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The survivor may even come see the event as a powerful life lesson. Judith Lewis
Herman (1997) adds, The belief in a meaningful world is formed in relation to others
and begins early in lifetraumatized people suffer damage to the basic structures of the
self. Their sense of self has been shattered and can only be rebuilt as it was built initially,
through connections with others (p.61).
W hat br eaks? Shay asks, When a soldier is broken by combat, what breaks?
(1994, p. 165). Examining this issue from a mythological perspective, Shay describes
multiple areas of the human being that are prone to breaking including feelings of
emptiness, hopelessness, and suffocating despair. He states that the broken spiritwill often a display hostile, mistrustful attitude toward world, disconnection with others,
chronic on-edge feeling, and impending feeling of doom. Shay warns that these
symptoms can be mistaken as borderline or antisocial personality disorder. While he
believes that normal is not possible, recovery is possible as survivors of severe trauma
adopt their own lives including their limitations with passion and existential
authority (p. 185).
T he b rok en s p irit . According to Wilson, The broken spirit is a metaphor for the
fracturing of the soul, self, and identity (2004, p.110). While the concept has had many
names (soul, self, life energy), the spirit is the core, inner sanctum of the ego and the self
of a person (p. 110). Wilson contends that when this human domain becomes
fragmented, it results in the loss of coherency and continuity in the being. What is
broken is the sense of connection with the critical dimensions of [human] existence
(ibid.). These include ones connection with the self and others, nature and the sacred,
hopes for the future and sources of meaning in life. Disintegration of these virtues (to
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borrow a term from Erikson, below) occurs when the self is shattered by trauma or
extreme stress.
The structure of the self unravels, dismantles, and reverts to regressive forms of primitive ago functioning at a rudimentary survival level. What remains arefragmented pieces of the self that can be devoid of energy, hope, trust and viablesystem of meaning (p. 119).
Wilson viewed the dialectic between cohesion and fragmentation as a continuum
for the posttraumatic self (p. 114). Following trauma, the individual will fall somewhere
along this continuum from extreme fragmentation of the self to higher levels of cohesion.
Wilson outlined several possible manifestations of this continuum from the empty self
characterized by significant disintegration of the identity, to the cohesive self which is
characterized by ability to spring back from trauma demonstrating resiliency. In
between, there are several variations of the fragmented self which is characterized by
traits of identity diffusion, fragility, and strong feelings of discontinuity within
themselves and with others and are prone to dissociation. Finally, the integrated
transcendent self denotes the person who has been fragmented by their experience, but
has healed and transcended the trauma through engaging in self reflection and efforts
toward self actualizing (p. 123). Frankl (1994) described this as active transcendence
in which the old self is shed and replaced with a new, more vital and functional, self (p.
131) which, once reassembled can become a new form of strength and beauty (p.112).
D evelo pmen tal th eory . Earlier we discussed developmental theory with regard to
assumptions about the initial identity or ego development processes that have been
completed by the adult service member prior to experiencing deployment stress.
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Revisiting this issue from a different perspective (not with regard to initial identify
formation but of developmental disintegration) Erik Eriksons Stages of Identity
Development (1980) provides a significantly relevant framework for understanding the
formation and transformation of the identity across the lifespan as well as a contextual
model for examining the disintegration of the Core Self.
At the point of early adulthood when most military personnel join the service, most
have navigated through the first five or six developmental stages and have achieved some
degree of the underlying virtues of those tasks (table 4). However, many are still in the
process of working through the stages associated with establishing industry
(competence), identity (self) and intimacy (relationships). The military can provide
opportunities for the individual to find a sense of purpose, bond with others and achieve a
sense of belonging and sense of self. However, experiencing extreme stress can
undermine and unravel the developmental tasks previously attained, shattering the
existing schema and resulting in developmental regression. In returning military
personnel, we often see signs of a breakdown of the fundamental virtues of previous
developmental stages.
ST AGE T ASK V IR TU E IN C R ISIS
Stage 1 Trust vs. Mistrust Hope Develop mistrust, paranoidworld view, loss of hope infuture
Stage 2 Autonomy vs. Shame Will Shame and doubt debilitatethe individuals ability tomove forward
Stage 3 Initiative vs. Guilt Purpose The person is unable toconnect with individual
purpose or meaning
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Stage 4 Industry vs. Inferiority Competence Individual feels incompetent,inferior undeserving and
judges self harshly
Stage 5 Identity vs. Role Confusion Fidelity Feels betrayed by group
Stage 6 Intimacy vs. Isolation Love Unable to connect with othersor feel belongingness
Stage 7 Generativity vs. Stagnation Care Self-absorption stagnatesdevelopment and healing
Stage 8 Integrity vs. Despair Wisdom Unable to find meaning inexperiences
T abl e 4
For the warrior who has experienced extreme stress or trauma, the core of their being
where these virtues reside, becomes fragmented and development regresses to earlier
stages. Of veterans, psychologist Erik Erikson stated, What impressed me most was the
loss in these men of a sense of identity. They knew who they were; they had a personal
identity. But it was as if, subjectively, their lives no longer hung together and never
would again. There was a central disturbance ofego identity (Erikson, 1963, p. 42).
A ros e b y an y oth er n ame There have been many attempts to identify and
describe the elusive domain of human existence we identify as the spiritual domain and
differentiate this facet of being from the physical and mental domains. The review of
existing literature, both professional, and general, use the terms spirit, psyche,
personality, soul, schema, ego, and self, interchangeably. To further confuse matters, the
terms soul or spirit carry deep religious connotations which lead to a much different
discussion entirely. In the interest of clarifying this ambiguous terminology, for the
purpose of this treatise I will refer to this domain as the Core Self. The Core Self will
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refer to the vital, dynamic, interconnected component of the whole being that represents
the Noetic (spiritual) domain of the individual. While ever changing and evolving as new
experiences are integrated, this domain represents a manifestation of the individuals
accumulated experiences, past and present. Within this realm is held the individuals
unique compilation of values, beliefs, faith, trust, preferences, motivation, love, esteem,
goals, ambition, and world view.
T rauma -I nduc ed Exist ential Dis -I nt egration Mod el (TI ED )
C linical D evelopm ent of t he TI ED Mod el.
