In this paper, we consider ethical issues related to the treatment of posttraumatic stress disorder (PTSD) in combat zones, via exposure therapy. Exposure-oriented interventions are the most well-researched behavioral treatments for PTSD, and rigorous studies across contexts, populations, and research groups provide robust evidence that exposure therapy for PTSD is effective and can be widely disseminated. Clinical procedures for Prolonged Exposure therapy, a manualized exposure-oriented protocol for PTSD, are reviewed, and we illustrate the potential benefits, as (...) well as the potential difficulties, associated with providing this treatment in combat zones. Several ethical considerations are identified: (1) Assuming successful treatment, is it ethical to send individuals with a known risk of developing PTSD back into combat? (2) If treatment is unsuccessful in theater (perhaps due to the confounding factor of ongoing danger), could that impact treatment effectiveness for soldiers who attempt therapy again post-deployment? (3) If the military finds combat-zone treatment effective and useful in maintaining an efficient work force, will treatment become mandatory for those diagnosed with PTSD? (4) What unintended consequences might be associated with large-scale dissemination of exposure therapy in or near combat, outside of mental health care infrastructures? (5) How would genetic variations known to be associated with PTSD risk influence decisions regarding who receives treatment or returns to combat? We conclude with a review of the personal and societal costs associated with not providing evidence-based PTSD treatments wherever possible. (shrink)

Treatment of military-related posttraumatic stress disorder is a major public health care concern. Since 2001 over 2.5 million troops have been deployed to Iraq or Afghanistan, many of whom have experienced direct combat and sustained threat. Estimates of PTSD rates related to these wars range from 8% to over 20%, or 192,000 to 480,000 individuals. Already, nearly 250,000 service members of Operations Enduring Freedom, Iraqi Freedom, and New Dawn have sought VA health care services for PTSD. This recent (...) increased need for mental health services comes in addition to the ongoing needs of Vietnam-era and other veterans who continue to suffer from PTSD. PTSD is related to high co-morbidities of other mental health difficulties, poorer physical health status, and increased medical care utilization. Such high demand for services is an important contributor to the large cost associated with combat-related PTSD. Accordingly, promoting successful, cost-effective treatment strategies for PTSD is a chief public health care priority. (shrink)

Religious leaders face numerous mental health challenges, and prior research suggests that some experience symptoms of post-traumatic stress disorder due to work-related experiences. This study employed a diverse sample of 274 religious leaders to qualitatively describe the types of work-related experiences they identify as particularly stressful or overwhelming, assess the prevalence of PTSD symptoms associated with these experiences, and test hypothesized associations between PTSD symptoms and narcissism. The study found that the stressful experiences reported typically involved relational conflict, (...) having limited resources, or caring for people suffering. Over half of the sample endorsed symptoms that were above the cutoff for a clinical concern for PTSD, and PTSD symptoms were significantly associated with symptoms of both vulnerable narcissism and grandiose narcissism. Practical implications for the ongoing formation and support of religious leaders are discussed. (shrink)

When someone is trying to teach us mathematics, he will not begin by assuring us that he knows that a + b = b + a. —Wittgenstein Wittgenstein reminds us that the avenue toward belief isn’t through logic alone. We do not know those things that we have only reasoning to support. We feel sure of those things which by experience, and belief have come to exist within us, with an ‘absence of doubt.’ To consider the impact of knowing on (...) behavior, it could be said that we act, from what we know. The purpose of this paper is to consider how we come to know on a multi-model level, as exemplified by both a semiotic theory base and a situated example of how the notion of an individual Umwelt can house particular ‘knowledge’ and act upon it. PTSD, or Posttraumatic Stress Disorder, is a diagnosis, which can be given when individuals suffer negative and long lasting effects that stem from traumatic experience. (shrink)

PTSD was formalized as a diagnosis by the American Psychiatric Association in 1980 with the publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM), 3rd edition. Since that time, the diagnosis has been widely utilized in the courts including the use in criminal proceedings. PTSD may play a role in the assessment of violent crimes both as a possible contributing factor in the perpetrators as well as a consequence in the victims. There are a number of (...) ethical and clinical considerations in the use of this diagnosis. Importantly, the diagnostic criteria have changed to a degree with subsequent editions of the DSM. This may have an impact on the interpretation of past legal judgments. Moreover, extensive psychiatric comorbidity may complicate the clinical picture, e.g., mood disorders, substance use disorders, or psychosis. The diagnosis of PTSD is still based on clinical, largely subjective criteria, e.g., biological markers are not yet utilized. As such, there may not be consistent agreement about the diagnosis among experts. This paper summarizes some of these relevant issues in adjudicating violent crimes. (shrink)

