IRAQ WAR CLINICIAN GUIDE
Iraq War Clinician's Guide - Network Of Care
Iraq War Clinician's Guide - Network Of Care
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-Iraq War Clinician Guide 184 Appendix I<br />
associated with PTSD" (seealso the article by Southwick el a1 in this issue) might<br />
increase biologic susceptibility to cardiovascular, gastrointestinal, endocrine, autoimmune,<br />
and other medical disorders. Adverse health beliaviors (smoking,<br />
drinking, ealiig disorders. sexual behavior) associated with 1TSD might affect<br />
health risk. Comorbid deoression. anxiehr disorders. and alcoholismlsubstance<br />
~ .~ ~~<br />
abusc might increase discox sus~e~tibili;~. and h~i~litened vigilance or perceptions<br />
of autonomic cbnges might increase rates of hc2lth complaints<br />
SALUTARY EFFECTS OF <strong>WAR</strong>-ZONE EXPOSURE<br />
The significant problems associated with MSD among military veterans<br />
have overshadorved the fact that some veterans who have extensive combat<br />
exposure are rvell adiusted and hieh function in^.^^" Moreouer. war-zone exoosuie<br />
can have ~0ter;tiallv saluta; effects. alt6ououeh - these effects .~. mav no< be<br />
~<br />
-~<br />
obervcd imniediatcty afier war at;d may not involve all a>pects of function. For<br />
e~aniple, Elder and Clipp" studied pvrsonality change from ndolmence to mid.<br />
life in male Korean Waiand World War Ilveteraos. Veterans with heavy combat<br />
exposun! had the greatest gains in resilience and decreases in helpless6ess relative<br />
to less-exposed veterans but at a price-the heavy exposure group also had<br />
the most painfulmemories and en~otional distress.<br />
SUMMARY<br />
1. Military personnel exposed to war-zone tmuma are at risk lor developing<br />
PTSD. Those at greatest risk are those exposed to the highes! levels ol<br />
war-zone stress, those wounded in action, those incarcemtcd as prisoners<br />
of war, and those who nlanifest acute war-zone teactionr, such as CSR.<br />
2. In addition to problems directly attributable to PlSD symptoms per se,<br />
individuals witli this disorder frequently suffer from other comorbid psychiatric<br />
disorders, such as depression, other anxiety disorders, and alcohol<br />
or substance abuselde~~endence:le mulling constellation of psychiatric<br />
syrnpto~ns f~~quelllly impairs matital, vontional, and social function.<br />
3. Vie likelihood of developing chronic I'TSD depends on prc~nilitary and<br />
poslnrilitary factors in addition to features of the trauma itsell. Prcmilitary<br />
(actors include negative environmental factors in childhood, econotnic<br />
deprivation, family psycliiatric history, age of enhy into the military,<br />
premilitary edr~calional attainment, and pe~sonality characteristin. I'ostmilitary<br />
factors include social support and the veteran's coping skills.<br />
4. Among Allrentan military personnel, there nre three populations at risk<br />
lor unique problenis that may amplify the psychological impact of warzone<br />
stress. 3iey are women whose tr2ar-zone experiences may be complicated<br />
by sexual assault and harassment; rronrvhite ethnic minority individuals<br />
~vhose premilitary, postmilitary, and nrilitary experience is affected<br />
by the many manifestations of racism; and those with war-related<br />
physical disabilities, rvhose PTSD and niedical problems often exacerbate<br />
each other.<br />
(Ither panems include delayfd. chronic, &d intermittent k15D.'<br />
P<br />
DEPARTMENT OF VETERANS AFFAIRS<br />
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w---<br />
NATIONAL CENTER FOR PTSD