Living with an OSI.

[Old Sweat]

I wonder how valid the theory about urbanization removing people from encounters with death or injury is, and thus inducing mental strain or even PTSD when finally they must face it.

At the risk of adding nothing but noise to the discussion, I grew up on a farm a long time ago. While the slaughtering and rendering of pigs ended while I was very small, I do remember vaguely one (dead, of course) being dipped into boiling water to soften the bristles prior to butchering. I have seen lots of chickens running around spurting blood after their heads had been chopped off prior to becoming Sunday dinner. Unfortunately I had to administer first aid to a friend who suffered a mildly disfiguring and very bloody face wound. By the time I joined the army three weeks after my 18th birthday, I also had shot my share of rabbits, grouse, rats at the local dump and pigeons. I am not sure any of that would have helped me if I had encountered the violent death of a fellow human being.

I do know when six of my troops were wounded by the premature detonation of an artillery round 15 metres outside the muzzle of one of my guns, everybody on the gun position remained calm and professional while administering first aid and arranging their evacuation. Nobody seemed to act oddly after the event, or at least no odder than usual.

 

[Armymedic]

Petamocto et all.
Your theory is flawed. It is not having previous experiences of death or gore, nor is it where you grew up.

It is all about (and I paraphrase) the sensation of overwhelming fear that accompanies the threat to ones life.

Please reread the except from the DSM-IV-TR which outlines the very first criteria for diagnosis:

"309.81    DSM-IV Criteria for Posttraumatic Stress Disorder
A. The person has been exposed to a traumatic event in which both of the following have been present:
(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) the person's response involved intense fear, helplessness, or horror."

One can kill all the animals they want, or witness all the blood and gore in the world, but if they do not fear for their own lives during those instances, then all those previous experiences are moot. It is the body's chemical response to all those hormones and physiological factors that somehow cause a person to develop PTSD. Nobody knows why this happens.

Hence the reason why there is no such thing as a "bullet proof" or "bullet resistant" mind. And why no other correlations have been found as to how to prevent people from developing the condition.

 

[dogger1936]

SFB
Thats a good explination. Even a few weeks ago  I would have disagreed with you, as I didnt think I was scared when I was hit. As actually  I was overly calm and told one of my superiors to "buck up" as I seen him taking cover as slightly "cowardice" at the time. seeing people I knew blown to bits and talking about starbucks green tea lattes.

Little did I know he was acting normal and my "heman" approach was my brain protecting itself. What appeared as overly calm and collective was actually my way of dealing with extreme situations.

As for this animal killing thing. I came from a town smaller than the current street I live on. 30 % of our food was killed "onsite" by us. However I never think of certain moose I've killed. I constantly remember the faces of the many people I've killed. What didnt bother me then sure plays on my mind now. I have killed and destroyed many families. And sure rational thought is they were taliban, fact is they were still someones children,some ones dad.

I also read all of grossmans books.

My life wasnt a shitshow until I got home for 5-6 months. I then dealt with it for dam near a year until it got too much.

 

[Greymatters]

Its a great definition and I dont think anyone is arguing with it.  I would however point out that the definition provided is a summary of current agreed medical opinion on how to define PTSD but does not provide all the variables that are not agreed upon.   

Correct me if this sounds wrong, but that definition says that it is entirely based on each persons perception of the event.  Perception is influenced by each persons unique past history experience training and knowledge, the same principles that acclimation is based on.  Acclimation means every person has different limit(s), a point at which they can no longer say 'Im not afraid' or 'that doesnt bother me', any point beyond which a person will experience PTSD. 

Alongside this, but completely seperate is that some singular events are so tramautic that no one has a mental defense against it, such as the death of a child from war, or crime, or vehicle accident.  That can and has shattered many people, even those who thought themselves 'bulletproof'.

Does that sound so different from the definition?

 

 

[SeanNewman]

Petamocto et all...your theory is flawed.

Nicely written!    I guess since I quoted the article I am supporting it in a way.

As per earlier pages though, it is not black or white.  The diagnosis part is not the same as pregnancy or AIDS when you have it or you don't, the diagnosis with PTSD comes when you get past a certain point.

It can be compared to a race, where it was decided that "If you cross the line in less than X minutes you will be diagnosed as slow".  I know that's a bit silly of a comparison, but really that's what it is.  The scale of OSIs ranges from no symptoms to some to more to a lot to all.

What that study was looking at (just like Grossman) was not whether or not you could keep everyone out of PTSD diagnosis (not possible), but what can you do to give people as many tools as possible to keep their slider to the left.

They didn't say that watching animals get killed when you are young will prevent anything, just that it lowers the probability of getting PTSD for gore-based reactions.  Prevent?  Of course not.  Reduce OSIs for stres/fear-based OSIs?  No.

 

[Armymedic]

Petamocto,

Posting the same incorrect info over and over again will not make you right. If you are quoting an article, then reference it.

