ISTSS News - News

Kids Who Grow Stronger After Trauma

Wed, 08 Sep 2010 11:44:00 -0500

By Sue Shellenbarger

Like most children hit by a disaster or tragedy, 8-year-old Laurel Shepard was upset for months after her brother and grandparents were killed in a plane crash, says her mother Julie Shepard. Haunted by nightmares, she rarely left her mother's side.

Three years later, Laurel is still anxious, but Ms. Shepard is also seeing some new qualities: more empathy for other kids, deeper relationships with family and a new creative energy that led her to produce a documentary on her brother. "I was shocked" by the growth in Laurel, now 11, says Ms. Shepard, Beaverton, Ore.

As the anniversary of the 9/11 terrorist attacks draws near, research on children traumatized by disaster is revealing that some children have a surprising capacity not only to bounce back, but to grow stronger than before. Once thought possible only in adults, this "post-traumatic growth" is marked by increases in self esteem and compassion, a greater appreciation for relationships and a deeper sense of meaning or spirituality.

Children may say, for example, that they learned as a result of a disaster "how nice and helpful people can be," based on a scale developed by Ryan Kilmer, an associate professor of psychology at the University of North Carolina, Charlotte, and others to measure post-traumatic growth.

They may feel better able to handle big problems. Or they may appreciate each day more, feel closer to other people or believe they understand better "how God works."

Surprisingly, those who at first may seem the most upset, ruminating on their fears or sadness and what the disaster means to them, tend to be the ones who later exhibit post-traumatic growth. The rumination and distress catalyze the growth process, Dr. Kilmer says. (Some traumas may be so severe, however, that growth isn't possible—such as serious and prolonged abuse by a parent, he adds.)

That doesn't mean these kids don't feel distressed or sad. Research shows as many as 95% of children exposed to disasters have symptoms of post-traumatic stress, such as hopelessness, anger, guilt or withdrawal. Some 31% of 23,000 schoolchildren affected by Hurricane Katrina in 2005 are still reporting trauma symptoms, says Joy Osofsky, a professor of pediatrics and psychiatry at the Louisiana State University Health Sciences Center. Another study shows psychiatric illness rates doubled among children who lost a parent in the 2001 terrorist attacks.

Certain children are more likely than others to grow after disasters or tragedies. They have to be able to recognize both positive and negative feelings about an event at the same time—an ability some children develop as early as age 7, Dr. Kilmer says. The ability to maintain a sense of hope and optimism is helpful.

No one knows how long this growth process takes, but it may go on for years. Nicolas Malavasi was 8 years old when his father was lost on an Argentine mountain-climbing expedition, says his mother, Joni Jackson. His father was never found and was declared officially deceased. Nicolas was devastated. At first, he "shut down" emotionally, so overwhelmed that he sometimes withdrew "to sit in his chair and stare out into space," says Ms. Jackson of Westminster, Colo.

She enrolled Nicolas in grief therapy at Judi's House, a Denver nonprofit center where therapists often work with bereaved children for several years, giving them a chance to encourage post-traumatic growth.

Nicolas worked through his sadness and anger by talking with therapists and other grieving kids and by doing artwork and crafts. At first, he drew pictures of a mountain with his father standing atop it, waiting to be seen and rescued. In later paintings, the mountain was engulfed in ominous black clouds.

Five years later, Ms. Jackson says she is seeing signs of growth. Nicolas shows a mature ability to put small problems in perspective and greater empathy. One recent evening, he told her that a friend "looked really sad in school today; I hope he's OK," Ms. Jackson says.

Adults can help by allowing traumatized children to express their emotions and pent-up energy—a step toward regaining self control. Younger children might "show you with finger paint what it feels like or have a puppet talk" about it, says Judy Becerra, director of programs at Judi's House.

For months, one child whose entire family was killed in a car crash played in a tray of sand at Judi's House, throwing miniature cars and scrambling them, and having an ambulance come, Ms. Becerra says. Then one day, in an abrupt shift, he lined up the cars neatly, built a tidy neighborhood around them and "never made any wrecks again," she says. He also stopped having nightmares and began relating better to other children.

Other kids express pent-up feelings in padded rooms equipped with foam balls and punching bags. The Dougy Center for Grieving Children & Families, Portland, Ore., another program that works with children, has a padded "volcano room" for this purpose, says Donna Schuurman, executive director.

Well-meaning parents sometimes interfere by telling kids, "Don't be angry," or "Don't be sad," Dr. Schuurman says. It is better to "let them ask why and struggle with why, and be mad at God or the system," she says. "Post-traumatic growth doesn't always look pretty. Struggle and growth often go together."

Parents can help the process along by encouraging the child to think about any positives, saying, for example, "You mentioned you never realized you could be this strong. Tell me more about that." Such encouragement is linked to post-traumatic growth in kids, according to a study of Katrina survivors by Dr. Kilmer and Virginia Gil-Rivas in the latest issue of Child Development.

Teens can benefit from projects that give them a chance to earn respect and make a contribution. Ryan Gregoire was 15 when Hurricane Katrina flooded his Chalmette, La., home and forced his family to evacuate. By the time they returned almost a year later, his belongings and neighborhood were destroyed.

He joined a leadership group of 25 fellow students at Chalmette High School, many of whom had been homeless and living in poverty. With adult advisers, the group cleaned the highway and planted a "remembrance garden," says Mr. Gregoire, now 20.

"Because we had lost so much, we learned to rely on personal relationships," he says. "We came back together stronger than we were before."

Questions loom over drug given to sleepless vets

Mon, 30 Aug 2010 14:45:00 -0500

By MATTHEW PERRONE (AP) – 3 hours ago

WASHINGTON — Andrew White returned from a nine-month tour in Iraq beset with signs of post-traumatic stress disorder: insomnia, nightmares, constant restlessness. Doctors tried to ease his symptoms using three psychiatric drugs, including a potent anti-psychotic called Seroquel.

Thousands of soldiers suffering from PTSD have received the same medication over the last nine years, helping to make Seroquel one of the Veteran Affairs Department's top drug expenditures and the No. 5 best-selling drug in the nation.

Several soldiers and veterans have died while taking the pills, raising concerns among some military families that the government is not being up front about the drug's risks. They want Congress to investigate.

In White's case, the nightmares persisted. So doctors recommended progressively larger doses of Seroquel. At one point, the 23-year-old Marine corporal was prescribed more than 1,600 milligrams per day — more than double the maximum dose recommended for schizophrenia patients.

A short time later, White died in his sleep.

"He was told if he had trouble sleeping he could take another (Seroquel) pill," said his father, Stan White, a retired high school principal.

An investigation by the Veterans Affairs Department concluded that White died from a rare drug interaction. He was also taking an antidepressant and an anti-anxiety pill, as well as a painkiller for which he did not have a prescription. Inspectors concluded he received the "standard of care" for his condition.

It's unclear how many soldiers have died while taking Seroquel, or if the drug definitely contributed to the deaths. White has confirmed at least a half-dozen deaths among soldiers on Seroquel, and he believes there may be many others.

Spending for Seroquel by the government's military medical systems has increased more than sevenfold since the start of the war in Afghanistan in 2001, according to documents obtained by The Associated Press under the Freedom of Information Act. That by far outpaces the growth in personnel who have gone through the system in that time.

Seroquel is approved to treat schizophrenia, bipolar disorder and depression, but it has not been endorsed by the Food and Drug Administration as a treatment for insomnia. However, psychiatrists are permitted to prescribe approved drugs for other uses in a common practice known as "off-label" prescribing.

But the drug's potential side effects, including diabetes, weight gain and uncontrollable muscle spasms, have resulted in thousands of lawsuits. While on Seroquel, White gained 40 pounds and experienced slurred speech, disorientation and tremors — all known side effects.

Last year, researchers at Vanderbilt University published a study suggesting a new risk: sudden heart failure.

The study in the January 2009 edition of the New England Journal of Medicine found that there were three cardiac deaths per year for every 1,000 patients taking anti-psychotic drugs like Seroquel. Seroquel's unique sedative effect sets it apart from others in its class as the top choice for treating insomnia and anxiety.

AstraZeneca PLC, maker of the drug, said it is reviewing the study. The FDA is conducting its own review, citing the limited scope of the Vanderbilt study.

According to the Veterans Affairs Department, Seroquel is only prescribed as a third or fourth option for patients with difficult-to-treat insomnia stemming from PTSD.

Marine Cpl. Chad Oligschlaeger, 21, was being treated for PTSD when he died in his sleep at Camp Pendleton, Calif., in May 2008. Oligschlaeger was taking six types of medication, including Seroquel, to deal with anxiety and nightmares that followed two tours of duty in Iraq.

The military medical examiner attributed the death to "multiple drug toxicity," indicating that Oligschlaeger, too, died from a drug interaction. Because of the complex reactions between various drugs, medical examiners do not attribute such deaths to any one medication.

After consulting with physicians, parents Eric and Julie Oligschlaeger now believe their son died of sudden cardiac arrest caused by Seroquel.

"Right now, I'm so angry, and I believe someone needs to be held accountable," said Julie Oligschlaeger, of Austin, Texas. "The protocol absolutely has to change."

The Defense Department's deputy director for force health protection, Dr. Michael Kilpatrick, said the government has not seen any increase in dangerous side effects from Seroquel and other drugs.

Physicians interviewed by the AP said they began prescribing Seroquel because it was the only drug that offered relief from the nightmares and anxiety of PTSD.

"By accident, some people were giving them Seroquel for anxiety or depression, and the veterans said, 'This is the first time I have slept six or seven hours straight all night. Please give me more of that.' And the word spread," said Dr. Henry Nasrallah of the University of Cincinnati, who has treated PTSD patients for more than 25 years.

Most of the soldiers and veterans seeking treatment for PTSD do so at hospitals run by the VA or the Defense Department.

The VA's spending on Seroquel has increased more than 770 percent since 2001. In that same time frame, the number of patients covered by the VA increased just 34 percent.

Seroquel has been the VA's second-biggest prescription drug expenditure since 2007, behind the blood-thinner Plavix. The agency spent $125.4 million last fiscal year on Seroquel, up from $14.4 million in 2001.

Spending on Seroquel by the Department of Defense, has increased nearly 700 percent since 2001, to $8.6 million last year, according to purchase records.

Nasrallah and others said they use drugs like Seroquel off-label because so few treatments are approved for PTSD. The FDA has only cleared two drugs for the condition, the antidepressants Paxil and Zoloft, and they do not always work.

The only published study on use of Seroquel for PTSD-related insomnia involved just 20 patients who were followed for six weeks at a VA medical center in South Carolina. The study, which showed moderate improvement in sleep, was funded by AstraZeneca at the request of VA psychiatrist Dr. Mark Hamner, who has studied the use of Seroquel for PTSD.

In his written conclusion, published in 2003, Hamner urged caution in interpreting the results because of the study's small size and short duration.

Hamner is working on larger, federally funded studies of Seroquel. For now, he acknowledges, there is little published research on the use of the drug for PTSD.

"Clinical judgment is really the best we can use at this time because there isn't really a good database to facilitate decision-making," said Hamner, who works at the Ralph H. Johnson Medical Center in Charleston, S.C.

He stressed that VA guidelines require doctors to monitor patients for dangerous side effects with drugs like Seroquel.

The drug, approved in 1997, is AstraZeneca's second-best-selling product, with U.S. sales of $4.2 billion last year. But that success has been marred by allegations that the company illegally marketed the drug and minimized its risks. AstraZeneca agreed to pay $520 million in April to settle federal allegations that its salespeople pitched Seroquel for numerous off-label uses, including insomnia.

Pharmaceutical companies are prohibited from marketing drugs for unapproved uses. AstraZeneca also faces an estimated 10,000 product liability lawsuits, most alleging that Seroquel caused diabetes.

Since White died, his family has been searching for an explanation — and for a way to prevent other deaths.

"We trusted the knowledge of the physicians, that they weren't going to do any harm," White's father said. "And we also trusted the drug companies because that's who provides the research for the physicians. That's what our battle is now: trying to get changes made."

Thousands Strain Fort Hood's Mental Health System

Tue, 24 Aug 2010 11:39:00 -0500

By Gregg Zoroya, USA TODAY

FORT HOOD, Texas — Nine months after an Army psychiatrist was charged with fatally shooting 13 soldiers and wounding 30, the nation's largest Army post can measure the toll of war in the more than 10,000 mental health evaluations, referrals or therapy sessions held every month.

About every fourth soldier here, where 48,000 troops and their families are based, has been in counseling during the past year, according to the service's medical statistics. And the number of soldiers seeking help for combat stress, substance abuse, broken marriages or other emotional problems keeps increasing.

A common refrain by the Army's vice chief of staff, Gen. Peter Chiarelli, is that far more soldiers suffer mental health issues than the Army anticipated. Nowhere is this more evident than at Fort Hood, where emotional problems among the soldiers threaten to overwhelm the system in place to help them.

