Transcript Military 101

Military 101
Presenters:
Dr. Kimberly A. Kick, LCSW, PhD
Jolaina Falkenstein, MA, LAMFT
Boots on Ground Consulting, Inc.
BootsOnGroundConsulting.com
Myth versus Reality
MILITARY STRUCTURE
ENLISTING IN THE MILITARY
 Must
be 18, or 17 with parental
consent
 Must be a high school graduate.
 Must complete basic training
for chosen branch
 After completing basic training,
must attend a technical school
to learn Military Occupational
Skill (MOS)
WHO SERVES?
 Approximately
2,267,000
Americans between the ages of
17 and 59
 Or,
less than 1 percent of the
total U.S. population!!!
TOTAL FORCE STATISTICS
**Active Duty vs. Guard/Reserve
Guard/Reserve
(n=1,965,368)
37.2%
Active Duty
(n=3,329,697)
62.8%
**Includes Service Members and family members
Active Duty
Guard/Reserve
BRANCH STATISTICS
Air Force Active Duty (15%)
Air Force Guard/Reserve
(9%)
Army Active Duty (27%)
Army Guard/Reserve (24%)
Marine Active Duty (8%)
Marine Reserve (1%)
Navy Active Duty (13%)
Navy Reserve (3%)
Coast Guard Reserve
(.27%)
**Numbers include Family Members and Service Members
AIR FORCE
“AIM HIGH…FLY, FIGHT, WIN”


Missions: Air, Space, and
Cyberspace
Numbers:
 Active
Duty: 300,000+
 Reserve: 70,000+
 National Guard: 88,988
 Male to Female Ratio:
4.0:1
 Age of Entry: 18 to 27
years
“HOME is where the Air Force
sends us”
AIRMAN’S CREED
I am an American airman.
I am a warrior.
I have answered my nation's call.
I am an American airman.
My mission is to fly, fight, and win.
I am faithful to a proud heritage,
a tradition of honor,
and a legacy of valor.
I am an American airman,
guardian of freedom and justice,
my nation's sword and shield,
its sentry and avenger.
I defend my country with my life.
I am an American airman:
wingman, leader, warrior.
I will never leave an airman behind,
I will never falter,
and I will not fail.
ARMY
“THIS WE WILL DEFEND”

Largely ground movement,
some air support as well

Largest and oldest branch of
the military

Numbers:

Active Duty: 571,108

Reserve: 201,235

National Guard: 352,689

Male to Female Ratio: 5.4:1

Age of Entry: 17-35 years
“I’m an Army wife. What’s your
super power?”
SOLDIER’S CREED
I am an American Soldier. I am a Warrior and a
member of a team. I serve the people of the United
States, and live the Army Values. I will always place
the mission first. I will never accept defeat. I will
never quit. I will never leave a fallen comrade. I am
disciplined, physically and mentally tough, trained
and proficient in my warrior tasks and drills. I always
maintain my arms, my equipment and myself. I am an
expert and I am a professional. I stand ready to
deploy, engage, and destroy, the enemies of the
United States of America in close combat. I am a
guardian of freedom and the American way of life. I
am an American Soldier.
COAST GUARD
“SEMPER PARATUS”


Mission: Safeguarding the
nation’s maritime interests
Assigned to DHS
Numbers:
 Active Duty: 42,000+
 Reserve: 7,800
 Male to Female Ratio: 6:1
 Age of Entry: 18 to 27
years (Reserve up to 39)

“Have seabag…will travel”
COAST GUARDMAN’S CREED
I am proud to be a United States Coast Guardsman.
I revere that long line of expert seamen who by their devotion to duty and
sacrifice of self have made it possible for me to be a member of a service
honored and respected, in peace and in war, throughout the world.
I never, by word or deed, will bring reproach upon the fair name of my
service, nor permit others to do so unchallenged.
I will cheerfully and willingly obey all lawful orders.
I will always be on time to relieve, and shall endeavor to do more, rather
than less, than my share.
I will always be at my station, alert and attending to my duties.
I shall, so far as I am able, bring to my seniors solutions, not problems.
I shall live joyously, but always with due regard for the rights and privileges
of others.
I shall endeavor to be a model citizen in the community in which I live.
I shall sell life dearly to an enemy of my country, but give it freely to rescue
those in peril.
With God’s help, I shall endeavor to be one of His noblest Works...
A UNITED STATES COAST GUARDSMAN.
MARINES
“SEMPER FI”

First on ground- Quick reaction

“Once a Marine, always a
Marine.”

