TIME Mental Health/Psychology

PTSD Is Linked to Food Addiction in Women, New Study Finds

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"Weight status is not just a symptom of willpower and education," a researcher says. "There may be psychological factors in play too"

A new study published in JAMA Psychiatry has found that women who suffer from the worst symptoms of posttraumatic stress disorder (PTSD) are twice as likely to be addicted to food than those who do not, Reuters reports.

Researchers link symptoms of PTSD in women to a psychological dependence on food, or food addiction. But the study doesn’t mean that there is a direct connection between PTSD and overeating.

“We don’t know if it’s causal. It’s an interesting relationship and probably worth following up,” Susan Mason, from the University of Minnesota in Minneapolis, told Reuters.

To find out whether women were more likely to have a food addiction, in 2008 researchers asked 49,408 female nurses about PTSD symptoms. A year later they then asked the same group about food addiction.

They found the more symptoms of PTSD a woman had, the more likely it was for her to be addicted to food.

The findings could help doctors treat women with eating disorders, reports Reuters.

“Clinicians may be able to look for that information to deliver better care,” Mason said.

Researchers still don’t know what occurs first — food addiction or PTSD — but they hope the study will help them connect the dots.

“I just want this to add to a lot of research that people’s weight status is not just a symptom of willpower and education,” Mason said. “There may be psychological factors in play too.”

[Reuters]

TIME Innovation

Five Best Ideas of the Day: September 11

1. National service is a critical American value that has the power to unite us.

By Condoleezza Rice and Robert Gates in Time

2. The challenge for America’s strategy against ISIS isn’t our military might. It’s the will of our partners in Iraq and Syria.

By Jeff Shesol in the New Yorker

3. After a decade of urban violence, blacks in America report PTSD symptoms at the same rate as veterans of our last three wars.

By Lois Beckett in Essence

4. Municipal buses move more than 5 billion people annually. Converting them to electric power would slash carbon emissions dramatically.

By Daniel Gross in Slate

5. To gather valuable health data from the poor, texting survey questions yields impressive results.

By the University of Michigan Health System

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Brain

Erasing Bad Memories May Soon Be Possible

Blank photo
Getty Images (1); Illustration by Mia Tramz for TIME

Using state of the art laser and gas techniques, scientists working with mice make stunning breakthroughs in turning bad memories into better ones

Memories are a complex combination of objective information—the color of a car, the size of a building—and less tangible emotional feelings, like fear, anxiety, joy, or satisfaction. But to scientists, memories are nothing more than a series of chemical and physical changes, the firing of a nerve here, which sends electrochemical impulses to another nerve there, which together encode everything that we associate with a memory.

But exactly what do those changes look like? And is it possible to override them? In a milestone paper published in the journal Nature, scientists may have provided some answers, explaining how emotional baggage gets attached to memories, and how that can be manipulated to quite literally turn bad memories good. In separate work appearing in the journal PLOS ONE, researchers say that a commonly used anesthetic gas, xenon, if administered at exactly the right moment, can also strip the painful and negative feelings associated with a traumatic memory, essentially neutralizing it.

The findings from both groups come from mouse studies, but the two teams are confident that the results will further efforts to understand and find new ways to treat depression and post traumatic stress disorder in people.

In the Nature study, Susumu Tonegawa and his team showed for the first time exactly where in the brain both positive and negative memories are created, and how these emotional layers can be switched around. They exploited a cutting-edge technique they developed called optogenetics to track an emotional memory as it’s made and also manipulated in the brains of mice. They studied both positive experiences—male mice were allowed to spend about an hour with female mice—and negative experiences—the mice were given mild foot shocks.

MORE: 5 Secrets to Improve Learning and Memory

First, the researchers administered a protein, called channelrhodopsin, into mice nerve cells that were activated during and immediately after those experiences (the positive and the negative). The protein reacts to a specific blue wavelength of laser light—and the scientists discovered that when that light was administered to the the part of the mouse’s nerve cells that fired up after those good or bad experiences, the emotion associated with the memory was relived as though it were happening all over again, even absent the stimulus that created it in the first place.

“Optogenetics for the first time allowed us to pin down the cells in the brain that literally carry the information for a specific memory,” says Tonegawa.

The real revelation came when the scientists tested how malleable the connection between the shock and the memory was. They allowed the shocked mice to spend time with females while their brains were hit with the blue light—which triggered their fear of the shock even though they didn’t get one. After 12 minutes of the laser exposure, the mice relaxed. But it wasn’t that they had replaced their fear with more pleasant feelings. Images of their brains showed that new circuits, presumably the ones associated with more positive feelings of being with females, had sprouted between the emotional regions of the brain and the memory center. Likewise, the mice that had had the pleasurable experience with their female counterparts were given the shock while exposed to the blue light, and now showed more fear and anxiety. The original emotional associations were not eliminated and replaced. Instead, says Tonegawa, the positive and negative circuits compete with each other, and whichever is dominant becomes the prevailing emotion linked to a memory.

MORE: This Is the Brain Circuit That Makes You Shy

That could explain how some psychotherapy currently works. To help depressed patients address their feelings, some therapists will revisit negative or emotionally painful experiences. Because memories are not recalled and returned in exactly the same way like a recording, any new information attached to that memory—such as more neutral or positive perspectives about the episode—can help to diffuse its negative impact. Tonegawa’s work in animals suggests that it’s possible to make that psychotherapy technique even more effective if therapists can help patients to focus on more positive feelings while reconsolidating painful memories.

That’s what another group, at McLean Hospital, is hoping to do with a much more simplistic strategy. Edward Meloni, an assistant professor of psychiatry at Harvard Medical School and Marc Kaufman, director of the McLean Hospital Translational Imaging Laboratory, found that the gas xenon, which is used in anesthesia (primarily in Europe), can neutralize the fear associated with a traumatic memory. Exposing mice that had experienced foot shocks to the gas dramatically reduced their fear behaviors – such as freezing up and avoiding areas associated with the painful shock – for up to two weeks. That’s because xenon preferentially targets certain receptors, called NMDA, on brain nerves that are concentrated in learning and memory regions. So when a traumatic memory is activated, those neurons involved in recalling that memory are prime targets for xenon, which blocks the cells from making their usual connections to the emotional hub in the brain known as the amygdala. “My speculation is that xenon lessens the impact of the emotional component, the real emotional pain associated with a traumatic experience,” says Meloni.

MORE: Memories Can Now Be Created — And Erased — in a Lab

It’s not clear yet whether the gas will have similar effects on long-standing traumatic memories such as those involved in PTSD, but Kaufman and Meloni plan to set up a human trial as soon as possible. Ideally, says Meloni, if xenon proves to be effective and safe for reshaping memories, patients who experience debilitating nightmares would be able to give themselves a squirt of xenon just as they would use an asthma inhaler. Since the gas dissipates quickly, so far there doesn’t seem to be a reason to worry about other potentially harmful effects on the brain.

And what about situations that don’t quite reach the level of PTSD, but are traumatic nonetheless, such as the death of a loved one or a bad breakup? “In general I think those painful experiences are probably not going to be impacted by xenon because there really isn’t a specific memory that is reactivated, like a flashbulb moment of trauma,” he says. “It’s more a global heartbreak.”

Because xenon isn’t specific to blocking the negative connections to the brain’s emotional nexus, Kaufman says it’s possible the gas could also be helpful in reducing the highs and the reward sensation associated with addiction. More studies will need to show that xenon could play a role in those situations as well, but both he and Meloni are optimistic. “We’ve got a good start in animals, and as we work through the ladder in getting it to people, I’m hopeful,” says Meloni.

TIME politics

Montana Senator’s Plagiarism Scandal Has a Silver Lining

John Walsh
Sen. John Walsh, D-Mont., speaks during an event in the Capitol Visitor Center on the importance of the Land and Water Conservation Fund, July 23, 2014. Tom Williams—CQ-Roll Call,Inc.

Sen. Walsh's mental health may have nothing to do with lifting from other scholars, but the acknowledgement of PTSD and depression reveals a changing moment in politics.

Sen. John Walsh (D – Montana) is being accused of plagiarism for failing to properly cite the work of others in the master’s thesis he wrote while at the Army War College in 2007. Indeed, it has been widely reported that as much as a quarter of what the senator wrote—and presented as his own work—may have been the ideas and/or words of other prominent experts on Middle East policy.

When asked about this apparent transgression, Sen. Walsh stated that he believed he had done nothing wrong. He didn’t recall using sources improperly, but he is considering apologizing to scholars he failed to cite. A campaign aide for the senator acknowledged the plagiarism, but indicated that Sen. Walsh did not intend to deceive anyone and that his actions should be viewed in the context of a successful military career during which he was a highly decorated officer who served with distinction in the Montana National Guard. The aide noted that Sen. Walsh was going through a difficult period in 2007. One of the soldiers from his unit in Iraq had committed suicide during this time. The senator has acknowledged that he is being treated for post-traumatic stress disorder. He is currently taking antidepressant medication as part of this treatment.

We can’t know what Sen. Walsh intended when he failed to include citations for ideas that were not his when he wrote his thesis seven years ago. One indication of whether this act represents a flaw in the senator’s character, a lapse in judgment, or a failure to understand academic standards and practices is to look for a similar pattern of behavior—or lack thereof—across his life and career. Those on both sides of the political spectrum will be doing just that as this story unfolds.

