title: Diagnosis and treatment of PTSD-related compulsive checking behaviors in veterans of the Iraq war: the influence of military context on the expression of PTSD symptoms.
abstract: This case study presents an overview of the conceptualization and treatment of two veterans of the Iraq War who presented for combat-related treatment at a Veterans Administration Medical Center. In addition to posttraumatic stress disorder (PTSD) symptoms of reexperiencing, arousal, and avoidance, the veterans exhibited compulsive checking behaviors that appear to be influenced by theater-specific combat duties and traumatic events. These cases represent what the authors believe to be an increasingly common expression of PTSD in veterans of the Iraq and Afghanistan wars. Both veterans were treated with prolonged exposure therapy, which includes imaginal and in vivo exposure to anxiety-provoking stimuli, processing of traumatic events, and self-assessment of anxiety. Treatment also included in vivo exposure with response prevention techniques borrowed from the literature on obsessive-compulsive disorder to address compulsive checking behaviors within the ecological context of each patient's symptom presentation. Measures related to PTSD and depression were obtained before, during, and after treatment. Treatment was associated with significant declines in symptom severity and improved functioning for both veterans. The unique nature of the conflict in the Middle East represents role challenges for soldiers that affect symptom presentation. Variations in symptom presentation can in turn complicate efforts to identify and appropriately address PTSD-related health concerns in this population. Thus, clinicians and researchers must remain cognizant of how theater-specific duties influence the manifestation and treatment of PTSD in order to provide optimal care to a new generation of veterans.
authors: Charleston VAMC, Mental Health 116, 109 Bee St., Charleston, SC 29401, USA. Tuerk@musc.edu
authors: Peter W
authors: PW
authors: Tuerk
authors: Anouk L
authors: AL
authors: Grubaugh
authors: Mark B
authors: MB
authors: Hamner
authors: Edna B
authors: EB
authors: Foa
mesh_terms: D000328:Adult; D015283:Citalopram / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data*; D009771:Obsessive-Compulsive Disorder / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000188:drug therapy*; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors