Is PTSD Linked to Violence? What’s an Effective Cure for PTSD? The case against a United States soldier who is accused of going on a shooting rampage earlier this month in two Afghan villages that left women and children dead has focused global attention on post-traumatic stress disorder (PTSD) and other “invisible wounds of war” and of traumatic events like rape.
The suspect in the case, Staff Sgt. Robert Bales, 38, is being held in Fort Leavenworth, Kansas, even as a military investigation into his case continues. The case has also triggered a system-wide review of mental health facilities in the U.S. defense system.
Court records show that Bales had gone on four tours of duty in Iraq and Afghanistan after he enlisted in the military after the Sept. 11 terrorist attacks. His lawyer, Attorney John Henry Browne, has said he will cite PTSD to defend the serviceman.
What is PTSD?
Post-traumatic stress disorder is a mental illness that results when a person experiences traumatic or life-threatening events — war, rape and other sexual assaults, violent physical attacks, torture, child abuse and even natural disasters such as earthquakes and floods, and automobile or airplane crashes.
People with this disorder are distraught by having to relive in their minds the traumatic event again and again, through nightmares and during the day, disturbing memories. Sometimes, innocuous events that are similar to the traumatic events trigger sudden intrusive flashbacks. When these happen, sufferers lose touch with reality and relive the images, sounds, and other sensations from the trauma.
Others who suffer PTSD may seem emotionally numb and detached, then alternately, irritable and easily startled. Still others may feel guilty about surviving a traumatic event that killed other people. Other symptoms include trouble concentrating, depression and sleep difficulties.
Some PTSD sufferers lash out with unpredictable, angry outbursts at family and friends. Alternatively, they may seem to have no affection for their loved ones.
Called “shell shock” or “combat fatigue” in war veterans, in victims of sexual or physical abuse the disorder is called “rape trauma” or “battered woman syndrome.” The American Psychiatric Association (APA) adopted the current name of the disorder in 1980.
Post-traumatic stress disorder can disrupt a sufferer’s life severely. Aside from the emotional pain of reliving the trauma, symptoms may cause a person to think that he or she is “going crazy.” Symptoms usually begin shortly after the traumatic event — but some people may not show symptoms for several years. The disorder can last for years if it’s left untreated.
PTSD can bring on physical health issues like arthritis and back pain, interpersonal problems, reduced daily functioning, and overall, a lower quality of life. For most sufferers, maintaining employment can be difficult or impossible.
Often, PTSD is accompanied by depression, panic disorder — and because drugs and alcohol are a means of self-medication — substance abuse. People who suffer from PTSD may unwittingly worsen their problems by abusing alcohol or drugs to cope with the symptoms. Others work very long hours to prevent any “down” periods when they might relive the trauma. Mostly, because of their extreme anxiety and distress about the event, they try to avoid anything that reminds them of it.
Less diagnosed to save money?
But because a U.S. service member with the diagnosis becomes eligible for more and substantial financial benefits, U.S. Army psychiatrists may have been overturning diagnoses of post-traumatic stress disorder systematically — in order to save money.
That, at least, is the accusation of Senator Patty Murray (D-Washington) who is chairwoman of the Senate Veterans’ Affairs Committee.
Late in March, Murray’s office said that a review of PTSD cases dating to 2007 found that more than 40 percent had been reversed by a medical screening team. Specifically, of the 1,680 patients screened, more than 690 had been diagnosed with post-traumatic stress disorder –but the military psychiatric team had reversed more than 290 of those diagnoses during that period.
The forensic psychiatry unit at the Madigan Army Medical Center on Joint Base Lewis-McChord — the unit responsible for the diagnostic reversals — is now being investigated for reversing diagnoses to save up on money that would have gone to provide care and benefits to members of the military if they had gotten a diagnosis of PSTD.
A system-wide review of mental health facilities is also being conducted by the Army inspector general to determine whether the change in diagnosis was isolated or a common practice — and how and why those diagnoses were changed, Army Secretary John McHugh told Congress recently.
The U.S. war in Afghanistan is the longest military conflict in American history — and many of the troops who have fought there also saw combat in Iraq. Doctors say at least one third of all soldiers who had gone to both wars returned with mental health problems. Last year alone, 100,000 vets who served in Iraq and Afghanistan received treatment for post-traumatic stress.
“We have in the military writ large over 50,000 folks in uniform who have had at least four deployments,” says McHugh.
Prescribed with addictive opioids, instead
But instead of being taken out of duty and given therapies for their disorder, war veterans with post-traumatic stress disorder were given high-risk drugs like opioids, the Voice of America reports.
VOA cited the shocking findings of a study that followed more than 140,000 U.S. military veterans who had served in Iraq and Afghanistan between 2005 and 2010 — and who had been prescribed an opioid within a year of getting a pain diagnosis at a veterans’ hospital.
