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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.
Am J Psychiatry. 2009 Jul; 166(7):762-7.AJ

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+Show Affiliations

Charleston VAMC, Mental Health 116, 109 Bee St., Charleston, SC 29401, USA. Tuerk@musc.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19570938

Citation

Tuerk, Peter W., et al. "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." The American Journal of Psychiatry, vol. 166, no. 7, 2009, pp. 762-7.
Tuerk PW, Grubaugh AL, Hamner MB, et al. 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. Am J Psychiatry. 2009;166(7):762-7.
Tuerk, P. W., Grubaugh, A. L., Hamner, M. B., & Foa, E. B. (2009). 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. The American Journal of Psychiatry, 166(7), 762-7. https://doi.org/10.1176/appi.ajp.2009.08091315
Tuerk PW, et al. 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. Am J Psychiatry. 2009;166(7):762-7. PubMed PMID: 19570938.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Tuerk,Peter W, AU - Grubaugh,Anouk L, AU - Hamner,Mark B, AU - Foa,Edna B, PY - 2009/7/3/entrez PY - 2009/7/3/pubmed PY - 2009/8/15/medline SP - 762 EP - 7 JF - The American journal of psychiatry JO - Am J Psychiatry VL - 166 IS - 7 N2 - 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. SN - 1535-7228 UR - https://www.unboundmedicine.com/medline/citation/19570938/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_ L2 - https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2009.08091315?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -