Post-traumatic Stress Disorder after Deployment

Alejandra C. Hinojosa
English 1312/RWS 1302
Elizabeth Lang

Abstract
According to the Department of Defense casualty website, 177 service members
have died of self- inflicted wounds while serving in Operation Iraqi Freedom and another
29 have died of self-inflicted wounds while serving in Operation Enduring Freedom
(Department of Defense Personnel and Procurement Statistics, Statistical Information and
Analysis Department, 2009). In addition, it has been reported that suicides in the Army
reached a historic high in 2008 at 20.2 per 100,000 service members (Anne Scott Tyson,
2009). An interview with Lt. Lowell Haehn from 86th

Introduction
Post-traumatic stress disorder amongst soldiers after deployment is no longer a
taboo subject. Lt. Joshua Pallota from Alpha Company, 3rd Battalion and 172nd Infantry
of the 86th Infantry Brigade Combat Team, posted this comment on his Facebook, it said,
They teach me how to put a uniform on, but they dont teach me how to take it off
(Hemingway, 2014). Joshua was 25 years old when he took his life, he belonged to a
2010 Vermont Army National Guard deployment to Afghanistan. Upon his return he
immediately began to struggle with post-traumatic stress disorder and traumatic brain
injuries. Nearly 25% of the 3,000 soldiers who were a part of this deployment to
Afghanistan have PTSD symptoms of varying degrees (Hemingway, 2014). Posttraumatic stress disorder (PTSD) is one of the most commonly reported psychological
outcomes following deployment. Many factors other than the actual deployment itself can
play a role on the severity of a soldiers diagnosis. The correlation for PTSD can be
defined as followed: Pre-, peri- and post-trauma. Each case is different and the
determination is reviewed by this systematic review mechanism used for PTSD.

Pre-PTSD
It is an anxiety disorder that can develop in response to a traumatic event that
causes intense fear, helplessness or horror. The increasing numbers that suffer from this
psychological disorder are veterans that have spent time in the hot zone as some may
refer to it. PTSD is quite common among military veterans due to the daily exposure to
potentially traumatic events such as active combat zones. Approximately one in every
five service members who return from deployment in Afghanistan and Iraq have

symptoms of PTSD or depression (JAN, 2010). There exist different correlations for
PTSD for its considered a broad disorder. Many experiences may factor in the evolution
of this disease and it varies in each person. For example, before a diagnosis can be
determined doctors assess the patient for pre-trauma that includes their personality type,
psychiatric history and any prior trauma. Common pre-trauma also includes vulnerability
factors and adverse childhood experiences.
Dr. Bruce Dohrewend, Ph.D., and colleagues did just that. After focusing on the
roles of three primary factors of pre-, in a study of 260 male veterans, the data indicated
that 98 percent of the veterans who developed the PTSD syndrome had experienced one
or ore traumatic events in the past. But combat exposure alone was not sufficient to cause
the PTSD syndrome. This suggests that there were other factors and vulnerabilities
involved for the male veterans exposed that did develop the PTSD syndrome. Soldiers
who were 25 or younger that entered war at such a young age and soldiers who inflicted
had on civilians or prisoners of war also played a huge role in the development of PTSD
after deployment. (Nauert, 2013).
Peri-PTSD
Whereas Peri-trauma, factors relate to the severity of any past trauma exposure
and reactions developed due to this particular event. Post-trauma factors include social
support and subsequent stressful life events (Hemingway, 2014). What some commonly
refer to it as Peri-traumatic dissociation is found to be the strongest predictor for PTSD
compared to pre- and post-. Measures of peri-traumatic dissociation have been found to
predict PTSD symptoms beyond the level of stress exposure, general dissociative
tendencies, locus of control, and social support (Olde, Van de Hart, Kleber, Van Son,

Wijnen & Pop, 2005). A traumatic event is more likely to affect a person significantly
more if during or after the event he/she believes they are responsible in some way or
didnt do what was necessary to remedy the situation when it occurred. The victim will
usually feel alone and isolated. The severity and proximity, type and nature of past
trauma plays an important role in the development of PTSD in a later time in life. There
may be other peri-traumatic emotions. Of course emotions differ by gender. The graph
below is an example indicates the percentage of service members affected by PTSD, and
rated by gender.

Rates of PTSD: Men versus

Women

Post-Traumatic Stress Disorder

1st Lt. Lowell Johnson, acting company commander for the Alpha Company in
Fort Bliss describes post-trauma as waking up from a long coma. During this complicated

stage, a soldier coming back from a 12-month tour in Pul-E-Alam, Afghanistan,is

experiencing shell shock. An interview was conducted and a series of questions were
asked:

Was Pre-traumatic stress a factor in your PTSD diagnosis after deployment?

What was the most traumatic experience endured during his deployment?

What were the first signs of PTSD experienced once home?

Did he feel confident the U.S Army would provide the resources to cope with
PTSD?