Numbers:

Active Duty: 300,000+

Reserve: 39,500+

Male to Female Ratio: 15.1:1

Age of Entry: 18-29
“The Marine Corps is a way of life and
not a job. If you can’t accept it on
those terms, then your marriage is
doomed to fail.” ~Marine Corp spouse
UNITED STATES MARINE CREED
This is my rifle. There are many like it, but this one is mine.
My rifle is my best friend. It is my life. I must master it as I
must master my life.
My rifle, without me, is useless. Without my rifle, I am useless.
I must fire my rifle true. I must shoot straighter than my
enemy who is trying to kill me. I must shoot him before he
shoots me. I will...
My rifle and myself know that what counts in this war is not
the rounds we fire, the noise of our burst, nor the smoke we
make. We know that it is the hits that count. We will hit...
My rifle is human, even as I, because it is my life. Thus, I will
learn it as a brother. I will learn its weaknesses, its strength,
its parts, its accessories, its sights and its barrel. I will ever
guard it against the ravages of weather and damage as I will
ever guard my legs, my arms, my eyes and my heart against
damage. I will keep my rifle clean and ready. We will become
part of each other. We will...
Before God, I swear this creed. My rifle and myself are the
defenders of my country. We are the masters of our enemy. We
are the saviors of my life.
So be it, until there is no enemy, but peace!
NAVY
“NON SEBI SED PATRIAE”

Defends the right to travel and
trade freely on the world’s
oceans and protects our
national interests overseas

Numbers:

Active Duty: 328,648

Reserve: 49,501

Male to Female Ratio: 5.1.:1

Age of Entry: 17-34
“There is nothing more enticing,
enchanting, and enslaving than life at
the sea.” Joseph Conrad
SAILOR’S CREED
I am a United States Sailor.
I will support and defend the Constitution of the
United States of America and I will obey the orders of
those appointed over me.
I represent the fighting spirit of the Navy and those
who have gone before me to defend freedom and
democracy around the world.
I proudly serve my country's Navy combat team with
Honor, Courage and Commitment.
I am committed to excellence and the fair treatment
of all.
Characteristics
Regular Separations
and Reunions
Military Speak
High Risk Jobs
“Mission First”
Characteristics
Code of ethics
adhered by ALL
Authoritarian
parenting style
Parent
focused
Blended Families
Positive Characteristics
Highly
Adaptable
Honor
Disciplined
Duty
Selfcontrolled
Loyalty
Positive Characteristics
Committed
Crosscultural
exposure
Sense of
community
Attention to
detail
Done right
the 1st time
Mental Health Effects of
Serving in OEF/OIF

Wars in Afghanistan and Iraq are longest combat
operations since Vietnam

Stressors include:

Threat of death or injury

Witnessing death or severe wounding of others

On high alert 24/7

Being away from home for extended period of time (more so
for National Guard and Reservists who did not expect this)

Nearly 50% of those who have served in OEF/OIF have been
Guard or Reservists

Military Sexual Trauma (MST)
Mental Health Effects of
Serving in OEF/OIF

Research asked Soldiers and Marines about war-zone
experiences and their symptoms of distress (2003)
Combat
Stressors
Seeing
Dead
Bodies
Being
Shot
At
Being
Receiving
Ambushed/ Rocket/
Attacked
Mortar
Fire
Know
Someone
Killed/
Seriously
Injured
Iraq Army
95%
93%
89%
86%
86%
Iraq Marines
94%
97%
95%
92%
87%
66%
58%
84%
43%
Afghanistan
Army
39%
Mental Health Effects of
Serving in OEF/OIF

Soldiers and Marines with more combat stressors had
higher rates of mental health problems.

Those who served in Iraq had higher rates of PTSD than
those who served in Afghanistan.

Strong link between combat stress and PTSD.

10%-18% of OEF/OIF troops likely to exhibit symptoms of
PTSD upon return from theatre.

OEF/OIF veterans are at increased risk for other mental
health problems.

Rates of depression range from 3%-25%
Source: National Center for PTSD (ptsd.va.gov)
Combat Stress

Term to describe normal behavioral, physiological, and
psychosocial reactions experienced pre, during, or post
combat.

Normal reaction to an abnormal situation.

Symptoms include:

Difficulty concentrating

Higher levels of anxiety or being fearful

Feeling sad

Regressing

Stomach problems
Source: Department of Defense Stress Awareness
Combat Stress

Physical symptoms can include: fatigue, chest pain,
shortness of breath, muscle shaking, and headaches.

