Part 1 of 5
By David Barker
AMVETS Department of Ohio 2002
Some people feel that personal experience is needed when dealing with PTSD cases, and many others feel it is not a factor at all --just a situation. During my experience as a Veterans Service Officer, I have been told by an overwhelming majority of my PTSD clients that they relate better to a person who has actually experienced a stressor.
As someone who personally experienced a violent stressor, I have found it is easier for me to relate to a veteran who is under stress at the time. However, it has been my experience that the person who assists the claimant needs compassion and empathy as well.
Post Traumatic Stress Disorder
The essential feature of PTSD is the development of characteristic symptoms that follow a psychologically traumatic event. This event is generally considered to be outside the range of usual human experience.
The developed characteristic symptoms involve re-experiencing the traumatic event; numbing of responsiveness to, or reduced involvement with, the external world; and a variety of autonomic, dysphoric, or cognitive symptoms. The stressor producing this syndrome would evoke significant symptoms of distress in most people, and is out of the range of such common conflict. The trauma may be experienced alone (rape or assault) or the company of groups of people (military combat). Stressors producing this disorder include natural disasters (floods, earthquakes), accidental man-made disasters (car accidents with serious injuries, airplane crashes, large fires), or deliberate man-made disasters (bombing, torture, death camps).
Some stressors frequently produce the disorder (e.g. torture), while others only occasionally (e.g. a car accident). Frequently, there is a concomitant physical component to the trauma, which may even involve direct damage to the central nervous system (e.g. malnutrition, head trauma). This disorder is apparently more severe and longer lasting when the stressor is of human design. The severity of the stressor should be recorded by professionals, and the specific stressor should be noted on Axis: IV.
The traumatic event can be re experienced in a variety of ways. Commonly the individual has recurrent painful, intrusive recollection of the event, or recurrent dreams or nightmares during which the event is re-experienced. In rare instances, there are dissociative-like states, lasting from a few minutes to several hours, or even days, during which components of the event are re-lived and the individual behaves as though experiencing the event at that moment. Such states have been reported in persons exposed to the criteria found in DSM IV 309.81 Post Traumatic Stress A Disorder. Diminished responsiveness to the external world, referred to as psychic numbing or emotional anesthesia, usually begins after the traumatic event. A person may complain of feeling detached or estranged from other people, that he or she has lost the ability to become interested in previously enjoyed significant activities, or that the ability to feel emotions of most types, especially those associated with intimacy, tenderness, and sexuality, is markedly decreased.
After experiencing the stressor, many develop symptoms of hyper-alertness, exaggerated startle responses, and difficulty falling asleep. Recurrent nightmares in which the traumatic event is relived and which terminal sleep disturbance may be present. Some have impaired memory and difficulty concentrating. Symptoms are often intensified when activities resemble the actual trauma (e.g. cold snowy weather or uniformed guard for death camp survivors or hot humid weather for Vietnam veterans).
Associated features: symptoms of depression and anxiety are common, and in some instances may be so severe as to be diagnosed as an anxiety or depressive disorder. Increased irritability, unexpected explosions of aggressive behavior, with minimum or no provocation. Impulsive behavior also can create problems such as unexplained trips, unexplained changes in life styles. Symptoms may begin immediately or soon after the trauma. It is not unusual, however, for the symptoms to surface months or years later following the trauma. Impairment may be mild or affect every aspect of life. Phobic avoidance of situations or activities that resemble the trauma are common and often create occupational or recreational impairment. Psychic numbing often interferes with interpersonal relationships, such as family life. It often leads to self defeating behavior sometimes including suicide. Substance disorders are common .
The appearance of apparent psychotic symptoms are interpreted by many professionals as psychosis; but, are actual symptoms of PTSD in a normal person.
Early in 1990, one of my clients came into my office to discuss his VA claim for Post Traumatic Stress Disorder. After we reviewed the stressor letter regarding his being 50 meters from a falling helicopter, which exploded upon impact, killing all aboard, two on the ground (his comrades) and knocking the veteran several steps back while being signed by the fire from the blast; and, the VA stated: "that was not a life threatening situation, out of the normal range of human emotion", etc. He gracefully presented me a bill from the VA Out Patient Clinic in Columbus, Ohio. The bill totaled $129.00 , including interest and fees, for his PTSD, which the VA had determined was non-service connected. Of course, we all know the VA had treated many veterans for nervous disorders for years with no mention of cost to the veteran. Suddenly it all changed with medical care cost recovery. Even a veteran, with the proof and stressors to go with his proof, ended up paying for his treatments, prior to the claim being service connected.
Now some of our fellow comrades may think if the veteran makes enough money to be in category B or C, he or she should be able to afford the charges. Well, this is not necessarily true. Often, the veteran may have insurance the VA can bill for the treatment; but, not always. The veteran was disabled due to his PTSD and as a result his insurance was not in force at that time. He had been placed in category C by the VA due to his prior year income, which had ceased. This veteran was finally rated as service connected for PTSD at 10 percent. The veteran had witnessed the helicopter crash. He was not on the chopper, he witnessed the crash. A claim approved in 1992 by the Rating Specialist that was non-combat.
"Basic Stress Problems: Frustration"
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