The medical criteria as outlined, and quoted in page 5 of this thread, in the Diagnostic and Statistical Manual, Fourth Edition, Text Revision (which is THE BOOK for mental illness) for the DIAGNOSIS of of the CONDITION called Post Traumatic Stress Disorder is very defined.

If the diagnosis is not of PTSD, then perhaps it with fit one of the other diagnostic criteria for the plephany of mental disorders contained in the DSM-IV-TR. There is not any heading in this medical reference for "Operational Stress Injuries", and there definately is not any "scale of OSIs".

For medical clinicians who have to make the diagnosis, it does not get any more black and white.

And last time I checked your profile, it did not say you were one of those, so how about getting back into your own lane.

 

[SeanNewman]

SFB,

Normally I do not let people get under my skin, but you have managed to due to how wrong you are in your insistance that a PTSD diagnosis is not based on a scale.

Clinician-Administered PTSD Scale (CAPS)

Blake, Weathers, Nagy, Kaloupek, Charney, & Keane, 1995
Description
The CAPS is the gold standard in PTSD assessment. The CAPS is a 30-item structured interview that corresponds to the DSM-IV criteria for PTSD. The CAPS can be used to make a current (past month) or lifetime diagnosis of PTSD or to assesses symptoms over the past week. In addition to assessing the 17 PTSD symptoms, questions target the impact of symptoms on social and occupational functioning, improvement in symptoms since a previous CAPS administration, overall response validity, overall PTSD severity, and frequency and intensity of five associated symptoms (guilt over acts, survivor guilt, gaps in awareness, depersonalization, and derealization). For each item, standardized questions and probes are provided. As part of the trauma assessment (Criterion A), the Life Events Checklist is used to identify traumatic stressors experienced. CAPS items are asked in reference to up to three traumatic stressors.

The CAPS was designed to be administered by clinicians and clinical researchers who have a working knowledge of PTSD, but can also be administered by appropriately trained paraprofessionals. The full interview takes 45-60 minutes to administer, but it is not necessary to administer all parts (e.g., associated symptoms).

Scoring
The most frequently used scroing rule is to count a symptom as present if it has a frequency of 1 or more and an intensity of 2 or more. A PTSD diagnosis is made if there is at least 1 "B" symptom, 3 "C" symptoms, and 2 "D" symptoms as well as meeting the other diagnostic criteria. Severity scores can also be calculated by summing the frequency and intensity ratings for each symptom. Alternative scoring options have been devised and are described in Weathers, Ruscio & Keane (1999).

Sample item
B1: Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.

Frequency
Have you ever had unwanted memories of (EVENT)? What were they like? What did you remember?
IF NOT CLEAR: Did they ever occur while you were awake, or only in dreams? [EXCLUDE IF MEMORIES OCCURRED ONLY DURING DREAMS]
How often have you had these memories in the past month (week)?

0 Never
1 Once or twice
2 Once or twice a week
3 Several times a week
4 Daily or almost every day
Intensity
How much distress or discomfort did these memories cause you? Were you able to put them out of your mind and think about something else? How hard did you have to try? How much did they interfere with your life?

0 None
1 Mild, minimal distress or disruption of activities
2 Moderate, distress clearly present but still manageable, some disruption of activities
3 Severe, considerable distress, difficulty dismissing memories, marked disruption of activities
4 Extreme, incapacitating distress, cannot dismiss memories, unable to continue activities
Versions
In the past there were different versions of this measure corresponding to different time periods. The CAPS-1 assessed current and lifetime PTSD. The CAPS-2 assessed one week symptom status. These versions were then renamed CAPS-DX (for diagnosis) and CAPS-SX (for symptom). These two versions were later combined into the CAPS, which can be used to assess either symptoms or diagnoses. A version for children and adolescents (CAPS-CA) is also available.

References
Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., & Keane, T. M. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75-90.

Weathers, F. W., Keane, T. M., & Davidson, J. R. (2001). Clinician-Administered PTSD Scale: A review of the first ten years of research. Depression and Anxiety Vol, 13(3), 132-156.

Weathers, F. W., Ruscio, A. M., & Keane, T. M. (1999). Psychometric properties of nine scoring rules for the Clinician-Administered Posttraumatic Stress Disorder Scale. Psychological Assessment, 11(2), 124-133.

Additional Reviews
Orsillo (2001) p. 259.

Orsillo, Susan M. (2001). Measures for acute stress disorder and posttraumatic stress disorder. In M.M. Antony & S.M. Orsillo (Eds.), Practitioner's guide to empirically based measures of anxiety (pp. 255-307). New York: KluwerAcademic/Plenum. PILOTS ID 24368

CAPS Training
To learn about training to give a CAPS assessment, see CAPS Training Information.

http://ncptsd.va.gov/ncmain/ncdocs/assmnts/clinicianadministered_ptsd_scale_caps.html

 

[Armymedic]

Did you even read what you posted?

The CAPS is the gold standard in PTSD assessment. The CAPS is a 30-item structured interview that corresponds to the DSM-IV criteria for PTSD.

