Patterns of mutual and nonmutual spouse abuse in the U.S. Army (1998-2002)

The pattern and severity of substantiated mutual and nonmutual spouse abuse between U.S. Army enlisted personnel and their spouses was determined for 1998 to 2002. The number of nonmutual and mutual abuse victims was equal in 1998, but by 2002 there were about twice as many non mutual as mutual victims. The rate per thousand of mutual abuse decreased by 58% while that of nonmutual abuse decreased by 13%. The rate per thousand of female victims was always greater than male victims for non-mutual abuse and the severity of abuse of female victims was always more severe than male victims. The active duty female had the highest risk of becoming a victim. These patterns of mutual and nonmutual domestic abuse in the U.S. Army suggest that prevention and educational approaches could be developed that would be useful to prevention specialists and to clinicians as the Army pursues avenues to reduce domestic violence.

Concealment of psychopathology in forensic evaluations: a pilot study of intentional and uninsightful dissimulators

Dissimulation is the concealment of genuine psychiatric symptoms in an attempt to present a picture of psychiatric health. In this pilot study, the authors set out to demonstrate that defendants may conceal psychiatric illness even in forensic settings, contrary to their apparent self-interest. They reviewed their records for forensic assessments of dissimulators and malingerers and classified dissimulators as "intentional" or "uninsightful" depending on whether their concealment of symptoms appeared to be a volitional act or driven by a lack of insight. Although there were obvious diagnostic differences, the only other significant difference between malingerers and dissimulators was that malingerers were more likely to be facing charges related to financial crimes. Uninsightful dissimulators were significantly older than were intentional dissimulators. Uninsightful dissimulators were also more likely to be psychotic, particularly delusional and schizophrenic, than were intentional dissimulators. While forensic psychiatrists are vigilant in attempts to detect malingering, these data suggest that they should be equally vigilant regarding the possibility of dissimulation. Although further study is indicated, it appears that dissimulators are a heterogeneous group.

Psychiatry in the Korean War: perils, PIES, and prisoners of war

In the initial months of the Korean War, very high numbers of psychological casualties occurred among American troops, 250 per 1,000 per annum. Initially, these men were evacuated to Japan or the United States, and very few of them were returned to duty. Then the principles of early and far-forward treatment, learned in the previous world wars, were reinstituted. Up to 80% of neuropsychiatric casualties were returned to duty. During and after the war, the prisoners of war were believed to have been "brainwashed," have "give-it-upitis," and exhibit apathy and depression. Mistakenly believed to be signs of moral decay, the psychiatric symptoms during and after release were probably a result of extended inhumane treatment and vitamin deficiencies.

Assessment of personality and crew interaction skills in successful naval aviators

PURPOSE

We were interested in studying a full range of successful aviators to discern which personality factors were present and whether these factors correlate with age, rank, and accumulated flight time.

METHOD

The Armstrong Laboratory Aviator Personality Survey (ALAPS) was administered to 312 designated naval aviators and flight officers from a variety of aircraft communities. The sample included O-3/O-4 elite aviators who were selected for their squadron billets based on superior performance, O-5/O-6 aviators selected for command positions, and 59 flag officers.

RESULTS

The junior aviators scored higher on the factor associated with Dogmatism and lower on the factor associated with Team Orientation and Socialness. This pattern was reversed for the flag officers, while O-5/O-6 aviators received intermediate scores on each of these factors.

CONCLUSIONS

The present study demonstrates a correlation between specific ALAPS factors and experience, rank, age, and flight time. The combination of high Dogmatism, low Team Orientation, and low Socialness in junior aviators could suggest lower openness to crew input and increased risk for mishaps.

[Nervous disorders and pithiatism in French soldiers during the Great War]

Nervous disorders due to war are known since antiquity. From 1915 young physicians wrote theses about this problem in military psychiatry. The question of hysteria breed many difficulties. Physicians of the time make a remarkable nosographical work during the sessions of the neurologic and of the psychiatric French societies, so as in their feature articles. Babinsky's term of "pithiatisme" comes back into medical vocabulary of WW I. The "torpillage" (a kind of electrical treatment), impels sharp controversies, but reveals to be a precious mean against malingering. Prs and Drs P. Marie, J. Déjerine, A. Léri, A. Souques, H. Claude, J. Froment, Cl. Vincent, H. Meige, G. Roussy, J. Lhermitte, G. Ballet and Babinski, mentioned their applied treatment, from psychotherapy to electricity, going by injections of bromide serum or isolation. Hysterical disorders were very important by number during this "drôle de guerre". They finally admit that they are bound to emotion.

[On the activities and influence of the British psychoanalysts during the Second World War]

The first part of this paper describes some of the activities of the members of the British Society prior to and during the Second World War, including the reception of the refugee psychoanalysts from Nazi Germany, preparations to deal with casualties, and plans for the reconstruction of the Health and Psychiatric Services after the war. The second part of the paper deals with the influence of those that they worked with in the armed forces, on the development of Psychoanalysis in Britain. The Author describes examples of the part played by Psychoanalysts and Psychiatric colleagues with whom they worked during the war, on the development War Office Selection Boards (W.O.S.B.'s), Civil Resettlement Units (C.R.U.'s) for returning Prisoners of War, and other caring facilities in Military Hospitals, and the influence of participation in these events on the decision of some non-analysts to become trained as psychanalysts.

The impact of posttraumatic stress disorder in military situations

The constant threat to life and gruesome sights and sounds of war take their toll on the soldier psychologically as well as physically. A significant number of war veterans suffer from a wide range of debilitating psychological symptoms that vary in duration. For some the symptoms are transient, while for others profound and prolonged psychological and somatic sequelae manifest in the form of posttraumatic stress disorder (PTSD) and other comorbid conditions. This article reviews current understanding regarding combat stress reaction--often the first indicator of psychological breakdown--and posttraumatic sequelae. The longer-term detrimental consequences of PTSD and the impact of secondary traumatization. reactivation, and delayed-onset PTSD are also addressed.

Living in history and ego strength

From his observations as a member of the U.S. Armed Forces during World War II, the author examines the relationship between the ability to form constructive historical identifications--to "live in history"--and ego strength. He surmises that the American soldier's failure to draw upon such identifications represents an ego weakness that resulted in a greater frequency and intensity of psychopathology during the war.

[Results and prospects of activities of military medical examination units in the Armed Forces of Russian Federation]

The role and place of military medical examination as one of the factors of national security in the system of medical support of the Armed Forces personnel is evaluated. National significance of military medical examination organs, legal and social character of medical expert conclusions which they draw is discussed. Characteristic of structure and dynamics of disease main indices causing difficulties in troop recruitment and servicemen discharge is given. Measures necessary for improvement of medical examination quality under modern conditions are mentioned.

Adaptation of immigrant psychiatrists from the former Soviet Union in the Department of Mental Health of the Israel Defense Forces

Psychiatrists from the former Soviet Union serve in the Department of Mental Health of the Israel Defense Forces. The new immigrant psychiatrists confront a wide range of difficulties during the process of integration to the military system and adaptation to the specifically military aspects of psychiatry. These include unfamiliarity with the military system, cultural clashes with the different groups of soldiers representing the various subgroups of the absorbing society, the psychopathology of soldiers, which is different from that seen in civil psychiatry, and the change in focus in the military mental health service, which emphasizes the importance of evaluating ego strength. Arbitrarily, one can describe four stages of adaptation that the immigrant psychiatrist has to pass through before recruitment and during service until adaptation and integration in the new role take place. Individual and group supervision are the main means by which the assimilation process is eased. The military service smooth the acculturation process and has an important role in helping the immigrant's adaptation to Israeli society and in building his or her professional identity.

Army psychiatry in the Korean War: the experience of 1 Commonwealth Division

This study seeks to investigate the incidence of psychiatric casualties in 1 Commonwealth Division during the Korean War. It had been hypothesized that these casualties were unusually low compared with earlier conflicts. Casualty returns and psychiatric reports were analyzed and showed that the war fell into two phases determined by the intensity of combat, which, in turn, influenced the nature of the psychiatric disorders encountered. Rates of acute combat stress were closely correlated with battle casualties, although not with total psychiatric admissions or nonbattle injuries. The limitations imposed on the psychiatric liaison service by the medical organization suggested that the incidence of psychosomatic cases, including cold injury, may have been unintentionally underreported.

