IRAQ WAR CLINICIAN GUIDE

Iraq War Clinician Guide 177 Appendix I
I'OSr~TIUlJhlATICSRESS DIWRDER IN THE MII.TARY VETER,\N 267
prevnlence estimates suggcst that more than half of male (53.IU/o)and almost half
of female (48.1%%) Vietnam vclerans have experienced clinically significant symp
toms in relation lo their war-zone experiences.
Other War Cohorts
After tire fortnaliution of PTSD as a diagnosis, isolated case reporls began
callingatle~rtionto the fact that some \,eurans of wars before Vietnam had MSD.
brger shidies of older war cohorls began appearing in the mid-19805, and snore
recent data show remarkable similarity between World War II and Vietnam
veterans in their psychophysiologic reactivity to stimuli reminiscent oftlreir war
trauma." The prevalence of PTSD in older veterans, however, is unknown be
cause no study has used a sample tcprcsentative of the larger population. Eslimates
from community samples are low-roughly 2% for current PTSD.h" In
patients hospitalized for medical illness, Blake el al' found the prevalence of
current MSD in World War I1 and Korean War veterans who had never sought
psychialric ln'atmcnt to be9*/" and 7%. Among those who had previously sought
psychiatric treatment, 37% of the World War 11 veterans and 80% of the Korean
War veterans had current MSD. Rosen el all: found that 54% of a group of
psychiatlic patienls who had been in combat during World War II met criteria
for PTSD. The pnrvalcnce of current PTSD was 27%.
Data show evidence of PTSD in American men and rvomen who served in
the Persian Gulf (Wolfe]: unpublished data, 1993). A few days after return to the
United Stales, Il~e prevalence of current PlSD in men %\*as 3.2%and in women
9.6%. Approximately 18 months later, these figures increased to 9.4% and 19.8%.
This sttrdy is important because it demonskates that mSD may omtr in military
personnel who had relatively brief war-7ane exposure, even following a successful
war that received much popular support.
PSYCHIATRIC AND PSYCHOSOCIAL CORRELATES
MSD in the military veteran is frequcnlly assaciatcd with other psyclriatric
disorders, especially major depressive disorder and alcohol and substance use
disorders. Kulka et al" reported that male Vielnanr veterans with PTSD were
more likely than theater vetemns without PTSD to have a history of lifetime
dysthymia and of lifetime and current major depressive episode, panic disorder,
obsessive disorder, gencralizcd anxiety disorder, alcohol abuseldependence.
substance abuseldependence, and antisocial pcrmnalily disorder. Fenmle veterans
with PTSD were similar to their nrale counterpartc. except that they did not
differ from fernale veterans rvithout PTSD in tlre prevalence of current obsessivemnrpulsivc
disorder, current alcohol abuse/dependence, and lifetime substance
abusefdependeace; figures for current subslance abuse and both lifetilne and
current antisocial personality disorder rrrere not analyzed because of sample size
IimitationsP
The temporal relationship between I"1W and otl~er cornnorbid disorders may
differ as a lunction of war cohort. Davidsorr el aI0 reported that age of onset for
PTSD was similar in both World War I1 and Vietnam veterans, but relatively
more Vietnam veterans l~ad a psychial~ic diagnosis that predated their expericnces
in combat.
Military veterans with P'l.SD also may experience hmctional impairmarl,
especially, we suspect, if the course of their disorder is clrmnic. Kulka et al"
found that both male and female Vietnam veterans rvith II'SD were less likely to
DEPARTMENT OF VETERANS AFFAIRS
-.-
NATIONAL CENTER FOR PTSD