Posttraumatic Stress Disorder: A Treatable Public Health Problem

Abstract

Clinical social workers need to be aware of the growing problem of untreated and undertreated trauma in society. This is an especially important issue affecting our veteran population. According to the U.S. Department of Veterans Affairs, posttraumatic stress disorder (PTSD) affects 6.8 percent of the general population (Kessler, Sonnega, & Bromet, 1995; Kulka et al., 1990). There are reports of Iraq and Afghanistan veterans returning with PTSD rates as high as 50 percent (Helmer et al., 2007). The emotional and financial costs of this diagnosis to society are staggering. Affected veterans can have difficulty functioning in both the home and the job environment, so they may receive disability payments for life. Those seeking help face additional expenses for mental health treatment and medications; others who self-medicate risk alcohol and drug abuse. There may be additional costs for treatment of family members living with someone affected by PTSD. Why is the rate of PTSD now so much higher than in previous conflicts? The higher rate may be due to several factors, including the following: * Our troops have been engaged in cities and towns where they cannot easily distinguish enemy combatants from civilians. The enemy combatants do not wear uniforms, and any typically dressed citizen could be a suicide bomber. * The length and number of tours of duty has increased. During the Vietnam War, a tour was one year, and soldiers knew their service was complete at the end of that time. Further tours came only if one volunteered. In our current wars, tours last 12 to 15 months, and some units have been redeployed four times. * Due to medical advances, more vets are surviving their wounds, although they may be missing limbs or have survived other severe physical injuries. * Many of our soldiers are National Guards, not full-time career military. They have full-time jobs and families here at home. When their deployment ends, they return to civilian life. The military has worked hard to inform returning veterans about what they might experience emotionally and how it may affect their families. However, most veterans do not ask for help with PTSD symptoms out of shame or fear that it will negatively affect their career advancement. Newly returned National Guards are given medical insurance that expires in three months. The post in PTSD means that symptoms begin months or years later. Some veterans are so traumatized that they are unable to leave their homes, and their insurance has run out. In my practice, I see older veterans from the Gulf War and the Vietnam War who are experiencing an increase in PTSD symptoms--memories, flashbacks, and nightmares--triggered by watching television news about the current conflicts. Fortunately, we have a highly effective psychotherapeutic treatment called eye movement desensitization and reprocessing (EMDR) that works very quickly to end PTSD in clients (Shapiro, 1989). Numerous randomized studies attest to its efficacy as an evidence-based treatment for PTSD (Bisson & Andrew, 2007; Bradley, Greene, Russ, Dutra, & Westen, 2005). It is recommended by many organizations and insurance companies, including the American Psychiatric Association (2004) and the Department of Veteran Affairs and Department of Defense (2004). In studies comparing EMDR to cognitive therapy, exposure, desensitization, and Prozac, the effectiveness of EMDR equals or exceeds other PTSD treatments, and it is generally faster (Van der Kolk et al., 2007). A Veterans Affairs study also demonstrated that EMDR successfully relieves phantom limb pain, which may be a common problem for the many veteran amputees (Russell, 2008; Schneider, Hofmann, Rost, & Shapiro, 2008). In one study of multiply traumatized veterans, 12 sessions of EMDR relieved the symptoms in 77 percent of the veterans (Carlson, Chemtob, Rusnak, Hedlund, & Muraoka, 1998). Veterans typically dislike talking to nonveterans about their combat experience. …