PTSD cases greater than Camp Pendleton's count

By: DONALD P. BENTLEY - Commentary | Saturday, July 28, 2007 7:37 PM PDT ∞

On July 15, your paper ran an article titled, "Pendleton reports dropoff in PTSD" (post-traumatic stress disorder). The Pentagon report indicating that up to one-third of Marines who served in Iraq and Afghanistan may be affected is definitely more accurate than the Pendleton figure of less than 1 percent. Consider the following:

1. A large number of Marines are directed to anger and stress management groups.

2. Through the "One Source" program, many Marines are utilizing up to six free confidential sessions with civilian licensed psychotherapists, such as myself.

3. Married Marines are engaging in increased numbers of family psychotherapy sessions with their spouse and/or children through the mental health provision of their Tricare insurance program.

Through the aforementioned programs, Marines seek counseling for depression, stress, relationship and family problems, anger, alcohol abuse, communication problems, marital conflict, and many other life issues. However, with 30 years of experience, it is clear to me that appropriate differential diagnostic criteria indicate that about a third of Marines I counsel are experiencing enough PTSD symptoms to warrant that diagnosis.

According to the diagnostic manual for mental disorders, in cases of PTSD, a person's response involves intense fear, helplessness or horror. The most severe symptoms include:

1. Recurrent and intrusive distressing recollections of the event(s), including images, thoughts and perceptions.

2. Recurrent distressing dreams, and/or

3. Acting or feeling as if the traumatic event(s) were recurring (including a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated).

However, this same manual (published by the American Psychiatric Association) delineates up to 15 other PTSD symptoms. These include:

1. Significant distress or impairment in social, occupational or other important areas of functioning.

2. Sleep difficulties.

3. Outbursts of anger.

4. Restricted range of affect (unable to have loving feelings).

5. Markedly diminished interest or participation in significant activities, and

6. A sense of foreshortened future (e,g.: does not expect to have a career, marriage, children or a normal lifespan).

Since Marines may present with one or more symptoms of PTSD, I suspect that the Pendleton assertion that less than 1 percent of Marines are affected may be based only upon those with the most severe symptoms. Conversely, the Pentagon figure of up to one-third takes all 18 symptoms into account.

According to an article in the July 24 North County Times, a lawsuit has been filed on behalf of 320,000 to 800,000 Iraq war veterans who may be at risk of having PTSD. The suit, against the U.S. Department of Veterans Affairs, claims that many veterans are not receiving appropriate treatment. The VA has maintained that many veterans may have other mental disorders or pre-existing conditions, rather than PTSD.

I am not surprised, as I have seen in my practice a high percentage of Marines who have been diagnosed with other disorders or without any psychiatric diagnosis. The VA, like Camp Pendleton, has not taken into account the totality of PTSD symptoms. Moreover, it is imperative to understand that many symptoms may not be manifested until several months or years after the traumatic event(s). This is diagnosed as "PTSD, with delayed onset."

As a Vietnam veteran and a licensed psychotherapist, I have an interest in only the absolute best mental health treatment possible for our military personnel and veterans. I can understand why Marines are reluctant to report their symptoms, using programs such as "One Source" and "Tricare," as well as anger and stress management groups instead. I am honored and proud to help these heroes in any manner possible. However, neither I nor any other community-based civilian psychotherapist is able to replace the intensity of treatment that the base hospital and clinics should provide.

I would suggest and encourage a better assessment tool for PTSD for Marines returning from Iraq, as I am convinced the Pentagon figure of nearly one-third is more accurate than the Pendleton assertion of less than 1 percent. I make no claim or accusation as to the reason for the discrepancy. Professionally, during the past 30 years, I have advocated for outstanding and superior mental health treatment for military personnel, veterans and their families. I would encourage others to join me. They have earned and deserve everything we can do for them.

Donald P. Bentley, LCSW, BCD, is a licensed clinical social worker based in Oceanside.