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Wounds of War Conference Diane T. Castillo, Ph.D. Coordinator, WSDTT February 6, 2008.

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Presentation on theme: "Wounds of War Conference Diane T. Castillo, Ph.D. Coordinator, WSDTT February 6, 2008."— Presentation transcript:

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2 Wounds of War Conference Diane T. Castillo, Ph.D. Coordinator, WSDTT February 6, 2008

3 Definitions Definitions Diagnoses and Statistics Diagnoses and Statistics Effective Treatments Effective Treatments

4 Public Law 102-585 – Mandated outreach and counseling Public Law 102-585 – Mandated outreach and counseling Public Law 103-452 – MST counseling to men as well as women Public Law 103-452 – MST counseling to men as well as women Public Law 106-177 – Veterans Millennium Health Care Act Public Law 106-177 – Veterans Millennium Health Care Act Above laws require assessing and treating all veterans with MST Above laws require assessing and treating all veterans with MST

5 When you were in the military, did you ever receive uninvited or unwanted sexual attention (i.e., touching, cornering, etc.)? When you were in the military, did you ever receive uninvited or unwanted sexual attention (i.e., touching, cornering, etc.)? –or –or When you were in the military did anyone use force or the threat of force to have sex against your will? When you were in the military did anyone use force or the threat of force to have sex against your will?

6 Sexual Harassment-Repeated, unsolicited, verbal or physical contact of a sexual nature Sexual Harassment-Repeated, unsolicited, verbal or physical contact of a sexual nature Sexual Assault-Actual sexual contact through the use of threat, non-consensual Sexual Assault-Actual sexual contact through the use of threat, non-consensual Rape-Non-consensual sexual penetration through use of force Rape-Non-consensual sexual penetration through use of force Abuse-Intentionally caused or attempted bodily injury or apprehension of injury Abuse-Intentionally caused or attempted bodily injury or apprehension of injury

7 Depression Depression Anxiety Anxiety Sleep Difficulties Sleep Difficulties Alcohol/SA Alcohol/SA Somatic Complaints Somatic Complaints

8 Trauma Trauma 3 Categories of Symptoms 3 Categories of Symptoms Reexperiencing Reexperiencing Avoidance/Numbing Avoidance/Numbing Hyperarousal Hyperarousal Symptoms last more than 1 month Symptoms last more than 1 month

9 The person has been exposed to a traumatic event in which both of the following were present: The person has been exposed to a traumatic event in which both of the following were present: 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; 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; The persons response involved intense fear, helplessness, or horror. The persons response involved intense fear, helplessness, or horror.

10 Reexperiencing (min. of 1) Reexperiencing (min. of 1) Intrusive recollections Intrusive recollections Nightmares Nightmares Flashbacks Flashbacks Psychological distress with reminders Psychological distress with reminders Physiological reaction to reminders Physiological reaction to reminders Avoidance/Numbing (min. of 3) Avoidance/Numbing (min. of 3) Avoidance of thoughts, feelings Avoidance of thoughts, feelings Avoidance of reminders Avoidance of reminders Social isolation Social isolation Feelings of detachment from others Feelings of detachment from others Reduction of emotions (positive) Reduction of emotions (positive) Sense of foreshortened future Sense of foreshortened future

11 Hyperarousal (min. of 2) Hyperarousal (min. of 2) Sleep difficulties Sleep difficulties Irritability and/or anger outbursts Irritability and/or anger outbursts Poor concentration Poor concentration Exaggerated startle response Exaggerated startle response Hypervigilence Hypervigilence

12 Mean Age=49.9, SD=10.4 Mean Age=49.9, SD=10.4 77% Veteran, 20% ChampVA, 3% AF 77% Veteran, 20% ChampVA, 3% AF 43% Army, 29% AF, 22% Navy, 3% Marine Corps 43% Army, 29% AF, 22% Navy, 3% Marine Corps 14% OIF/OEF veterans 14% OIF/OEF veterans 60% white, 26% Hispanic 9% African American, 3% Native American, 2% other 60% white, 26% Hispanic 9% African American, 3% Native American, 2% other 42% married, 29% divorced, 26% never married 42% married, 29% divorced, 26% never married

13 72% sexual trauma, 8% other, 20% combo 72% sexual trauma, 8% other, 20% combo 28% childhood trauma, 31% adult, 41% both 28% childhood trauma, 31% adult, 41% both 69% diagnosed with PTSD + another diagnosis (31% PTSD only) 69% diagnosed with PTSD + another diagnosis (31% PTSD only) 84% more than one trauma 84% more than one trauma

14 MalesFemalesTotal YesReports MST 2,718 (1.2%) 2,952 (23.2%) 5,670 (2.3%) NoDoes Not Report MST 232,90712,724245,631 Screened Declined to Answer 1,7642692,033

15 Trauma clinic for mennot just for combat- related trauma Trauma clinic for mennot just for combat- related trauma Womens Stress Disorder Treatment Team military/ childhood/other adult rape; other traumas Womens Stress Disorder Treatment Team military/ childhood/other adult rape; other traumas Both programs offer individual and group counseling as well as medication evaluation/management Both programs offer individual and group counseling as well as medication evaluation/management

16 Staff: Two f/t psychologists Two f/t psychologists One f/t social worker One f/t social worker One h/t psychiatrist One h/t psychiatrist One h/t nurse clinical specialist One h/t nurse clinical specialist

17 Assessment Assessment Initial Interview Initial Interview Psychological Testing (MMPI, MCMI, BDI, BUSS) Psychological Testing (MMPI, MCMI, BDI, BUSS) CAPSClinician Administered PTSD Scale CAPSClinician Administered PTSD Scale

18 Treatments: Groups, Individual, Medication Treatments: Groups, Individual, Medication Core Groups: Core Groups: PsychEd (intro) PsychEd (intro) Cognitive Processing** Cognitive Processing** Skills Skills Sexual Intimacy Sexual Intimacy Focus (exposure therapy)** Focus (exposure therapy)** **Most effective for PTSD

19 CAPS: CAPS: Current: M=73.8, SD=27.7 Current: M=73.8, SD=27.7 Lifetime: M=104.9, SD=24.7 Lifetime: M=104.9, SD=24.7 MMPI2: MMPI2: Peaks on: F(86.8), 2(78.5), 8(82.5), PK(79.2), and PS(79.3) Peaks on: F(86.8), 2(78.5), 8(82.5), PK(79.2), and PS(79.3) MCMI2: MCMI2: Peaks on Schizoid and Avoidant scales (BR>80). Peaks on Schizoid and Avoidant scales (BR>80). BDI: M=24.7, SD=11.9 BDI: M=24.7, SD=11.9

20 Focus--Sig. improvement on: Focus--Sig. improvement on: Overall PTSD Overall PTSD Avoidance/ Numbing Avoidance/ Numbing Cognitive--Sig. improvement on: Cognitive--Sig. improvement on: Overall PTSD Overall PTSD Avoidance/Numbing Avoidance/Numbing Hyperarousal Hyperarousal Skills--Sig. improvement on Skills--Sig. improvement on Avoidance/ Numbing Avoidance/ Numbing Sexual Intimacy: No sig. improvement in PTSD Sexual Intimacy: No sig. improvement in PTSD

21 MST is priority for VA in assessing for and treating male and female veterans MST is priority for VA in assessing for and treating male and female veterans MST can result in variety of symptoms, particularly PTSD MST can result in variety of symptoms, particularly PTSD Effective treatments are available for treating PTSD and are available at VA Effective treatments are available for treating PTSD and are available at VA


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