ rest before returning to the war zone. For those with severe or chronic symptoms, treatments focused on daily activity to increase functioning, in hopes of returning them to productive civilian lives. In European hospitals, “hydrotherapy” (water) or “electrotherapy” (shock) were used along with hypnosis.

Battle Fatigue or Combat Stress Reaction (CSR)

In World War II, the shell shock diagnosis was replaced by Combat Stress Reaction (CSR), also known as “battle fatigue.” With long surges common in World War II, soldiers became battle weary and exhausted. Some American military leaders, such as Lieutenant Gen. George S. Patton, did not believe “battle fatigue” was real. A good account of CSR can be found in Stephen Crane’s Red Badge of Courage, which describes the acute reaction of a new Union Army recruit when faced with the first barrage of Confederate artillery.
Up to half of World War II military discharges were said to be the result of combat exhaustion. CSR was treated using “PIE” (Proximity, Immediacy, Expectancy) principles. PIE required treating casualties without delay and making sure sufferers expected complete recovery so that they could return to combat after rest. The benefits of military unit relationships and support became a focus of both preventing stress and promoting recovery.

Development of the PTSD diagnosis

In 1952, the American Psychiatric Association (APA) produced the first Diagnostic and Statistical Manual of Mental Disorders (DSM-I), which included “gross stress reaction.” This diagnosis was proposed for people who were relatively normal, but had symptoms from traumatic events such as disaster or combat. A problem was that this diagnosis assumed that reactions to trauma would resolve relatively quickly. If symptoms were still present after six months, another diagnosis had to be made.
Despite growing evidence that trauma exposure was associated with psychiatric problems, this diagnosis was eliminated in the second edition of DSM (1968). DSM-II included “adjustment reaction to adult life” which was clearly insufficient to capture a PTSD-like condition. This diagnosis was limited to three examples of trauma: unwanted pregnancy with suicidal thoughts, fear linked to military combat, and Ganser syndrome (marked by incorrect answers to questions) in prisoners who face a death sentence.
In 1980, APA added PTSD to DSM-III, which stemmed from research involving returning Vietnam War Veterans, Holocaust survivors, sexual trauma victims, and others. Links between the trauma of war and post-military civilian life were established.
The DSM-III criteria for PTSD were revised in DSM-III-R (1987), DSM-IV (1994), DSM-IV-TR (2000), and DSM-5 (2013) to reflect continuing research. One important finding, which was not clear at first, is that PTSD is relatively common. Recent data shows about 4 of every 100 American men (or 4%) and 10 out every 100 American women (or 10%) will be diagnosed with PTSD in their lifetime.
An important change in DSM-5, is that PTSD is no longer an Anxiety Disorder. PTSD is sometimes associated with other mood states (for example, depression) and with angry or reckless behavior rather than anxiety. So, PTSD is now in a new category, Trauma- and Stressor-Related Disorders. PTSD includes four different types of symptoms: reliving the traumatic event (also called re-experiencing or intrusion); avoiding situations that are reminders of the event; negative changes in beliefs and feelings; and feeling keyed up (also called hyperarousal or over-reactive to situations). Most people experience some of these symptoms after a traumatic event, so PTSD is not diagnosed unless all four types of symptoms last for at least a month and cause significant distress or problems with day-to-day functioning.

Today and tomorrow

Today VA operates more than 200 specialized programs for the treatment of PTSD. In Fiscal Year (FY) 2013, more than a half million Veterans diagnosed with PTSD received treatment at VA medical centers and clinics.
VA is committed to provide the most effective, evidence-based care for PTSD. It has created programs to ensure VA clinicians receive training in state-of-the-art treatments for PTSD. At of the end of FY 2013, VA had trained more than 5000 of its clinicians to use Cognitive Processing Therapy (CPT) or Prolonged Exposure (PE), which are cited by the Institute of Medicine Committee on Treatment of PTSD as proven to be effective treatments for PTSD.
VA’s National Center for PTSD was created in 1989 by an act of Congress, and celebrated its 25th anniversary on August 29, 2014. We continue to be at the forefront of progress in the scientific understanding and treatment of PTSD. In addition to improving upon existing treatments, we are researching effective new treatments. We are also developing new educational products such as our What is PTSD?whiteboard video. For more information on the National Center for PTSD, please visit our About Us section of the website.

Sources

National Center for PTSD May 2017
Portions of this fact sheet originally appeared in a Veterans Day observance post on VA’s blog, VAntage Point (November 7, 2013). For more information about the history of the PTSD diagnosis, see PTSD History and Overview in the Professional Section of our website.

