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Invisible wounds: understanding PTSD

Service member appearing distressed with hand on head. Post-traumatic stress disorder develops in some people after exposure to a traumatic event. It affects approximately 8 million Americans and can interfere with a person’s daily life and impact personal relationships. (U.S. Air Force photo by Senior Airman Christian Clausen/Released)

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Posttraumatic Stress Disorder

In the United States, 60% of men and half of all women experience at least one traumatic event in their lives, according to the Department of Veterans Affairs' National Center for PTSD. Roughly 8 million adults live with post-traumatic stress disorder.

Trauma exposure itself doesn’t mean everyone will experience PTSD. “We know that a number of variables put people at risk: prior trauma history, lack of social support, suffering an injury as a result of the trauma, and preexisting mental health issues,” said Holly O’Reilly, a clinical psychologist. The effects of trauma also accrue over time, she added, “So repeated trauma exposure will increase the likelihood of developing post-traumatic symptoms.”

PTSD is a mental health condition that some people develop following exposure to a traumatic event, said O’Reilly, who works at the Psychological Health Center of Excellence, a division of the Defense Health Agency Research and Development Directorate. Although anxiety and depression can overlap with PTSD symptoms, the conditions are different. Anxiety is a pattern of worrying or being fearful of something that could happen while depression refers to a depressed mood for two weeks or more, explained O’Reilly. “Individuals with symptoms of PTSD continue to be anxious as a result of a prior trauma experience or exposure,” she said.

An official diagnosis of PTSD requires exposure to a traumatic event and symptoms from four different categories. They include reliving trauma through intrusive memories; avoidance of any reminders of trauma; persistent negative thoughts and emotions associated with the trauma; and hyperarousal, which is consistently feeling “on edge,” particularly in response to reminders of the trauma. People may be easily startled, feel irritable, or have difficulty falling asleep.

PTSD can interfere with a person’s daily life and impact personal relationships. “Individuals who have symptoms of PTSD may demonstrate difficulty completing everyday tasks, experience persistent anxiety, or have upsetting reminders of previous traumatic events,” said O’Reilly.

As people practice social distancing, social isolation may contribute to PTSD symptoms, she cautioned. If a person used social activity to avoid intense emotions, the loss of social activity could lead to thinking about past trauma and a worsening of symptoms.

“Research has shown that PTSD can be treated successfully via evidence-based psychotherapy,” she said. “The best way for individuals to fully recover is to fully participate in evidence-based psychotherapy, allowing them to process their response to the trauma and learn skills to move forward.”

A common misconception is that a diagnosis of PTSD will negatively impact a person’s career, but without treatment, symptoms will persist and may even worsen. PTSD treatments work and people can fully recover, said O’Reilly. Even years after the initial trauma, people can still benefit from treatment, but the sooner a person seeks therapy, the better. Many types of evidence-based PTSD treatment usually take two to three months to complete and occur in weekly individual sessions. O’Reilly encourages practicing new therapy skills outside of the sessions.

PTSD can result in changes to changes in the brain, but it may not be permanent, said Dr. Robert Ursano, director of the Uniformed Services University of the Health Sciences’ Center for the Study of Traumatic Stress, who spoke recently at a PTSD roundtable. “We know specifically three primary and several other areas in the brain but principally the prefrontal cortex, the hippocampus and the medulla show alterations in those with PTSD versus that those who don't,” he said. “We also have data that showed that after treatment the brain can change back again.” PTSD is a highly treatable disorder with effective medications and psychotherapies, he added.

“If you or someone you care about has symptoms of PTSD and they cause distress or interfere with daily activities, you should seek help from your local behavioral health clinic,” said O’Reilly, adding all military hospitals and clinics have PTSD experts available. “You may also connect through Military One Source, or the inTransition program,” she added. Resources on PTSD treatment are available on the Psychological Health Center of Excellence website.

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Seizures among Active Component service members, U.S. Armed Forces, 2007 – 2016