An alternative to objectifying approaches to understanding Post-traumatic Stress Disorder grounded in hermeneutic phenomenology is presented. Nurses who provided care for soldiers injured in the Iraq and Afghanistan wars, and sixty-seven wounded male servicemen in the rehabilitation phase of their recovery were interviewed. PTSD is the one major psychiatric diagnosis where social causation is established, yet PTSD is predominantly viewed in terms of the usual neuro-physiological causal models with traumatic social events viewed as pathogens with dose related effects. (...) Biologic models of causation are applied reductively to both predisposing personal vulnerabilities and strengths that prevent PTSD, such as resiliency. However, framing PTSD as an objective disease state separates it from narrative historical details of the trauma. Personal stories and cultural meanings of the traumatic events are seen as epiphenomenal, unrelated to the understanding of, and ultimately, the therapeutic treatment of PTSD. Most wounded service members described classic symptoms of PTSD: flashbacks, insomnia, anxiety etc. All experienced disturbance in their sense of time and place. Rather than see the occurrence of these symptoms as decontextualized mechanistic reverberations of war, we consider how these symptoms meaningfully reflect actual war experiences and sense of displacement experienced by service members. (shrink)

There are a number of considerations, including ethical and clinical or diagnostic factors, in utilizing the diagnosis of posttraumatic stress disorder in criminal proceedings. The reliability and validity of the diagnosis may be questioned. Legal precedent may consider extant diagnostic criteria for PTSD and comorbid diagnoses. However, these diagnostic criteria are often in flux considering new research findings. For example, the introduction of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric (...) Association, includes some changes in the PTSD diagnostic criteria. How will this affect interpretation of past legal judgments? Moreover, PTSD has significant psychiatric comorbidity, e.g., substance abuse, which in itself may influence violent behavior and its consequences. Some of these comorbid diagnoses also have changes in their diagnostic criteria. The introduction of biological tests in the assessment of PTSD will likely facilitate more objective diagnosis. (shrink)

In part one of this paper I discuss how issues of combatant misconduct and illegality have led military academies to become more focused on professionalism rather than on the tensions between military ethics and military training. In order to interrogate the relationships between training and ethics, between becoming a military professional and being a military professional, between military professionals and society, I turn to the work of Martin Cook, Anthony Hartle, and J. Glenn Gray. In part two I focus on (...) Cook’s analysis of the conflict between the self-understanding and the expected behavior of military professionals. In part three I focus on Hartle’s analysis of how the experience of alienation by military professionals can help to create the culture of military professionals. In part four I introduce a new theory of professionalism based on the existential and phenomenological philosophy of J. Glenn Gray, which can help us to better understand the philosophical and psychological stakes of what it means to become a military professional. I conclude in part five by suggesting that the most pressing issue in the military is not a lack of professionalism, but a lack of trust. (shrink)

The present paper contributes to the analysis and understanding of post-traumatic stress disorder from the perspective of Husserlian phenomenology. The particular approach taken integrates the experience of a ptsd trigger into Husserl’s descriptive framework of noematic constitution. By analyzing the constituent makeup of a particular object that acts as a trigger for ptsd symptoms, a descriptive account of how an ordinary noematic correlate becomes a pathological traumatic correlate is provided. This is done in three steps. First, the traumatic (...) correlate is shown to emerge by way of a judgment. Then, the role of the Ego will be examined to identify the point where the intentional relation between sufferer and traumatic correlate becomes pathological. Third, a phenomenological description of belief characteristics indicates the mechanism by which this pathology is maintained. I conclude by showing the connection between a phenomenological account of ptsd triggers and the current therapeutic practice of prolonged exposure therapy. (shrink)

