Understanding Combat Related Post Traumatic Stress Disorder This page intentionally left blank Understanding Combat Related Post Traumatic Stress Disorder W F. M D ALTER C ERMOTT McFarland & Company, Inc., Publishers Jefferson, North Carolina, and London LIBRARYOFCONGRESSCATALOGUING-IN-PUBLICATIONDATA McDermott, Walter F., ¡946– Understanding combat related post traumatic stress disorder / Walter F. McDermott. p. cm. Includes bibliographical references and index. ISBN 978-0-7864-6946-8 softcover : acid free paper ¡. Post-traumatic stress disorder. 2. Post-traumatic stress disorder—Treatment. 3. Soldiers—Mental health—United States. 4. Veterans—Mental health—United States. 5. Combat— Psychological aspects. 6. Psychology, Military. 7. Soldiers—United States—Biography. 8. Veterans—United States—Biography. 9. Post- traumatic stress disorder—Patients—United States—Biography. I. Title. RC552.P67M383 2012 616.85'21—dc23 2012008064 BRITISHLIBRARYCATALOGUINGDATAAREAVAILABLE © 2012 Walter F. McDermott. All rights reserved No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying or recording, or by any information storage and retrieval system, without permission in writing from the publisher. Front cover image © 2012 Shutterstock Manufactured in the United States of America McFarland & Company, Inc., Publishers Box 6¡¡, Je›erson, North Carolina 28640 www.mcfarlandpub.com To the tens of thousands of Americans who died fighting in the Vietnam War, especially to those men who died alone. You will never be forgotten. This page intentionally left blank T C ABLE OF ONTENTS Preface 1 1.Introduction 3 2.History of Combat Disorders 7 3.Symptoms and Diagnosis of PTSD 10 4.Post Trauma PTSD Rates 12 5.Family Difficulties 16 6.The Veteran’s Spouse 19 7.Psychotherapy 24 8.Cognitive Psychotherapy 33 9.Shattered Assumptions 39 10.Fear and Anxiety 48 11.Psychological Treatments of Fear 56 12.Memory Difficulties 67 13.Nightmares and Flashbacks 74 14.Social Avoidance 83 15.Guilt 94 16.Anger and Violence 105 17.Depression and Suicidal Thoughts 114 18.Low Self-Esteem 134 19.Substance Abuse 141 20.Medications 144 vii viii Table of Contents 21.Experimental Treatments 152 22.Chronic Pain and PTSD 155 23.Mild Traumatic Brain Injury and PTSD 172 24.Special Combat Veteran Populations 179 Resources for the Combat Veteran 187 Notes 189 Bibliography 193 Index 199 P REFACE This book is about the invisible wounds of war: Post Traumatic Stress Disorder (PTSD). In a semi-memoir format, it provides an explanation of the historical development of PTSD, its myriad symptomsand the scien- tifically verified psychological and medical treatments for the disorder. In the United States and Great Britain alone there are hundreds of thousands of war veterans suffering PTSD symptoms. Our current Mideast wars are generating thousands of new PTSD cases. Because it is a psychological hidden wound, veterans afflicted with PTSD may find it difficult to under- stand the troubling symptoms of their disorder. Combat veterans and their families can learn to better understand PTSD by reading this book. I wrote this book from a unique perspective: I am a Vietnam combat veteran and clinical psychologist who has treated combat PTSD veterans for more than 28 years. I served in an artillery battery assigned to the 9th Infantry Division in Vietnam’s Mekong Delta from 1969 to 1970. For most of my psychological career I worked as a staff psychologist at the Jack- sonville, Florida, VA Outpatient Clinic’s Mental Health Unit. This com- bination of experiences enables me to analyze PTSD symptoms from a personal perspective as well as a professional one. Combining the basic tenets of cognitive psychotherapy and my own military experience, I developed and refined many unique therapeutic ideas and insights. These innovative therapeutic concepts are described in detail and in plain language. For example, the reader will learn that the Bible’s fourth commandment is usually mistranslated, an awareness of which can help some combat PTSD veterans ease pathological guilt over killing the enemy. An early chapter addresses those unsung victims of com- bat stress, the spouses of PTSD veterans. It helps them comprehend this alien combat disorder by detailing its similarities to the negative psycho- logical aftereffects of a sadly more familiar trauma: rape. The book also 1