Healing Combat Trauma

Traumatic War Experiences Predict Future Health Woes, Study of Civil War Vets Shows

In some medical news that you might have missed, a study came out that was published in the February, 2006 issue of the Archives of General Psychiatry that studied historical records pertaining to Civil War veterans, the amount of trauma they experienced in combat, and what the after-effects were in later years to their health.  Fascinating stuff, of course.

According to the article, "An archival examination of military and medical records of Civil War veterans was conducted. Degree of trauma experienced (prisoner-of-war experience, percentage of company killed, being wounded, and early age at enlistment), signs of lifetime physician-diagnosed disease, and age at death were recorded." Additionally, "The US Pension Board surgeons conducted standardized medical examinations of Civil War veterans over their postwar lifetimes. Military records of 17,700 Civil War veterans were matched to postwar medical records."

The conclusion?  "Greater exposure to death of military comrades and younger exposure to war trauma were associated with increased signs of physician-diagnosed cardiac, gastrointestinal, and nervous disease and more unique disease ailments across the life of Civil War veterans." In other words, younger soldiers were at greater risk; and the more brother (or today, also sister) soldiers who died, the harder it was for the combat veterans.  Makes sense, doesn't it?

Editor's note: The study's citation is: Arch Gen Psychiatry. 2006 Feb;63(2):127-8, and it's linked here. 

The Dept. of "No Real Surprises Here": Chiropractic Doesn't Help Veterans Suffering from PTSD

An article in the current issue -- June, 2009 -- of Military Medicine takes a look at the effects of chiropractic on veterans with PTSD, and finds the results lacking.  The study is called "A cross-sectional analysis of clinical outcomes following chiropractic care in veterans with and without post-traumatic stress disorder,” and it was authored by Drs. Andrew Dunn, Steven Passmore, Jeanmarie Burke and New York Chiropractic College student David Chicoine.

According to an article in trade publication ChiroEco.com, that study "investigates clinical outcomes for 130 veteran patients with neck or low back complaints at the VA of Western New York. This study found that patients with post-traumatic stress disorder had significantly lower lower levels of improvement than those without post-traumatic stress disorder on self-reported outcome measures of neck and low back disability."

These results are not really surprising, because -- unlike another form of bodywork, massage therapy, which does have proven results for helping PTSD symptoms -- there's nothing about chiropractic per se that indicates it would be helpful. Spinal subluxations, while combat veterans may be experiencing them, aren't really part of the PTSD profile, and relieving them wouldn't necessarily have any effect whatsoever on reducing PTSD symptoms.  They're just not related. That said, it's progress that chiropractic is offered in military health care settings, and we're sure it brings combat veterans some relief -- in the appropriate context, which PTSD is not.

For a look at complementary and alternative medicine therapies ("CAM") that have shown benefit in treating PTSD, click here.  For a look at bodywork therapies, click here.  For a look at mind-body medicine approaches, click here.  To read the article in ChiroEco.com, click here.

A Harvard Study Confirms More Combat Exposure = More PTSD

The Atlantic magazine this month has a story about the Grant Study, a longitudinal study which followed 268 "Harvard Men," from the classes of '42, '43 and '44, from their sophomore year in college, through for the next 42 years.  The Grant Study men, those who are still alive, are now in their 80s, and approaching death. It wasn't the purpose of the study, but because so many of the men served in World War II, the study was able to comment that, among other things:

"More than 80 percent of the Grant Study men served in World War II, a fact that allowed (the study's administrator) Vaillant to study the effect of combat. The men who survived heavy fighting developed more chronic physical illnesses and died sooner than those who saw little or no combat, he found. And “severity of trauma is the best predictor of who is likely to develop PTSD.” (This may sound obvious, but it countered the claim that post-traumatic stress disorder was just the manifestation of preexisting troubles.)

The full story, called "What makes us happy," by Joshua Wolf Shenk, is linked here.

Puget Sound Veterans Hospital Tries Meditation for PTSD

The Seattle Times reports in today's paper that a veterans hospital in the Seattle area is trying a version of mindfulness meditation for combat veterans with PTSD.  The article is called, "Seattle hospital teaches meditation to troubled vets," by Michelle Ma.  The eight-week course, which has been held for a year, has proved to be of some value to veterans, and current plans are to study the effects more in-depth. 

The article in the Seattle Times is linked here.

For links to other posts we've done about mind-body medicine, including meditation, and PTSD, click here.

Let's Hope This Isn't More "Blame the Victim" Thinking on Combat Veterans with PTSD, But...

A recent medical study, published in the British Medical Journal and reported on Friday, suggests that "the risk of combat-related post-traumatic stress disorder (PTSD) increased by two- to threefold in military personnel who had significant mental or physical problems before deployment, according to a study of 5,400 veterans."  In other words, those who were vulnerable beforehand, were even more susceptible to PTSD than their peers.  Hmmmn.

It's always interesting, and is going to stay interesting, to contemplate what, if any, predictive or predisposing factors there are for who develops later develops combat-based PTSD and why.  At the very least, this study throws yet more analysis into the mix, in a story that will continue developing for years.

According to the BMJ, the conclusion of the study was that:

"Low mental or physical health status before combat exposure significantly increases the risk of symptoms or diagnosis of post-traumatic stress disorder after deployment. More vulnerable members of a population could be identified and benefit from interventions targeted to prevent new onset post-traumatic stress disorder."

The study, which was supported by the U.S. Department of Defense, reported that:

"More than half of post-combat PTSD diagnoses involved veterans who ranked below the 15th percentile in mental or physical health at baseline, Cynthia LeardMann, of the Naval Health Research Center in San Diego, and colleagues reported online in BMJ.

"We have identified an at-risk population whose functional health seems to predict vulnerability to PTSD after combat deployment," the authors said. "In theory, such a population could be targeted for PTSD prevention programs, early intervention after exposures to stress, or even protection from stressful exposures, when possible."

The findings came from the Millennium Cohort Study, which has accumulated data on military personnel since 2001, before the wars in Afghanistan and Iraq. Investigators collected follow-up data from June 2004 to February 2006.

A previous report based on the study suggested that combat exposure -- as opposed to deployment -- significantly increased the risk of new-onset PTSD. Building on that observation, the authors examined the association between baseline mental and physical health and the risk of new symptoms or a diagnosis of PTSD.

The current analysis involved 5,410 combat veterans who completed baseline and follow-up questionnaires. The questionnaire includes a 17-item self-report measure of PTSD symptoms.

Baseline health status was determined by participants' scores on the mental and physical summaries of the SF-36V (veterans) health survey. A new PTSD diagnosis was based on DSM-IV criteria (derived from the questionnaires) or self-reported physician diagnosis.

The analysis showed that 7.3% of the participants had new-onset symptoms or a diagnosis of PTSD at follow-up by DSM-IV criteria. When self-reported physician diagnosis was included, the rate increased to 8.6%.

The authors stratified the participants into three groups according to mental and health status scores: below the 15th percentile, 15th to 85th percentile, and above the 85th percentile.

Combat veterans who scored below the 15th percentile of the mental summary had a relative risk of PTSD of 3.51 compared with those in the 15th to 85th percentile.

A score below the 15th percentile of the physical summary more than doubled the risk of PTSD (RR 2.22).

Overall, 58% of new PTSD diagnoses involved combat veterans who were below the 15th percentile for either summary.

Subgroups at increased risk for new PTSD symptoms or diagnosis included:

• ≥3 combat exposures during deployment, 2.60
• Women, 2.33
• Current smokers, 1.56
• Non-officers, 1.77
• Reserve/National Guard members, 1.85
• Army veterans, 2.04"

Editor's Note: The full reference is: LeardMann CA, et al "Baseline self reported functional health and vulnerability to post-traumatic stress disorder after combat deployment: Prospective U.S. military cohort study."  The full citation is: BMJ 2009; 339: DOI:10.1136/bmj.b1273. For the link to the full article, click here.

Suicide Predictors in Young Men -- Combat Trauma Not Included

We've talked on the blog before about "suicide maps" and various predictors of suicide, however imperfect they may be.  Today there's an item from a medical journal that details a Finnish study -- aka, a medical study performed in Finland -- which essentially says, adolescent boys and young men who committed suicide frequently also showed some form of psychiatric illness at age 8 -- which happened to be the age where they were first evaluated, in the study.  Young women who killed themselves, didn't show this particular trend. Now, not to say that this study is in any way conclusive about PTSD -- since obviously it didn't even touch on that as a topic -- but it is interesting, since some of the research indicates that PTSD can be particularly difficult if it is "laid on top of" a previous, significant traumatic experience (often in childhood). In some ways, this study may not be all that germane to our topic, but it's interesting to note, in any case, since there are obviously a number of young men (and women) who commit suicide in the armed forces, and as veterans -- and it's always worthwhile to comb the scientific literature for any other reasons, or contributing factors into, why this might actually be.  Here's the info from the study:

Childhood Psychiatric Problems May Predict Suicide Attempts in Males

Most males who commit suicide or need hospital care for suicide attempts during their teen or early adult years appear to have high levels of psychiatric problems at the age of 8, according to a report in the Archives of General Psychiatry. However, later suicide attempts in females are not predicted by mental health issues at this age.
 