PTSD Does Not Mean You’re Crazy

[no_toc]What is PTSD?

understandingptsd_booklet

Posttraumatic Stress Disorder (PTSD) can occur after you have been through a traumatic event. A traumatic event is something terrible and scary that you see, hear about, or that happens to you, like:

  • Combat exposure
  • Child sexual or physical abuse
  • Terrorist attack
  • Sexual or physical assault
  • Serious accidents, like a car wreck
  • Natural disasters, like a fire, tornado, hurricane, flood, or earthquake

During a traumatic event, you think that your life or others’ lives are in danger. You may feel afraid or feel that you have no control over what is happening around you. Most people have some stress-related reactions after a traumatic event; but, not everyone gets PTSD. If your reactions don’t go away over time and they disrupt your life, you may have PTSD.

How does PTSD develop?

Most people who go through a trauma have some symptoms at the beginning. Only some will develop PTSD over time. It isn’t clear why some people develop PTSD and others don’t.

Whether or not you get PTSD depends on many things:

  • How intense the trauma was or how long it lasted
  • If you were injured or lost someone important to you
  • How close you were to the event
  • How strong your reaction was
  • How much you felt in control of events
  • How much help and support you got after the event

What are the symptoms of PTSD?

PTSD symptoms usually start soon after the traumatic event, but they may not appear until months or years later. They also may come and go over many years. If the symptoms last longer than four weeks, cause you great distress, or interfere with your work or home life, you might have PTSD.

There are four types of symptoms of PTSD:

  • Reliving the event (also called re-experiencing symptoms) You may have bad memories or nightmares. You even may feel like you’re going through the event again. This is called a flashback.
    • Memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place. For example:
      • You may have nightmares.
      • You may feel like you are going through the event again. This is called a flashback.
      • You may see, hear, or smell something that causes you to relive the event. This is called a trigger. News reports, seeing an accident, or hearing a car backfire are examples of triggers.
  • Avoiding situations that remind you of the event You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.
    • You may avoid crowds, because they feel dangerous.
    • You may avoid driving if you were in a car accident or if your military convoy was bombed.
    • If you were in an earthquake, you may avoid watching movies about earthquakes.
    • You may keep very busy or avoid seeking help because it keeps you from having to think or talk about the event.
  • Negative changes in beliefs and feelings The way you think about yourself and others may change because of the trauma. You may feel fear, guilt, or shame. Or, you may not be interested in activities you used to enjoy. This is another way to avoid memories.
    • You may not have positive or loving feelings toward other people and may stay away from relationships.
    • You may forget about parts of the traumatic event or not be able to talk about them.
    • You may think the world is completely dangerous, and no one can be trusted.
  • Feeling keyed up (also called hyperarousal) You may be jittery, or always alert and on the lookout for danger. Or, you may have trouble concentrating or sleeping. This is known as hyperarousal.
    • You may have a hard time sleeping.
    • You may have trouble concentrating.
    • You may be startled by a loud noise or surprise.
    • You might want to have your back to a wall in a restaurant or waiting room.

What other problems do people with PTSD experience?

People with PTSD may also have other problems. These include:

  • Feelings of hopelessness, shame, or despair
  • Depression or anxiety
  • Drinking or drug problems
  • Physical symptoms or chronic pain
  • Employment problems
  • Relationship problems, including divorce

In many cases, treatments for PTSD will also help these other problems, because they are often related. The coping skills you learn in treatment can work for PTSD and these related problems.

Will I get better?

“Getting better” means different things for different people, and not everyone who gets treatment will be “cured.” Even if you continue to have symptoms, however, treatment can help you cope. Your symptoms don’t have to interfere with your everyday activities, work, and relationships.

What treatments are available?

When you have PTSD, dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But treatment can help you get better. There are two main types of treatment, psychotherapy (sometimes called counseling) and medication. Sometimes people combine psychotherapy and medication.

Psychotherapy for PTSD

Psychotherapy, or counseling, involves meeting with a therapist. There are different types of psychotherapy:

  • Cognitive behavioral therapy (CBT) is the most effective treatment for PTSD. There are different types of CBT, such as cognitive therapy and exposure therapy.
    • One type is Cognitive Processing Therapy (CPT) where you learn skills to understand how trauma changed your thoughts and feelings.
    • Another type is Prolonged Exposure (PE) therapywhere you talk about your trauma repeatedly until memories are no longer upsetting. You also go to places that are safe, but that you have been staying away from because they are related to the trauma.
    • A similar kind of therapy is called Eye Movement Desensitization and Reprocessing (EMDR), which involves focusing on sounds or hand movements while you talk about the trauma.

Medications for PTSD

Medications can be effective too. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD. Another medication called Prazosin has been found to be helpful in decreasing nightmares related to the trauma.

IMPORTANT: Benzodiazepines and atypical antipsychotics should generally be avoided for PTSD treatment because they do not treat the core PTSD symptoms.

Source: National Center for PTSD

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