1. Posttraumatic Stress Disorder (PTSD) in Veterans
Chapter 6
Posttraumatic Stress Disorder (PTSD) in Veterans

2. DSM Diagnostic Criteria for PTSD*
(According to the DSM-IV-TR; APA, 2000) Exposure to an actual or perceived threat provoking intense fear or helplessness.
Three symptom clusters
At least one reexperiencing symptom
At least three avoidance or emotional numbing symptoms
At least two hyperarousal symptoms
Symptoms last more than one month.
Significant distress or impairment in social, occupational, of other functioning.
*Changes being proposed in upcoming revision (DSM-V)
Subjective perception
Large T:
Threat to life or physical integrity
Demands extraordinary coping efforts
Sense of helplessness, fear, horror, or disgust
Shatters basic assumptions
Leads to exaggerated appraisals
Small t:
For example, small t traumas might include adult events such as partnership breakdown or childhood experiences of humiliation.
Consider, for instance, the devoted wife of a successful and admired politician whose secretive and illegal consorting with prostitutes suddenly becomes exposed in the news media. Children, especially, can be traumatized without a physical threat. Consider the teenage daughters of the aforementioned politician. Also, imagine the difference in the degree of psychological trauma between a middle-aged adult learning that his father did not really die in the war but was in an institution for the criminally insane versus an only child aged 12 finding that out for the first time and realizing that his mother has been lying to him.

3. Early Conceptions of PTSD
Nineteenth century: “traumatic neurosis”
Freud: Hysteria based on actual or fantasized sexual trauma
World War I: “shell shock”

4. Models to Explain PTSD Psychodynamic Model General Adaptation Syndrome
Early childhood trauma and psychological conflicts
General Adaptation Syndrome
Physiological response to stress
Biological Model
Chronic or potentially permanent physiological changes
Transactional Theories of Stress
Contextual and environmental factors emphasized
Diathesis-Stress Model
Amalgam of the above models
Genetic vulnerabilities, early childhood experiences or brain abnormalities

5. Current, More Empirically Supported Models of PTSD
Behavioral Models
Feared stimuli overgeneralized
Avoidance of overgeneralized stimuli is reinforced
Cognitive Models
Traumatic event reinforces negative beliefs about one’s safety and competence
Cognitive distortion that the world is a dangerous place
Biological Models

6. Discussion Questions Regarding Case Study
Discuss what you know about the case and possible resources.
What are the societal, cultural, and community contexts of the case?
What are elements of SSG Brown’s world that could serve to maintain his problems?
How would you address the maintenance of problems?
What else would you want to know about the case and about SSG Brown’s situation to develop a better understanding of him?
How would you locate resources for SSG Brown and for yourself as a social worker?
What beliefs and perceptions did you have about PTSD and about veterans before reading this chapter, and how did they change after reading this chapter?
How does the veteran experience compare and contrast to the civilian experience in general and with trauma?