The spiritual domain . Many theorists not only acknowledge that the spiritual
domain exists and have made attempts to describe it, they also suggest that this domain
can be injured or wounded, resulting in an array of emotional, social, and behavioral
outcomes. In my own quest to understand the phenomenological effects of war on the
soldiers and veterans with whom I work, I arrived at similar conclusions. I have
witnessed the way that the war experiences can injure individuals at the very core of their
being through my clients who have shared their struggles to understand the profound
changes that they feel in themselves. The prolonged experience of engaging in war can
lead to a wounding of the core self. While many refer to these wounds as PTSD, I have
come to believe that this wound is separate and distinguishable from the diagnosis of
PTSD and I propose that this phenomenon is a separate, but highly co-morbid, condition
that arises in response to the same etiological conditions. While PTSD is an anxiety-
based condition that manifests as a result of experiencing extreme trauma, I believe that
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what we have been missing is separate, spiritually-based condition that manifests as a
result of other aspects of the war experience. With several years of validated research to
support the criteria of PTSD, it is clear that many of our warriors today suffer from
reliving their traumatic experiences, hyper-vigilance, avoidance, and numbing related
specifically to traumatic events of combat. They suffer from nightmares, endure
flashbacks, and report that they are unable to shake the feeling of intense anxiety as if
they are on guard nearly all of the time. However, the diagnosis of PTSD by itself does
not accurately or effectively encompass all of the symptoms reported by returning service
members. Even though being deployed to a war zone (with the awareness of the potentialof trauma/mortality and focus on the mission) could certainly be regarded as a prolonged
stressor, meeting the criteria for consideration of the diagnosis of Complex-PTSD, many
warriors reports that they did not have a traumatic event during the deployment, yet
over 50% of patients seeking treatment have exhibited the DESNOS symptoms upon
their return (Ford, 1999). To address the leftover symptoms we must turn our attention to
humanistic and existential theory to delve further into examining the effects of trauma
and extreme stress on the core self and to provide a framework for understanding our
clients when they talk about feeling as if their very soul has become fragmented. Much
like the age-old Nature vs. Nurture argument, the field has been divided for generations
between regarding this constellation of symptoms as an anxiety-based or dissociative
disorder. When backed into a corner without many options, one tends to feel the need to
choose sides. Yet, as we step back to observe the whole picture (i.e. the whole person),
we begin to see that this is a complex three-dimensional issue, affecting every domain of
the individual body, mind and soul. It is impractical to continue trying to merge all the
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symptoms together under one diagnosis? What if we looked at it through two lenses
instead of one? When I started exploring this as two distinct, yet highly co-morbid
conditions, the components of the proposed model, Trauma-Induced Existential Dis-
Integration, began to fall into place.
Franklian P syc h ology . The underlying framework for this model is based
heavily on the tenets of Franklian Psychology (also known as Logotherapy). Developed
throughout the 20 th century by Viktor Frankl, Logotherapy (Logos referring to
meaning) is often referred to as the Third Viennese School of Psychotherapy. In
contrast to Freuds Psychoanalytic theories which postulate that human beings are
motivated by their quest for pleasure, or Adlers theories which emphasize a quest for
power, Frankl states that our greatest motivator is our quest for personal purpose or
meaning. Franklian Psychology rests on three basic pillars: life has meaning under all
circumstances; human beings are motivated by the search for their own unique meaning
in their lives; and, human beings have the freedom (and responsibility) to discover
meaning in all that they do or experience even in the face of great suffering (Frankl,
1988, p. 16). One of the assumptions present in Frankls theory is the observation that
suffering is inevitable; it is one characteristic of being human that we all share no matter
what our socioeconomic status, or culture. Statistically, 50 % of us can expect to survive
at least one traumatic event over the course of our lives (Meagher, 2007, p. 21). All
human beings will, at some time in their lives, experience what he called the tragic
triad of pain, guilt, and death (Fig 2). There is no human being who may say that he
has not failed, that he does not suffer, and that he will not die. (Frankl 1988, p 73).
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Figur e 2
S u ffe ri n g is i nev ita bl e: an o pp ortu n ity f or me an i n g . The assumption that all humans
suffer is an ironically comforting quality that allows a therapist who may not have
experienced war to emotionally identify with the clients experience of trauma, and can
connect with regard to the clients suffering since that is something we all share. It levels
the playing field, so to speak, and connects us with all others. It also normalizes
suffering as a uniquely human experience and validates the feelings associated with our
suffering. Another assumption made in Franklian Psychology is the belief that humans
are able to reflect on their suffering and strive to discover personal meaning in the
experience. Whether the traumatic event is sudden and unexpected, or prolonged,
Logotherapy recognizes that a person who has endured a profoundly stressful experience
may be injured in body, mind, and/or the spirit (noos). The third assumption inherent in
Logotherapy is the belief that human beings (in general) have within them, the ability to
rise above, overcome, and even grow from their adversity. We have built in ability to
adapt to our changing environment and to the stresses and circumstances of like out
adaptability acts as protection. (Meagher, 2007, p. 22). Franklian psychology
emphasizes the quest for meaning and enrichment of the strengths of the individual to
overcome tragedy, specifically addressing the injuries and healing of the spirit (noos).
Pain
DeathGuilt
TRAGIC TRIADcan lead to
Existential Vacuum& Despair
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Frankl differentiates between the emotional discomfort of searching for meaning which
he views as being a desired human trait, and the pathological emptiness or void he calls
the existential vacuum.(1988).
Struggling for a meaning of life, or wrestling with the question of whether thereis a meaning to life, is not in itself a pathological phenomenon. There is no needto feel ashamed of existential despair because of the assumption that it is anemotional disease, for it is not a neurotic symptom but a human achievement andaccomplishment (ibid., p.91).
