PTSD and Veterans: PTSD and Veterans: Understanding and Understanding and

AccommodatingAccommodating

Presented by: Cheryl Chesney-Walker, Presented by: Cheryl Chesney-Walker, Executive Director for Health Executive Director for Health

Careers/Education and Special Services Careers/Education and Special Services for Students, VCU Medical Center, MCV for Students, VCU Medical Center, MCV

CampusCampusSeptember 26, 2008 AHEAD Fall September 26, 2008 AHEAD Fall

ConferenceConference

Background on PTSDBackground on PTSD

• Posttraumatic Stress DisorderPosttraumatic Stress Disorder• The person has been exposed to a traumatic event The person has been exposed to a traumatic event

in which both of the following were present:in which both of the following were present:• The person experienced, witnessed, or was The person experienced, witnessed, or was

confronted with an event or events that involved confronted with an event or events that involved actual or threatened death or serious injury, or a actual or threatened death or serious injury, or a threat to the physical integrity of self or othersthreat to the physical integrity of self or others

• The person’s response involved intense fear, The person’s response involved intense fear, helplessness, or horror. helplessness, or horror. Note:Note: In children, this may In children, this may be expressed instead by disorganized or agitated be expressed instead by disorganized or agitated behaviorbehavior

• Source: DSM-IV-TRSource: DSM-IV-TR

PSTD CriteriaPSTD Criteria

• The traumatic event is persistently re-experienced in one (or more) of the The traumatic event is persistently re-experienced in one (or more) of the following ways:following ways:

• Recurrent and intrusive distressing recollections of the event, including Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. images, thoughts, or perceptions. Note:Note: in young children, repetitive play in young children, repetitive play may occur in which themes or aspects of the trauma are expressedmay occur in which themes or aspects of the trauma are expressed

• Recurrent distressing dreams of the event. Recurrent distressing dreams of the event. Note:Note: in children, there may be in children, there may be frightening dreams without recognizable contentfrightening dreams without recognizable content

• Acting or feeling as if the traumatic event were recurring (includes a sense Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when flashback episodes, including those that occur on awakening or when intoxicated). intoxicated). Note:Note: In young children, trauma-specific reenactment may In young children, trauma-specific reenactment may occuroccur

• Intense psychological distress at exposure to internal or external cues that Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic eventsymbolize or resemble an aspect of the traumatic event

• Physiological reactivity on exposure to internal or external clues that Physiological reactivity on exposure to internal or external clues that symbolize or resemble and aspect of the traumatic eventsymbolize or resemble and aspect of the traumatic event

• Source: DSM-IV-TRSource: DSM-IV-TR

Symptoms and Behaviors of Symptoms and Behaviors of PSTDPSTD• Persistent avoidance of stimuli associated with the trauma and Persistent avoidance of stimuli associated with the trauma and

numbing of general responsiveness (not present before the numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:trauma), as indicated by three (or more) of the following:

• Efforts to avoid thoughts, feelings, or conversations associated Efforts to avoid thoughts, feelings, or conversations associated with the traumawith the trauma

• Efforts to avoid activities, places, or people that arouse Efforts to avoid activities, places, or people that arouse recollections of the traumarecollections of the trauma

• Inability to recall an important aspect of the traumaInability to recall an important aspect of the trauma• Markedly diminished interest or participation in significant Markedly diminished interest or participation in significant

activitiesactivities• Feeling of detachment or estrangement from otherFeeling of detachment or estrangement from other• Restricted range of affect (e.g., unable to have loving feelings)Restricted range of affect (e.g., unable to have loving feelings)• Sense of a foreshortened future (e.g., does not expect to have Sense of a foreshortened future (e.g., does not expect to have

a career, marriage, children, or a normal life span)a career, marriage, children, or a normal life span)• Source: DSM-IV-TRSource: DSM-IV-TR

Symptoms and Behaviors Symptoms and Behaviors ContinuedContinued

• Persistent symptoms of increased arousal Persistent symptoms of increased arousal (not present before the trauma), as (not present before the trauma), as indicated by two (or more) of the following:indicated by two (or more) of the following:

• Difficulty falling or staying asleepDifficulty falling or staying asleep• Irritability or outbursts of angerIrritability or outbursts of anger• Difficulty concentratingDifficulty concentrating• HypervigilanceHypervigilance• Exaggerated startle responseExaggerated startle response• Source: DSM-IV-TRSource: DSM-IV-TR

Acute Stress DisorderAcute Stress Disorder

• The person has been exposed to traumatic The person has been exposed to traumatic event in which both of the following were event in which both of the following were presented:presented:

