Personality Disorders as a Basis for Discharge and Denial of Benefits in the Military: Logical or Abusive?

ABSTRACT: The US Department of Defense specifically states that intellectual disability and personality disorders are not diseases for compensation purposes, and disabilities from them may not be service connected absent a superimposed mental disorder. In addition, the diagnosis of a personality disorder led to the discharge of 31,000 troops during the years 2001 to 2010. I review the history of these developments, and how the Diagnostic and Statistical Manual of Mental Disorders enabled these actions. In contrast, the United Kingdom and Canada do not allow such actions. Whether our approach is logical seems highly questionable, especially given the significant problems with the DSM's definitions of personality disorders, definitions at odds with the literature.

Military psychologists and cultural competence: exploring implications for the manifestation and treatment of psychological trauma in the British armed forces.

This paper considers the manifestation and treatment of psychological trauma in the military. The article describes how military psychologists conceptualise psychological trauma within the culture of the Armed Forces (AF), which is reflected in the process of acquiring what has been referred to as cultural competency. Psychologists in this context acquire an understanding of the manner in which the psychological and organisational systems and culture of the military affect the presentation of psychological trauma, including post-traumatic stress disorder (PTSD). The paper outlines core psychological features of military life, including some of the ways in which the AF functions effectively as an adaptable fighting force. This highlights, for example, the potential for stigma within and between military personnel who experience mental health difficulties. The article proceeds to examine aspects of help-seeking in military mental healthcare, how symptoms can present at different stages in a deployment process, and the consequences that such problems can cause for military conduct and performance. Psychological care in the military is structured within an occupational mental health ethos, in which psychologists fulfil a range of clinical, organisational and leadership roles. These dynamics are explored with examples of care pathways and clarity on evidence-based interventions for trauma and PTSD in those experiencing military-related psychological injuries. Two vignettes are then offered to illustrate how some of these interventions can be used psychotherapeutically in addressing symptoms pertaining to hyperarousal, hypervigilance, guilt and shame.

Leadership in 21st century military healthcare: what did clinical psychologists ever do for us?

Psychology is integral to the concepts and practice of leadership. Leadership models often have their roots in psychological paradigms, making it intrinsically easy for psychologists to grasp and apply them alongside clinical models. Psychologists' 'second-order' skills have been used to good effect in the changing landscape of military mental healthcare: modelling adaptive responses to change, understanding the non-conscious aspects of relationships in hierarchical organisations, working with systems, the ability to diagnose situational requirements and act accordingly, drawing on a range of psychological theories and leadership styles. The clinical psychologist as a professional who can help others 'reframe' a situation or experience is key to their leadership role within healthcare settings, 'enabling others to achieve shared purpose in the face of uncertainty'. The contribution that clinical psychology has made to leadership in Defence over the past 20 years will be illustrated by personal accounts from 'experts by experience'.

Neuropsychology and clinical health psychology in the UK Ministry of Defence.

Neuropsychological testing has been used in a wide range of applications across military settings, including the selection of personnel to engage in covert operations, battlefield assessment and rehabilitation following blast exposure, traumatic brain injury, other neurological conditions and assessment of malingering. Over recent decades, military psychologists have helped to shape the advances in assessing and remediating the psychological sequela that is associated with operationally related neurological and other physical injuries. This paper will present an overview of some of the neuropsychological and related services within the UK Armed Forces, which are provided to service personnel with traumatic brain and other physical injuries.

Los trastornos relacionados con traumas y factores de estrés en la Junta Médico Pericial Psiquiátrica de la Sanidad Militar Española / Trauma and stress related disorders evaluated by the Spanish Military Health Psychiatric Expert Medical Board