ObjectivesThis study aims to systematically analyze the effects of mind–body exercises on post-traumatic stress disorder symptoms, depression, and anxiety in patients with PTSD. Furthermore, it intends to provide scientific evidence-based exercise prescriptions.MethodsChinese and English databases were used as data sources to search for studies on the effects of mind–body exercises on symptoms associated with patients with PTSD from January 1980 to November 2020. After a rigorous screening, 16 eligible randomized controlled trials were included in the meta-analysis.ResultsMind–body exercises exerted (...) a significant effect on PTSD symptoms [standard mean difference = −0.41, 95% confidence interval −0.64 to −0.19, p < 0.001], depression, and anxiety among patients with PTSD. Subgroup analysis demonstrated that 60–150 min per session for 8–16 weeks of mindfulness was more effective in improving symptoms in patients with PTSD under 45 years of age compared with other subgroups. For depression, 150–180 min of yoga exercises once per week was effective. For anxiety, the frequency, timing, duration, and type of mind–body exercises that are most effective in relieving anxiety in patients with PTSD cannot be determined at this time due to the limited number of eligible RCTs.ConclusionsMind–body exercises were found to be significantly effective in improving PTSD symptoms, depression, and anxiety in patients with PTSD. Therefore, they can be used as an adjunct to intervention for symptoms of patients with PTSD. However, this conclusion requires further confirmation through additional scientific and objective RCTs.Systematic Review Registration:Unique Identifier: INPLASY2020120072. (shrink)

This book deals with a series of problems associated with the contemporary psychiatric approach to trauma, encapsulated in the diagnostic category of PTSD, by means of a philosophical analysis inspired by the works of Jacques Lacan, Slavoj i ek and Alain Badiou.

Post-Traumatic Stress Disorder is a mental health condition in which the experience of a traumatic event causes a series of psychiatric and behavioral symptoms such as hypervigilance, insomnia, irritability, aggression, constricted affect, and self-destructive behavior. This paper investigates two case studies to argue that the experience of PTSD is not restricted to humans alone; we have good epistemic reason to hold that some animals can experience genuine PTSD, given our current and best clinical understanding of the disorder in (...) humans. I will use this evidence to argue for two claims. First, because the causal structure of PTSD plausibly requires reference to a traumatic conscious experience in order to explain subsequent behaviors, the fact that animals can have PTSD provides new evidence for animal consciousness. Second, the discovery of PTSD in animals puts pressure on accounts which hold that animal behavior can be fully explained without reference to subjective experience. (shrink)

Although post-traumatic stress disorder is now constituted by a set of characteristic symptoms, its roots lie in Post-Vietnam Syndrome, a label generated by a Vietnam-era advocacy movement that focused not on symptoms but on war’s traumatic context. When Post-Vietnam Syndrome was subsumed into the abstract, individualistic, symptom-centered language of DSM-III and rendered as PTSD, it not only lost this focus on context but also neglected the experiences of veterans who suffer from things done or witnessed, not primarily from what (...) was done to them, in war. This agent-related trauma has been rediscovered in contemporary work on moral injury, but moral injury too is increasingly subjected to the hegemony of the symptom. Focusing on symptoms, however, unhelpfully pathologizes and individualizes trauma, neglects traumatic context, and legitimates problematic therapeutic approaches. Trauma researchers and clinicians should decenter the language of symptoms and focus instead on context and on alternative accounts of trauma. (shrink)

This study investigates the relationship between moral stress reactions and resulting coping efforts in severely morally challenging situations. Long-term positive reactions and post-traumatic stress disorder (PTSD) indicators following morally challenging situations are also studied. The sample consisted of cadets and officers (n = 332) from Norway and Sweden. Long-term positive reactions were found to be associated with limited moral stress reactions during the challenging episode and frequent use of acceptance and positive reappraisal coping strategies. Long-term high scores on a (...) PTSD indicator scale covaried with high scores on Openness, a strong moral stress reaction, and frequent use of instrumental coping strategies. The main conclusion is that the immediate moral stress reaction and coping strategies following morally challenging situations appear to be related to both positive long-term reactions and to indicators of PTSD. (shrink)

