INTRODUCTION TO THE POST TRAUMATIC STRESS DISORDER: Written by David Barker in 1983, revised 1988, 1992, 2000.
Some people feel that personal experience is needed when dealing with PTSD cases, many others feel it is not a factor at all, just a situation. During my experience as a Veterans Service Officer, I have been told by an overwhelming majority of my PTSD clients that they relate better to a person who has actually experienced a stressor.
As a person who personally experienced a violent stressor, I have found it is easier for me to relate to a veteran who is under stress at the time. However, it has been my experience that the person who assists the claimant needs compassion and empathy as well.
Post Traumatic Stress Disorder Criteria:
Reference DSM III, DSM III-R and DSM IV.
The essential feature is the development of characteristic symptoms following a psychologically traumatic event that is generally considered to be outside the range of usual human experience.
The developed characteristic symptoms involve reexperiencing the traumatic event; numbing of responsiveness to, or reduced involvement with, the external world; and a variety of autonomic, dysphoric, or cognitive symptoms.
The stressor producing this syndrome would evoke significant symptoms of distress in most people, and is out of the range of such common conflict. The trauma may be experienced alone (rape or assault) or the company of groups of people (military combat). Stressors producing this disorder include natural disasters (floods, earthquakes), accidental man made disasters (car accidents with serious injuries, airplane crashes, large fires), or deliberate man made disasters (bombing, torture, death camps). Some stressors frequently produce the disorder (e.g. torture) and others only occasionally (e.g. car accident). Frequently there is a concomitant physical component to the trauma which may even involve direct damage to the central nervous system (e.g. malnutrition, head trauma). This disorder is apparently more severe and longer lasting when the stressor is of human design. The severity of the stressor should be recorded by professionals and the specific stressor is noted on Axis:IV.
The traumatic event can be reexperienced in a variety of ways. Commonly the individual has recurrent painful, intrusive recollection of the event, or recurrent dreams or nightmares during which the event is reexperienced. In rare instances there are dissociative like states, lasting from a few minutes, to several hours, or even days, during which components of the event are relived and the individual behaves as though experiencing the event at that moment. Such states have been reported in combat veterans. Diminished responsiveness to the external world, referred to as psychic numbing or emotional anesthesia, usually begins after the traumatic event. A person may complain of feeling detached or estranged from other people, that he or she has lost the ability to become interested in previously enjoyed significant activities, or that the ability to feel emotions of most types, especially those associated with intimacy, tenderness, and sexuality, is markedly decreased.
After experiencing the stressor, many develop symptoms of hyper-alertness, exaggerated startle responses, and difficulty falling asleep. Recurrent nightmares in which the traumatic event is relived and which terminal sleep disturbance may be present. Some have impaired memory and difficulty concentrating. Symptoms are often intensified when activities resemble the actual trauma (e.g. cold snowy weather or uniformed guard for death camp survivors or hot humid weather for Vietnam veterans).
Associated features: symptoms of depression and anxiety are common, and in some instances may be so severe as to be diagnosed as an anxiety or depressive disorder. Increased irritability, unexpected explosions of aggressive behavior, with minimum or no provocation. Impulsive behavior also can create problems such as unexplained trips, unexplained changes in life styles. Symptoms may begin immediately or soon after the trauma. It is not unusual, however, for the symptoms to surface months or years later following the trauma.
Impairment may be mild or affect every aspect of life. Phobic avoidance of situations or activities that resemble the trauma are common and often create occupational or recreational impairment. Psychic numbing often interferes with interpersonal relationships, such as family life. It often leads to self defeating behavior sometimes including suicide. Substance disorders are common.
The appearance of apparent psychotic symptoms are interpreted by many professionals as psychosis; but, are actual symptoms of PTSD in a normal person.

This is a chapter from my book The Combat Veteran From WWII to the Present which is upgraded for this forum.
DISGRACED BY OUR OWN

Early in 1990, one of my clients came into my office to discuss his VA claim for Post Traumatic Stress Disorder. After we reviewed the stressor letter regarding his being 50 meters from a falling helicopter, which exploded upon impact, killing all aboard, two on the ground (his comrades) and knocking the veteran several steps back while being singed by the fire from the blast; and, the VA stated: " that was not a life threatening situation, out of the normal range of human emotion", etc. He gracefully presented me a bill from the VA Out Patient Clinic in Columbus, Ohio. The bill totaled $129.00, including interest and fees, for his PTSD, which the VA had determined was non-service connected. Of course, we all know the VA had treated many veterans for nervous disorders for years with no mention of cost to the veteran. We have accepted that the treatment for a combat veteran, be automatic according to law, well, we were wrong. Even a combat veteran, with the proof and stressors to go with his proof, did end up paying for his treatments, prior to the claim being service connected.

Now some of our fellow comrades may think if the veteran makes enough money to be in category B or C, (now it is Priority Group 1 through 8) he or she should be able to afford the charges. Well, this is not necessarily true. Often, the veteran may have insurance the VA can bill for the treatment; but, not always. The veteran was disabled due to his PTSD in combat, and as a result his insurance was not in force at that time. He had been placed in category C (he would now be Priority Group 8 and not be enrolled!) by the VA due to his prior years income, which had ceased. Even if he still worked, the idea of the VA charging a combat veteran for PTSD treatments should make us ill. I asked one of my contacts in the VA why the charges could not be processed on the Agent Orange provision passed by the Congress (HR 1961 Radiation/Ionization- Agent Orange Act) and signed by former President Ronald W. Reagan. He asked: "could we do that? Agent Orange doesn't cause nervous problems, does it?" My response to him was there is scientific evidence that dioxin contamination creates anxiety problems in animals and possible in some humans. This was enough for a change in the policy at that time. I was then told: "we are going to have to change the Agent Orange processing of claims anyway, due to the new rules on what the VA will accept as Agent Orange residuals". This was stated to me by a contact who wished to remain anonymous, and to this day he still remains that way. Again, why subject a veteran to insurance claims and probably alert his/her employer to the fact he/she needs treatment for mental hygiene conditions and risk more prejudicial treatment at work and make it worse than it was before.

This veteran was finally rated as service connected for PTSD at 10%. This could be looked at in the context of DSM-IV, in advance. The veteran had witnessed the helicopter crash. He was not on the chopper, he witnessed the crash.

A terrible postscript: a veteran who is in Priority Group 8 cannot enroll in a VA PTSD program, unless they are already grandfathreed in the system. If they are fortunate enough to be eligible, they will be charged $50.00 per visit co-pay!.

I have a website with much information on PTSD and other veteran issues. Hopefully you will click on the link and visit. I have attempted to include my PTSD book "The Combat Veteran From WWII to the Present" in my other books. This work has helped many thousands obtain service connected compensation, as well as personal help in dealing with their stressors. I do not write in the technical sense many people desire and expect, I write in the same manner, as if we were in a conversation. It is there for your use.
http://www.geocities.com/dave_barker_amvet/index.html