INTRODUCCIÓN: Los trastornos relacionados con traumas y factores de estrés son unos trastornos extraordinariamente frecuentes que provocan un elevado coste personal, económico y social. OBJETIVOS: Describir los eventos estresantes o traumáticos, las principales características personales y profesionales y los diagnósticos de los sujetos evaluados en la Junta Médico Pericial Psiquiátrica de la Sanidad Militar Española que fueron diagnosticados de un trastorno psiquiátrico relacionado con un evento. Diseño y Sujetos: Estudio observacional descriptivo transversal realizado sobre los miembros de las Fuerzas Armadas Españolas y de la Guardia Civil que acudieron a la Junta Médico Pericial Psiquiátrica, durante el periodo 2004-2010. RESULTADOS: El tipo de evento más frecuente en la muestra fue el llamado entorno laboral desagradable u hostil, se constató una amplia mayoría de hombres frente a las mujeres, la edad media a la que sucedió el acontecimiento fue de casi 34 años, la Guardia Civil acaparó a cerca del 60% de los casos de la muestra, el empleo más frecuentemente encontrado fue el de soldado, marinero o guardia civil (OR-1) y el diagnóstico más utilizado lo constituyó el trastorno por estrés postraumático. CONCLUSIÓN: Se ha encontrado que los eventos estresantes o traumáticos que más frecuentemente ocasionaron los diferentes trastornos de este grupo fueron: los entornos laborales desagradables u hostiles, los accidentes, los atentados terroristas y las características-condiciones del destino que ocasionan una insatisfacción laboral

INTRODUCTION: Trauma and stress related disorders are very common disorders that produce a high personal, economic and social cost. OBJECTIVES: To describe the stressful or traumatic events, the main personal and professional characteristics and diagnoses of the subjects evaluated by the Spanish Military Health Psychiatric Expert Medical Board who were diagnosed with a psychiatric disorder related to an event. Design and Subjects: Cross-sectional observational study of members of the Spanish Armed Forces and the Spanish Civil Guard who attended the Psychiatric Expert Medical Board, during the period 2004-2010. RESULTS: The most frequent type of event in the sample was called unpleasant or hostile work environment, related to gender a large majority of men was found, the average age at which the event happened was 34 years, the Spanish Civil Guard monopolized about 60% of the cases in the sample, the rank most frequently found was soldier, sailor or civil guard (OR-1) and PTSD was the main diagnosis. CONCLUSION: Has been found that stressful or traumatic events that most often led to different conditions of this group were: unpleasant or hostile work environment, accidents, terrorist attacks and the characteristics of the destination-conditions which cause job dissatisfaction

[Prospects of IT usage in the field of military psychiatry].

Development of effective information support for monitoring of internal health, based on the principles of complex diagnostics, provides the necessary tools objektive evaluation and prediction of mental health in servicemen. Effectiveness of psychiatric prophylaxys technologies depends on compliance with a number of fundamental principles, the main of which should be considered as a multidimensional assessment of mental health in servicemen and real cooperation of different specialists (commanders, specialists of medical and psychological service) for its implementation. In this case, an introduction of information and communication technologies on the basis of the district (fleet) and the Central Military Hospital, as well as other bodies of military control will be almost justified only when creating a full-fledged "information field of military psychiatry" that implements the basic principles of the monitoring system of mental health and includes necessary infrastructure. The practical implementation of this system will allow to personjfyfy medical and psychological assistance to military personnel, to improve early diagnosis of mental disorders, addictive .and suicidal behaviour, and thus increase the effectiveness throughout psychiatric prophylaxis in the army.

Perceived military organizational support and peacekeeper distress: a longitudinal investigation.

Many professions vital to the safety of society require workers to face high magnitude and potentially traumatizing events. Because this routine exposure can cause high levels of stress in workers, it is important to investigate factors that contribute to both risk of posttraumatic stress disorder (PTSD), and healthy responses to stress. Although some research has found social support to mitigate the effects of posttraumatic stress symptoms, scant research has investigated organizational support. The aim of the present study is to investigate the temporal relationship between stress symptoms and perceived organizational support in a sample of 1,039 service members deployed to the peacekeeping mission to Kosovo. Participants completed self-report measures of stress symptoms and perceived organizational support at 4 study time points. Bivariate latent difference score structural equation modeling was utilized to examine the temporal relationship among stress and perceived organizational support. In general, across the 4 time points, latent PCL scores evidenced a salient and negative relationship to subsequent POS latent difference scores. However, no significant relationship was found between latent POS variables and subsequent PCL latent difference scores. Findings suggest that prior stress symptoms are influencing service member's perceptions of the supportiveness of their organization such that increased prior stress is associated with worsening perceptions of support. These results illustrate that targeting stress directly may potentiate the positive influence of organizational support and that institutional support programs should be adapted to better account for the negative biases increased distress may encourage.

