1. Understanding PTSD in war veterans drjohnmundt@hotmail.com www.drjohnmundt.com

2. TRAUMA PTSD POST TRAUMATIC STRESS DISORDER

3.  RESILIENCE is the norm  POST-TRAUMATIC GROWTH is common  RECOVERY is possible

4. Understanding “PTSD”:  Re-experiencing of traumatic events  Avoidance (of reminders, of emotion)  Hyperarousal & hypervigilance

5. PTSD Criteria from DSM-IV: A. Exposure to a traumatic event, with both of the following present (1) The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) The person’s response involved intense fear, helplessness, or horror

6. PTSD Criteria from DSM-IV: B. Re-experiencing of the event (in one or more of the following ways) (1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. (2) recurrent distressing dreams of the event (in children, frightening dreams without recognizable content) (3) acting or feeling as if the traumatic event were recurring (includes reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur while intoxicated) (4) intense psychological distress at exposure to cues (5) physiological reactivity on exposure to cues PTSD in OEF/OIF veterans

7. Understanding “TRIGGERS”  Think “full body” : memories are laid down memories are laid down in all sensory spheres in all sensory spheres  Terrain: desert, urban  Weather: heat, wind, humidity  Songs, sounds  Smells: olfactory memories  People: automatic responses to persons who appear Middle Eastern; children who appear Middle Eastern; children

8. SITUATIONAL TRIGGERS: -Mimic feelings of helplessness, danger -Invasive medical procedures -Seclusion or restraint Understanding CUES or “TRIGGERS”: SITUATIONAL TRIGGERS: -Mimic feelings of helplessness, danger -Invasive medical procedures -Seclusion or restraint

9. Driving: “signature trigger” for OEF/OIF veterans  Nature of war in Iraq & Afghanistan  Need for high speeds, evasive maneuvers

10. PTSD Criteria from DSM-IV: C. Persistent Avoidance of stimuli associated with the trauma and numbing of general responsiveness, with three or more of the following: (1) efforts to avoid thoughts, feelings, or conversations associated with the trauma (2) efforts to avoid activities, places, or people that arouse recollections of the trauma (3) inability to recall an important aspect of the trauma (4) markedly diminished interest or participation in significant activities (5) feeling of detachment or estrangement from others (6) restricted range of affect (7) sense of a foreshortened future

11. PTSD Criteria from DSM-IV: D. Persistent symptoms of Arousal, with two or more of the following: (1) difficulty falling or staying asleep (2) irritability or outbursts of anger (3) difficulty concentrating (4) hypervigilance (5) exaggerated startle response

12. PTSD Criteria from DSM-IV: E. Duration of the symptoms more than one month F. Clinically significant distress or impairment in social, occupational or other areas of functioning

13. THINKING OUTSIDE THE “DSM Box”: What does PTSD feel like?  Sense of immediacy (“happening right now”)  Re-experiencing of original memories and sensory impressions  Involuntary

14. THINKING OUTSIDE THE “DSM Box”: Other “symptoms” GUILT:  Rational or irrational  Understanding atrocities  “survivor guilt” (also guilt for leaving, being “intact”)

15. THINKING OUTSIDE THE “DSM Box”: Other “symptoms” GRIEF:  Multiple losses without time to grieve  Affective numbing, anger/revenge  Impact of pre-war losses, post-war losses  Deaths of loved ones during deployment

16. THINKING OUTSIDE THE “DSM Box”: Other “symptoms”  Anger at Government  Mistrust of Authority  Desire to return to warzone  Damage to spirituality

17. Duration of problems & DSM criteria: < 2 days: no diagnosis (“COSR”) >2 days, <4 weeks: Acute Stress Disorder >4 weeks, <3 months: PTSD, acute >3 months: PTSD, chronic PTSD in OEF/OIF veterans

18. Deployment, Homecoming & the Family What happens?  Displacement of veteran from prior role  Family adapts in his / her absence  Change in roles  Change in lifestyle  Change in family dynamics  Homecoming : veteran returns  Loss of roles  Efforts to re - establish and / or create roles

19. PTSD negatively impacts relationships:  Separation and divorce  Family violence  Impaired parenting  Sexual/Intimacy problems  Caregiver burden “The Bind That Ties” - Ned Broderick “The Bind That Ties” - Ned Broderick

20. Deployment: Impact on Family Spouse/partner  “Where is the person I knew?”  Has adapted/ changed  Has unrealistic expectations  Vicarious traumatization (“PTSD by proxy”)

21. Deployment: Impact on Family Spouse/partner (continued)  separation/ divorce  stalking

22. Deployment: Impact on Family Children  “Who Is This?”  “This is scary.”  Regression  Exposure to trauma

23. Deployment: Impact on Family TEENAGERS “Who are you to tell me what to do?!?!?!”

24. Understanding “PTSD” & impact on kids:  Re-experiencing of traumatic events: symptoms can be scary, confusing  Avoidance (of reminders, of emotion): parent seems detached, uncaring  Hyperarousal & hypervigilance: parent acts grouchy, mean, impatient

25. Parent’s “PTSD”: Children’s Responses  Growing up too fast: taking on the adult role  Feeling & behaving like the parent in order to connect  Learning to be silent about trauma  “Too much information!” : “Intergenerational transmission of trauma”  Filling in the gaps  Secondary traumatization: family violence

26. Deployment: Impact on Family PARENTS  “What happened to my son/daughter?”  “Can’t you shake this off?”  “This reminds me of my own service…” own service…”

27. Deployment: Impact on Family SPECIAL CASE OF MOTHERS:  Early separation from newborns  Problems reattaching  Change in roles

28. drjohnmundt@hotmail.com www.drjohnmundt.com