Andre Sourander, MD, of Turku University Hospital in Finland, and colleagues studied 5,302 Finnish individuals born in 1981. Eight years later, information about psychiatric conditions, school performance, and family demographics was gathered from children, parents, and teachers. Participants were then tracked through national registers through 2005.
 
Between the ages of 8 and 24, 40 participants died, including 24 males and 16 females. Of those, 13 males and two females died from suicide. A total of 54 males and females (1%) either completed suicide or made a suicide attempt serious enough to result in hospitalization.
 
Of the 27 males who either seriously attempted or completed suicide, 78% screened positive for psychiatric conditions at the age of 8, compared with 11% of 27 females who had serious or completed suicide attempts. In addition, males who would go on to make life-threatening or completed suicide attempts were more likely at the age of 8 to live in a family that did not consist of two biological parents, have psychological problems as reported by a teacher or have conduct, hyperactive, or emotional problems. However, none of these factors at 8 predicted later suicidal behavior in females, and depression at age 8 was not associated with suicide attempts for either sex.
 
Previous research has shown that in females, suicide is associated with depression and other affective disorders, which increase sharply after the beginning of puberty. This may explain why childhood psychiatric conditions do not predict later suicidal behavior in girls, the authors noted.
 

— Source: American Medical Association

Study Shows Young Adults with PTSD More Likely to Commit Suicide

On the one hand, this sounds like fairly self-explanatory science.  So why the inclusion on this blog?  Because of the (young) age of many active duty military, and even recent veterans -- news like this is relevant.

Young Adults With PTSD May Be More Likely to Attempt Suicide

"Posttraumatic stress disorder (PTSD)—but not exposure to traumatic events without the development of PTSD—may be associated with subsequent attempted suicide in young adults, according to a report in Archives of General Psychiatry.

Approximately 421,200 to 842,400 Americans aged 15 to 24 attempt suicide every year, according to background information in the article. Holly C. Wilcox, PhD, of Johns Hopkins Children’s Center, Baltimore, and colleagues studied 1,698 young adults of a group of 2,311 who had been tracked since entering the first grade in Baltimore public schools. Fifteen years later, 90-minute interviews were conducted with the participants (average age of 21) to assess the occurrence of traumatic experiences, suicide attempts, and the development of PTSD.

Of the participants interviewed, 1,273 (81%) had been exposed to a traumatic event and 100 (6%, or 8% of those exposed to trauma) developed PTSD. Suicide had been attempted by 10% of those with PTSD, compared with 2% of those who were exposed to trauma but did not develop PTSD and 5% of those who had never been exposed to traumatic events.

“The mechanisms involved in the association between PTSD and suicide attempts are not known,” the authors wrote. “There could be a common pre-existing predisposition to PTSD and suicide attempts that was present before the trauma occurred. Studies of early trauma and suicidal behaviors have implicated depression and impulsivity as possible mediators or possible pre-existing susceptibility traits.”

— Source: American Medical Association

EFT: "Emotional Freedom Technique" for Combat Veterans

If you know anyone who's watched "The Secret," with its emphasis on "the Law of Attraction" -- heck, if you know anyone who's watched Oprah, who promoted "The Secret" extensively on her shows -- you know someone who's probably heard of EFT.

What you might not realize is there's a body of work developing that shows its effectiveness with PTSD.  And some of its biggest fans are the veterans themselves, who've tried it.

"EFT," or "Emotional Freedom Technique," is a form of what's known as "energy psychology," or "energy work."  It was developed by a Stanford engineer -- note, not a psychologist -- Gary Craig, who calls it accurately "a needle-free form of acupuncture."

Craig and EFT practitioners have done some remarkable work with PTSD veterans.  If this subject interests you, or you've looked into various forms of treatment before, and you're even slightly open-minded about trying something with a large upside and very little (or nonexistent) downside, this video in particular is worth watching.  Here's the link. 

