IRAQ WAR CLINICIAN GUIDE

Iraq War Clinician Guide 178 Appendix I
269 FRIEDMAN el at
be married and had more divorces, more marital problems, and more occuyational
instability than Vietnam veterans withwt PTSD. In addition, m D in the
men was associated with increased social maladjustment Thirty-five percent
were homeless or vagrant, 2546 had mmmitted 13or more acts of violenceduring
the previous year, and 50% had been arrested or jailed more than once since the
age of 18.
Some patients with MSD are severely, chronically incapacitated. Similar to
individuals with other persistent mental disorders, such as schizophrenia, their
social functioning is markedly restricted. They often rely heavily on public housing,
community support, and public mental Irealtl~ services. The severity of MSD
may result in repeated hospitalizations over the years andniay require ongoing
outpatient treatment?'
RISK AND PROTECTIVE FACTORS
Not all people who are exposed to a traumaticevent go on to develop lyI5D.
It is now generally recognized that both'the likelihood of ever developing PTSD
and the likelihood of developing chronic YSSD depend on pretraumalic and
post-traumatic faclors as well as on features of the lrauma ilself. In one study
that examined predictors of lifetime FED, premilitary facbrs accounted for 9%
of the variance, military factors 19%, and postnrilitary factors 12%."
Premilitary Faclors
Who a person is before entering the military influences both the nature of
military experiences and his or her reactions to those experiences. The risk of
ITSD is increased by younger age of entry into the military, less premililary
education, prior psychiatric disorder, and childhood beixlvior pr~blems.'".~' Normal
penonalily characterislics also may play a role. Using premililary Minnesota
Multiphasic Personality lnvenlory (hllMPI) %tors, we found that risk of PTSD
was increased by normal range elevalions on several scales, especially Psychhpathic
1)evialc and hlasculinity-Fen~ininity;~An interesting study of hvins who
were either Viehrarn or Vietnam-era veterans found that genetic factors accounted
for 30% of PTSD symptom liability, even alter controlling for amount of
war-zone exposure.'* Negative environmental faclors in childhood, however,
such as physical abuse, economic deprivation, and parental mental disordcr, also
increase the risk of MSD following war-zone exp~sure?.~ Given such (indines,
it is reasonable to think that sexual and emotional abuse inchildhood also would
increase the risk of I'lSD in \,elenns.
Military Factors
A high amount of war-zone exposure dramatically increases one's risk ol
PTSD. (War-zone exposure refers here not only to aclual combat, but also lo its
results as expcricnced by individuals who deal with injury and death, such as
medical or graves registration personnel. In female veterans, war-zone exposure
additionally may involve sexual harassment and a~aull.~) Male \'ielnam \,etcr.
;ins witit high war-zone exposure am seven limes more likely than veterans rvilh
low or moderate exposure to have corrcnt PTSI); female velerans rvith high war-
DEPARTMENT OF VETERANS AFFAIRS
NATIONAL CENTER FOR PTSD