His response to the first question, Lt. Johnson stated him not having absolutely no
pre trauma before his deployment. Afghanistan was the key factor in his PTSD
prognosis. Lt. Johnson was stationed in a zone that was constantly being
threatened with Improvised explosive devices (IED). One explosive hit the side
building about 100 feet from his bunk. He felt the impact and most of his building
was demolished. Lowell wasnt hurt, but did witness soldiers with serious
injuries. He helped transport injured soldiers to medical facilities nearby, some
with open wounds. Before heading home Lt. Johnson began experiencing PTSD
symptoms. Once boarding a plan from Dallas TX to El Paso TX, he described his
experience as surreal and a hard pill to swallow. Seated on the plane, landing in
Dallas, none of the passengers moved from their seats and patiently waited for all

soldiers on the flight to unboard the plane while clapping as a celebration for their
safe arrival home. One of the common symptoms of Post trauma is numbness, and
that is how Lt. Lowell felt when he saw his parents for the first time after
deployment. Lack of social support was a feeling he became very familiar with as
well. A crucial protective factor from PTSD after a trauma is the ability to rely on
family, friends, and community to help with isolation and as a distraction tactic of
traumatic memories. Blaming the victim also plays a big role, a rejection or public
disapproving of the war for which they sacrificed. Lt. Johnson recalled a phone
conversation he had with an uncle who scolded him for not sending a thank you
note after sending him a care package during deployment. Some of the statements
made by his uncle included you had more than enough time to send something
and you werent really at war. Those were statements that affected Lowell and
made him second-guess his ability of coping with PTSD. He felt his disorder
wasnt a big deal and felt the need to control and cope with it by himself.
PTSD Treatment
The biggest question in the interview: what was his confidence level of possible
resources offered to soldiers after deployment to help cope with post-traumatic stress. He
stated many resources are available for service members but many are unknown. A
service member is not required by law to take any counseling except an assessment postdeployment. The Post-Deployment Health Reassessment Program (PDHRA) is a battle
mind questionnaire, which required to be administered to service members 90 to 180 days
after their return from deployment. Battle-mind is the soldiers inner strength to face fear
and adversity with courage. Key components include: self-confidence and mental

toughness. Battle-mind skills help a soldier survive in combat, but may cause problems
out in the world (Walter Reed Army Institute of Research, 2006). Lt. Johnson described
the assessment training as redundant and an overflow of information. The United States
Government Accountability Office (GAO) requires military service members to
electronically submit PDHRA questionnaires. According to GAO, they did not find
PDHRA questionnaires for a percentage of 319,000 active and reserve members who
returned from deployment to Iraq or Afghanistan between January 1, 2007, and May 31,
2008 (GOA, 2009) There is no assurance that service members that were required to
submit PDHRA questionnaire were given the opportunity to identify and address health
concerns that could emerge over time following deployment. GOA found that when
monitoring service members participation in the administration of the questionnaire
didnt maintain clear documentation and generally didnt clearly describe the potential
problems, actions needed to be taken and whether these actions had resolved any
problems presented after deployment. If PDHRA was administered 90 to 180 days after
deployment, Army Reserve and Army National Guard service members reported higher
rates of mental health concerns than their active military counterparts. Researchers noted
that Army Reserve and Army National Guard service members, unlike their active peers,
typically transition back to civilian life after deployment. They may be particularly at
risk for developing mental health conditions, due to their lack of interaction with fellow
service members following their return from deployment and the added stress of
transitioning back to civilian life (GOA, 2009). While filling out the entire PDHRA is
highly encouraged, this assessment is mostly voluntary. The main part of the
questionnaire involves demographic specifics, but questions concerning their mental,

emotional or physical health are not mandatory to answer. If a service member is

separated before or during the reassessment period, there is no mechanism in place to
offer to fill out the PDHRA questionnaire. Once a service member is completely
separated from the service, they have no further obligation to the military services
therefore not required to fill out the questionnaire. It can be very difficult to locate and
contact prior service members after separation has been complete. Air Force is the only
exception, which implements this policy to administer the PDHRA demographic AND
medical portion to active and reserve members as part of their separation process from
the military. As mentioned before, all other military entities only encourage the medical
portion of the questionnaire but is not mandatory. Until this day that section is still
voluntary for service members which diffuses the possibility for intervention. For those
service members that completed the medical section, typically their healthcare providers
use professional judgment to decide whether further evaluation is needed. If referrals for
further evaluation are recommended health care providers will contact service members
and give them 30 days to comply by contacting a medical professional. After that time
period has lapsed, health-care providers again contact service members and offer
assistance in scheduling and attending appointments.
PTSD Quality Assurance Program
PDHRA is deemed unreliable by many networks the DOD established a
deployment health quality assurance program, although most of their information is
retrieved from PDHRA information, the quality assurance program takes that extra step
by conducing on-site military visitations to monitor and report compliances from active
component sites, this happens on a quarterly basis. They also report annually to the

Armed Services Committees of the House of Representatives and Senate. Although the
PDHRA is still being administered to military service members, another commonly used
instrument for post-traumatic stress disorder is the PTSD Checklist. This is a 17 item
self-report questionnaire that as been shown to have excellent psychometric properties
(Dickstein, Weathers, Angkaw, Nievergelt, Yurgil, Nash, Baker, Litz & Marine
Resiliency Study Team, 2014).
Conclusion
In conclusion, post-traumatic stress disorder is a very common disability that
affects a high percentage of military service members. The magnitude of the disorder
depends solely on the pre-, peri- and post factors of PTSD. The more traumatic a service
members life is pre-deployment the more traumatic their symptoms will develop postdeployment. Peri post-traumatic stress disorder plays a huge role, for a service member
develops certain emotions about their past traumatic events. Their mind processes the
severity, proximity of past traumatic events. Age and gender are contributing factors of
the severity of PTSD overall. Its in this phase, when the service member diagnosed with
PTSD reaches the highest level of anxiety and emotions of guilt become present.
Treatment on paper is infinite for service members post deployment yet effective
resources are usually unknown. Mandatory is not procedure. There are many gaps to fill
and when that time comes, its usually too late.

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