Those are the screening questions you ask to determine if the person fits into the DSM-IV criteria. In fact, the article even states this is so, the very area you yourself highlight.

A PTSD diagnosis is made if there is at least 1 "B" symptom, 3 "C" symptoms, and 2 "D" symptoms as well as meeting the other diagnostic criteria.

You are so ignorant about the subject you do not even know what you are trying to tell me.

 

[SeanNewman]

You are so ignorant about the subject you do not even know what you are trying to tell me.

You asked for references to show that a PTSD diagnosis was based on a scale and I them it to you.  I am not making this up and defending it as my own words, I am only showing you what is on the US Department of Veterans' Affairs website.

Am I saying that I know more than you on the topic?  No.  But I think I can trust them as a reference when the very test they use has the word "scale" in it.

Not sure what else can be written, and I'm not going to get into a p!ssing contest with you.  If you need to have the last word then by all means please do.

 

[Chico M]

Just my Two cents worth.

This year when seen by a psychiatrist...I was evaluated as per DSM IV - TR  as well as Axis I, II, III, IV, V.

That is all that was on the rather lengthy report as his assessment criteria.

Cheers  :yellow: 

 

[Bruce Monkhouse]

Petamocto, I know who SFB is and you arguing with him about PTSD diagnosis would be as stupid as I challenging you on Infantry tactics.......

 

[Fishbone Jones]

You asked for references to show that a PTSD diagnosis was based on a scale and I them it to you.  I am not making this up and defending it as my own words, I am only showing you what is on the US Department of Veterans' Affairs website.

Am I saying that I know more than you on the topic?  No.  But I think I can trust them as a reference when the very test they use has the word "scale" in it.

Not sure what else can be written, and I'm not going to get into a p!ssing contest with you.  If you need to have the last word then by all means please do.

Why is it that you constantly, on almost any subject, have to try and tell people that have years of experience,  that do these things for a living, that they don't know what they are talking about and that you, quoting some article ad nauseum somehow makes your opinion right. :

 

[SeanNewman]

Petamocto, I know who SFB is and you arguing with him about PTSD diagnosis would be as stupid as I challenging you on Infantry tactics.......

Hence the reason I have freely admitted that I know less about PTSD than he does.

Recce,

He asked for a reference suggesting that PTSD was diagnosed on a scale basis.  I gave it to him, and a rather credible reference at that.

Are you honestly that biased against me that you don't see that as fair play?  Am I not allowed to defend my argument with credible references, or would you prefer me to be kicked in the corner for your own amusement?

SFB,

Nowhere on here have I even implied that you don't know what you're talking about.  You simply asked for a reference and I posted one, that is all. 

I am interested in knowing how it is not based on a scale though, that's all you have to do to to sell me.  I know you have the background, and I know you have the experience.  But every reference I can find says that PTSD is not black and white, but a matter of making a diagnosis once the patient gets past a certain point.  Yes, at that point there is a clear distinction that he has it, but it's not like 10 seconds ago he had nothing and now he has full-blown PTSD.

 

[Bruce Monkhouse]

BACK ON TOPIC FOLKS!!!

 

[SeanNewman]

There are a large number of members here that could live, quite easily, with that scenario. Thanks for the visual, even if it's only in our imagination. 

 

[Kat Stevens]

Wow, this thread is really making my agent orange act up.

 

[Fishbone Jones]

Is that your own nine, or are they waiting for you to return it to the lockup?

 

[Armymedic]

You asked for references to show that a PTSD diagnosis was based on a scale and I them it to you.  I am not making this up and defending it as my own words, I am only showing you what is on the US Department of Veterans' Affairs website.

Reread the page you referenced. You referenced CAPS, which is an ASSESSMENT scale. It is a series of questions which, if answered a certain way, aid the clinician to support the diagnosis of PTSD because they specifically refer to DSM-IV criteria. There is no grading of PTSD. Either you have it or you do not.

In layman terms, the numbers on the bathroom scale to do not say you are obese, they just describe your weight. It is the interpretation of that weight, in the proper context which will say if you are obese or not.

 

[SeanNewman]

Is that your own nine, or are they waiting for you to return it to the lockup?

You know what, I would be willing to bet a large sum of money that if we ever met in person we would get along quite well (as would pretty much everyone on this board who posts regularly).

I will make the first step here because I am the junior on this site by saying that I am sorry if I have crossed you in some way in the past.

You could have jumped on the picture as your chance to finally ban me, but I appreciate that you saw the humour in it and I have gained a lot of respect for you because of that.

[/gayness]

 

[Fishbone Jones]

You know what, I would be willing to bet a large sum of money that if we ever met in person we would get along quite well (as would pretty much everyone on this board who posts regularly).

I will make the first step here because I am the junior on this site by saying that I am sorry if I have crossed you in some way in the past.

You could have jumped on the picture as your chance to finally ban me, but I appreciate that you saw the humour in it and I have gained a lot of respect for you because of that.

[/gayness]

Done