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1/25/2018
This retrospective study estimated the rates of seizures diagnosed among deployed and non-deployed service members to identify factors associated with seizures and determine if seizure rates differed in deployment settings. It also attempted to evaluate the associations between seizures, traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) by assessing correlations between the incidence rates of seizures and prior diagnoses of TBI and PTSD. Seizures have been defined as paroxysmal neurologic episodes caused by abnormal neuronal activity in the brain. Approximately one in 10 individuals will experience a seizure in their lifetime. Line graph 1: Annual crude incidence rates of seizures among non-deployed service members, active component, U.S. Armed Forces data •	A total of 16,257 seizure events of all types were identified among non-deployed service members during the 10-year surveillance period. •	The overall incidence rate was 12.9 seizures per 10,000 person-years (p-yrs.) •	There was a decrease in the rate of seizures diagnosed in the active component of the military during the 10-year period. Rates reached their lowest point in 2015 – 9.0 seizures per 10,000 p-yrs. •	Annual rates were markedly higher among service members with recent PTSD and TBI diagnoses, and among those with prior seizure diagnoses. Line graph 2: Annual crude incidence rates of seizures by traumatic brain injury (TBI) and recent post-traumatic stress disorder (PTSD) diagnosis among non-deployed active component service members, U.S. Armed Forces •	For service members who had received both TBI and PTSD diagnoses, seizure rates among the deployed and the non-deployed were two and three times the rates among those with only one of those diagnoses, respectively. •	Rates of seizures tended to be higher among service members who were: in the Army or Marine Corps, Female, African American, Younger than age 30, Veterans of no more than one previous deployment, and in the occupations of combat arms, armor, or healthcare Line graph 3: Annual crude incidence rates of seizures diagnosed among service members deployed to Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn, U.S. Armed Forces, 2008 – 2016  •	A total of 814 cases of seizures were identified during deployment to operations in Iraq and Afghanistan during the 9-year surveillance period (2008 – 2016). •	For deployed service members, the overall incidence rate was 9.1 seizures per 10,000 p-yrs. •	Having either a TBI or recent PTSD diagnosis alone was associated with a 3-to 4-fold increase in the rate of seizures. •	Only 19 cases of seizures were diagnosed among deployed individuals with a recent PTSD diagnosis during the 9-year surveillance period. •	Overall incidence rates among deployed service members were highest for those in the Army, females, those younger than age 25, junior enlisted, and in healthcare occupations. Access the full report in the December 2017 MSMR (Vol. 24, No. 12). Go to www.Health.mil/MSMR

This infographic documents a retrospective study which estimated the rates of seizures diagnosed among deployed and non-deployed service members to identify factors associated with seizures and determine if seizure rates differed in deployment settings. The study also evaluated the associations between seizures, traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) by assessing correlations between the incidence rates of seizures and prior diagnoses of TBI and PTSD.

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Healthcare Burdens Attributable to Various Mental Disorders, U.S. Armed Forces 2016

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Did you know…? In 2016, mood disorders and substance abuse accounted for 25.9% of all hospital days. Together, four mental disorders – mood, substance abuse disorders, adjustment, and anxiety – and two maternal conditions – pregnancy complications and delivery – accounted for 53.6% of all hospital bed days. And 12.4% of all hospital bed days were attributable to injuries and poisonings. Here are the mental disorders that affected U.S. Armed Forces in 2016: Pie Chart titled Bed days for mental disorders in 2016: •	Mood Disorder (46,920 bed days) – the orange pie slice. •	Substance Abuse Disorders (44,746 bed days) – the blue pie slice. •	Adjustment Disorder (30,017 bed days) – the purple pie slice. •	Anxiety Disorder (20,458 bed days) – the gray pie slice. •	Psychotic Disorder (6,532 bed days) – the light blue pie slice. •	All other mental disorders (3,233 bed days) – the violet pie slice. •	Personality disorder (2,393 bed days) – the forest green pie slice. •	Somatoform (552 bed days) – the lime green pie slice. •	Tobacco dependence (2 bed days) – the white pie slice. Bar graph shows percentage and cumulative percentage distribution, burden “conditions” that accounted for the most hospital bed days, active component, U.S. Armed Forces 2016.  % of total bed days (bars) for mood disorder, substance abuse disorders, adjustment disorder, pregnancy complications; delivery; anxiety disorder; head/neck injuries, all other digestive diseases, other complications NOS; other back problems, all other signs and symptoms; leg injuries, all other maternal conditions; all other neurologic conditions; all other musculoskeletal diseases; all other skin diseases;  back and abdomen; appendicitis; all other infectious and parasitic diseases; all other cardiovascular diseases; all other mental disorders; all other respiratory diseases; arm/shoulder injuries; poisoning, drugs; foot/ankle injuries; other gastroenteritis and colitis; personality disorder; lower respiratory infections; all other genitourinary diseases; all other malignant neoplasms; cerebrovascular disease.  See more details on this bar graph in the Medical Surveillance Monthly Report (MSMR) April 2017 Vol. 24 No. 4 report, page 4. This annual summary for 2016 was based on the use of ICD-10 codes exclusively. Read more on this analysis at Health.mil/MSMR. #LetsTalkAboutIt Background of graphic is a soldier sitting on the floor in a dark room.

This infographic documents the mental disorders that affected U.S. Armed Forces in 2016.

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Signs of Mental Health Distress

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Depression 101

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