Battleland

An Easier PTSD Diagnosis

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ISAF

A U.S. soldier on patrol in eastern Afghanistan.

Being diagnosed with post-traumatic stress disorder could get easier following the upcoming annual meeting of the American Psychiatric Association where the group’s fifth edition of its Diagnostic and Statistical Manual (DSM-5) is slated to be released in San Francisco.

DSM-5 has new guidelines and criteria for many psychiatric diagnoses. There is already lots of controversy about this latest revision.

Here I’d like to focus on the diagnosis with most relevance for military service members and veterans: PTSD.

Essentially the new criteria make it easier to meet the criteria for PTSD, by eliminating so called Criterion A-2, and by adding symptoms that make a PTSD diagnosis more likely.

Criterion A-2 is the requirement that people experience extreme fear, helplessness and horror at the time of a traumatic incident.

This is a good change.

When the bomb goes off or they are shot at, most well-trained service members do not experience helplessness or horror. They are well-trained; they drag their wounded buddies to safety, lay down suppressing fire, and continue with the mission.

But they still may have intrusive memories: seeing their friend’s heads blown off, or the dead children in the vicinity of the bomb blast.

In the past, they did not strictly meet the criteria for PTSD, so they might get a related diagnosis like anxiety disorder, not otherwise specified (NOS).

Added elements recognized in the PTSD diagnosis include: cognitive difficulties; depressive symptoms; and strong body reactions to smells or other triggers reminding them of the event.

The big questions to me are

– How and when these changes will affect the disability system?

– Will the military and VA adopt the new changes? If so, when?

– If adopted, will veterans who previously did not meet the earlier criteria for PTSD be re-evaluated?

To add to the complexity, many service members receive multiple disability evaluations. They may receive a medical evaluation board (MEB). Then they may receive one or more TDRL (temporary disability retirement list) evaluations through the military. Then another one or more through the Department of Veterans’ Affairs.

Which diagnostic criteria should be used for each evaluation?

According to the APA, the changes are voluntary and to be implemented over time.

However, that’s not a good enough answer for service members and their families stuck amid the disability process.

The PTSD diagnosis has always been surrounded with controversy (proof: I’m hosting a workshop on Controversies in PTSD at the APA).

One controversy that received a lot of attention last year is whether the diagnosis should be changed to Post-Traumatic Stress Injury. I’m in favor of that change. Another one is whether PTSD sufferers should be eligible for a Purple Heart medal. I’m ambivalent on that. It’s grist for a future post.

In the more immediate term, the military needs to decide what, and when, to do in terms of deciding when it will change the criteria. The Army already relaxed its PTSD criteria in April 2012. But more needs to be done. To do right by our troops, the view from here is that both the Pentagon and VA should embrace the new criteria without delay.

2 comments
DanielHaszard
DanielHaszard

A patient,victim speaks on treatments.

There are two kinds of antipsychotics the 50 year old tried and tested inexpensive *typical* antipsychotics like Thorazine,and the newer so-called *atypicals* like Risperdal,Seroquel,Zyprexa.
 These drugs are lifesavers for those with delusional mental illness which is only 1 percent of the population.
 The saga of the so called *atypical antipsychotics* is one of incredible profit.Eli Lilly made $70 BILLION on Zyprexa franchise (*Viva Zyprexa* Lilly sales rep slogan).
 Described as *the most successful drug in the history of neuroscience* the drugs at $12 pill are used by states to medicate deinstitutionalized mental patients to keep them out of the $500-$1,200 day hospitals.There is a whole underclass block of our society,including children in foster care that are the market for these drugs,but have little voice of protest if harmed by them.I am an exception,I got diabetes from Zyprexa as an off-label treatment for PTSD and I am not a mentally challenged victim so I post.
 --Daniel Haszard -

TexLex86
TexLex86

I do believe the criteria need to be changed. Not everyone who suffers from PTSD display the same symptoms or were even even in an event that caused them bodily harm. However, being a soldier going through the MEB process myself I can tell you that it is so hard to explain to someone that you joined the Army one way, deployed one way, came back one way, and now are leaving the military just all jacked up. They want to quickly label these things as anxiety or adjustment disorder, but for me being an Army brat before I joined the military, adjusting to this lifestyle is far from the issue. I do hope that one day, they can really take a hard look at this issue and realize that although there will be some soldiers who may claim they have issues they don't there are far more soldiers who are so jacked up in the head than they know. Too many soldiers are just being put out of the military without proper diagnosis or the right help that they need and will probably suffer for the rest of their lives. I'm glad that someone is taking a stance on this issue. Good article. 


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