Due to advances in medicine, a malignant neoplasm is a chronic disease that can be treated for a lot of patients for many years. It may lead to profound changes in everyday life and may induce fear of life. The ability to adjust to a new situation may depend on temperamental traits and stress coping strategies. The research presented in this paper explores the relationships between quality of life, PTSD symptoms, temperamental traits, and stress coping in a sample of (...) patients diagnosed with cancer. One hundred and twenty nine participants aged 24–81 years, 69 females diagnosed with breast cancer and 60 males diagnosed with lung cancer completed Formal Characteristics of Behavior – Temperament Inventory, Coping Inventory for Stressful Situations, PTSD Inventory, and Quality of life SF-36 questionnaire. Higher level of emotional reactivity and higher level of perseveration was associated with lower emotional quality of life. Higher level of emotion oriented-coping and higher level of avoidant-distracted coping was associated with higher level of PTSD symptoms. Emotion-oriented coping and avoidant-distracted coping are ineffective in dealing with stress in the case of patients diagnosed with cancer, because they are associated with a higher level of PTSD symptoms. The significance of temperamental traits for quality of life in the situation of the patients is marginal. Control of specific factors concerned with current health and treatment status is needed the future research. (shrink)

In this paper, we will attempt to describe an integrative model that links stress, trauma, and post-traumatic health disorders through biological, psychological, and behavioral mechanisms of influence. Each of these phenomena has its specificities but also shares common characteristics (sources, symptoms, and consequences) related to health and an individual’s functioning. Prolonged stress and sudden experiences can lead to trauma, and repeated experiences of trauma over time can result in the development of post-traumatic stress disorder (PTSD). This key mechanism illustrates (...) how long-term stress and trauma can lead to severe health impairment. A review of the literature on this topic, along with our many years of experience and research in these areas, reveals that the majority of authors in their research primarily focus on one of these topics, usually stress. There are fewer studies that provide a comprehensive representation of both stress and trauma. We have not come across any research that unifies all three topics in their presentation, highlighting the common elements as well as the specificities and differences. The aim of this paper is to demonstrate, through an integrative approach, the combined impact of these three phenomena on health and an individual’s functioning. First, we will describe each of these phenomena along with their respective specifications. Finally, we will attempt to integrate the knowledge of physiological and psychological mechanisms for dealing with stress, trauma, and post-traumatic stress disorder. Although challenging, we will also touch upon prevention strategies towards the end. (shrink)

With my research, I wish to contribute to the discussion of post-traumatic psychopathologies from a phenomenological perspective. The main question I pursue is to what extent PTSD can be understood as an intersubjective psychopathology and which implications this view might have. In this paper, I argue that the mode of perception allowing for intersubjective experience is vulnerable to disruptions through traumatic events. I begin with a short elaboration on what intersubjectivity entails before proceeding to illustrate how it can be (...) impaired. Then, I focus on the concept of empathy as a mode of perception: I propose that due to a disruption of the ability to empathize an individual suffering from PTSD may cease to experience the other as another subject that offers possibilities for interaction. The traumatized individual is thus unable to establish meaningful connections with others. I offer some implications this view might entail for thinking about trauma treatment. (shrink)

BackgroundAlthough a large number of clinical trials on interventions demonstrating efficacy (or lack thereof) are conducted annually, much of this evidence is not accessible to scientists and clinicians.ObjectivesWe aimed to determine the publication rate of posttraumatic stress disorder (PTSD) trials that have been registered in clinical trial registries, and the factors associated with publication.MethodsTrials, completed on January 15, 2015, were identified via the US National Institutes of Health clinical trials registry, the European Union Clinical Trials Register and the WHO (...) International Clinical Trials Registry Platform. A systematic search for publications (published by the end of March 2018) related to each of the registered trials were then performed.ResultsFour hundred and thirty-eight of 1982 potentially eligible trials were included. Only 34% of interventional trials were registered prior to initiation, 9% were registered within 2 months of starting and 20% after trial completion. Of the 438 included trials, 72% had generated peer-reviewed publications, while an additional 7% had disseminated results in some other form (such as on the trial database), 26 months after trial completion. Randomisation of a trial was the only factor individually associated with publication, in logistic regression analysis (p < 0.001). Intervention type, university as sponsor and study registration prior to completion were factors that influenced the time to publication, using Cox regression (p < 0.001).ConclusionsThis study underscores the importance of timely and accurate publication and dissemination of trial results, in order to avoid the potential waste of resources and to ensure research integrity and patient safety. We suggest that authors and journal editors adhere to conditions set out by the International Committee of Medical Journal Editors and that more diligent data sharing is encouraged through prospective trial registration and trial reporting websites. (shrink)

Merleau-Ponty and a Phenomenology of PTSD begins from the premise that trauma can be better treated if it is better understood. To that end, this book builds a prismatic account of trauma, encompassing neuroscience, psychology, and phenomenology in order to establish that trauma is an embodied, adaptive response to a world without meaning.