Some are asking if there is a relationship between PTSD and plagiarism. There is none—at least not a direct one. There is, however, a clear relationship between the experience of trauma and possible impairment across a number of areas, including cognitive and emotional functioning. The relationship is even stronger if you experience repeated trauma. Imagine driving to work and having a head-on collision on the highway. Miraculously you walk away with no physical injuries, but others around you die. Imagine that this happens to you not once but several times over the course of several months or a year. You begin to have difficulty sleeping, concentrating and focusing. You might feel depressed, you might have flashbacks, and you most certainly will have guilt and possibly shame. Could this experience of repeated trauma affect your judgment or your ability to process information critical to your success in your relationships, at school, or in your career? Absolutely.

Though the consequences – if any – of Sen. Walsh’s actions in 2007 are yet to be determined, it is important that we continue to have conversations and discussions about the very real impact that trauma can have on someone’s long-term functioning. We need these discussions not because we should excuse behavior that is inappropriate, unethical or criminal, but because one in four Americans suffer from diagnosable mental health conditions, along with the trauma that often creates those conditions. Sometimes war causes these injuries, sometimes a natural disaster, or a rape, or an assault. Sometimes it is a bad role of the genetic dice that leads to significant impairment. Isn’t it better to discuss these issues openly and, by doing so, encourage appropriate care and relieve unnecessary suffering?

Perhaps one silver lining resulting from the last 13 years of war—and many tragic stories of those who have struggled upon their return from battle—is that we as a nation are becoming a bit more comfortable with the topic of mental health. Until now, few if any politicians or other public or military officials have been willing to admit they have a mental health issue, let alone suggest it may have clouded their judgment. Perhaps we are more willing to entertain the possibility that the cause of someone’s behavior just might be a bit more complicated than we think. After all, mental health is a part of the human condition. We all experience it, and sometimes the difference between being mentally sharp and healthy or not depends on whether we swerve the wrong way, are born with the wrong DNA or watch a buddy die in combat.

Barbara Van Dahlen, named to the TIME 100 in 2012, is a licensed clinical psychologist and the founder and president of Give an Hour. A notable expert on the psychological impact of war on troops and families, Dr. Van Dahlen has become a thought leader in mobilizing civilian constituencies in support of active duty service members, veterans and their families.

TIME politics

Veterans Affairs Needs to Get a Clue About PTSD Treatment

Veterans
Iraq war veteran Zach Choate, 26, leads a group of veterans to a rally on the steps of Russell Building to call for a end to the redeployment of troops who have diagnosed with Post Traumatic Stress Disorder (PTSD). Choate was redeployed while still recovering from wounds inflicted by an IED. Tom Williams—CQ-Roll Call,Inc.

Some medical centers may have a goldmine of PTSD data, which could help improve treatment. If only the department could get its act together.

Both the Departments of Defense and Veterans Affairs spend huge sums every year to treat post-traumatic stress disorder: $294 million and more than $3 billion, respectively, in 2012. But does the treatment help? According to a new congressionally mandated, 300-page report from the Institute of Medicine, neither the Pentagon nor the VA—the two agencies responsible for providing PTSD treatment to soldiers and veterans—have a clue.

The investigating committee found “spikes of excellence in both departments,” said its chairman, Sandro Galea of Columbia University’s Mailman School of Public Health. It also identified “tremendous variability in how care is implemented and an absence of data that tell us if programs are working or not.” Overall, the modest data that do appear in the IOM report are not particularly encouraging.

Members of the expert panel visited some of the VA’s Specialized Intensive PTSD Programs, or SIPPs, which are inpatient or residential programs of up to four months. They reviewed the results of all 39 such programs during 2012 and found that, after four months of treatment, the average patient still qualified for a diagnosis of PTSD.

This isn’t entirely surprising. The VA learned in the 1990s that their 16-week specialty inpatient programs were ineffective, and closed them down. Under political pressure in the 2000s, they started them up again.

But there might be good news—if only we could demonstrate it. After all, the majority of PTSD patients in the VA are not treated in inpatient or residential settings, but as outpatients. Presumably, these patients are better off than those referred to intensive programs.

So how do they fare? Are they better able to benefit from state of the art cognitive-behavioral therapies, such as prolonged exposure and cognitive processing? Clinicians routinely use these interventions to good effect in treating PTSD among civilians. We have every reason to expect that, in most cases, these therapies–in conjunction with psychotherapy and couples or family therapy or medication—have indeed helped veterans.

In any case, the IOM says there are no data. Well, not quite. While not reliably collected across the entire VA health system, there is some tracking information on treatment outcomes. For several years, the VA has required clinicians in every VA medical center to complete a PTSD Checklist (PCL) for each patient every 90 days. The PCL provides a total symptom severity score.