According to the study, published in the Journal of the American Medical Association, veterans with PTSD were two-and-a-half times more likely to be on these opioids or narcotics.
“Veterans who had a mental health diagnosis, but particularly PTSD (post-traumatic stress disorder) were far more likely than their counterparts without mental health problems to receive opiate pain medication,” says Dr. Karen Seal, co-author of the study.
Dr. Seal and her colleagues also expressed concern about the quantity of drugs prescribed. “These patients tend to receive higher dose opiates than their counterparts and would request early refills of their opiates — which indicates that they are using them more quickly than they should be,” Dr. Seal said.
The investigators also say that many of the veterans on these drugs — whether they were mentally ill or not — had higher rates of accidents, alcoholism, violent injuries, suicides and overdoses.
The researchers say the findings mean that alternative methods of treatment — physical therapy, talk therapy or acupuncture — should be offered more widely,
“The study really woke us up to the reality of the serious adverse consequences that can occur with the use of opiates in returning Iraq and Afghanistan veterans who have pain and mental health problems,” Dr. Seal says.
Indeed, this may be the key to unlocking — and solving — the mysterious link between PSTD in war veterans and violent acts.
PTSD: no link with violence
After all, research shows that PTSD symptoms include irritability, disrupted sleep and hypervigilance, and lashing out at friends and family — but extreme violence is not a behavior that the disorder is tied to, says Dr. Lisa Jaycox, behavioral scientist at Rand Corporation.
“There’s no good data linking PTSD to acts of extreme violence like the kinds that have been in the news,” Dr. Jaycox says. Rand is a nonprofit global policy think tank first formed to offer research and analysis to the U.S. armed forces. Currently, it’s financed by the U.S. government and private endowment, corporations in the healthcare industry and other industries, universities and private individuals.
But Dr. Jaycox does agree that the soldier being held for the recent massacre in Afghanistan, Bales, was likely suffering from PTSD. Multiple deployments are a red flag and Bales was on his fourth combat tour when the shooting in Afghanistan occurred, she says.
“Definitely, the more exposure to combat trauma, the more likely people are to develop post-traumatic stress disorder,” she says.
Therapies that help PTSD
Dr. Michael Yochelson, part of a military medical team that assessed returning soldiers for post-traumatic stress disorder and traumatic brain injury, tells VOA that treating post-traumatic stress disorder takes more than a quick fix.
Psychiatrists and health experts agree that treating post-traumatic stress disorder involves not only drugs, but psychotherapy — or a combination of both.
What’s more, opioids are not commonly known to improve the condition. Instead, psychoactive drugs that help are antidepressants or anxiety-reducing drugs to treat the mood disturbances that sometimes accompany the disorder. Opioids are more likely to worsen PTSD.
But the mainstay of PTSD treatment is psychotherapy and exposure therapy — which is a form of cognitive behavioral therapy is absolutely essential, doctors say. With these therapies, patients will notice — within a few months a significant drop off in the intensity and frequency of their symptoms, doctors say.
Psychotherapy helps sufferers confront the traumatic experience, work through their strong negative emotions, and overcome their symptoms. Many people with PTSD also benefit from group therapy with other individuals suffering from the disorder.
911 dispatchers also suffer PTSD, marijuana may help
Meanwhile, a new study by researchers from the Northern Illinois University shows that 911 dispatchers may be at risk, too, for post-traumatic stress disorder.
The researchers found that even though 911 dispatchers were not directly in the traumatic event, they also experienced the emotional distress associated with PTSD. Their research is published in the Journal of Traumatic Stress.
According to the study, the dispatchers experienced a high level of distress following 32 percent of potentially traumatic calls and 3.5 percent of the dispatchers reported symptoms severe enough to be classified as PTSD.
The study of 171 emergency dispatchers who worked in 24 states showed that not knowing what happens after calls are dispatched was identified as a significant stressor for 911 dispatchers. “We don’t know the end result. We don’t know if they made it. There is no formal communication back to us,” Monica Gavio, a coordinator for the Burlington County, New Jersey, 911 communications center, tells ABC News.
The most stress-causing kind of calls identified were:
• a child’s unexpected injury or death, 16 percent
• suicidal callers, 13 percent
• police-officer shootings, 10 percent
• unexpected death of an adult, 10 percent
A September 2011 study showed that 637 male lab rats subjected to severe trauma-causing events — restraint, forced swims and anesthetization — went on to develop PTSD symptoms like exaggerated startle response and elevated stress hormones.
In that study, researchers also demonstrated that the PTSD rats got well when they were given a synthetic compound that mimics the effects of THC — the main psychoactive ingredient in marijuana — two to 24 hours after the stressful event. The study was published in the journal Neuropsychopharmacology. There are other studies, as well, that suggest that marijuana may help with PTSD.
Is PTSD Linked to Violence? What’s an Effective Cure for PTSD? Posted 16 April 2012.