Behavioral Reactions can include: rage, agitation, fear,
panic, restlessness, bizarre behavior, inability to think
clearly.

Recommended treatment=rest

Estimated 18.5% of returning service members from
OEF/OIF have PTSD or depression, 19.5% have TBI.

When assessing severity of symptoms ask to what extent
the symptoms interfere with the veterans ability to
work, play, and love.
Trauma

Trauma Disorders in the DSM-5 include:

Reactive Attachment Disorder (children)

Disinhibited Social Engagement Disorder (children)

Posttraumatic Stress Disorder

Acute Stress Disorder

Adjustment Disorders

Individuals who experience short-term, or singleincident trauma may only experience symptoms for a
few weeks.

Most service members deployed to combat zones
experience multiple traumas.
Posttraumatic Stress Disorder
(309.81)

Criteria include:

Exposure to actual or threatened death, serious injury, or
sexual violence. Can be through direct experience,
witnessing traumatic event occur to others, learning that
the traumatic event happened to a loved one, or
experiencing repeated or extreme exposure to aversive
details of the traumatic event (first responders, police
officers witnessing child abuse).
Posttraumatic Stress Disorder
(309.81) Symptoms

Recurrent, involuntary, and intrusive distressing
memories of traumatic event.

Recurrent distressing dreams.

Dissociative reactions (flashbacks) where individual
feels as though traumatic event is occurring.

Intense or prolonged psychological distress at exposure
to internal or external cues that symbolize or represent
traumatic event.

Physiological reactions to internal or external cues that
symbolize or represent traumatic event.
Posttraumatic Stress Disorder
(309.81) Symptoms

Persistent avoidance of stimuli associated with
traumatic event.

Negative alterations in cognitions and mood associated
with the traumatic event.

Marked alterations in arousal and reactivity associated
with traumatic event.

Disturbance causes clinically significant distress or
impairment in social, occupational, or other areas of
functioning.

Disturbance not attributable to a substance.
Rates of PTSD for OEF/OIF
Service Members

OEF/OIF service members more likely to develop PTSD.
Factors affecting this:

Longer deployments

Increased severe combat exposure (deployment to
“forward” areas close to enemy, witnessing others killed
or severely injured)

Increased severity of physical trauma

TBI

Lower rank

Lower level of schooling

Low morale and poor social support within unit
Rates of PTSD for OEF/OIF
Service Members

OEF/OIF service members more likely to develop PTSD.
Factors affecting this:

Being single

Family problems

Member of Guard or Reserves

Prior exposure to trauma

Female

Hispanic ethnic group
Source: U.S. Department of Veteran Affairs, http://www.ptsd.va.gov/public/PTSDoverview/reintegration/overview-mental-health-effects.asp
PTSD

https://www.youtube.com/watch?v=NkWwZ9ZtPEI

What symptoms of PTSD does this soldier exhibit?

What are some issues regarding his reintegration back
into civilian life?

How would you as a helping professional intervene?
Acute Stress Disorder (308.3)DSM-5

Symptoms last between 3 days to 1 month postexposure to a traumatic event.

Traumatic events may include:

Combat in war

Threatened or actual violent personal assault

Natural or human-made disasters

Severe accidents
Acute Stress Disorder (308.3)
Symptoms

Recurrent involuntary, intrusive distressing memories.

Recurrent distressing dreams related to the event.

Dissociative reactions where individual feels event is
recurring.

Intense or prolonged psychological distress.

Marked physiological reactions in response to internal or
external cues symbolic of event.

Persistent inability to experience positive mood.
Acute Stress Disorder (308.3)
Symptoms

Altered sense of reality on one’s surroundings or self.

Inability to remember an important aspect of traumatic
event.

Attempts to avoid traumatic memory.

Attempts to avoid external reminders that arouse
distressing memories, thoughts, feelings.

Disturbance of sleep.

Hypervigilance.

Problems concentrating.

Exaggerated startle response.
Screening & Assessment

Sequence for clinical intervention:

check for suicide/homicide, family problems, medical
issues

Screening

Formal Assessment

Formulation/treatment planning

Prioritization of goals for intervention.

Gather information about experiences during deployment
Screening & Assessment

Look for co-existing conditions-depression, anxiety,
alcohol/substance abuse.

