Assessment and Treatment of Combat-Related PTSD in Returning War Veterans

Over the past 9 years approximately 2 million U.S. military personnel have deployed in support of Operation Iraqi Freedom in Iraq and Operation Enduring Freedom in and around Afghanistan. It has been estimated that 5–17% of service members returning from these deployments are at significant risk for combat-related posttraumatic stress disorder (PTSD). Many of these returning war veterans will seek medical and mental health care in academic health centers. This paper reviews the unique stressors that are related to the development of combat-related PTSD. It also reviews evidence-based approaches to the assessment and treatment of PTSD, research needed to evaluate treatments for combat-related PTSD, and opportunities and challenges for clinical psychologists working in academic health centers.     

The Evaluation and Treatment of Comorbid Pain and PTSD in a Military Setting: An Overview

The present article reviews the growing prevalence of comorbid pain and post-traumatic stress disorder (PTSD) in the military. This has been caused by the ongoing military conflicts in Iraq and Afghanistan, where new combat conditions/strategies are causing these comorbid conditions. Fortunately, comprehensive interdisciplinary treatment programs, originally developed for a civilian population and in academic settings, are being successfully "translated" or utilized in the military environment. Recent data demonstrating this translational clinical intervention are presented. Finally, challenges encountered when translating these interventions in a military environment are also discussed.     

Overvaluation of shape and weight among overweight children and adolescents with loss of control eating

Little is known about the phenomenology of pediatric loss of control (LOC) eating. Overvaluation of shape and weight, however, appears to be diagnostically meaningful among binge eating adults. We explored the significance of shape and weight overvaluation among children and adolescents with LOC eating. Participants (n = 526) included 149 overweight youth with LOC eating and 377 overweight controls (CON). Participants were categorized as those reporting at least moderate overvaluation (LOC-Mod, n = 74; CON-Mod, n = 106) or less than moderate overvaluation (LOC-Low, n = 75; CON-Low, n = 271), and compared on measures of eating-related and general psychopathology. LOC-Mod evidenced lower self-esteem than CON-Low, and greater behavioral problems than CON-Mod and CON-Low, but did not differ from LOC-Low in these domains. With the exception of LOC-Low and CON-Mod, all groups differed on global eating-disorder severity, with LOC-Mod scoring the highest. Overvaluation of shape and weight appears to be of questionable importance in defining subtypes of youth with LOC eating. However, as overvaluation and LOC eating each independently predicts eating-disorder onset, their confluence may confer even further risk for eating-disorder development. Longitudinal studies should address this possibility. Developmentally appropriate discussion about body image disturbance may be indicated in interventions targeting pediatric LOC eating and/or obesity.     

Pronouns and progress: a psychoanalytic primer

Psychoanalytic psychotherapists have the role responsibility to hover evenly over everything that is said--and not said--in the analytic situation. Pronouns may be worthy of special attention. Just as children demonstrate a predictable course in the acquisition and mastery of pronouns, it may be that the analytic patient also shows a predictable sequence in the deployment of pronouns over the course of a successful treatment. The analytic patient will move from a focus on "They," to joining the analyst in "We," before ultimately separating to become an "I." A third person focus in the opening phase, may, with familiarity, move to second person intimacy, ultimately yielding to first person agency. These grammatical markers occur in the opening, middle and termination/follow-up phases of a successful psychoanalytic treatment, during which the pre-morbid introjects are identified, chewed up, and, eventually nudged aside by the healthier therapeutic-introject, from which a new or renewed identity may emerge. Analysis of the Grimm's fairy tale "The Wolf and the Kids" illustrations the importance of metabolizing old introjects.