Character strengths: a study of argentinean soldiers

The primary objective of this research was to study the differences in positive traits between military and civilian college students and between cadets in their first and final years at a military academy. Second, the research aimed to study the relations between positive traits and the academic and military performance of cadets in their first and final years, according to the classification of positive traits by Peterson and Seligman (2004). To accomplish these objectives, a sample of university students from a military educational institution and a sample of civilian university students were studied. The instruments used were a 24-item self-report measure of positive traits, a measure of social desirability, and objective scores of academic and military performance. The results generally showed that when age and career stage were held constant, the scores of the military students were higher than the scores of the civilian students across various strengths. Military students reported higher levels of the character strength of spirituality than did civilian students. The relationships between strengths and performance differed for students in their first and final years at the military academy. In particular, cadets with the higher levels of academic or military performance in their last year, i.e., the cadets best adapted to the academy, reported higher levels of the character strength of persistence when compared to low-performing cadets in the same year of study (AU)

Los objetivos de esta investigación fueron, por una parte, estudiar las diferencias en rasgos positivos entre estudiantes universitarios militares y civiles, y entre cadetes de primero y último año de una academia militar; y por otra, estudiar la relación entre los rasgos positivos y los rendimientos académicos y militares de cadetes de primero y de último año, siguiendo la clasificación de rasgos positivos de Peterson y Seligman (2004). Para ello se trabajó con una muestra de estudiantes universitarios de una institución militar educativa y con una muestra de estudiantes universitarios civiles. Se utilizó un autoinforme de rasgos positivos de 24 ítems, una medida de deseabilidad social y las calificaciones objetivas de los rendimientos académicos y militares. Los resultados generalmente mostraron que, equilibrados por edad y progreso en la carrera, las puntuaciones de los varones militares son más altas que las puntuaciones de los varones civiles en varias fortalezas. Se observó que los estudiantes militares muestran mayores niveles de la fortaleza espiritualidad que los estudiantes civiles. Son diferentes las relaciones entre las fortalezas y los rendimientos para primero y último año de cursada militar. Particularmente en el último curso, se observó que los cadetes de altos rendimientos académicos o militares, i. e., los cadetes con mejor adaptación a la academia, muestran mayores niveles de la fortaleza persistencia, en comparación con los cadetes de bajos rendimientos del mismo año de estudios (AU)

Salem VAMC-U.S. Army Fort Bragg Warrior Transition Clinic telepsychiatry collaboration: 12-month operation clinical perspective.

OBJECTIVE: To describe the clinical experience in the first Veterans Affairs (VA)-U.S. Army Warrior Transition Clinic (WTC) telepsychiatry operation (September 2008-August 2009). MATERIALS: Joint VA and U.S. Army records. METHODS: Analysis of intake, follow-up, and last visit records. RESULTS: One hundred twenty active-duty U.S. Army soldiers were seen (394 clinic visits). Ninety-eight soldiers had one or more combat tours, principally in Iraq and Afghanistan. Posttraumatic stress disorder was diagnosed in 50.0% of the cases by the WTC telepsychiatrists. The majority of the soldiers had medical comorbidities, especially chronic pain (75.0%), in addition to mental health problems. Several of the soldiers were recovering from trauma (20.8%) and/or surgery (23.3%), 11.7% exhibited traumatic brain injuries, and 17.5% had headaches. Disrupted relationships (74.2%) were notable for non-family members, especially military cohorts such as other persons in the same WTC squad or platoon. CONCLUSION: The observations in this report come from a cross-section of soldiers who were triaged to meet WTC admission criteria. As this is the prototype VA-U.S. Army telepsychiatry collaboration, there are no comparative data at this time. The nature of the medical and psychiatric problems treated in the military WTC represents an index of the more severe combat trauma treated on military bases from ongoing combat operations and may predict future VA-U.S. Army collaborative telepsychiatry clinic experiences.