Post-traumatic Stress Disorder Checklist-Military Version
(PCL-M)-17 item self-report checklist. Access at
http://www.ncptsd.org/publications/assessment/adult_
self_report.html

Traumatic Life Events Questionnaire (TLEQ) & PTSD
Screening and Diagnostic Scale (PSDS)
http://portal.wpspublish.com/
Screening & Assessment

National Center for PTSD recommends evaluation &
education on following domains:

Work functioning

Interpersonal functioning

Recreation & self-care

Physical functioning

Psychological Symptoms

Past distress & coping

Previous traumatic events

Deployment-related experiences
http://www.ptsd.va.gov/professional/pages/vets-iraq-warguidelines.asp
Adjustment Disorders
(309.__)

Emotional or behavioral symptoms in response to
identifiable stressor within 3 months of onset of
stressor.

Distress that is out of proportion to severity or intensity
of the stressor.

Significant impairment in occupational, social, or other
important areas of functioning.

Symptoms do not represent normal bereavement.

Once stressor has ended, symptoms do not persist for
more than an additional 6 months.
Types of Adjustment
Disorders

309.0
Adjustment Disorder with Depressed Mood

309.24 Adjustment Disorder with Anxiety

309.28 Adjustment Disorder with Mixed Anxiety and
Depressed Mood

309.3
Adjustment Disorder with Disturbance of
Conduct

309.4
Adjustment Disorder with Mixed Disturbance
of Emotions and Conduct
309.9
Adjustment Disorder Unspecified
TBI
DSM-5 Diagnostic Criteria


Defined as brain trauma with specific characteristics that
include at least one of the following:

Loss of consciousness

Posttraumatic amnesia

Disorientation and confusion
Presentation may vary and can include:

Difficulties concentrating,

Problems with complex attention

executive ability, learning,

memory,

slow processing of information,

social cognition disturbances.
TBI

According to the CDC, Traumatic Brain Injury (TBI) “..is
an injury to the head that results in a decreased level of
consciousness, loss of memory, skull fracture,
intracranial lesion, or neurological or
neuropsychological abnormality.”

Primary injury is the blow or jolt to hear, secondary
injury is swelling, bleeding, and metabolic changes.

Can range from mild to severe

Around 90% of mTBI sufferers recover with no residual
problems.

TBI can result in functional changes including:


Thinking, sensations, movement, language, emotions
Symptoms may not occur immediately after the head
trauma, but can appear weeks or months later
TBI

Studies estimate 20%-22% of those having served in
OEF/OIF screen positive for TBI, usually from a blast
(Carlson et al., 2010)

Consuming alcohol after suffering from a TBI increases
risk of engaging in dangerous behavior

TBI has been called the signature wound of OEF/OIF.

Behavioral manifestation can include irritability,
impulse control, changes in mood.

TBI can range from mild to moderate or severe

Individuals suffering from moderate to severe TBIs can
present with: unprovoked seizures, depression,
cognitive impairment, unemployment, aggression,
isolation
Treatment of TBI

In OEF/OIF blast injuries are a major cause of TBI

The DoD and VA has established clinical guidelines for
non-deployed and deployed settings

Treatment can include Cognitive Rehabilitation Therapy
(CRT)

CRT is a constellation of techniques to improve:
memory, attention, perception, learning, planning and
judgment

Examples of CRT are using computer-assisted programs
to complete writing tasks and interaction
TBI

https://www.youtube.com/watch?v=qbxVINWh88o

Similarities between PTSD and TBI include:

Depression

Anxiety

Insomnia

Irritability and anger

Trouble concentrating

Fatigue

Hyperarousal

Avoidance
Source: Brady et al., (2009); Bryant, (2008); Stein & McAllister, (2009).
Depression

Estimated that more than 17-21 million people suffer
from depression in U.S. every year

Cuts across SES, race, gender, age, although women are
twice as likely to be dx with depression as are AA, and
the poor

Seeing more depression in SMVF as draw downs continue

Symptoms: feelings of worthlessness, hopelessness,
sleeplessness, changes in appetite, excessive crying,
remaining in bed for longer than normal,
anger/irritability, self-loathing, reckless behavior
Depression

Stigma associated with depression in the military:

Reinforced by the system, fear of negative retribution

Feel and express anger, frustration, rage as it is more
acceptable than feeling depressed

For those who get help, may return to the unit and be
described as weak

Estimated over 1/5 of those returning from deployment
return with PTSD, trauma disorder, depression. Less than
½ of these service members seek treatment
Laura’s Story
Boots on Ground Consulting,
Inc.
Serving those who serve us
Thank You