Counselors are booked. The 12-bed inpatient psychiatric ward is full more often than not. Overflow patient-soldiers are sent to private local clinics that stay open for 10 hours a day, six days a week to meet the demand.

"We are full to the brim," says Col. Steve Braverman, commander of the Carl R. Darnall Army Medical Center on the post.

PTSD: Hundreds of soldiers incorrectly dismissed

BUREAUCRACY: Benefits process streamlined for vets with PTSD

That doesn't even count those soldiers reluctant to seek care because they are ashamed to admit they need help or the hundreds who find therapy outside the Army medical system, Braverman and other medical officials say.

Officials worry the problems may worsen — for the military and the country.

"If Fort Hood is representative of the Army — and 10% of the Army is assigned to Fort Hood — then if you follow the logic, our numbers should be scalable to any other post in the country," says acting base commander Maj. Gen. William Grimsley.

"I worry that if we don't see this through the right way over the long haul ... we're going to grow a generation of people 10 or 15 years from now who are going to be a burden on our own society," he says. "And that's not a good thing for the Army. That's not a good thing for the United States."

Statistics provided to USA TODAY by Fort Hood commanders show the explosion of mental health issues here:

•Fort Hood counselors meet with more than 4,000 mental health patients a month.

•Last year, 2,445 soldiers were diagnosed with post-traumatic stress disorder (PTSD), up from 310 in 2004.

•Every month, an average of 585 soldiers are sent to nearby private clinics contracted through the Pentagon's TRICARE health system because Army counselors cannot handle more patients. That is up from 15 per month in 2004.

•Hundreds more see therapists "off the network" because they want their psychological problems kept secret from the Army. A free clinic in Killeen offering total discretion treated 2,000 soldiers or family members this year, many of them officers.

•Last year, 6,000 soldiers here were on anti-depressant medications and an additional 1,400 received anti-psychotic drugs.

"I don't think we fully understand the total effect of nine years of continuous conflict on a force this size," Chiarelli says, reacting to those statistics.

"Those numbers are pretty staggering," says Kathy Beasley, a health care executive with the Military Officers Association of America. She wonders what will happen when those soldiers leave the military. "Do we have the supply and the people in our systems to take care of that?"

Every time more counselors are hired here, their schedules immediately fill up with patients. "It's almost like a Field of Dreams," Braverman says, referring to the famous line from the 1989 film about a baseball field on an Iowa farm that spontaneously draws crowds. "If you build it, they will come."

'Life can slowly slip away'

Staff Sgt. Josh Rivera came back from his third tour in Iraq this year eager to save his marriage.

"When a soldier is constantly gone and actually fighting, not just deploying and sitting in an office, life can slowly slip away," says Rivera, 32, a native of the Bronx, N.Y.

IN KENTUCKY: Losses mount at Fort Campbell, Ky.

Thirty-nine cumulative months of war had left him distant from his family and confused about his role in their lives, Rivera says. All that made sense was the infantry, which he loves. Rivera resisted seeing a counselor until his marriage was in real trouble, he says.

The Army therapist who met with Rivera and his wife, Julie, gently guided them back to basics — what brought them together 10 years before, why each mattered to the other and what they wanted out of life, the couple say.

Chaplains provide marriage counseling, but for soldiers who want to see a licensed marriage counselor, the base's social work department has two, each with a caseload of 60 couples, says Lt. Col. Nancy Ruffin, department director.

She has to refer some troubled marriages to private clinics, and not all the soldiers are willing to do that, Ruffin says.

The demand for other types of counseling also far exceeds supply. There are not enough social workers to treat soldiers suffering the emotional effect of sexual assault. Ruffin says she has one social worker, who is handling 50 cases.

Fort Hood has an intensive, three-week therapy program, followed by eight weeks of group therapy, for soldiers suffering stress-related issues, including post-traumatic stress disorder. It has a waiting list of 80 soldiers.

The child and adolescent psychiatric services at Fort Hood handle more than 1,000 visits, assessments or counseling sessions with military children each month, up from about 800 in 2004. It refers about 30 overflow cases off base each month, up from zero in 2004, the base statistics show.

Fort Hood has one of the most robust mental health programs in the Army. It has 171 behavioral health providers and 28 new hires are on the way, says Lt. Col. B. Kirk Phillips, a psychiatrist and director of mental health care at the Darnall medical center. This is up from about 50 mental health workers in 2004.

Because of war and deployments, not only are there more soldiers suffering emotional problems, they are sicker than ever and require more counseling sessions, Phillips says. Even after the latest round of hiring, Phillips says, a recent internal analysis showed the mental health staff will need an additional 58 counselors to meet the demand.

Suicides outpacing 2009

Despite the increase in mental health resources, there have been 14 confirmed or suspected suicides among Fort Hood soldiers this year. That figure outpaces 2009 and matched each of the three worst years for suicides in recent base history, 2006-2008. In June, the Army recorded 32 suicides overall, the highest monthly total since it began keeping records.

Army Sgt. Douglas Hale Jr., 26, was one of the most recent Fort Hood suicides.

On July, 6, Glenda Moss received this text message from Hale, her son: "i love u mom im so sorry i hope u and the family and god can forgive me."

Her son had tried to kill himself in May. She feared he might try again. She immediately called the Army and then drove the 90 minutes from her home in King, Texas, to the base.

It was too late. Hale had walked into a restaurant across Highway 190 from Fort Hood, asked to use the bathroom, locked the door and shot himself in the head with a newly purchased handgun, according to a police report. He was removed from life support a few days later.

Moss knew her son was very troubled. When his second combat tour to Iraq ended in 2007 after 15 months, he was diagnosed with PTSD and severe depression, began drinking heavily, saw his marriage disintegrate and, finally, left the base without permission last year.

He was brought back to Fort Hood in May after being taken into custody by police in King for being absent without leave, his mother said. He attempted suicide in his barracks that month.

The Army sent him to a psychiatric hospital in Denton, Texas. Army doctors told him "we don't have enough people here (at Fort Hood) to help you," his mother recalls.

A statement released by Fort Hood in response to questions about Hale's case says, "Space and staff shortages prevent us from treating all our patients on post. While it is our intent to treat patients within our facilities, the reality is we cannot at the present time."

Base officials declined to discuss the specifics of Hale's case while an Army investigation continues.

Moss says her son seemed to be in good spirits after leaving the Denton hospital following a month of treatment in June. He spent the July 4th weekend at his mother's home before she drove him back to Fort Hood on July 5.

Moss says the Army can do more to watch over troubled soldiers like her son. "They need to do as much as they can to stop this, because if they don't, the Army's going to be responsible for a lot more (suicides)," she says. "I don't want another family to have to deal with what I went through.

'Stigma was still a problem'

After the mass killings in November, Fort Hood launched a campaign to gauge the psychological health in the community. The goal was to see how many people needed help, whether they were getting it and how many counselors were needed. Part of the effort was an online, confidential survey in February to get soldiers' views. Troops were offered incentives such as a day off from work to participate. More than 5,000 responded.

One in four said they would be viewed as weak, treated differently or harm their careers if they admitted suffering emotional issues, says Col. William Rabena, who led the campaign. The attitude was particularly strong among majors, lieutenant colonels and full colonels.

"Stigma was still a problem," Rabena says.

For those soldiers afraid to seek help, who decline to go to Army therapists or private clinics that contract with the military, there are alternatives.

A Pentagon program offers soldiers a limited number of counseling sessions with private therapists that will remain off their medical records. The program is called Military OneSource, and it provides up to 12 free and confidential therapy sessions when soldiers call a toll-free hotline. From May 2009 to May 2010, there was a 72% increase in sessions provided by the program in the Fort Hood area, from 822 to 1,412, says Air Force Maj. April Cunningham, a Pentagon spokeswoman.

Another option for Fort Hood soldiers who want to keep their psychological problems secret from the Army is a free clinic in Killeen called Scott & White Military Homefront Services. The therapy provided at this clinic does not show up as a mental health diagnosis on a soldier's medical record.

The five therapists at the project are booked solid, says the director, Maxine Trent, a psychotherapist and the wife of a retired Navy SEAL.

The clinic has seen 7,117 soldiers, spouses and their children since it opened in 2008, says Matthew Wright, a director with Scott & White Healthcare of Temple, Texas, which operates the project.

Soldiers, many of them officers, come into the clinic seeking therapy for the first time in their careers, Trent says.

"Generally, you have the parade rest," she says, demonstrating how they sit with backs straight, arms outstretched and palms on knees. The tension in their bodies, she says, is palpable.

"Those who have been back-to-back deployed vibrate. ... There's different energy. There's hyper-vigilance that you won't see anywhere else," Trent says. "They walk in here not sleeping. They walk in here having mood disruptions, angry driving, explosions at wife and/or husband and kids."

When her offices opened, Trent canvassed the wives of Fort Hood commanders to get a sense of what she was facing. "They told us basically, 'We know everything we need to know about deployment. Please don't set up any programs to teach us about deployment,' " Trent recalls. " 'What we don't know how to do is to keep doing it (deployments). We're tired. We're exhausted.' "

Even this program struggles to cope with all those needing help and getting the money to pay for it.

A $750,000 grant from the Dallas Foundation and the Association of the U.S. Army for the project is nearly gone and officials are trying to secure more funding, Wright says.

Adam Borah, who runs the outpatient psychiatric clinic at Fort Hood, sees progress in the many soldiers stepping forward to seek help. "The bad news is that there are a lot of people out there who need behavioral heath care," he says.

Braverman worries that if the number of patients keeps climbing, soldiers will give up waiting to see someone and avoid seeking help. Private clinics that contract with the military to handle overflow patients are overworked, says Chuck Lauer, a senior administrator at Darnall Hospital. "These guys (local private therapists) are putting in six days a week. Some of them have their practices open 10 hours a day," Lauer says.

Staff Sgt. Rivera, who got the marital help, worries for the soldiers. "The military needs to know that they are losing very good soldiers and squads and platoons to multiple deployments," he says. "The amount of help needed is actually overwhelming."

Advocates see trouble for misdiagnosed soldiers

Mon, 16 Aug 2010 13:24:00 -0500

By ANNE FLAHERTY (AP) – 22 hours ago

WASHINGTON — At the height of the Iraq war, the Army routinely dismissed hundreds of soldiers for having a personality disorder when they were more likely suffering from the traumatic stresses of war, discharge data suggests.

Under pressure from Congress and the public, the Army later acknowledged the problem and drastically cut the number of soldiers given the designation. But advocates for veterans say an unknown number of troops still unfairly bear the stigma of a personality disorder, making them ineligible for military health care and other benefits.

"We really have an obligation to go back and make sure troops weren't misdiagnosed," said Dr. Barbara Van Dahlen, a clinical psychologist whose nonprofit "Give an Hour" connects troops with volunteer mental health professionals.

The Army denies that any soldier was misdiagnosed before 2008, when it drastically cut the number of discharges due to personality disorders and diagnoses of post-traumatic stress disorders skyrocketed.

Unlike PTSD, which the Army regards as a treatable mental disability caused by the acute stresses of war, the military designation of a personality disorder can have devastating consequences for soldiers.

Defined as a "deeply ingrained maladaptive pattern of behavior," a personality disorder is considered a "pre-existing condition" that relieves the military of its duty to pay for the person's health care or combat-related disability pay.

According to figures provided by the Army, the service discharged about a 1,000 soldiers a year between 2005 and 2007 for having a personality disorder.

But after an article in The Nation magazine exposed the practice, the Defense Department changed its policy and began requiring a top-level review of each case to ensure post-traumatic stress or a brain injury wasn't the underlying cause.

After that, the annual number of personality disorder cases dropped by 75 percent. Only 260 soldiers were discharged on those grounds in 2009.

At the same time, the number of post-traumatic stress disorder cases has soared. By 2008, more than 14,000 soldiers had been diagnosed with PTSD — twice as many as two years before.

The Army attributes the sudden and sharp reduction in personality disorders to its policy change. Yet Army officials deny that soldiers were discharged unfairly, saying they reviewed the paperwork of all deployed soldiers dismissed with a personality disorder between 2001 and 2006.

"We did not find evidence that soldiers with PTSD had been inappropriately discharged with personality disorder," wrote Maria Tolleson, a spokeswoman at the U.S. Army Medical Command, which oversees the health care of soldiers, in an e-mail.

Command officials declined to be interviewed.

Advocates for veterans are skeptical of the Army's claim that it didn't make any mistakes. They say symptoms of PTSD — anger, irritability, anxiety and depression — can easily be confused for the Army's description of a personality disorder.

They also point out that during its review of past cases, the Army never interviewed soldiers or their families, who can often provide evidence of a shift in behavior that occurred after someone was sent into a war zone.

"There's no reason to believe personality discharges would go down so quickly" unless the Army had misdiagnosed hundreds of soldiers each year in the first place, said Bart Stichman, co-director of the National Veterans Legal Services Program.