Theater Mental Health Encounter Data (TMHED): overview of study design and methods.

Research has documented higher risks for mental health problems among service members deployed to war zones, yet a research limitation has been that assessment has generally occurred often years after combat exposure. The Operational Stress Control and Readiness program integrated mental health practitioners with 1st Marine Division units serving in Iraq. This team documented mental health visits between January 2006 and January 2007 and developed the Theater Mental Health Encounter Database (TMHED). This report describes the TMHED study design, measures, and cases. Of 1336 patients (3180 patient visits), 10% were women, 75% were high school educated, 55% were mid-paygrade enlisted, and 63% were on their first combat deployment. Compared with the overall deployed population, patient percentages included higher percentages of Marines and Navy personnel but lower percentages of Army and Air Force personnel, more junior enlisted but fewer officers, and fewer college graduates. TMHED provides an unprecedented opportunity to study early psychiatric intervention in a combat zone and prospectively examines postdeployment health and career outcomes.

[Servicemen mental health monitoring in different stages of military service].

The effectiveness of psychoprophylactic work on each of military service basic stages and how to optimize it have been presented. The universal system of mental health monitoring in whole period of military service has been developed. A possibility of differentiated rapid assessment of mental status for effective monitoring of mental health has been analyzed. Some practical recommendations for the unit doctors in the principles of servicemen distribution by group of mental health level and taking the appropriate organizational decisions have been advised.

[From the history of the Kirov Evacuation Hospital N 1322 during the war].

During the Great Patriotic War in Kirov Red Army soldiers provided specialized psychiatric care. 24 June 1942 on the basis of evacohospital N 1322 was organized by the psychiatric ward. This department carries out all necessary psychiatric care until November 1945.

The acceptability of 'Trauma Risk Management' within the UK Armed Forces.

BACKGROUND: Trauma-support programmes may benefit employees of organizations that routinely expose their staff to traumatic events. However, in order for such programmes to be effective, staff need to find them acceptable. AIMS: To investigate whether Trauma Risk Management (TRiM), an example of such a programme, is acceptable within a military population and whether it is viewed as complementing or replacing pre-existing personnel support systems. METHODS: Semi-structured interviews were undertaken with serving Royal Navy personnel who had served on one of six ships, which had received TRiM training some 12-18 months previously. Three hundred and thirty interview transcripts were subjected to qualitative analysis and themed categories were generated. RESULTS: The majority of personnel who were aware of TRiM were supportive of its aims. TRiM was also viewed as supplementing other personnel support measures rather than replacing them. Personnel interviewed thought that TRiM practitioners needed to be carefully selected, supported by line management and to pay particular attention to the issue of confidentiality. CONCLUSIONS: The TRiM system appeared generally acceptable to military personnel and is seen to supplement rather than replace existing mechanisms. However, these data support careful selection of potential TRiM practitioners and demonstrate the need for senior management support for the system if it is to be accepted by those who might benefit from its use.

Transition from military to VHA care: psychiatric health services for Iraq/Afghanistan combat-wounded.

OBJECTIVE: Veterans from the wars in Afghanistan and Iraq (OEF/OIF) report high rates of mental distress especially affective disorders. Ensuring continuity of care across institutions is a priority for both the Department of Defense (DoD) and the Veterans Health Administration (VHA), yet this process is not monitored nor are medical records integrated. This study assessed transition from DoD to VHA and subsequent psychiatric care of service members traumatically injured in OEF/OIF. METHODS: Inpatients at a DoD trauma treatment facility discharged in FY02-FY06 (n=994) were tracked into the VHA via archival data (n=216 OEF/OIF veterans). Mental health utilization in both systems was analyzed. RESULTS: VHA users were 9% female, 15% Hispanic; mean age 32 (SD=10; range 19-59). No DoD inpatients received diagnoses of post-traumatic stress disorder (PTSD); 21% had other mental health diagnoses, primarily drug abuse. In the VHA, 38% sought care within 6 months of DoD discharge; 75% within 1 year. VHA utilization increased over time, with 88-89% of the transition cohort seeking care in FY07-FY09. Most accessed VHA mental health services (81%) and had VHA psychiatric diagnoses (71%); half met criteria for depression (27%) or PTSD (38%). Treatment retention through FY09 was significantly greater for those receiving psychiatric care: 98% vs 62% of those not receiving psychiatric care (x(2)=53.3; p<.001). LIMITATIONS: DoD outpatient data were not available. The study relied on administrative data. CONCLUSIONS: Although physical trauma led to hospitalization in the DoD, high rates of psychiatric disorders were identified in subsequent VHA care, suggesting delay in development or recognition of psychiatric problems.

