Posted on May 2, 2016
Study Offers New Statistics on How Many OEF/OIF Veterans Have PTSD : U.S. Medicine
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Just a question? No disrespect intended. When only 10% of military personnel that deploy actually see combat how is it that 16% have PTSD? I am a numbers guy and I don't trust either the media or the government when it comes to numbers.
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SGT William Howell
I just want to reiterate I am by no means trying to belittle that we have an issue with PTSD among our service members and vets. I am not a mental health professional and would never try to act like I know more than they do. I am just trying to understand why we group everybody into the generic group of PTSD. Are there sub groups of PTSD? If not, then why? Wouldn't it make sense when trying to not only budget money for treatment, but also help doctors to understand what brought on the illness?
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SGT William Howell
SFC Wade W. Thanks Wade for your understanding. I am interested in your thoughts as well if there is any people that deal with SM/Vets with PTSD on a daily basis. Maj Kim Patterson CSM (Join to see)
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Maj Kim Patterson
SGT William Howell - As a mental health professional and as a trauma responder, also certified in Critical Stress Intervention Management, I have dealt with many who meet the criteria for PTSD. For reference, here is DSM 5 (Diagnostic and Statistical Manual of Mental Disorders) which outlines said criteria.
The Diagnostic and Statistical Manual of Mental Disorders provides standard criteria and common language for the classification of mental disorders. It is published by the American Psychiatric Association. The fifth revision (DSM-5) was released in May 2013. This revision includes changes to the diagnostic criteria for PTSD and Acute Stress Disorder.
The reason the PTSD diagnostic criteria were revised is to take into account things we have learned from scientific research and clinical experience.
What are the major revisions to the PTSD diagnosis?
Classification
PTSD (as well as Acute Stress Disorder) moved from the class of anxiety disorders into a new class of "trauma and stressor-related disorders." All of the conditions included in this classification require exposure to a traumatic or stressful event as a diagnostic criterion. The rationale for the creation of this new class is based upon clinical recognition of variable expressions of distress as a result of traumatic experience. The necessary criteria of exposure to trauma links the conditions included in this class; the homogeneous expression of anxiety or fear-based symptoms, anhedonic and dysphoric symptoms, externalizing anger or aggressive symptoms, dissociative symptoms, or some combination of those listed differentiates the diagnoses within the class (1).
Diagnostic criteria
Overall, the symptoms of PTSD are mostly the same in DSM-5 as compared to DSM-IV. A few key alterations include:
The three clusters of DSM-IV symptoms are divided into four clusters in DSM-5: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. DSM-IV Criterion C, avoidance and numbing, was separated into two criteria: Criteria C (avoidance) and Criteria D (negative alterations in cognitions and mood). The rationale for this change was based upon factor analytic studies, and now requires at least one avoidance symptom for PTSD diagnosis.
Three new symptoms were added:
Criteria D (negative alterations in cognitions and mood): persistent and distorted blame of self or others, and persistent negative emotional state
Criteria E (alterations in arousal and reactivity): reckless or destructive behavior
Other symptoms were revised to clarify symptom expression.
Criterion A2 (requiring fear, helplessness, or horror happen right after the trauma) was removed in DSM-5. Research suggests that Criterion A2 did not improve diagnostic accuracy (2).
A clinical subtype "with dissociative symptoms" was added. The dissociative subtype is applicable to individuals who meet the criteria for PTSD and experience additional depersonalization and derealization symptoms (3).
Separate diagnostic criteria are included for children ages 6 years or younger (preschool subtype) (4).
What are the implications of these revisions?
Assessment
PTSD assessment measures, such as the PC-PTSD, CAPS, and PCL, are being revised by the National Center for PTSD to be made available upon validation of the instruments. Please see our Assessments section for more information.
Prevalence rates
Based on initial analyses of the DSM-5 criteria, the prevalence of PTSD will be similar to what it is currently in DSM-IV (5,6). Research also suggests that similarly to DSM-IV, prevalence of PTSD for DSM-5 was higher among women than men, and prevalence increased with multiple traumatic event exposure (6).
National estimates of PTSD prevalence suggest that DSM-5 rates were slightly lower than DSM-IV (6). Discordant findings in diagnostic prevalence were attributable to three major changes in the DSM-5 criteria for PTSD:
The revision of Criterion A1 in DSM-5 narrowed qualifying traumatic events such that the unexpected death of family or a close friend due to natural causes is no longer included. Research suggests this is the greatest contributor (>50%) to discrepancy for meeting DSM-IV but not DSM-5 PTSD criteria.