• The person experienced, witnessed, or The person experienced, witnessed, or was confronted with an event or events was confronted with an event or events that involved actual or threatened death that involved actual or threatened death or serious injury, or a threat to the or serious injury, or a threat to the physical integrity of self or othersphysical integrity of self or others

• The person’s response involved intense The person’s response involved intense fear, helplessness, or horrorfear, helplessness, or horror

• Source: DSM-IV-TRSource: DSM-IV-TR

Symptoms and Behaviors of Symptoms and Behaviors of Acute Stress DisorderAcute Stress Disorder• Either while experiencing or after experiencing the distressing Either while experiencing or after experiencing the distressing

event, the individual has three (or more) of the following event, the individual has three (or more) of the following dissociative symptoms:dissociative symptoms:

• A subjective sense of numbing, detachment, or absence of A subjective sense of numbing, detachment, or absence of emotional responsivenessemotional responsiveness

• A reduction in awareness of his or her surroundings (e.g., “begin A reduction in awareness of his or her surroundings (e.g., “begin in a daze”)in a daze”)

• DerealizationDerealization• DepersonalizationDepersonalization• Dissociative amnesia (i.e., inability to recall an important aspect of Dissociative amnesia (i.e., inability to recall an important aspect of

the trauma)the trauma)• Marked symptoms of anxiety or increased arousal (e.g., difficulty Marked symptoms of anxiety or increased arousal (e.g., difficulty

sleeping, irritability, poor concentration, hyper vigilance, sleeping, irritability, poor concentration, hyper vigilance, exaggerated startle response, motor restlessness).exaggerated startle response, motor restlessness).

• Source: DSM-IV-TRSource: DSM-IV-TR

Generalized Anxiety Generalized Anxiety DisorderDisorder• Excessive anxiety and worry (apprehensive expectation), occurring Excessive anxiety and worry (apprehensive expectation), occurring

more days than not for at least 6 months, about a number of more days than not for at least 6 months, about a number of events or activities (such as work or school performance).events or activities (such as work or school performance).

• The person finds it difficult to control the worry.The person finds it difficult to control the worry.• The anxiety and worry are associated with three (or more) of the The anxiety and worry are associated with three (or more) of the

following six symptoms (with at least some symptoms present for following six symptoms (with at least some symptoms present for more days than not for the past 6 months). more days than not for the past 6 months). Note:Note: Only one item is Only one item is required in children.required in children.

• Restlessness or feeling keyed up or on edgeRestlessness or feeling keyed up or on edge• Being easily fatiguedBeing easily fatigued• Difficulty concentrating or mind going blankDifficulty concentrating or mind going blank• IrritabilityIrritability• Muscle tensionMuscle tension• Sleep disturbance (difficulty falling or staying asleep, or restless Sleep disturbance (difficulty falling or staying asleep, or restless

unsatisfying sleep)unsatisfying sleep)• Source: DSM-IV-TRSource: DSM-IV-TR

Combat Related Hearing LossCombat Related Hearing Loss

• VA’s National Center for VA’s National Center for Rehabilitative Auditory Research Rehabilitative Auditory Research recommends hearing protection for recommends hearing protection for sounds louder than a lawn mover (90 sounds louder than a lawn mover (90 decibels). Weapons and equipment decibels). Weapons and equipment used in the military often far exceed used in the military often far exceed this level.this level.

Military Sound LevelsMilitary Sound Levels

• Apache helicopter, pilot, Decibels: 104Apache helicopter, pilot, Decibels: 104

• 9mm pistol, Shooter, Decibels: 1579mm pistol, Shooter, Decibels: 157

• Grenade, within 50 ft., Decibels:164Grenade, within 50 ft., Decibels:164

• 105mm towed howitzer, Gunner, Decibels: 105mm towed howitzer, Gunner, Decibels: 183183

• MAAWS recoilless rifle, Gunner, Decibels: MAAWS recoilless rifle, Gunner, Decibels: 190190

• Source: U.S. Army Center for Health Source: U.S. Army Center for Health Promotion and Preventive MedicinePromotion and Preventive Medicine

Symtomology of Hearing Loss Symtomology of Hearing Loss for Veteransfor Veterans

• DepressionDepression• Lack of socialization caused by inability to Lack of socialization caused by inability to

understand others in conversations.understand others in conversations.• Mild to moderate brain damage from Mild to moderate brain damage from

combat blast exposure. This is a new combat blast exposure. This is a new phenomenon with little research.phenomenon with little research.