I found this theory is especially relevant and applicable to understanding and addressing
the needs of our returning warriors, for whom a strong sense of personal meaning is so
prevalent in their lives. According to Frankl, emotional illness and depression is a result
of the individuals inability to find or create their own sense of meaning in life, leading to
an internal emptiness and disconnection with ones sense of personal meaning. The loss
of this personal connection with personal meaning or purpose causes a chain reaction of
existential crises, which leads to a shattering of the Core Self. What was once a cohesive
structure becomes fragmented or dis-integrated. This dis-integration affects the
individuals sense of who they are as a person (or who they once were); their individual
sense of purpose, and ultimately their ability connect with others or find meaning in their
new lives. According to Franklian theory, it is this ability to remain connected within
ones self in the face of adversity that leads the individual toward resiliency, recovery and
growth. He postulates that not only do all human beings share the experience of pain and
suffering, but that we all have the capacity of overcome the suffering through an
individual sense of meaning and purpose. Through his work with suicidal and
despondent patients who had lost all hope or desire to continue living, Frankl developed a
strong belief in the resiliency of human beings to overcome tragedy and adversity
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through this ability to create or find our own personal sense of meaning from these
challenging experiences in life. It is through embracing this sense of personal meaning or
purpose that provides the strength and determination to endure suffering and the
opportunity to grow as a person (Graber, 2004). Frankls theories were put to the test
when he, himself, was imprisoned in German concentration camps for three years during
the Holocaust. His determination to see his parents and wife again and to publish his
manuscript to bring his theories to the public fueled his determination to survive, even as
those around him were giving up. As the great philosopher, Nietzsche, declares He who
has a why to live can bear almost any how (2010).T ragic o p ti m ism. Frankl believed that the path to healing this disintegration of
the Noos was through reintegrating the parts of the self through meaning-making. He
postulated that there were three primary ways that human being create or find meaning in
their lives. First, the path to meaning making was through looking outside of, and
beyond the self. In fact, self-absorption was considered to be detrimental to finding
meaning and leads to pathology and despondency. It is through reaching outside of the
self through work, love, and/or experiencing nature/beauty, that we find our sense of self.
He referred to these components as the Triad of Optimism (fig, 3) (Frankl, 2006, p.111).
The Triad of Tragic Optimism:
Figur e 3
Love
BeautyWork
Meaning-Making
Growth & Resilience
Re-Integration
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The Triad of Tragic Optimism provides the means to discover or create personal
meaning. From this perspective, human beings actualize their potential meaning in life
by focusing on a cause to serve or another person to love rather than by focusing on the
self. Logotherapy encourages de-reflection (looking outside oneself) rather than hyper-
reflection (looking within the self) and believes that self actualization is not a goal - it
is a by-product derived from the activity of creating meaning. Frankl refers to this as the
transcendence of human existence (2006, pp. 110-111).
W ork . Personal meaning can be created or discovered through work or
generatively. Whether it is a job, a volunteer position, or creating something that is
meaningful, finding meaning through work or creation allows the individual to give
something of themselves to the world. The creation of this work gives their life purpose
and meaning and helps sustain in the difficult moments. For Frankl, he experienced this
first hand as he fought to retain his manuscript during his containment in the
concentration camps of Auschwitz. He was motivated to bring his theories to the world
to help others and this purpose often helped him endure the pain and suffering of the
concentration camp (2006).
Love. Another path to life meaning is through love and our relationships with
others. Our lives have meaning because we know that we are connected to another
person. We matter to someone else. Often we can endure suffering in order to see our
loved ones again or to be strong for them. Frankl also stated that his desire to see his
wife and parents again gave meaning to his struggle to survive each day in the
concentration camps. Our own personal life meaning is discovered through our
relationships and that knowledge that other people need us. I have spoken to many
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suicidal clients whose only reason for not attempting suicide is that it would hurt a loved
one (Frankl, 2006, p. 110).
B eauty . The third path to meaning in the Triad of Optimism is what Frankl
referred to as Aesthetics, also referred to as beauty or nature. This realm is personal and
unique. It represents the moments in life when we feel connected with nature and all
things. It may be through an increased awareness of the divine, or of our interconnected
relationship with nature seen through a beautiful sunset. Meaning turns suffering into
human achievement and accomplishment, motivating and empowering one to take
responsible action and leads to the concept of posttraumatic growth and resiliency (2006,
p.111).
T rauma -I nduc ed Exist ential Dis -I nt egration .
While the literature review presented thus far represents only a fraction of the
available material related to trauma, I feel that it is sufficient to establish the foundation
from which to discuss the need and development of a new conceptual framework. As we
have seen, attempts to define the post-trauma phenomena have had a long and varied
history, and have been riddled with controversy and confusion. Throughout generations,
service members returning from war and/or combat have reported similar symptom
clusters regardless what professional paradigms were prevailing at the time. Even today,
with decades of research validating the existence of PTSD, our warriors continue to
suffer with the same of debilitating symptoms as in previous generations and are still not
adequately defined, addressed or treated under our current guidance. We are a country at
war, and the numbers of service members who have already returned from war, and the
number who will be returning, are staggering. We have learned much over the years and
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generations of previous wars, but it is time to take our knowledge to the next level. I
believe we must take a serious and intentional look at the symptoms that do not fit our
current classification system, and attempt to understand how and why these symptoms
continuously hang together. Paradigms are changing and emphasizing a move toward
holistic treatment. Can we address the needs of our returning service members from a
holistic perspective and fill the gaps we are seeing in the field and translate to more
effective treatment?
The proposed model, Trauma-Induced Existential Dis-Integration provides the
framework needed to address the indentified gaps in our existing nomenclature andelevate our understanding of the existential effects of extreme stress and trauma on the
individuals who experience it. Integrating practice wisdom, clinical observation, and
multiple evidence-based theories, the proposed model provides a platform from which to
examine the elusive symptoms of extreme stress that are beyond the scope of PTSD,
while integrating these symptoms into an etiologically-based therapeutic model. Finally,
the model seeks to provide within its framework, the implication for treatment that
embodies an expectation of transformation, growth, and recovery taking treatment into
the realm of holistic care. Within the name, lies the framework for etiology, diagnosis,
and treatment and provides the nomenclature that will facilitate discussion and further
inquiry.
T rauma -I nduc ed (Etiology ): In accordance with the etiological assumptions for
Disorders of Extreme Stress Not Otherwise Specified (DESNOS), TIED is often seen in
people who have endured extreme, prolonged or severe trauma or stress-laden
experiences. However, it can be noted that people can experience TIED without a
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specific trauma event and that enduring extreme stress can bring about the phenomenon
of TIED. While this essay specifically focuses on the application of this theory to the
military population, war is not the only environment that may produce this phenomenon,
but is certainly conducive to the development of this condition. It is noted that this
phenomemon can be found in a variety of populations and people across the lifespan. A
hallmark feature for TIED is that an external experience triggers an internal existential
crisis during which the person begins to question their very existence, life meaning, and
future. This experience can involve an increased awareness of ones own mortality,
facing death, danger, or significant life change.
