About Post Traumatic Stress Disorder (PTSD) and Brain Injury in Iraq’s War Veterans

By Katherine van Wormer, PhD, MSSW

Introduction
In 1980, in response to the veterans of the Vietnam War and the militancy of the antiwar movement, the American Psychiatric Association (APA) acknowledged the symptoms of Post Traumatic Stress Disorder (PTSD). The diagnosis of PTSD was then included in the DSM (Diagnostic and Statistical Manual of Mental Disorders). The feminist movement was influential in this development as well due to their advocacy for a diagnosis in recognition of the trauma of rape.

The DSM IV-R (2000) describes PTSD, in short, as the “re-experiencing of an extremely traumatic event that the person has experienced or witnessed, accompanied by symptoms of increased arousal (such as sleep disturbance, irritability, hypervigilance, difficulty concentrating) and by avoidance of stimuli associated with the trauma and numbing.”

Post Traumatic Stress Disorder Related to Combat
After the war in Vietnam was over, some 30 percent of Vietnam combat veterans suffered from PTSD; flashbacks to horrible near-death situations were common. A study conducted in 2003 involved 6,200 soldiers who had served in Iraq and Afghanistan several months before. Research was conducted by a team of social scientists at the Walter Reed Army Institute of Research.

Results showed that one in six of the veterans displayed symptoms of PTSD, major depression, or anxiety; 12 percent had symptoms of PTSD alone. (These figures are an underestimate as the study was done before the far more brutal urban combat efforts got underway.) The risk of developing trauma rose in proportion to the number of instances of combat in which the soldier had engaged.

According to a more recent Post-Deployment Health Reassessment, which is administered to all service members, 38 percent of regular soldiers and 31 percent of Marines report psychological symptoms. Among members of the National Guard, the figure rises to 49 percent. Those who had served repeated deployments were at extremely high risk of problems and the toll on their family members was great.

The exact rate of PTSD in women veterans is unknown. Studies conducted after the Gulf War  concluded that female service members were more likely than their male counterparts to develop PTSD. This is consistent with the 2 to 1 ratio of female to male PTSD sufferers in the general population.

Males with psychological symptoms from battle, however, are three times more likely to be given a diagnosis of PTSD than females, according to the Pentagon Task Force report.

One explanation for this may be cultural expectations that make it difficult for society and mental health providers to recognize women as combatants. Additionally, there is a tendency to diagnose women as having depression, anxiety and borderline personality disorder instead of combat-related PTSD.

For several reasons, the impact of the Iraq and Afghanistan wars is expected to be more severe than the impact of previous wars. (1) The experience of combat, engagement in gun battles, and handling the bodies of dead comrades is a constant in these wars, (2) the experience of killing people at close range is a frequent occurrence, (3) extended lengths of service with only short periods of rest and recuperation in between are taking a psychological toll on soldiers; and (3) many of the injuries in this war are to the brain.

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