Our feature story this week examines an emerging phenomenon known as "secondary PTSD," in which soldiers with little or no combat experience struggle with PTSD-like symptoms. Soldiers' families can also be affected by the condition, and the military is struggling with how to handle the mental health crisis. Still, there are a few key resources that are currently available.
The National Vietnam Veteran Readjustment Study, conducted in 1983 in response to a congressional mandate, found that about 30 percent of all soldiers deployed to Vietnam had PTSD some time after their deployment, and 15 percent--about 450,000 men and women--still met criteria for PTSD nearly two decades later. An additional 19 percent had something termed "partial PTSD."As noted later in the feature, there are scant treatment options available for military families struggling with PTSD. The same goes for soldiers who don't fit the profile of a stereotypical PTSD sufferer.
"They didn't have the full syndrome, but were clearly affected psychologically by their war experience and were very symptomatic and reporting functional problems," says Dr. Matthew Friedman, executive director of the VA's National Center for PTSD and a professor of psychiatry and pharmacology at Dartmouth's Geisel School of Medicine. "We never had a good place to put those people, except to call it adjustment disorder. And the problem with that is there's a lot of variants for adjustment disorder."
To a layperson, adjustment disorder sounds an awful lot like PTSD. It is defined as "the development of emotional or behavioral symptoms in response to an identifiable stressor," followed by "marked distress" and "significant impairment in social, occupational, or other important areas of functioning."
"They're significantly worse than non-affected people and significantly better than people above the threshold for PTSD," Friedman says. "There's never been a good place in the DSM for the sometimes life-changing fact that it doesn't have to be an event that might kill you that could be the worst thing that ever happened to you."
Friedman lists several synonymous terms for secondary PTSD--secondary traumatization, vicarious PTSD, compassion fatigue--but says none of them are officially recognized by the American Psychiatric Association. "People recognize the phenomenon, but exactly how to characterize it is still a matter of discussion," he says. The symptoms include many of the hallmarks of regular PTSD, such as withdrawing into one's self, mood swings, and anxiety, but the critical difference is there's no direct exposure to a traumatic event. Rather, the causes can include learning that a traumatic event occurred to a close family member, secondhand knowledge of some horrific incident, or the cumulative stress of constant vigilance.
Sen. Patty Murray has proposed legislation that would, as we note, "expand counseling services to cover soldiers far removed from the battlefield, including pilots of remote-controlled, unmanned aerial drones; military morticians working "outside the theater of combat operations"; and the mental-health professionals who themselves tend to the troops' psyches." But that bill is still being working its way through Congress.
Here are the mental health resources currently available to immediate family members of soldiers, according to a spokesperson for the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.
-After Deployment. A website that provides "private self-assessment and skill development modules for many common adjustment topics associated with operational stressors (e.g. sleep, grief, spirituality)"Virtually all of those listed above are available only online or by phone. The way for military spouses to obtain a referral for one-on-one counseling session is to visit Military One Source. (Spouses are eligible for up to 12 in-person sessions with a mental-health professional)
-The Defense Centers of Excellence Outreach Center (24/7 phone/chat)
-PTSD Coach (interactive website)
-Military Kids Connect ("Kids Deploy Too")
-Sesame Street Workshop for kids
-Suicide Prevention: Interactive Tools
-The National Suicide Prevention Lifeline (AKA Veterans Crisis Line): 1-800-273-8255 or VeteranCrisisLine.net
-Each military installation (including JBLM) also has family support centers, which are "a one-stop-shop for service members and their families to access information on key resources that enhance the readiness of military families."
Outside the military, The Soldiers Project is a nonprofit that offers free, confidential mental-health counseling to Washington service members, veterans, and their families.
Also, the Facebook group Military With PTSD is a way to connect and consult with others armed forces families struggling with PTSD issues.