Exist ential (Symptmatology ): Based on the structure of the whole being as
postulated by Aristotle, Frankl, and others, TIED recognizes the existence and
importance of the Noos, or spiritual domain as a viable human entity referred to as the
Core Self. TIED recognizes that this domain can be wounded by experiences of
extreme stress which leads to an existential crisis or vacuum shattering the previous
sense of self at the core of ones being (values, feelings, beliefs, choices, purpose) and is
related to the persons sense of who they are, why they exist, why they made certain
choices, whether or not they matter, or make a difference. Existentialism is the branch of
philosophy conceptualizing the individuality of each persons quest to understand life and
his or her place in it through deriving meaning from life events. Based on my own
clinical observation, psycho-social assessments and attempts to diagnose returning
service members, along with the work of others such as Herman and van der Kolk, the
diagnostic criteria for TIED is similar to the symptoms outlined in the DESNOS criteria
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which has been validated by multiple studies. While DESNOS covers a wide variety of
symptoms, TIED specifically focuses on the following symptom clusters;
1. alteration in regulation of affect and impulses (Irritability, risk-taking,impulsive purchases, attempts to replace the lost meaning),
2. alteration in attention or concentration - (Hyper-reflection on self, obsessivefocus on changes to self, depersonalization),
3. alterations in self perception (Feeling permanently changed or damaged,Feeling that no one can understand, changes in Core Self virtues),
4. alterations in relations with others (Dis-connection or discomfortemotionally connecting with others, mistrust, paranoia, and
5. alterations in systems of meaning (Strained or lost sense of meaning or purpose, despair, hopelessness, loss of previously sustained beliefs).
Ample research is available to suggest the existence and prevalence of these symptoms
clusters among returning veterans in conjunction with the centuries of anecdotal reports
from previous eras of soldiers throughout time. TIED recognizes these symptoms as
central to the individuals discomfort and not associated features of another diagnosis.
In addition, while it is important for this constellation of symptoms to have a specific and
unique identity, it should be noted that experiencing these symptoms does not,
necessarily suggest the presence of pathology. The presence of a degree of tension
created in the moments in life that offer the greatest opportunity for meaning-making and
growth is considered by Frankl to be a healthy and natural sign of growth and resiliency.
All too often, the normal emotional reaction to the abnormal events of war,
separation, deployment, is considered to be pathological. However, while the discomfort
of this life crisis or existential vacuum may be normal, the person often needs guidance
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and reassurance to navigate through this process of re-integration. In addition, if the
person becomes stuck or stagnate in this existential vacuum, it can lead to serious
pathological problems such as depression, identity diffusion, and suicide. For the
individual, this is a process that spans a continuum between normal/functional to
pathological/dysfunctional. Pathology is based on the intensity and severity of the
individuals feelings of being disconnected from their core self and sense of purpose.
Dis -int egration ( N ormal, P at h ological & R ecov ery ): The concept that what
was once whole or connected is now fragmented and lacks cohesion or integration. This
dis-integration happens on many levels from the core of the being, to a connection with
the self, others, society, or higher sense of purpose or divinity. According to Dr. Charles
Figley, this injury is permanent in the sense that that the pieces will not go back together
exactly the way they were before (2007). Healing comes from the re-integration of the
fragmented components of the self to help the person become whole again. TIED
recognizes that the new self will be permanently changed by the experiences. This
change can be positive and can result in the individual becoming stronger and more
resilient than before. The goal of therapy is to support the client as he or she re-integrates
these fragments while deriving meaning from the experiences.
Fac e Validity - Addr esses C linical Obs ervation . Trauma-Induced Existential
Dis-Integration attempts to provide a diagnostic and treatment structure to address the
clients primary question, who am I now? A hallmark characteristic of this syndrome,
it is an indicator that the individual is trying to convey his or her awareness of the
profound changes and/or feelings of disconnection with ones core self and need for re-
integration. TIED recognizes that this is not the realm of the cognitive, or the physical, it
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is the realm of the spiritual self and can only be reached through exploration of existential
theory, particularly with Franklian Psychology, this model addresses this transformation
and sees it as a continuum from pathology to recovery.
The or etical assumptions . Embedded within the Trauma-Induced Existential
Dis-Integration model are the following assumptions adopted from other theories or
models presented. It assumes the existence of the Spiritual Domain as a very real, vital
and integral component of the whole. This domain is referred to at the Core Self. The
Core Self is the unique part of the human being that can be likened to the personality,
persona, ego or identity. Simply stated, it is who they are and who they know themselves
to be. The Core Self can be shattered or wounded by severe stress, trauma or extreme life
event. We assume that, prior to the experience of extreme stress; the Core Self was
integrated and functional (at least in the environment in which they were accustomed).
When the Core Self is wounded, it becomes dis-integrated, (as in, no longer
integrated). All of the Core traits that once formed a cohesive structure that was known
and comfortable to the individual are no longer integrated or cohesive. Fragments remain
of the Original self, along with fragments of new elements created from the new
experiences. The glue that holds the self together, or allows for resiliency during periods
of great stress or trauma is the individuals ability to create or discover meaning in these
experiences. An overwhelming of this process leads to an existential vacuum, which can
lead to despair and manifest into symptoms of extreme stress as outlined above.
Another assumption on which this model is based is that all humans will
experience periods of suffering in their lives and that we all have the potential capacity to
endure, survive, and even thrive in the face of great danger or adversity. This, of course,
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has been proven time and time again by everyday people. From war, the Holocaust,
crime, and natural disasters, people have a strength and determination to survive. TIED
assumes that the goal of treatment is to help the individual navigate their way through
this journey and reintegrate the fragments of the self with the new experiences leading to
transformation and growth.
Application : W h at do es t h is m ean for our military? Among returning
warriors, there exists a duality between those whose sense of Core Self remains
integrated as opposed to those who return dis-integrated. While both groups often
report having similar experiences during deployment, and both groups may report having
combat-related symptoms and readjustment challenges, the individual whose Core Self
remains integrated has an intact sense of self, ability to remain connected with others,
and has retained, or developed, a personal sense of purpose or life-meaning. Far from
being rigid, these are individuals who have integrated their life questions and war
experiences into a new sense of self. They appear to be much more resilient and able to
successfully reintegrate back into civilian life in spite of predicable anxiety and
readjustment issues. Whereas, the individual who returns with a fragmented, shattered or
disintegrated Core Self has much more difficulty deriving personal meaning from their
traumatic experience, becomes withdrawn and has disconnected from others, and has
difficulty re-integrating back into civilian life. These individuals display a high co-
morbidity with PTSD, Major Depressive Disorder, and other emotional/behavioral
conditions. They can be difficult to engage, have atypical responses to medication
management and traditional therapies, and express a myriad of bio-psycho-social
complaints. I have witnessed individuals in this group drift in and out of multiple
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treatment facilities and attempt numerous treatment modalities including a vast array of
medications, with little or no reported relief. As Dr. Tick astutely observes, You cannot
medicate the soul (2005, p. 116). This group often displays an increased risk for
dysfunction within multiple areas of life including interpersonal, emotional, vocational,
substance abuse, homelessness, and suicide. There are several aspects of military
services which lend our warriors to being more susceptible to this existential vacuum.
This is a volunteer fighting force. The warriors have chosen to serve and oftentimes, to
deploy. For some, this is a point of comfort and sense of personal choice and power, for
others this can increase the sense of guilt, remorse, and self doubt. Our soldiers arehighly trained, professional, intelligent warriors who have a deep sense of individual and
collective purpose and meaning to all that they do. These choices, strengths and
adaptability allow the Core Self to change and transform in order to survive. This
transformational process, with emphasis on the changes to the Core Self is outlined below
and summarized in table 5 on page 77.
O rigi nal C or e S el f . Prior to the experience of extreme stress or trauma (i.e. prior
to deployment), the individual is functioning with his or her Original Core Self intact.
Within this Core Self lies the sum total of the persons existence to this point. Past
experiences, previous learning, accomplishment of developmental tasks, previous abuse
or trauma, instilled values, belief system, hopes, dreams, preferences, motivations,
esteem, doubts, sense of self in the world and sense of meaning - all reside in a relatively
cohesive entity. While this entity is far from perfect, we will assume for the warrior
population, that it is generally stable and functioning, even with any possible deficits
such as previous trauma, abuse, or psychosocial issues. This persona often becomes the
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baseline to which later variations of the self will be compared. When they state, I am
not the person I used to be, they are holding the memory of this self in their mind, as
are their family members who cling to unrealistic expectations that the warrior will return
to the person they once had been. When preparing to go into battle, the Original Core
Self must transform from their civilian persona to the warrior persona in order to survive
and fulfill the mission. This transformation is adaptive and functional for survival yet,
ironically it is this powerful transformation, under the pressure of life and death
circumstances that creates such difficulties when a service member returns and tries to re-
integrate into their civilian life.
W arrior S el f. During the preparation for deployment the transformation from
civilian to warrior begins. First, there is the process of anticipatory separation from their
loved ones. They begin to plan and talk about their departure, and must face the
possibility that they may not return. They start emotionally separating long before the
geographic separation occurs. As they enter pre-deployment training cycles, they
begin to connect and bond with their battle buddies as the group motivation toward
fulfilling the mission is instilled. The bonds and connections that define the Original
Core Self, are loosened in order to assimilate and accommodate new demands. They
must transform to become an integral member of the group, troop, or battalion the
American Uniformed Services. This is an immensely powerful transformation since,
with this warrior identity, comes intense pride, patriotism, and purpose. The values of
life, death, freedom and safety lie in their hands. The individual must allow the
connection with their previous values, beliefs, and tendencies of the Core Self, to be
loosened in order to take on the values of the group and develop cohesion and the
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collective identity. The warriors life, the lives of their troop members and innocent
civilians depend on successfully making this transformation. When this happens, they
become more than just a member of a group, they become a part of something greater
than themselves. Something mythical, timeless they become warriors. This great sense
of purpose is something outside of themselves that they are willing to suffer, sacrifice and
die for. Their affiliation as a member of this group is seen and reinforced through the
powerful symbolic images of their uniform, the American flag, insignia, and their shared
credo (see appendix C). Throughout the deployment, they have the mission of holding
the countrys security, pride, and future, and the very life and death of countless battle buddies and civilians, in their hands. The values and beliefs of the Core Self and
previous connections with others are challenged, strained and even broken for the
individual to survive this abnormal life experience. This transformation challenges even
the most basic values forcing the individual to overcome ingrained human resistance to
kill by instilling a mission first, kill or be killed belief system (Grossman, 1996, p. 29).
This transformation is based on survival. There is an increased awareness that there is a
real element of perpetual danger and the warrior must be ready to put mission first and be
willing to die for the cause. Meaning and purpose of the group is greater than the
individual. Inside the individual, however there is a conflict between the values and
beliefs of the Original Self, and those adopted by the Warrior Self. Tim OBrien, a
combat veteran, describes this duality of within,
War has the feel the spiritual texture - of a great ghostly fog, thick and permanent. There is no clarity, everything swirls. The old rules no longer binding, the old truths no longer true. Right spills over into wrong. Order blendsinto chaos, love into hate, ugliness into beauty, law into anarchy, civility intosavagery. The vapors suck you in. You cant tell where you are, or why youre
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there and the only certainty is overwhelming ambiguity. In war you lose your sense of the definite, hence your sense of truth itself, and therefore its safe to saythat in a true war story, nothing is every absolutely true (OBrien, 1980 as quotedin Herman, 1997, p.53).
This quote provides a glimpse into the internal conflict and profound opportunity for
deep existential and philosophical questioning as everything they once knew to be true
begins to come apart. There is no external certainty, and therefore, no internal certainty
or cohesion. The existential experience can be similar for those who engaged in combat
and in those who were there in support and did not experience battle or traumatic
experiences. The mere fact that they were separated from their previous life and
relationships, and serving the same mission, still aware of their own mortality, and having
the time to ruminate on their life, purpose, goals and existence. I believe this helps to
explain why we often see a similar constellation of symptoms in those who did not
experience combat or trauma and therefore, would not meet the diagnosis of PTSD. They
may not exhibit symptoms of anxiety, but may return with many of the DESNOS
symptoms discussed earlier.
D is-I n t e grat ed S el f. Upon return from the deployment experience, the individual
carries with them fragments of the Original Core Self as well as fragments of the Warrior
Self but, neither of these adequately fit their new environment. The grip held on the
values, beliefs, and motivations of the Warrior Self must now loosen in order to
transform to meet new demands and to be able to reintegrate into civilian life. Previous
relationships must be renewed and the person must often (especially in the case of
National Guard and Reservists) return to previous neighborhoods and jobs. The person
struggles to re-integrate these pieces of the selves into a cohesive structure that meets
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the demands of the new reality. Their experiences and new knowledge must be
integrated into this new self as well. Horowitz explains this as a failure to re-schematize
inner cognitive maps of self and the world to accord with a new realityenduring
preexisting attitudes are in sharp discord with the experiences produced by traumatic
events (Horowitz, 1997) leading to what he calls Stress alarm (Horowitz 1999, p. 10).