The most moving part of the video, in my opinion, is the obvious before and after shots of the veterans themselves, going from visibly struggling, to visibly coping, in very short amounts of time. The excitement of a family member, shown later on the video, is also palpable.  A few studies have also been done on EFT and PTSD -- a book has also just been published -- with more studies to come.  The results are refreshingly impressive, though, for such a low-tech technique.  According to the video, veterans report symptoms drop 63% after treatment, according to a self-reporting scale used by the military.  Symptoms of depression and anxiety reduced by 50%, on average. Cortisol levels -- we've talked about their significance here, here and here -- drop 25% after one hour-long treatment.

Watch the video first, to orient yourself as to what EFT is and how the sample of combat veterans from various wars -- Vietnam, the Gulf War, and Iraq -- responded to it. Then, to learn more, here's an article from the Scottish press about a combat vet and his experience with it.  Here's a story about a Vietnam vet and his experience with EFT. There's a new book by Gary Craig on EFT for PTSD. If you're a veteran, there's a study you can be part of that we blogged about the other day, and that study includes several sessions of EFT. (That post is linked here.)

But if you're intrigued -- after watching the video -- and you want to know more, you probably want to find an EFT practitioner to try it out with.  There's a subset of practitioners listed on the Web, linked  here, who are interested in working with veterans, including -- gasp! -- some who already work at the VA.  If there's no one in your area, you could try this link instead, to find an EFT practitioner who may not have a special interest in veterans, and yet could introduce you to the practice.  It seems to be something low-tech, affordable, simple to learn, and an after an initial introduction, very much DIY (Do It Yourself).  Practitioners may also be willing to negotiate or lower their fees for veterans: Ask.

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Editor's note: Talking about EFT, or any other technique, should not imply or be misread as an endorsement. In any case, YMMV (your mileage may vary).

 

Combat Veterans, PTSD and Domestic Violence - A Sometimes Deadly Combination

Domestic Violence a Growing Problem for Veterans

“The increasing number of veterans with posttraumatic stress disorder [PTSD] raises the risk of domestic violence and its consequences on families and children in communities across the United States,” says Monica Matthieu, Ph.D., an expert on veteran mental health and an assistant professor of social work at Washington University in St. Louis. “Treatments for domestic violence are very different than those for PTSD. The Department of Veterans Affairs [VA] has mental health services and treatments for PTSD, yet these services need to be combined with the specialized domestic violence intervention programs offered by community agencies for those veterans engaging in battering behavior against intimate partners and families.”

Matthieu and Peter Hovmand, Ph.D., a domestic violence expert and an assistant professor of social work at Washington University, are merging their research interests and working to design community prevention strategies to address this emerging public health problem.

“The increasing prevalence of traumatic brain injury and substance use disorders along with PTSD among veterans poses some unique challenges to existing community responses to domestic violence,” says Hovmand. “Community responses to domestic violence must be adapted to respond to the increasing number of veterans with PTSD. This includes veterans with young families and older veterans with chronic mental health issues.”

VA research shows that male veterans with PTSD are two to three times more likely than veterans without PTSD to engage in intimate partner violence and more likely to be involved in the legal system.

— Source: Washington University in St. Louis

Projects Target PTSD-Related Relationship Aggression

"Living with posttraumatic stress disorder (PTSD) can strain any relationship—sometimes to the point of violence against a loved one. University of Arkansas psychologist Matthew T. Feldner, Ph.D., is part of two national research projects aimed at preventing relationship aggression in couples coping with PTSD and treating this type of aggression when it has already developed.

“The main aims of these projects are to reduce the number of new cases of interpersonal violence and reduce the number of cases already existing,” Feldner says. “We teach couples skills for better relationship behaviors, such as how to communicate better and how to manage anger.”

All people receiving these interventions will be closely monitored and referred for more intensive individual therapy should the need arise. Rather than going back to focus on the roots of the PTSD, Feldner says the couples in these interventions “will focus on the here and now of how the PTSD is affecting their relationship.” While teaching couples about the features of PTSD and improving their relationships, the group treatment can also serve as a gateway to further treatment for PTSD and other services.

If these interventions succeed in preventing or treating relationship aggression, Feldner says that these would be groundbreaking, landmark projects. “Ultimately, we are hoping we can conduct these interventions in such a way that they could be useful for the VA and could be extended to community populations as well, for situations that are not specifically military,” Feldner says."

— Source: University of Arkansas, Fayetteville