• IsolatedIsolated• ParanoidParanoid• Emotionally unstableEmotionally unstable

Statistics on Hearing Loss and Statistics on Hearing Loss and PTSD for Iraq and Afghanistan PTSD for Iraq and Afghanistan VeteransVeterans• Tinnitus (loud noise exposure is a very Tinnitus (loud noise exposure is a very

common cause of tinnitus, and it often common cause of tinnitus, and it often damages hearing as well) is the No. 1 damages hearing as well) is the No. 1 service connected health condition for Iraq service connected health condition for Iraq and Afghanistan veterans, with nearly and Afghanistan veterans, with nearly 70,000 diagnoses, according to the 70,000 diagnoses, according to the Veterans Benefits Administration. Veterans Benefits Administration.

• Defective hearing is No. 3 with almost Defective hearing is No. 3 with almost 60,000 cases.60,000 cases.

• PTSD is No. 4 with 38,000 cases.PTSD is No. 4 with 38,000 cases.• Source: VFW September 2008Source: VFW September 2008

What we do know.What we do know.

• Many Iraq and Afghanistan veterans will be Many Iraq and Afghanistan veterans will be returning to postsecondary education to utilize the returning to postsecondary education to utilize the 2008 GI Bill.2008 GI Bill.

• Many of the veterans will have disability needs that Many of the veterans will have disability needs that will need to be accommodated.will need to be accommodated.

• Veterans will need support in different aspects of Veterans will need support in different aspects of postsecondary education life.postsecondary education life.

• They may have difficulty adjusting to civilian life.They may have difficulty adjusting to civilian life.• They may have interpersonal relationship They may have interpersonal relationship

difficulties at home and at school.difficulties at home and at school.• They may or may not know that they need disability They may or may not know that they need disability

support services and how to seek out such services.support services and how to seek out such services.

What can we do?What can we do?

• Create linkages and support networking with our university Create linkages and support networking with our university and college Veteran’s Affairs office.and college Veteran’s Affairs office.

• Create a referral system between DSS and Veteran’s Affairs Create a referral system between DSS and Veteran’s Affairs office personnel.office personnel.

• Provide information on both the DSS and Veteran’s Provide information on both the DSS and Veteran’s websites on referrals, services, policies and procedures to websites on referrals, services, policies and procedures to seek out disability support services.seek out disability support services.

• Provide informational “fact sheets” on disability services for Provide informational “fact sheets” on disability services for your office to be disseminated to the Veteran’s prior to their your office to be disseminated to the Veteran’s prior to their enrollment in coursework.enrollment in coursework.

• Be sensitive to their unique needs as a non-traditional Be sensitive to their unique needs as a non-traditional student returning to postsecondary education.student returning to postsecondary education.

• Provide other educational resources to the Veteran’s. I.e. Provide other educational resources to the Veteran’s. I.e. University Counseling services, Vets Clubs (if they exist on University Counseling services, Vets Clubs (if they exist on your campus), financial aid services, etc.your campus), financial aid services, etc.

What is your plan?What is your plan?

• Who needs to be involved?Who needs to be involved?• How will your referral and support system work?How will your referral and support system work?• How will you put it into motion?How will you put it into motion?• How will you evaluate whether or not your plan is a good 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 one? What if it doesn’t work well for the Veterans, DSS and Veteran’s Affairs office?Veteran’s Affairs office?

• How many people will be involved and how many more may How many people will be involved and how many more may be needed?be needed?

• What are some of the most common accommodations that What are some of the most common accommodations that you feel you will need to encounter with Veteran’s? Are you you feel you will need to encounter with Veteran’s? Are you prepared to do so? If not, what steps need to be taken? prepared to do so? If not, what steps need to be taken?

• Does anyone on campus need to be educated about Does anyone on campus need to be educated about returning Veterans to postsecondary education? Who and returning Veterans to postsecondary education? Who and how will this happen?how will this happen?

Conclusion:Conclusion:

• Questions and answersQuestions and answers• Resources: Resources:

– Suicide Prevention: 1–800–273–TALK (8255)Suicide Prevention: 1–800–273–TALK (8255) – Vocational Rehabilitation and Employment Vocational Rehabilitation and Employment

Program's Program's http://www.vba.va.gov/bln/vre/index.htmhttp://www.vba.va.gov/bln/vre/index.htm

– Regional VA Benefits Office: Roanoke Regional Regional VA Benefits Office: Roanoke Regional Office 210 Franklin Rd. SW   Roanoke, VA 24011 Office 210 Franklin Rd. SW   Roanoke, VA 24011 1-800-827-1000    1-800-827-1000    

– On-Line  Resources for Veterans: On-Line  Resources for Veterans: http://www.vba.va.gov/bln/vre/resources.htmhttp://www.vba.va.gov/bln/vre/resources.htm