Diagnosis and Treatment of PTSD-Related Compulsive Checking Behaviors in Veterans of the Iraq War: The Influence of Military Context on the Expression of PTSD Symptoms

Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States
American Journal of Psychiatry (Impact Factor: 12.3). 08/2009; 166(7):762-7. DOI: 10.1176/appi.ajp.2009.08091315
Source: PubMed


This case study presents an overview of the conceptualization and treatment of two veterans of the Iraq War who presented for combat-related treatment at a Veterans Administration Medical Center. In addition to posttraumatic stress disorder (PTSD) symptoms of reexperiencing, arousal, and avoidance, the veterans exhibited compulsive checking behaviors that appear to be influenced by theater-specific combat duties and traumatic events. These cases represent what the authors believe to be an increasingly common expression of PTSD in veterans of the Iraq and Afghanistan wars. Both veterans were treated with prolonged exposure therapy, which includes imaginal and in vivo exposure to anxiety-provoking stimuli, processing of traumatic events, and self-assessment of anxiety. Treatment also included in vivo exposure with response prevention techniques borrowed from the literature on obsessive-compulsive disorder to address compulsive checking behaviors within the ecological context of each patient's symptom presentation. Measures related to PTSD and depression were obtained before, during, and after treatment. Treatment was associated with significant declines in symptom severity and improved functioning for both veterans. The unique nature of the conflict in the Middle East represents role challenges for soldiers that affect symptom presentation. Variations in symptom presentation can in turn complicate efforts to identify and appropriately address PTSD-related health concerns in this population. Thus, clinicians and researchers must remain cognizant of how theater-specific duties influence the manifestation and treatment of PTSD in order to provide optimal care to a new generation of veterans.

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    • "The most common symptoms of PTSD are characterized and are described in DSM and multiple others publications (Asmundson, Frombach et al. 2000, Bryant and Harvey 2000, Kazak, Alderfer et al. 2004, Lombardo and Gray 2005, Tuerk, Grubaugh et al. 2009, Wortmann, Park et al. 2011), and are in the table 2. "
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    ABSTRACT: Post-traumatic stress disorder (PTSD) is a serious behavioural and psychological abnormality that occurs after perceived or actual exposure to unusual, severe, acute stressful events. In addition to returning soldiers from war front, PTSD is also occur in civilian victims of wars, terrorist attacks, serious accidents, sexual abuse/rape, or other violent episodes, and following school and workplace bullying or harassments. However, early diagnosis, individualized effective therapies and appropriate follow-up programs could effectively lead to cure. In addition, to psychotherapy and pharmacotherapy, out of the box approaches need to be explored including meditation, music therapy, and relaxation methods. Not only is PTSD underdiagnosed, but it also misdiagnosed or mislabelled, including as depression or adjustment disorders. Treatment of PTSD needs to be well-coordinated with all stakeholders taking active part, synergistically, maximizing utilization of resources to prevent recurrences. However, mislabelling PTSD as a diagnosis, prevents patients getting effective therapy and thereby may harm them and their families. The provision of timely, effective therapeutic plans not only alleviates the PTSD symptoms, but also prevents recurrences; thus facilitating their return to normal productive lives. Several novel neurohormonal and structural brain abnormalities have been identified in patients with PTSD, allowing further understanding, and identifying new medications and management options to help PTSD victims.
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    • "However, some studies suggest that the risk of OCD is elevated in veterans particularly among those exposed to high war zone stress (Helzer, Robins, & McEvoy, 1997; Jordan et al., 1991). Although empirical evidence is limited, clinical experience with OEF/OIF veterans suggests there is a PTSD-OCD dimension, similar to that observed in other anxiety disorders (Sasson et al., 2005; Tuerk, Grubaugh, Hamner, & Foa, 2009). OCD and PTSD are associated with persistent, recurrent, intrusive, and unwelcome images, thoughts, or memories. "
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    ABSTRACT: The highly stressful conditions of a war zone may exacerbate or trigger a wide variety of symptoms including Obsessive Compulsive Disorder (OCD) once a service member returns home. Service members and new veterans of the Iraq and Afghanistan wars present to treatment with multiple psychosocial concerns and co-morbid psychiatric conditions. Evidence-based treatments including exposure based therapies are commonly recommended for use with returning veterans. Although studies support the efficacy of Exposure Response Prevention (ERP) therapy for treating OCD, eligibility for these studies limits participation to subjects who self-report a well-defined, circumscribed complaint. This approach is not typical of clinic clients who, more often than not, report multiple psychological issues. The following individual case study demonstrates how integrating hypnosis facilitated the cognitive-behavioral ERP therapy and treatment for a patient suffering from OCD.
    The American journal of clinical hypnosis 07/2010; 53(1):19-26. DOI:10.1080/00029157.2010.10401744 · 0.53 Impact Factor
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    ABSTRACT: The authors present a pilot study of 12 veterans diagnosed with combat-related PTSD and treated with prolonged exposure therapy (PE) via telehealth technology. A reference sample of 35 combat veterans treated with in-person PE in the same clinic is also included for a comparison. Feasibility and clinical outcomes of interest include technical performance and practicality of the telehealth equipment, patient safety, treatment completion rates, number of sessions required for termination, and clinical outcomes. Results indicated large statistically significant decreases in self-reported pathology for veterans treated with PE via telehealth technology. Preliminary results support the feasibility and safety of the modality. Suggestions for the implementation of PE via telehealth technology are discussed.
    Journal of Traumatic Stress 02/2010; 23(1):116-23. DOI:10.1002/jts.20494 · 2.72 Impact Factor
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