Substance abuse and sexual trauma in a female veteran population

An increasing number of researchers have explored connections between substance abuse, posttraumatic stress disorder (PTSD), and sexual assault histories in civilian women. Despite literature suggesting the prevalence of substance abuse and sexual assault for female veterans, few studies have investigated these variables in a female veteran population. Thus, this paper was designed to provide preliminary information about this group of women. The results of this preliminary study suggest a high incidence of PTSD related to sexual trauma in a substance-abusing population of female veterans and a high incidence of substance abuse among female veterans who presented requesting help for sexual trauma. Suggestions for future study include examination of comparison samples of female veterans with and without PTSD and substance abuse across a variety of dimensions, including psychiatric symptoms, substance use, treatment utilization, and impact of treatment. Implications for assessment are highlighted.

Predicting discharge from Airforce basic training by pattern of affect

We compared the efficacy of the state form of the MAACL-R (Zuckerman & Lubin, 1985) in predicting success in Air Force basic training. Results of discriminant functions analyses showed that the Anxiety, Depression, Hostility, Positive Affect, and Sensation Seeking scales of the state MAACL-R efficiently predicted success in basic training. The need to incorporate state measures into studies of prediction is discussed.

Dual agency, dual relationships, boundary crossings, and associated boundary violations: a survey of military and civilian psychiatrists

We hypothesized that psychiatrists with high dual-agency potential (military and health maintenance organization [HMO] psychiatrists) were more likely than non-HMO civilian psychiatrists to engage in dual relationships, report pressures to do so, participate in other general boundary-crossing activities, and report associated counter-therapeutic outcomes (boundary violations). Ninety military and 191 demographically matched civilian psychiatrists reported the number of boundary-crossing activities (including dual relationships) and associated counter-therapeutic outcomes in the preceding year with adult patients. Military and HMO psychiatrists reported greater external pressures than non-HMO civilian psychiatrists to engage in dual relationships; however, all three groups were similar in their reported numbers of dual relationships. The reported boundary-crossing activities and dual relationships studied here are not necessarily associated with reported boundary violations. The relative risk of a particular boundary crossing associating with harm to a patient likely depends on the therapeutic context and should be determined on a case-by-case basis.

The Army psychological autopsy: then and now

The conduct and reporting of an Army psychological autopsy is a complex and relatively infrequent event. The details of these reports may not be completely clear to the behavioral sciences personnel tasked with collecting the data. This paper reviews the current status of the Army psychological autopsy and contrasts it with the development of civilian psychological autopsies. The current thinking of the Department of Defense Health Affairs working group on psychological autopsies is presented. The epidemiological content of the Army psychological autopsy as a scientific resource is presented in the form of an analysis of the psychological autopsies for the 1995 Army suicide data. Suggestions for updating this unique command tool are included.

Duty-related and sexual stress in the etiology of PTSD among women veterans who seek treatment

OBJECTIVE

The stressful experiences of women serving in the military have been a focus of increasing concern. A model of the impact of stress related to military duty and stress related to sexual abuse and harassment on the development of posttraumatic stress disorder (PTSD) among female veterans was evaluated.

METHODS

Structural equation modeling was applied to data from 327 women treated in a VA clinical program for women with stress disorders. The model was a chronological one and included variables related to the women's premilitary experience, their military service, and their postmilitary experience.

RESULTS

Altogether 48 percent of the sample served overseas, and 12 percent were exposed to enemy fire. A total of 63 percent reported experiences of physical sexual harassment during military service, and 43 percent reported rape or attempted rape. Both duty-related and sexual stress were found to contribute separately and significantly to the development of PTSD. Sexual stress was found to be almost four times as influential in the development of PTSD as duty-related stress. Postmilitary social support played a highly significant mediational role between sexual stress during military service and development of PTSD.

CONCLUSIONS

Women's exposure to sexual stress in the military is much more prevalent than previously believed. It is particularly toxic for the development of PTSD. Correct assessment is essential to effective treatment.