'Lessons learnt from America'--Reflections from a fellowship examining the prevention, recognition and treatment of operational stress injuries in U.S. Army serving personnel.

These are my personal views and reflections from a hugely rewarding experience. They are not opinions or recommendations of the MOD or any other institution I am associated with. I realise that there may be various logistical reasons why my recommendations cannot be carried out; however I do hope that some will be able to be put into place. If nothing else I gained a massive amount from my travelling fellowship and it has already had a positive impact on my own clinical work. I hope to continue to pass on what I have learnt from the fellowship for many years to come. A special thank you goes to the Winston Churchill Memorial Trust for providing me with this fantastic opportunity and everyone who helped me before and during my visit.

Psychosocial buffers of traumatic stress, depressive symptoms, and psychosocial difficulties in veterans of Operations Enduring Freedom and Iraqi Freedom: the role of resilience, unit support, and postdeployment social support.

BACKGROUND: Little research has examined the role of protective factors such as psychological resilience, unit support, and postdeployment social support in buffering against PTSD and depressive symptoms, and psychosocial difficulties in veterans of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF). MATERIALS AND METHODS: A total of 272 OEF/OIF veterans completed a survey containing PTSD and depression screening measures, and questionnaires assessing resilience, social support, and psychosocial functioning. RESULTS: Lower unit support and postdeployment social support were associated with increased PTSD and depressive symptoms, and decreased resilience and psychosocial functioning. Path analyses suggested that resilience fully mediated the association between unit support and PTSD and depressive symptoms, and that postdeployment social support partially mediated the association between PTSD and depressive symptoms and psychosocial functioning. LIMITATIONS: Generalizability of results is limited by the relatively low response rate and predominantly older and reserve/National Guard sample. CONCLUSIONS: These results suggest that interventions designed to bolster unit support, resilience, and postdeployment support may help protect against traumatic stress and depressive symptoms, and improve psychosocial functioning in veterans.

Support of marines and sailors returning from combat: a comparison of two different mental health models.

As Navy medicine continues to support the Global War on Terrorism, various approaches are used to attenuate combat stress casualties. This article examines two different mental health models, one employed at sea and one in the combat zone, used for active duty forces immediately after cessation of combat operations. Both models focus on screening, early prevention, and treatment implemented during the transition from the combat theater to garrison. Returning by sea provided the opportunity for greater education and decompression of combat stress as the service members transitioned back to garrison when compared to those who returned by air. It was also found that the Post Deployment Health Assessment (PDHA) did not capture as many individuals with mental health issues leaving combat theater, which identified 6% on both missions, compared to the capture rate with the Post Deployment Psychological Screener (PDPS), which identified 16-20%. Limitations, opportunities, and recommendations for future interventions are discussed.

[Capabilities of telemedicine for solving tasks of psycho-prophylactic work among military servicemen of Air Force command posts].

The article is devoted to using of telecommunicational technologies for prophylaxis, diagnostics and treatment of psychic disorders by military servicemen of specialbuildings of command post of Air Force. Were defined main tasks of using telecomunicational net for improvement of psychic reliability of military operators during a combat duty. Was proposed a scheme of using forces and facilities of medical service in organization of psycho-prophylactic work with using telemedical technologies, was proved necessity of creation of coordination counsel in telemedicine.