Splitting DSM-IV Criterion C into two criteria in DSM-5 now requires that a PTSD diagnosis must include at least one avoidance symptom.
Criterion A2, response to traumatic event involved intense fear, hopelessness, or horror, was removed from DSM-5.
We must remember that trauma occurs outside the combat arena, particularly for first responders, along with sexual assaults, which currently are reporting higher numbers of PTS symptoms than combat exposure.
The Diagnostic and Statistical Manual of Mental Disorders provides standard criteria and common language for the classification of mental disorders. It is published by the American Psychiatric Association. The fifth revision (DSM-5) was released in May 2013. This revision includes changes to the diagnostic criteria for PTSD and Acute Stress Disorder.
The reason the PTSD diagnostic criteria were revised is to take into account things we have learned from scientific research and clinical experience.
What are the major revisions to the PTSD diagnosis?
Classification
PTSD (as well as Acute Stress Disorder) moved from the class of anxiety disorders into a new class of "trauma and stressor-related disorders." All of the conditions included in this classification require exposure to a traumatic or stressful event as a diagnostic criterion. The rationale for the creation of this new class is based upon clinical recognition of variable expressions of distress as a result of traumatic experience. The necessary criteria of exposure to trauma links the conditions included in this class; the homogeneous expression of anxiety or fear-based symptoms, anhedonic and dysphoric symptoms, externalizing anger or aggressive symptoms, dissociative symptoms, or some combination of those listed differentiates the diagnoses within the class (1).
Diagnostic criteria
Overall, the symptoms of PTSD are mostly the same in DSM-5 as compared to DSM-IV. A few key alterations include:
The three clusters of DSM-IV symptoms are divided into four clusters in DSM-5: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. DSM-IV Criterion C, avoidance and numbing, was separated into two criteria: Criteria C (avoidance) and Criteria D (negative alterations in cognitions and mood). The rationale for this change was based upon factor analytic studies, and now requires at least one avoidance symptom for PTSD diagnosis.
Three new symptoms were added:
Criteria D (negative alterations in cognitions and mood): persistent and distorted blame of self or others, and persistent negative emotional state
Criteria E (alterations in arousal and reactivity): reckless or destructive behavior
Other symptoms were revised to clarify symptom expression.
Criterion A2 (requiring fear, helplessness, or horror happen right after the trauma) was removed in DSM-5. Research suggests that Criterion A2 did not improve diagnostic accuracy (2).
A clinical subtype "with dissociative symptoms" was added. The dissociative subtype is applicable to individuals who meet the criteria for PTSD and experience additional depersonalization and derealization symptoms (3).
Separate diagnostic criteria are included for children ages 6 years or younger (preschool subtype) (4).
What are the implications of these revisions?
Assessment
PTSD assessment measures, such as the PC-PTSD, CAPS, and PCL, are being revised by the National Center for PTSD to be made available upon validation of the instruments. Please see our Assessments section for more information.
Prevalence rates
Based on initial analyses of the DSM-5 criteria, the prevalence of PTSD will be similar to what it is currently in DSM-IV (5,6). Research also suggests that similarly to DSM-IV, prevalence of PTSD for DSM-5 was higher among women than men, and prevalence increased with multiple traumatic event exposure (6).
National estimates of PTSD prevalence suggest that DSM-5 rates were slightly lower than DSM-IV (6). Discordant findings in diagnostic prevalence were attributable to three major changes in the DSM-5 criteria for PTSD:
The revision of Criterion A1 in DSM-5 narrowed qualifying traumatic events such that the unexpected death of family or a close friend due to natural causes is no longer included. Research suggests this is the greatest contributor (>50%) to discrepancy for meeting DSM-IV but not DSM-5 PTSD criteria.
Splitting DSM-IV Criterion C into two criteria in DSM-5 now requires that a PTSD diagnosis must include at least one avoidance symptom.
Criterion A2, response to traumatic event involved intense fear, hopelessness, or horror, was removed from DSM-5.
We must remember that trauma occurs outside the combat arena, particularly for first responders, along with sexual assaults, which currently are reporting higher numbers of PTS symptoms than combat exposure.
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I have a friend that deals with this exact situation with our Vets, She runs a company called Invictus Training. I am going to get her to join RP....She is needed here from what I see.
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Thanks for letting us know CSM (Join to see) that according to a recent study that just under 16% of OIF/OEF Veterans that deployed have PTS and have been diagnosed with PTSD.
I concur that "we" need to focus on treatments that help these Veterans thrive not just survive but to thrive along with their family members.
I concur that "we" need to focus on treatments that help these Veterans thrive not just survive but to thrive along with their family members.
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