Stichman's organization is working through a backlog of 130 individual cases of wounded service members who feel they were wrongly denied benefits.

Among those cases is Chuck Luther, who decided to rejoin the Army after the Sept. 11 attacks. He had previously served eight years before being honorably discharged.

"I knew what combat was going to take," he said.

Luther, who lives near Fort Hood, Texas, said throughout his time in the Army, he received eight mental health evaluations from the Army, each clearing him as "fit for duty."

Luther was seven months into his deployment as a reconnaissance scout in Iraq's violent Sunni Triangle in 2007 when he says a mortar shell slammed him to the ground. He later complained of stabbing eye pain and crippling migraines, but was told by a military doctor that he was faking his symptoms to avoid combat duty.

Luther says that he was confined for a month in a 6-by-8 foot room without treatment. At one point, Luther acknowledges, he snapped — biting a guard and spitting in the face of a military chaplain.

After that episode, Luther says, the Army told him he could return home and keep his benefits if he signed papers admitting he had a personality disorder. If he didn't sign, he said, he was told he would be kicked out eventually anyway.

Luther, whose account was first detailed by The Nation, signed the papers.

His case highlights the irony in many personality discharges. A person is screened mentally and physically before joining the military. But upon returning from combat, that same person is told he or she had a serious mental disorder that predated military service.

As in the civilian world, where many insurance companies deny coverage for illnesses that develop before a policy is issued, the government can deny a service member veteran health care benefits and combat-related disability pay for pre-existing ailments.

Despite the Defense Department's reforms, groups such as the National Veterans Legal Services Program say they don't have enough manpower to help all the veterans who believe they were wrongly denied benefits.

Stichman says his organization has more than 60 law firms across the country willing to take on the legal cases of wounded veterans for free. But even with that help, the group doesn't know when it would be able to take on even one new case.

A congressional inquiry is under way to determine whether the Army is relying on a different designation — referred to as an "adjustment disorder" — to dismiss soldiers.

Sen. Kit Bond, a Missouri Republican, wants the Pentagon to explain why the number of these discharges doubled between 2006 and 2009 and how many of those qualified to retain their benefits.

As for Luther, he got lucky. After about a year, he says the Veterans Administration agreed to reevaluate him and decided that he suffers from post-traumatic stress syndrome coupled by traumatic brain injury. The ruling gives him access to a psychologist and psychiatrist every two weeks, despite his discharge status, he said.

But Luther acknowledges that he still struggles. In June, he received word that the Army had turned down his appeal to correct his record, which means he could never return to the service or retire with full benefits.

A week later, he says, he lost his job delivering potato chips because a superior felt threatened by him. Luther says he misses the Army.

"When I was in uniform, that defined me," he said. "It's what made me, me."

PTSD greatest where war trauma is worst

Mon, 09 Aug 2010 10:53:00 -0500

NEW YORK, Aug. 3 (UPI) -- The prevalence of post-traumatic stress disorder remains high in Liberia nearly 20 years after the principal conflict, U.S. researchers say.

First author Dr. Sandro Galea of the Columbia University's Mailman School of Public Health says study investigators find certain villages in Liberia had a much higher prevalence of PTSD than others.

Villages that had experienced the greater burden of war had higher prevalence of PTSD.

"This suggests that there is much more to the aftermath of conflict than a 'path of blood' and that populations who are unfortunate enough to have been in the 'path of trauma' experiencing severe, violent conflict are likely to bear a burden of psychopathology for decades thereafter," Galea says in a statement.

The study is published in the American Journal of Public Health.

K-9 PTSD? Some vets say dogs stressed by war, too

Thu, 05 Aug 2010 13:23:00 -0500

By DAN ELLIOTT (AP)

PETERSON AIR FORCE BASE, Colo. — Gina was a playful 2-year-old German shepherd when she went to Iraq as a highly trained bomb-sniffing dog with the military, conducting door-to-door searches and witnessing all sorts of noisy explosions.

She returned home to Colorado cowering and fearful. When her handlers tried to take her into a building, she would stiffen her legs and resist. Once inside, she would tuck her tail beneath her body and slink along the floor. She would hide under furniture or in a corner to avoid people.

A military veterinarian diagnosed her with post-traumatic stress disorder — a condition that some experts say can afflict dogs just like it does humans.

"She showed all the symptoms and she had all the signs," said Master Sgt. Eric Haynes, the kennel master at Peterson Air Force Base. "She was terrified of everybody and it was obviously a condition that led her down that road."

A year later, Gina is on the mend. Frequent walks among friendly people and a gradual reintroduction to the noises of military life have begun to overcome her fears, Haynes said.

Haynes describes her progress as "outstanding."

"Pretty fabulous, actually," added Staff Sgt. Melinda Miller, who's been Gina's handler since May. "She makes me look pretty good."

PTSD is well-documented among American servicemen and women returning from wars in Iraq and Afghanistan, but its existence in animals is less clear-cut. Some veterinarians say animals do experience it, or a version of it.

"There is a condition in dogs which is almost precisely the same, if not precisely the same, as PTSD in humans," said Nicholas Dodman, head of the animal behavior program at Tufts University's Cummings School of Veterinary Medicine.

But some veterinarians dislike applying the diagnosis to animals, thinking it demeans servicemen and women, Dodman said. He added that he means no offense to military personnel when he uses the term.

Jack Saul, a psychologist on the faculty at Columbia University's Mailman School of Public Health, said PTSD is a diagnosis developed for humans, not dogs.

"That's not to say that animals can't be traumatized. It sounds like this dog was traumatized from the experience of extreme stress and fear," Saul said. "That causes an alteration in the animal's nervous system similar to an alteration of the nervous system in humans."

The military defines PTSD as a condition that develops after a life-threatening trauma. Victims suffer three types of experiences long afterward, even in a safe environment. They repeatedly re-experience the trauma in nightmares or vivid memories. They avoid situations or feelings that remind them of the event, and they feel keyed up all the time.

When Gina returned to Peterson last year after her six-month deployment in Iraq, she was no longer the "great little pup" Haynes remembered.

She had been assigned to an Army unit, and her job was to search for explosives after soldiers entered a house. The troops sometimes used noisy, blinding "flash-bang" grenades and kicked down doors, Haynes said, and Gina was once in a convoy when another vehicle was hit by an improvised bomb.

Back home at Peterson, Gina wanted nothing to do with people.

"She'd withdrawn from society as a whole," Haynes said.

Haynes, who has worked with more than 100 dogs in 12 years as a handler and kennel master, said he has seen other dogs rattled by trauma, but none as badly as Gina.

