Transcript Slide 1

PTSD and Veterans:
Understanding and
Accommodating
Presented by: Cheryl Chesney-Walker,
Executive Director for Health
Careers/Education and Special Services for
Students, VCU Medical Center, MCV Campus
September 26, 2008 AHEAD Fall Conference
Background on PTSD
• Posttraumatic Stress Disorder
• The person has been exposed to a traumatic event in
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which both of the following were present:
The person experienced, witnessed, or was confronted
with an event or events that involved actual or
threatened death or serious injury, or a threat to the
physical integrity of self or others
The person’s response involved intense fear,
helplessness, or horror. Note: In children, this may be
expressed instead by disorganized or agitated behavior
Source: DSM-IV-TR
PSTD Criteria
• The traumatic event is persistently re-experienced in one (or more) of the following
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ways:
Recurrent and intrusive distressing recollections of the event, including images,
thoughts, or perceptions. Note: in young children, repetitive play may occur in which
themes or aspects of the trauma are expressed
Recurrent distressing dreams of the event. Note: in children, there may be
frightening dreams without recognizable content
Acting or feeling as if the traumatic event were recurring (includes a sense of reliving
the experience, illusions, hallucinations, and dissociative flashback episodes, including
those that occur on awakening or when intoxicated). Note: In young children,
trauma-specific reenactment may occur
Intense psychological distress at exposure to internal or external cues that symbolize
or resemble an aspect of the traumatic event
Physiological reactivity on exposure to internal or external clues that symbolize or
resemble and aspect of the traumatic event
Source: DSM-IV-TR
Symptoms and Behaviors of PSTD
• Persistent avoidance of stimuli associated with the trauma and
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numbing of general responsiveness (not present before the trauma),
as indicated by three (or more) of the following:
Efforts to avoid thoughts, feelings, or conversations associated with
the trauma
Efforts to avoid activities, places, or people that arouse recollections
of the trauma
Inability to recall an important aspect of the trauma
Markedly diminished interest or participation in significant activities
Feeling of detachment or estrangement from other
Restricted range of affect (e.g., unable to have loving feelings)
Sense of a foreshortened future (e.g., does not expect to have a
career, marriage, children, or a normal life span)
Source: DSM-IV-TR
Symptoms and Behaviors
Continued
• Persistent symptoms of increased arousal (not
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present before the trauma), as indicated by two
(or more) of the following:
Difficulty falling or staying asleep
Irritability or outbursts of anger
Difficulty concentrating
Hypervigilance
Exaggerated startle response
Source: DSM-IV-TR
Acute Stress Disorder
• The person has been exposed to traumatic
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event in which both of the following were
presented:
The person experienced, witnessed, or was
confronted with an event or events that involved
actual or threatened death or serious injury, or a
threat to the physical integrity of self or others
The person’s response involved intense fear,
helplessness, or horror
Source: DSM-IV-TR
Symptoms and Behaviors of Acute
Stress Disorder
• Either while experiencing or after experiencing the distressing event, the
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individual has three (or more) of the following dissociative symptoms:
A subjective sense of numbing, detachment, or absence of emotional
responsiveness
A reduction in awareness of his or her surroundings (e.g., “begin in a
daze”)
Derealization
Depersonalization
Dissociative amnesia (i.e., inability to recall an important aspect of the
trauma)
Marked symptoms of anxiety or increased arousal (e.g., difficulty sleeping,
irritability, poor concentration, hyper vigilance, exaggerated startle
response, motor restlessness).
Source: DSM-IV-TR
Generalized Anxiety Disorder
• Excessive anxiety and worry (apprehensive expectation), occurring more
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days than not for at least 6 months, about a number of events or activities
(such as work or school performance).
The person finds it difficult to control the worry.
The anxiety and worry are associated with three (or more) of the following
six symptoms (with at least some symptoms present for more days than not
for the past 6 months). Note: Only one item is required in children.
Restlessness or feeling keyed up or on edge
Being easily fatigued
Difficulty concentrating or mind going blank
Irritability
Muscle tension
Sleep disturbance (difficulty falling or staying asleep, or restless
unsatisfying sleep)
Source: DSM-IV-TR
Combat Related Hearing Loss
• VA’s National Center for Rehabilitative
Auditory Research recommends hearing
protection for sounds louder than a lawn
mover (90 decibels). Weapons and
equipment used in the military often far
exceed this level.
Military Sound Levels
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Apache helicopter, pilot, Decibels: 104
9mm pistol, Shooter, Decibels: 157
Grenade, within 50 ft., Decibels:164
105mm towed howitzer, Gunner, Decibels: 183
MAAWS recoilless rifle, Gunner, Decibels: 190
Source: U.S. Army Center for Health Promotion
and Preventive Medicine
Symtomology of Hearing Loss for
Veterans
• Depression
• Lack of socialization caused by inability to
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understand others in conversations.
Mild to moderate brain damage from combat
blast exposure. This is a new phenomenon with
little research.
Isolated
Paranoid
Emotionally unstable
Statistics on Hearing Loss and
PTSD for Iraq and Afghanistan
Veterans
• Tinnitus (loud noise exposure is a very common
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cause of tinnitus, and it often damages hearing
as well) is the No. 1 service connected health
condition for Iraq and Afghanistan veterans,
with nearly 70,000 diagnoses, according to the
Veterans Benefits Administration.
Defective hearing is No. 3 with almost 60,000
cases.
PTSD is No. 4 with 38,000 cases.
Source: VFW September 2008
What we do know.
• Many Iraq and Afghanistan veterans will be returning to
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postsecondary education to utilize the 2008 GI Bill.
Many of the veterans will have disability needs that will
need to be accommodated.
Veterans will need support in different aspects of
postsecondary education life.
They may have difficulty adjusting to civilian life.
They may have interpersonal relationship difficulties at
home and at school.
They may or may not know that they need disability
support services and how to seek out such services.
What can we do?
• Create linkages and support networking with our university and
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college Veteran’s Affairs office.
Create a referral system between DSS and Veteran’s Affairs office
personnel.
Provide information on both the DSS and Veteran’s websites on
referrals, services, policies and procedures to seek out disability
support services.
Provide informational “fact sheets” on disability services for your
office to be disseminated to the Veteran’s prior to their enrollment
in coursework.
Be sensitive to their unique needs as a non-traditional student
returning to postsecondary education.
Provide other educational resources to the Veteran’s. I.e. University
Counseling services, Vets Clubs (if they exist on your campus),
financial aid services, etc.
What is your plan?
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Who needs to be involved?
How will your referral and support system work?
How will you put it into motion?
How will you evaluate whether or not your plan is a good one?
What if it doesn’t work well for the Veterans, DSS and Veteran’s
Affairs office?
• How many people will be involved and how many more may be
needed?
• What are some of the most common accommodations that you feel
you will need to encounter with Veteran’s? Are you prepared to do
so? If not, what steps need to be taken?
• Does anyone on campus need to be educated about returning
Veterans to postsecondary education? Who and how will this
happen?
Conclusion:
• Questions and answers
• Resources:
– Suicide Prevention: 1–800–273–TALK (8255)
– Vocational Rehabilitation and Employment
Program's http://www.vba.va.gov/bln/vre/index.htm
– Regional VA Benefits Office: Roanoke Regional Office
210 Franklin Rd. SW Roanoke, VA 24011 1-800-8271000
– On-Line Resources for Veterans:
http://www.vba.va.gov/bln/vre/resources.htm