Traumatic events impact on identity and may lead to a variety of self concept
disturbances such as identity diffusion (a chaotic sense of self fragmentation) or
depersonalization. Feeling disconnected and confused, individuals begin to judge
themselves, their actions and experience harshly leading to guilt and remorse. Theymay lose their connection with the powerful feelings of purpose and meaning that they
felt while in country. Upon return, they may have felt let down or even betrayed by the
group, unit, military or country and began to question what purpose their sacrifice served.
They may express that they think they may be going crazy and are sometimes afraid to
tell people for fear that these thoughts will be confirmed. They wrestle with values that
are so powerful and overwhelming that they feel no one could possibly understand.
Often, they have unrealistic expectations that they are supposed to return to the Original
Self, and when this does not happen, they feel a great deal of self doubt and fear about
who they are, or who they are supposed to be. Much of this transformation process is a
normal and natural part of being human. We are constantly learning, growing and
changing gradually meeting the tasks of development. But, for these individuals, too
much has happened too fast, under extreme conditions. This loss of self and purpose
leads to what Frankl called the existential vacuum. This is characterized by hopelessness
and despair. When the individual sees their goal as returning to the Original Self
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baseline, they will become fixated on the unrealistic attainment of this goal. This is often
reinforced by family members who were expecting the person to go back to being the
Original Self as well. A person fixated on themselves becomes hyper-reflective (focused
on their internal pain and suffering) which is in direct opposition to the path to healing
described by Frankl (1994, p.123). According to Logotherapy, the goal of treatment is to
find or create meaning by de-reflection (making connections outside of the self through
the Triad of Tragic Optimism). To begin to re-integrate the fragmented pieces of the self,
the person must become reconnected through reaching beyond themselves through their
work, experiences or relationships. Herman emphasizes that A secure sense of connection with caring people is the foundation of personality development. When this
connection is shattered, the traumatized person loses her basic sense of self (p. 52).
According to Lt. General Eric Schoomaker, Army leaders say that broken personal
relationships seem to be the most common thread linking suicides. "The one
transcendent factor that we seem to have, if there's any one that's associated with
[suicide], is fractured relationships of some sort" (Thompson, 2010). Clearly, the dis-
integration occurs first within the individual and then with the relationships, community,
work and finally, the self is dis-integrated with the world.
Re -I n t e grat ed C or e S el f. Many individuals have described experiencing a
profound, life-changing process during deployment or in the months of adjustment
following their return. Some turn to family, friends, clergy, or re-adjustment counseling
centers for support and assistance during this process. In addition to this existential pain,
many may also be suffering from PTSD and other emotional challenges and physical
injuries and pain. War wounds all part of the being and all must be addressed in a
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holistic model of care. These domains of body, mind and spirit (or Core Self) are
inseparable and intertwined. It is imperative that all three be considered in the holistic
treatment model.
Focusing on the Core Self (spiritual) domain, re-integration involves accepting
and embracing the fragments of both the Original Self and Warrior Self while realizing
that the end result of re-integration is a New Core Self. As Figley points out, the pieces
will not go back exactly the way they were, but can be whole again (Figley, 2007). It is
important for the individual to let go of the unrealistic goal of returning to the Original
Core Self in order to be able to move forward. New values, thoughts, feelings and beliefs
are re-integrated into a new cohesive structure and the person develops a connection with
new sense of life meaning or purpose. According to Frankl, the goal of treatment is
aimed at helping the individual discover or create meaning from their experiences and not
to fear the changes, but to embrace the New Self. Once the internal fragments are re-
integrated, the person is then able to genuinely connect with others. Conflict between
original self, warrior self, and new self has been resolved. The individual can become
stronger and more resilient than they had ever been before and may have better insight
and coping skills to deal with future stressors. There is a long tradition of this belief that
human beings have the potential to become stronger by overcoming adversity. Ernest
Hemmingway wrote, The world breaks every one and afterward many are strong at the
broken places (2010). Once re-integration is complete, the Core Self returns to a state of
homeostasis in which he or she is more at peace with their new identity and has
successfully assimilated the new knowledge and experiences into a new Core Self.
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T ransformation Mod el:
T abl e 3
Original S elf : Individual core-self is in homeostasis (below stress threshold)
Individual sense of core-self intact (I know who I am, what I feel,value & believe)
Individual sense of purpose intact (I know what I do and why)
Relationships (connections with others) are in homeostasis
Warrior S elf : Individual identity is replaced with group identity (unit identity)
The group identity and purpose becomes greater than oneself
Individual values and beliefs begin to be questioned if they conflictwith group
Faces the "Tragic Triad" daily (Guilt, Pain, Death) = ExistentialVacuum
Dis -I nt egrat ed S elf : Core assets of the self are questioned (values, beliefs, feelings, purpose)
Conflict between new thoughts, feelings, beliefs with originalself/warrior self
Fragmented sense of meaning and purpose
Discomfort engaging with others
R e-I nt egrat ed S elf : Conflict between original self, group self, and new self has beenresolved
Experiences have been reframed through meaning-making
The new values, thoughts, feelings and beliefs have been reintegrated
Person has developed connection with new sense of life meaning or
purpose
Person is able to connect with others
The individual is stronger and more resilient and has better copingskills to deal with future stressors
Identity (Self) returns to homeostasis
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Implications for T r eatm ent and R ecov ery
By reintegrating the spiritual domain back into the realm of the whole being and
truly offering a holistic model of care, we open many new doors to therapeutic
interventions that were once just out of our reach. I have experienced in my own practice
how powerful addressing this realm can be in a traditional therapeutic relationship. The
following points are ones I have discovered and lead my pracctices.
y Letting the patient know that we understand and share their pain, questions and
confusion is a wonderful step to leveling the playing field. We all suffer. We all
face adversity.
y Normalize this experience, let them know they are not alone (and that they are not
going crazy)
y Encourage exploration of these existential questions
y Focus on the strengths, and the future (time really does heal)
y Let them know that they are on a transformational journey and this is not the end,
it is just a temporary oasis
y Most of all, help them find meaning in their suffering, and a new purpose in life
Addressing these questions, giving it a language of its own and the permission to talk
about the changes to the Core Self), allowing them the opportunity to get to know
themselves again and possibly not fear this transformation or cling to unrealistic
expectations. This can lead to the concept of Post-Traumatic Growth (PT-G).
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P ost -T raumatic Gro w th & TI ED . Throughout time, human beings have proven
themselves to be resilient fighters and survivors of war, the Holocaust, natural and man-
made disasters, accidents, loss, and personal adversity. Throughout history, we have
risen to the demands of life with immense strength and determination. Where does this
strength come from? Do we strive for pleasure as Freud suggested, or for power as Adler
postulated? Ask a survivor of trauma or adversity what it was that helped them face the
suffering and they will tell you, in some variation, that they had some connection deep
inside the core of their being that allowed them to endure. Many will tell you that they
thought of loved ones or had to be strong for others. Through these connections, theyfound meaning in their difficult experiences. More than just enduring the experience,
many people report that, while they would not have chosen to have the trauma, they feel
that they are in some ways better for having had the experience. Research on this human
resiliency and concept of Post-Traumatic Growth is starting to emerge. According to
research conducted by Calhoun and Tedeschi (1999), posttraumatic growth refers to
positive psychological and personal changes that are produced as the result of an
individuals struggle with a difficult life circumstances that challenges their
understanding of the world and their place in it. These are not merely intellectual or even
emotional effects, and that is what makes them so powerful for many trauma survivors.
Posttraumatic growth is not simply a return to baseline from a period of suffering; instead
it is an experience of improvement that for some persons is deeply profound. According
to Calhoun, the clinician's role is to assist in the facilitation of meaning-making, and
reconstruction of schemas. Calhoun and Tedeschi (1999) have created a 21-item
assessment tool to help identify the qualities that are associated with Post Traumatic
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Growth. These qualities include; relating to others, personal strength, spiritual change,
and appreciation of life.
R esili ency . Another concept that is emerging in discussion, policies and
programs is the concept of resiliency. Research is also emerging with regard to using
resiliency programs as a preventative or protective measure within the military. Warrior
Resiliency and Family Resiliency programs are being implemented for deployed soldiers
and their family members with components being implemented before, during and after
deployment. This is being met with positive enthusiasm.
Logot he rapy . Franklian psychology provides a uncomplicated framework of theory and
therapy that specifically addresses the importance of meaning and purpose as a central
motivation in life. According to Frankl, having meaning and purpose in ones life gives
us a reason to live and endure hardships. Therapists are able to implement Logotherapy
within their existing therapeutic programming by offering their patients opportunities to
discover meaning through multiple therapeutic techniques and strive to reconnect with
others. These activities help the person focus on the future and re-integrate the
fragmented parts of the self.
C onclusion
The subject of post-deployment mental health has been a difficult and elusive
topic for generations. In my practice, and research, I have found myself traversing the
same paths as theorist, researchers and philosophers before me. In my review of the
literature I was shocked to find that others have been trying to resolve the issues related
to the diverse and debilitating symptoms that can destroy a person at the core of his or her
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Core Self. Struggling to find a framework in which to synthesize the symptoms that do
not fit the PTSD or other mental health diagnoses, and to try to understand what holds
these common symptoms together, the proposed model began to evolve.
The concept of Trauma-Induced Existential Dis-Integration (TIED) not only
provides a framework for the identification of individuals who may be at higher risk for
dysfunction (by examining the pervasive symptoms of existential crises). It also provides
an effective nomenclature by which we can discuss, research, and study the phenomenon.
In addition, embedded within the framework is the key to treatment and opportunity for
recovery by focusing on meaning-loss, meaning-making. This model goes beyond
anxiety, beyond behavioral conditioning, and beyond the physiological neuro-chemical
reactions to reach into the inner core where the shattered, dis-integrated self resides. If
we are to successfully provide holistic treatment, the injuries to this part of the
individual must be recognized, brought to light, and proactively treated. Once an
individual is able to heal the fragmented and dis-integrated parts of the self and able to
derive meaning from his or her experiences, the person is also better able to grow
stronger and more resilient from this experience leading to the concept of Post-Traumatic
Growth. Once the pieces of the inner self are re-integrated, the person can more wholly
connect with others and find meaning in life experiences.
Implications for Futur e
R esearc h . While this model is an example of evidence-based theory meets
practice wisdom, empirical research needs to be completed to further validate the criteria
and establish the validity of the theory that these symptoms are a manifestation of a
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wound to the soul. We are doing a great injustice to these individuals to misdiagnosis
them as having PTSD (in the current understanding of this anxiety based disorder)
Standardiz e nom enclatur e. When the diagnostic criteria for PTSD was finally
accepted and included in the DSM-III, it provided the language and criteria to standardize
the concept PTSD giving the field a common set of criteria with which to study the
phenomenon. The primary criteria has been validated time and again and has been used
to further the development of screening and assessment tools, and treatment modalities
with research on symptoms reduction. It is crucial to have an accepted name for this
condition that accurately describes the etiology, symptomology, progression and potential
treatment modalities and guide further research.
Develop scr eening tool . Many of the symptoms of DESNOS/TIED are very
disturbing and debilitating to the individual and can lead to severe despair, hopelessness
and suicidal ideation. Having a validated, effective screening tool would be helpful to
identify individuals who may be at risk and to help to determine the efficacy of programs
or treatment modalities.
T r eatm ent guid elin es. Once the existence of TIED are effectively validated,
screening and assessment tools are in place, research to determined effective treatment or
interventions can be developed to provide treatment guidelines that allow for holistic
care.
P r evention efforts . Understanding this transformational process as a journey can
link with other treatment and intervention programs to prepare individuals for the
experience of change to the Core Self. Resiliency training is starting to provide this care.
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Sp ecific to social work . Social work is accustomed to considering the person-in-
environment and are familiar with the need to treat the whole person. Social workers can
operate in the holistic realm; we focus on strengths, self-determination and personal sense
of meaning. Social workers have the unique opportunity and responsibility to help
define, identify and change the system to embrace a holistic approach. We must advocate
for the needs of our clients to be met through listening to their needs and developing and
implementing models of care that meet their needs. We need to help change the
expectations in the field from a paradigm of pathology to a paradigm of recovery.
Limitations
Work in progr ess . This is a work in progress. A thorough historical overview
has been completed that reveals a long history of wrestling with the diverse of elusive
needs of returning veterans. This is just a beginning and will hopefully continue to
evolve into a solid, validated theoretical and therapeutic model.
The ory -bas ed but not empirically support ed . While the basis of the model is
based on validated, empirically based models and classic theory, the model itself has not
been subject to empirical validation and study.
M eant to g en erat e discussion . At this point, this postulated theoretical model
has been presented and circulated through many avenues (professional conference, group
therapy sessions, and individual and family sessions, as well as being reviewed by
professionals in the field. This is meant to generate discussion and obtain feedback from
professionals and clients alike. Anecdotal feedback supports a high level of face-validity
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and support for the model. It is well received by clinicians, administrators, and clients. It
is easily understood and clients appear to be appreciative of the efforts to tell their story.
N ot an eithe r or, but a y es-and . It should be understood that I am not proposing to
change or eliminate the diagnosis of PTSD. I believe that we have a great deal of
validated research to support the PTSD (trauma-related anxiety disorder) criteria. I am
suggesting that we take a closer look at the symptoms that really do not fit in that
category and recognize the limitations of this diagnostic criteria to be an all
encompassing diagnosis for trauma experiences . As recognized by Judith Herman, what
we are seeing are, Two co-morbid manifestations of the same etiology effecting
different part of the self All are, in the end, inseparably connected (Herman p.32).
Summary . In my research, practice, and interviews, I found a common thread
among the individuals who were describing this pervasive sense of emptiness and dis-
integration at the core of their being. These individuals reported having lost (or were
questioning) a sense of purpose and meaning in their lives. Nothing had meaning they
had no purpose. Their sense of purpose and meaning in all things had broken down. In
some cases, they looked OK on the outside because they knew how to go through the
motions, but on the inside they were coming apart. They had no cohesion in the core of
their self (values, beliefs, thoughts, schema) were dis-integrated. Their sense of
relationships and connections were dis-integrated. Their very connection to the world
around them and their sense belonging to it was dis-integrated. In my practice, I have
found that the Trauma-Induced Existential Dis-Integration Model provides a framework
for building a bridge between the trauma dis-integrated state and recovery through the
activities of meaning-making and reintegration of the core self.
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While change is slow, it is it inevitable. Lessons learned from Vietnam include an
awareness of how deeply the wounds of the soldiers can spread to wound their families
and our society for generations. We are still feeling the generational effects of our poor
response to the reintegration and trauma needs of the Vietnam veterans and their families.
We have learned that early intervention and support is a key factor in successful
reintegration. Pretending there isnt an issue wont make it go away, and we either deal
with it now or deal with it later. Also changing is the realization that we have come a
long way, but we clearly have gaps in our understanding. It is hoped that this model will
serve to generate a forum and foundation for future study and research, and discussionand provide a glimpse into what the future could hold for true holistic treatment and
recovery from trauma.
Life does not owe you happiness it offers you meaning ~ Viktor Frankl
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R ef er enc es
American Psychological Association. (1952). Diagnostic and statistical manual of mental disorders . (1 st ed.) Washington, DC: Author.
American Psychological Association. (1968). Diagnostic and statistical manual of mental disorders . (2 nd ed.) Washington, DC: Author.
American Psychological Association. (1980). Diagnostic and statistical manual of mental disorders . (3 rd ed.) Washington, DC: Author.
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App endix A
C ompil ed List of C ommon Symptoms
DES N OS Diagnostic C rit eria
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C ompil ed List of C ommon Symptoms R eport ed by R eturning Warriors
C lassic P T SD Associat ed w ith P T SD and ot he r disord ers * = DES N OS
Disconnection with oneself *
Disconnection with others *
Guilt *
Remorse *
Shame *
Grief *
Rage *
Cognitive distortions and changes *
Feelings of worthlessness *
Increased risk of substance abuse *
Withdrawn from others, society *
Loss of time *
A/V hallucinations
Derealization *
Hopelessness (general) *
Suicidal Ideation or attempts *
Surreal Feelings *
Sleep Problems
Nightmares
Flashbacks
Hypervigilance
Avoidance of Stimuli
Driving/Road Anxiety/Rage *
Anxiety in Crowds
Trust Issues *
General Anxiety/Worry
Racing thoughts
Impatience
Low Tolerance Level *
Irritable *
Mood Swings *
Recklessness *
Crave/Seek Stimuli *
Adrenaline Rush
Euphoria
Risk Taking *
Anger & Rage *
Physical pain & ailments *
Denial *
Appetite Changes *
Fear of self
Poor Memory/forgetful *
Easily Frustrated *
Panic Attacks
Obsessive checking
Sexual difficulties
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Disord ers of Extr em e Str ess N ot ot he r w ise Sp ecifi ed (DES N OS ) C R IT ER IA:
I. Alteration in regulation of affect and impulse control: (A and one of B-F required)a. Affect regulation
b. Modulation of Anger
c. Self-Destructived. Suicidal preoccupatione. Difficulty Modulating sexual involvementf. Excessive risk-taking
II. Alterations in attention or concentrationa. Amnesia or
b. Transient dissociative episodes and depersonalizationIII. Alterations in self perception (two required)
a. Ineffectiveness b. Permanent damagec. Guilt and responsibilityd. Shamee. Nobody can understandf. Minimizing
IV. Alterations in relations with others (one required)a. Inability to trust
b. Revictimizationc. Victimizing others
V. Somatization
a. Digestive system b. Chronic painc. Cardiopulmonaryd. Conversion symptomse. Sexual symptoms
VI. Alterations in systems of meaninga. Despair and hopelessness
b. Loss of previously sustaining beliefs
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App endix B
Diff er ential Diagnosis Matrix
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Diff er ential Diagnosis Matrix
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App endix C
Soldi ers C r eed
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T he S ol d i ers C r eed
I am an American Soldier
I am a Warrior and a member of a team. I serve the people of the United States and live
the Army Values.
I will al w ays place the mission first.
I will never accept defeat.
I will never quit.
I will never leave a fallen comrade.
I am disciplined, physically and mentally tough, trained
and proficient in warrior tasks and drills. I always maintain my arms, equipment andmyself.
I am an expert and I am a professional.
I stand ready to deploy, engage, and destroy the enemies of the United States of Americain close combat.
I am a guardian of freedom and the American way of life.
I am an American Soldier.ARMY VAL UES
Loyalty Bear true faith and allegiance to the U.S. constitution, the Army, and other soldiers.Be loyal to the nation and its heritage.
DutyFulfill your obligations.Accept responsibility for your own actions and those entrusted t o your care.Find opportunities to improve oneself for the good of the group.
R esp ect R l th g ld l
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