The aim of this study was to investigate the association between temperament and social support and the level of quantitatively rated PTSD symptoms in a sample of HIV+ and HIV/aids men and women. A total of 310 men and women, including 182 HIV+ and 128 HIV/aids, were studied. Social support was assessed with the Berlin Social Support Scales. Temperament was assessed with the Formal Characteristics of Behaviour - Temperament Inventory. Intensity of PTSD symptoms was assessed with the PTSDF. (...) The best predictors of intensity of PTSD symptoms in HIV+ participants were support seeking and sensory sensitivity. Support seeking was positively associated, and sensory sensitivity was negatively associated with intensity of PTSD symptoms. (shrink)

The aim of the present study was to assess the impact of past traumatic war experiences on preadolescents in the Gaza Strip, which could be useful for psychological intervention with current and future child victims. Participants were 521 preadolescents from United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) schools, aged 11 and 13 years old. Sections I to IV from Iraqi Version-Arabic of Harvard Trauma Questionnaire was used to assess trauma experiences and Post-Traumatic Stress (...) Disorder (PTSD). The results show that the preadolescents in the Gaza Strip witnessed the destruction of their homes and the murder of family members and friends. A quarter of the individuals assessed either suffered torture or witnessed others undergoing it, including sexual assaults. Almost half of them experienced a lack of food and clean water. The traumatic and torture experiences seriously affected preadolescents’ mental health as 26.29% met criteria for the diagnosis of PTSD. The data analysis revealed two PTSD modalities, with the severity of impact depending on whether social implications were involved. Further research is required to check whether these two modalities fit to PTSD and complex PTSD. Understanding the effects of past wars on preadolescents in Gaza and distinguishing between different PTSD types could enhance comprehension of the impacts of current attacks on child victims. It can also aid in determining the type of intervention needed to minimize the impact on the mental health of Palestinian youth, enhancing their resilience through psychological and social support. (shrink)

Growing numbers of women in militaries worldwide, coupled with vast segments of women within war-affected populations globally, raise questions about gender as it structures trauma exposure, posttraumatic stress disorder, and other mental health consequences of war. In this study, we investigate the gendered associations between early-life wartime stress exposures and PTSD symptoms in older adulthood using data from the 2018 Vietnam Health and Aging Study, a unique data set documenting multiple dimensions of health and wartime stress exposures within a (...) sample of older adults who occupied diverse roles during the American war in Vietnam. Our results indicate that the severity of recent PTSD symptoms is significantly and positively associated with the severity of wartime stress exposure among both men and women. Vietnamese men’s social positions, particularly their predominance in combat, exposed them to more numerous war-related stressors. However, Vietnamese women experience a greater PTSD penalty associated with some wartime stress exposures, likely due to the burden of protecting family in wartime and incorporation into military and paramilitary roles with lesser preparation, training, and support than men. We conclude that women who survive major wars, both as soldiers and civilians, bear a significant burden of armed conflict’s lasting toll upon mental health. (shrink)

BackgroundThe 11th revision of the International Classification of Diseases included two distinct trauma-related diagnoses—Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder. The initial diagnostic factor for both disorders is exposure to a traumatic event. This study aimed to explore whether exposure to different traumatic experiences distinguish risk for PTSD and CPTSD.MethodsThe study sample comprised 158 trauma-exposed participants, Mage = 33.61. The Life Events Checklist-Revised was used to evaluate trauma exposure, and the International Trauma Questionnaire was used to assess risk (...) for ICD-11 PTSD and CPTSD. Multinomial logistic regression was used to determine traumatic events as predictors of risk for PTSD and CPTSD.ResultsAnalysis revealed that sexual abuse experienced in childhood or adulthood was associated with both PTSD and CPTSD. History of other unwanted sexual experiences and childhood physical abuse predicted CPTSD compared to PTSD, whereas exposure to natural disasters predicted PTSD compared to CPTSD.ConclusionsThe results showed that experiences of certain traumatic events, such as sexual trauma, childhood physical abuse or natural disasters, might help distinguish risk for PTSD and CPTSD. Nevertheless, future studies on specific aspects of trauma exposure are necessary. (shrink)