Haynes and other handlers coaxed Gina on walks, sending someone ahead to pass out treats for bystanders to give her. They got her over her fear of walking through doors by stationing someone she knew on the other side to reward her with pats and play. They eased her farther into buildings with the same technique.

"She started learning that everyone wasn't trying to get her," Haynes said. "She began acting more social again."

On a sunny afternoon last week, Gina dashed across her training yard, jumping over obstacles on command and deftly pushing a ball with her forelegs and chest. On a visit to a store on base, she trotted calmly down the aisles and sat quietly when a woman bent to pet her.

"She's such a lovable dog," Miller said, describing how the 61-pound Gina will lie in her lap. "I could literally hold this dog like a baby."

But Haynes said they're careful not to let their affection interfere with good training. Treating Gina like a human — for example, comforting her when she's frightened — can leave her thinking that her handler is pleased when she's afraid.

"She's just gorgeous and I love her, but you also have to balance it with — you have to do what's right," he said.

Gina has resumed some of her duties, searching cars for explosives at Peterson or other nearby military facilities. Eventually, she may be able to return to the kind of hazardous duty she did in Iraq, but that's at least a year away, Haynes said.

"We're not planning on doing it anytime in the near future because obviously, we don't want to mess up everything we've already fixed," he said.

Dodman said he doubts Gina can recover completely.

"It's a fact that fears once learned are never unlearned," Dodman said. "The best thing you can do is apply new learning, which is what (Gina's handlers are) doing," he said.

Haynes acknowledged that's a concern, and although he hopes Gina recovers 100 percent he doesn't know if she will.

"Anytime someone has that much fear about anything, then obviously it will be hard just to get it fixed," he said.

"But, I mean, we don't really have many other options," Haynes said. "You can't really give up on them. They're your partner."

Ecstacy Can Treat Trauma Patients - The Independent

Tue, 20 Jul 2010 00:24:00 -0500

It said that the drug had a ‘dramatic effect’ on people who suffered post-traumatic stress disorder (PTSD) and who did not respond to other treatments. Read more.

VA Simplifies Access to Health Care and Benefits for Veterans with PTSD

Mon, 19 Jul 2010 18:47:00 -0500

WASHINGTON – Department of Veterans Affairs News Release
Secretary of Veterans Affairs Eric K. Shinseki announced a critical step forward in providing an easier process for Veterans seeking health care and disability compensation for Post-Traumatic Stress Disorder (PTSD), with the publication of a final regulation in the Federal Register.

“This nation has a solemn obligation to the men and women who have honorably served this country and suffer from the often devastating emotional wounds of war,” said Secretary of Veterans Affairs Eric K. Shinseki. “This final regulation goes a long way to ensure that Veterans receive the benefits and services they need.”

By publishing a final regulation in the Federal Register to simplify the process for a Veteran to claim service connection for PTSD, VA reduces the evidence needed if the trauma claimed by a Veteran is related to fear of hostile military or terrorist activity and is consistent with the places, types, and circumstances of the Veteran’s service.

This science-based regulation relies on evidence that concluded that a Veteran’s deployment to a war zone is linked to an increased risk of PTSD.

Under the new rule, VA would not require corroboration of a stressor related to fear of hostile military or terrorist activity if a VA doctor confirms that the stressful experience recalled by a Veteran adequately supports a diagnosis of PTSD and the Veteran's symptoms are related to the claimed stressor.

Previously, claims adjudicators were required to corroborate that a non-combat Veteran actually experienced a stressor related to hostile military activity. This final rule simplifies the development that is required for these cases.

VA expects this rulemaking to decrease the time it takes VA to decide access to care and claims falling under the revised criteria. More than 400,000 Veterans currently receiving compensation benefits are service connected for PTSD. Combined with VA’s shorter claims form, VA’s new streamlined, science-based regulation allows for faster and more accurate decisions that also expedite access to medical care and other benefits for Veterans.

PTSD is a medically recognized anxiety disorder that can develop from seeing or experiencing an event that involves actual or threatened death or serious injury to which a person responds with intense fear, helplessness or horror, and is not uncommon among war Veterans.

Disability compensation is a tax-free benefit paid to a Veteran for disabilities that are a result of -- or made worse by -- injuries or diseases associated with active service.

For additional information, go to www.va.gov or call VA’s toll free benefits number at 1-800-827-1000.

Borderline Personality Associated with High Incidence of Trauma

Mon, 12 Jul 2010 10:17:00 -0500

Jul 11, 2010 Victor Salkowitz

It is estimated that between 60% and 70% of those diagnosed with Borderline Personality Disorder have histories of extensive trauma within their families of origin. This includes physical abuse, sexual abuse, psychological abuse, and neglect (American Academy of Experts in Traumatic Stress, 1997).

Waller (1984) notes that trauma, as reported by a group of eating disordered females, if occurring prior to the age of 14, were more likely to have a diagnosis of Borderline Personality Disorder.

Kernberg (1975) asserts that an early "borderline organization," natural to early development, begins during the first three years of life. He says the infant's fragile ego, with its inability to integrate "good" and "bad,' has a wedge driven into it by injurious stimuli from the environment, making the split deeper between the good and the bad. This places the individual on course for a Borderline Personality Disorder as an adult.

Shouldn't Most Borderlines Have PTSD?

If most Borderlines have a history of trauma, shouldn't most Borderlines have PTSD?

There are many clinicians who would want to look for Complex PTSD existing concurrently with Borderline Personality Disorder. Complex PTSD is a diagnosis not made official in the Diagnostic Statistical Manual (DSM), but is used among many clinicians who work with individuals with long periods of childhood abuse. Complex PTSD and the PTSD found in the DSM are similar, yet have significant differences (Whealin, Sloan, 2007).

Differences between PTSD and Complex PTSD

The PTSD as discussed in the DSM (acute trauma PTSD) is caused by an intense, life threatening traumatic event of limited duration. Complex PTSD develops in response to a perpetrator who has traumatized the victim over a long period of time.

Acute trauma PTSD usually develops during adulthood, after the personality has developed. Complex PTSD may develop during adulthood (as in Domestic Violence), but it commonly develops among abused children, when the personality is less developed and the individual is likely to feel more helpless and captive.

Earthquake Trauma: Team Works to Help Haiti Heal

Thu, 08 Jul 2010 10:33:00 -0500

By Efrem Graham

News Anchor & Reporter

Thursday, July 08, 2010

"Sometimes you are just trying to forget about it," said Eugene, a 27-year-old interpreter. "But it just comes right back to your mind."

Jan. 12 marked the day a 7.0 magnitude earthquake reduced Port au Prince to rubble, killing her uncle and more than 250,000 others.

Pignon is about 85 miles north of Port au Prince. The roads there are so rough and rocky, it's actually smoother to travel by donkey than by car. But its distance from Port au Prince was not enough for the area to escape the emotional impact of January's earthquake.

"I would go like, 'Is it in my mind?' or 'What's going on with me?'" Eugene said, recalling her sleepless nights.

Post-Traumatic Stress

Eugene is not alone in her restlessness. It has been a long six months for earthquake survivors and many are healing physically, but the emotional recovery is just beginning.

A team from Regent University in Virginia Beach, Va., is training counselors to treat those Haitians struggling with Post Traumatic Stress Disorder, or PTSD.

"They have assimilated to the trauma because life goes on and they have had to adapt," explained Dr. Benjamin Keyes who leads the team. "But all the memories of what went on, and all the things that they saw have never been talked about because in this country people just don't do that."

First Response Trauma Team

Keyes and his team are spending a week in Pignon to help victims discuss what they are going through.

"Knowing that we were trained to treat trauma, I wanted to come and I had a burden for the people, even after it moved from the front page of the newspaper," Regent graduate Vernicia Eure said. "I really wanted to come, and I asked God to help me keep Haiti in my heart."

Runell Washington, also a member of the trauma team, remembers watching the tragedy unfold on television.

"That kind of broke my heart to have this magnitude of devastation happen to a people and it only remain hot in the news for about a week-and-a-half or two weeks and then we were on to something else," she said. "I felt like that cry was so loud and the devastation so treacherous that we should have paid more attention and paid attention longer."

The university's work will continue in Haiti long after the trauma team leaves. Workers are counseling church leaders and also training them to treat people suffering with PTSD.

A Heart to Help Their Own

"It just amazes me every time just how much they desire to help their own people," Ryan Calhoun, another Regent volunteer, said. "They are coming here and many of them have been through several tragedies themselves, but they want to know how they can help others. They want to learn these counseling skills and take them out into their communities."

A pastor who lost his wife and children in the earthquake walks four hours to the training sessions in Pignon to learn how to help the people in his congregation.

"This is just a strong area in need and a strong area for God because here they are in the midst of this trauma and they want to reach out to each other," Keyes said. "And it's been quite a blessing."

Dr. Merrill Reese also helps lead the Regent University team.

"I would say based on the symptoms that we are hearing, [survivors] are finally coming through the shock stage and the numbing," Reese explained. "The realization that our lives have totally changed [is settling] so the timing for me couldn't be any better. It's like perfect timing."

Reason to Celebrate

Timing was critical for Pastor Jephthé Lucien, who invited the team of counselors to travel to Haiti. The earthquake triggered trauma in his 13-year-old adopted daughter so much she had to be hospitalized.

"As a father, it's been really painful," he said. "Personally for me, I have been preaching and sharing with people what they need to do when they are in a crisis. So I find out that it is easier to talk about it than go through it."

His daughter's weight dropped from 115 pounds to 62 pounds in just a matter of months. There had been no medical explanation for her weight loss until Dr. Keyes paid a visit.

"After he talked to her, he said that this was a classic case of anorexia," Lucien recalled. "But there is no way that us and our limited knowledge could have found that out."

Keyes was able to help diagnose the problem and get the girl better help.

"We have been able to get her to the University of Miami facility in Port au Prince," Keyes said. "She has two excellent surgeons from Miami. She is working with a psychologist and a nutritionist and what they are saying is that physically she is going to be well."

The days and months ahead are still critical, but Regent University trauma workers are giving the people of Pignon a reason to celebrate and worship God daily.

"Truly God is here at every corner, just waiting to reveal Himself. And not only is He waiting to do it, He is doing it," Reese said. "It is just exciting to be a part of."

PIGNON, Haiti - Nahomi Eugene's walk to work is a short distance from her home in Pignon, Haiti. But the daily journey has felt longer since Jan. 11 -- the last day she got a good night's rest.

Reading sessions help Haiti children through quake trauma

Fri, 02 Jul 2010 10:11:00 -0500

By Alice Speri (AFP)

PORT-AU-PRINCE — When the first story began only a handful of kids sat on the wet ground, watching and listening intently as a woman read aloud to them in the Port-au-Prince neighborhood of Tabarre.

Soon a crowd of 60 formed as curious children carrying baby siblings were joined by adults, eager for diversion from the tedium that, along with the rains, has settled into Haiti's sprawling camps since the January earthquake.

The scene repeats itself daily in the 15 tent cities where a program called Li Li Li! (Creole for Read Read Read!) works to promote literacy and help kids overcome the inevitable trauma from a catastrophe that left up to 300,000 dead.

The reader, Natacha Micourt, was an artist until the January 12 quake destroyed her studio and left her trapped under the rubble for two days. Now the 32-year-old painter earns 250 dollars a month as a Li Li Li! reader.

Micourt acts out stories of magic hats and Clifford, the big red dog, to the delight of the children, allowing them a brief escape from the grim reality of their post-quake existence.

"The kids just love it," she told AFP.

But Li Li Li! is not only about stress release, it is also an attempt to entrench a love for reading in a country where, before the earthquake, 44 percent of the population could not read or write, according to UN estimates.

"Illiteracy will go up even more after the earthquake because so many schools were destroyed," Li Li Li! coordinator Germinal Jocelyn told AFP.

Jocelyn's job is to scout out "unofficial" camps overlooked by Haitian authorities and relief organizations so the reading club can direct its efforts where they are most needed.

"NGOs don't come here, they don't even know these camps exist," she told AFP of the camp in Tabarre.

Li Li Li! is the brainchild of Michelle Karshan, an American and former spokeswoman for the government of ousted Haitian president Jean-Bertrand Aristide.

Karshan launched the initiative with two of her daughters, who also grew up in Haiti, to help them overcome their own shock after the earthquake.

"They felt powerless, but this made them feel like they were doing something," she said.

In the weeks after the quake, Karshan studied the benefits of telling stories to traumatized children, calling on friends to donate colorful books, which were vetted for appropriateness and translated into Creole.

For many soldiers, mental trauma lingers at home

Tue, 08 Jun 2010 13:10:00 -0500

Time Magazine

Roughly one in ten soldiers returning from Iraq faces ongoing struggles due to post traumatic stress disorder (PTSD), depression and other conditions, according to a new study published in the June issue of the Archives of Psychiatry

Read more: http://wellness.blogs.time.com/2010/06/07/for-many-soldiers-mental-trauma-lingers-at-home/#ixzz0qHKcTel2

Troops to get trauma help

Mon, 07 Jun 2010 10:14:00 -0500

A proposed service would track down veterans plagued by mental health issues. And a lifelong screening process would catch those with problems as they leave the Forces.

Read more: http://www.thesun.co.uk/sol/homepage/news/campaigns/our_boys/3002367/DAVID-Cameron-to-get-troops-trauma-help.html#ixzz0qAlWDirX

Survivors of Military Sexual Trauma Continue to Face Uphill Battle in Military

Fri, 21 May 2010 12:50:00 -0500

Written by Imperial Valley News

Friday, 21 May 2010

Washington, DC - John Hall (D-NY), Chairman of the Subcommittee on Disability Assistance and Memorial Affairs, and Michael Michaud (D-ME), Chairman of the Subcommittee on Health, conducted a hearing to evaluate military sexual trauma (MST) issues. The Department of Veterans Affairs (VA) refers to MST as the experiences of sexual harassment and/or sexual assault that occurred while a veteran was in the military. The hearing focused on ways in which the Veterans Benefits Administration (VBA), Veterans Health Administration (VHA), and the Department of Defense (DoD) can better address the needs of veterans impacted by MST and identify ways to better prevent, treat and properly compensate them.

“Veterans should be able to have access to treatment facilities and qualified staff with care and benefits delivered by employees who are properly trained to be sensitive to MST related issues,” said Chairman Hall. “Veterans need access to appropriate health care providers who have experience working with MST survivors. VA and DoD need to ensure that the proper treatment is available. MST survivors continually express frustration with the disability claims process, especially in trying to prove to the VA that the actual assault ever happened. For many women and men, when their disability claims for post-traumatic stress disorder related to MST are denied, they suffer a secondary injury, which results in an exacerbation of these symptoms.”

According to a 1995 DoD study of sexual victimization among active duty service members, acts of sexual harassment were reported by 78% of women service members and 38% of military men. Another study found that rates of sexual assault and verbal sexual harassment were higher during wartime than peacetime in their sample study population. One study found that 23% of female users of the VA health care system reported having experienced sexual assault while in the military. More recently, VHA reported that as of October 20, 2009, of the 5,340,754 patients seeking outpatient care at VHA facilities in FY 2009, 1.2% (65,264) of patients reported MST-related conditions.

Witnesses discussed the barriers faced by service members who are exposed to sexual trauma during their military service. According to Helen Benedict, author of The Lonely Soldier, “90 percent of victims never report assaults within the military because its culture is so hostile to them.” Anuradha Bhagwati of Service Women’s Action Network explains that MST survivors are likely to be further traumatized if they report the incident and the information becomes public. She says, “There is simply no guarantee that the chain of command will support survivors if they come forward.” Veteran advocates discussed the need for perpetrators to receive appropriate punishment for sexual assault and harassment, claiming that offenders are often relocated to another duty station or demoted rank instead of serving a jail sentence. Representing DoD, Director of the Sexual Assault Prevention and Response Office Kaye Whitley discussed how the military addresses sexual assault and cares for victims, but failed to address the disciplinary policy for perpetrators in her testimony.

“Service members who experience military sexual trauma and are brave enough to speak out about their experiences are often marginalized,” said Chairman Michaud. “For many, it means the end of their military career while their offenders often times remain unscathed. We must do better by the women and men who experience military sexual trauma.”

Additional recommendations to ensure proper treatment and benefits for MST survivors within the VA system included improved outreach to victims to alert them of available services and treatment options. Ms. Bhagwati suggested that MST survivors should have the option of fee-based care for all treatment, to combat lack of privacy, child care, and availability of evening or weekend appointments at some VA facilities. Iraq and Afghanistan Veterans of America Project Coordinator Jennifer Hunt recommended better tracking of MST survivors within the VHA and VBA systems. She urges VA to “track MST-related care at all VHA medical facilities, so that MST treatment data are readily accessible across the VA system, as recommended by the VA’s Office of Inspector General” and “identify, track and report to Congress the outcomes of disability claims that involve MST.”

Chairman of the House Committee on Veterans’ Affairs Committee Bob Filner (D-CA) said, “Today’s hearing shows the clear need for more gender-specific research and more tracking of this issue. Until the VA documents and records MST, instead of including MST survivors in a more general PTSD category, we will not fully understand the depth of the problem or ensure that veterans are receiving proper treatment. VA and DoD must work together to ensure victims – whether they report MST while in-service or not – do not face such an uphill battle to get the services they need and deserve.”

ISTSS member Edna Foa named one of TIME Magazine’s most influential individuals

Mon, 03 May 2010 10:37:00 -0500

TIME Magazine named ISTSS member, Edna Foa, PhD, to the 2010 TIME 100, the magazine’s annual list of the 100 most influential people in the world.

Dr. Foa is the developer of Prolonged Exposure Therapy for PTSD, a topic on which she presented at the ISTSS meeting last November in Atlanta, Georgia.

Photo credit: Candace diCarlo

Dr. Foa is the lead investigator studying PTSD for military personnel serving in and returning from combat in Iraq and Afghanistan as part of multidisciplinary and multi-institutional research consortium funded by the U.S. Department of Defense’s Psychological Health and Traumatic Brain Injury Research Program. This program aims to develop and evaluate the most effective early interventions possible for the detection, prevention, and treatment of combat-related posttraumatic stress disorder (PTSD) in active-duty military personnel and recently discharged veterans.

“Edna’s work has benefited the lives of patients and the training of practitioners throughout the world. I am delighted that TIME magazine has recognized her enormous contributions to the field,” says Dwight L. Evans, MD, chairman of the Department of Psychiatry at the University of Pennsylvania School of Medicine.

Dr. Foa has authored 20 books – some translated into multiple languages, including Spanish, German, Japanese and Chinese – and has published over 200 papers and book chapters. She has been honored for her contributions by the American Psychological Association, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Philadelphia Society of Clinical Psychologists. Dr. Foa received the Lifetime Achievement Award from the International Society for Traumatic Stress Studies and the Association for the Advancement of Behavior Therapy (ABCT). She is also the recipient of the Annual Signature Service Award from Women Organized Against Rape.

The full TIME 100 list and related tributes appear in the May 10 issue of TIME, available on newsstands on Friday, April 30, and now at time.com.

ABOUT PTSD
PTSD is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Approximately 7.7 million American adults age 18 and older have PTSD. The disorder frequently occurs after violent personal assaults such as rape, mugging, or domestic violence; military combat; terrorism; natural or human-caused disasters; and accidents.