IRAQ WAR CLINICIAN GUIDE

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Iraq War Clinician Guide 180
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Appendix I
There has hen relatively little attention focused on PTSD anrong nonwhite
military vet~rans,~ although Bgendod et al'O addressed post-Vietnam psycholog-
ical problems among black veterans, and Kulka el aP rigorously measured PTSD
in black and Hiianic subsamples of Vietnam Ureater and Vielnamcra veterans
and civilians." Little is known about WSD amon Anrerican Indian, Asian
American, Native Alaskan, Native Hawaiian, or Padfic lslander military veter-
ans, although research on this matter is in progress. Preliminary fmdings on
Viehiam theater veterans from the Sioux nation indicate high ales of PTSD ( S
Manson: personal communication, 1993). The NWRS data reviewed previously
showed increased prevalence among black and Hijpanic veterans relative to
whites* difference that could not be comoletefv . , exolained ~ , bv , increased war-
~~zone
exposure among the nonwhite minorilics. There are a numkr of factors
thal might contribute to any additional rick lor P1SD among nonwhite American
military personnel. These include negative environmentalfaclors in childhood,
limited emnomic opporlunities, racism in the tnilitary and at home, overidentili-
calion with the no&&iteenemy, exacerbationof traimatic stress bg institutional
racism. a bicultural identitv. ,. and nonmembers hi^, in the maioritv ,~, culture?
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though it is obviously of great imporlalice to inwsltgale possible associations
htu'cen cthnorultuml factors and 1TSD prei,alcncc rakes, 11 is nensary to do so
wilh ethnoculturallg sensitive inslrumenls. hlarsella el alJ ha\t. ar,:r~ed that
future =arch of this nature must use cross-culturnl and medical antlhpologic
research slmtegies.
Mow than 300,000 Americans were wounded in Vietnam, more than half
required hospitali7ation. and approximately one quarter (more than 75.000) be. ,
catne seriously disabled. V~anks to efficient evacuation procedures and nrodern
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medical technology, many survived who would not have lived in previous wars. A price for this survival was a 300"h higher rate of ampittations or of crippling :
wounds lo the lower extren1ities than occurred during World War II:V. I'eople
wilh chronic physical disabilities resulting from war-zone injuries have the
higher rates of PTSD, as stated eadier12 They are particularly vulnerable to
unremitting FI'SD. Thc persistent pain, disfigurement, and physical i~apairment
from which they suffer serve as constant reminders of the traumatic event(s) that
created these problenrs. In llris regard, the physical disability itself is a traumarelated
stimulus that constantly stirs Ihe pol of intrusion, avoidantlnumbing.
and arousal symploms. Treatment of such individuals is complicated and often
disappointing because it must address physical and FED problems simultaneously.
COURSE OF ILLNESS
. . The fact !hat lifetime prevalence cstin~ates of PlSD exceed cunent estimates
indicates thal some individuals experience reduction of symptoms, if not remvcry,
o\,er linle. Staling that a significant number of individuals who once had
M'SD no longer meet diaenostic criteria, Irowever, dws not mean that such
individuals are free of symptoms. Although recovery does occur, many individuals
conlitrue to suffer fron ~)nrlinlPXD. l'lrese individuals fall short of a rninitnum
of six symptoms. In many cases, howe\,er, these residual symptoms may
seriot~sly impair marital, familial, vocational, or social functioning.
Lor~gitudinal studies shotv that tlre course of l%D is quite variable. Al-
though sonre trauma sutvivors may become free of most or all 1'1SD symptoms,
others tnay develop a persisnt mental disorder marked by relapses and remis-
sions in uvhich patients :,re severely, chronically incapacilawd:'. " Uetween these
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DEPARTMENT OF VETERANS AFFAIRS
NATIONAL CENTER FOR PTSD