Battleland

The New Rules on PTSD

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VA

Wow. The new 17-page policy from the Army’s Office of the Surgeon General (OTSG ) on screening and treating PTSD is exciting and comprehensive. And will absolutely be controversial.

Although it is playing out in the news as related to the Fort Lewis controversy – were its reversals of PTSD diagnoses there fair? — this revamped policy has been many years in the making, with the input of many experts.

When I was at OTSG three years ago I was trying to get so-called Criterion A-2 changed. Criterion A-2 says that the person must experience fear, helpless and horror at the time of the traumatic event.

We were working with the American Psychiatric Association and other scientific groups, telling them that, no, Soldiers were not reacting with “extreme helplessness, fear and horror,” but were doing their job after the blast, laying done suppressive fire, picking up their wounded buddies, and doing their job.

Even with no horror at the time of the traumatic event, later, the intrusive memories would come, along with the accompanying PTSD symptoms. The new policy moves in the direction of removing Criterion A-2 (paragraph 6.c) and allowing a PTSD diagnosis.

The policy also has a number of other concrete recommendations about treatment, focused largely on evidence-based treatment. But I still have to digest this dense document, so I’ll save my comments on that for a later post. And the whole topic of PTSD and malingering is also better reserved for a future dispatch.

Of course, one controversial piece as related to Fort Lewis. Notes the Seattle Times:

The policy, obtained by The Seattle Times, specifically discounts tests used to determine whether soldiers are faking symptoms of post-traumatic stress disorder. It says that poor test results do not constitute malingering. The written tests often were part of the Madigan screening process that overturned the PTSD diagnoses of more than 300 patients during the past five years.

If you change the PTSD criteria, you change the Soldier’s diagnoses. In my opinion, it is unfair to criticize doctors who used the accepted criteria. Because that is what they were trained to do. If we shift to new criteria—which I do think we should do—don’t penalize the doctors who used the old.

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