This enables clinicians to track changes in symptoms and establish the optimal frequency of therapy sessions, according to Ron Acierno, former director of the PTSD Clinical Team at the Ralph H. Johnson VA Medical Center in Charleston, S.C. Acierno and his team conducted routine PCLs, though how consistently and completely the surveys were administered at other VA medical centers is unknown.

In medical centers that do comply with the VA mandate to collect PCLs, there may well be a small goldmine of data to be excavated. With this information, we could answer immediate questions about the improvement of veterans’ symptoms and functioning. We could begin to learn what kinds of outcomes we see for younger veterans of the post-9/11 era and Vietnam veterans whose wartime experience is now several decades ago. Yes, Vietnam veterans are very much in the picture as new PTSD patients. One out of every three new patients in 2012 in the VA’s specialized PTSD programs was a Vietnam-era veteran, according to the IOM–even though they last saw military service decades ago.

We could also examine differences in response to treatment between active duty personnel and veterans. Our colleagues tell us, impressionistically, that men and women still in the service are, in general, more motivated than the patients they have treated in the VA. That’s because the culture of the military mental health system aims to help soldiers resume participation, while the VA’s current disability policies often reinforce illness roles and inadvertently pose disincentives to work and recovery because compensation is contingent upon the severity of PTSD.

In establishing PTSD Awareness Day, the Senate resolved to “help ensure that those suffering from the invisible wounds of war receive proper treatment.”

In some, though not all VAs, they do. Now the mission is to ensure quality care is widespread, and to learn whether treatment is helping, who benefits most (and least) and why. Veterans with PTSD deserve the best care possible; accountability is critical to seeing that they get it.

C. Bartley Frueh is chair of the social sciences division at the University of Hawai‘i at Hilo. Sally Satel is a resident scholar at the American Enterprise Institute. Both are former VA clinicians.

TIME Military

The PTSD Epidemic: Many Suffering, Few Solutions

Soldiers with the U.S. Army's  Bravo Company, 1st Battalion, 36th Infantry Regiment rest in an Afgan National Police compound before going on patrol near Command Outpost AJK (short for Azim-Jan-Kariz - a near-by village) in Maiwand District
Soldiers with the U.S. Army's Bravo Company, 1st Battalion, 36th Infantry Regiment rest in an Afghan National Police compound before going on patrol near Command Outpost AJK in Maiwand District, Kandahar Province, Afghanistan on Jan. 24, 2013. Andrew Burton—Reuters

The scourge of wars in Afghanistan and Iraq is worse than we thought

Now that Iraq is falling apart, it seems only fitting that the U.S. government issues a fresh accounting revealing that neither the Pentagon nor the Department of Veterans Affairs has any idea if the billions they’re spending on PTSD treatments are doing any good.

A congressionally mandated Institute of Medicine panel reported Friday that neither agency assesses the success of their PTSD care. “Without tracking outcomes, neither DOD nor VA knows whether it is providing effective or adequate PTSD care, for which they spent $294 million and more than $3 billion, respectively, in 2012,” the 300-page study concludes.

Roughly 5% of all troops have been diagnosed with PTSD, the report says, but it’s nearly double—8%—for the 2.5 million who served in Afghanistan and Iraq. Post traumatic stress disorder is also increasing among older veterans. In 2013, the VA diagnosed 62,536 new cases in veterans who did not serve in the Iraq and Afghanistan wars. One out of every three new patients in 2012 in the VA’s specialized PTSD programs was a Vietnam-era veteran. All told, the number of veterans seeking PTSD care jumped from 190,000 in 2003 to more than 500,000 in 2012.

“Although these numbers are likely to underestimate the incidence and prevalence of PTSD, they demonstrate that action is needed to respond to this growing problem,” the study says. “Demands for post traumatic stress disorder services among service members and veterans are at unprecedented levels and are climbing.”

The IOM report is crammed with data about the extent of the problem, and figures to back them up (you can see more of them here):

  • Total Pentagon spending on PTSD treatment jumped from $29.6 million in 2004 to $294.1 million in 2012.
  • Outside PTSD care funded under the Pentagon’s TRICARE program climbed from $22.4 million in 2007 to $131 million in 2012.
  • Between 2006 and 2012, the number of hospitalizations of service members for PTSD increased by 192%.
  • The total annual cost for health care for a veteran who had PTSD was estimated to be $11,342, which was more than double the annual VA health care cost of a veteran without PTSD.

Even those who have dealt with the issue for years are surprised. “The acceleration of PTSD among service members and veterans is staggering,” says Elspeth Ritchie, a retired Army colonel and the service’s one-time top psychiatrist.

The Pentagon’s PTSD treatments “appear to be local, ad hoc, incremental, and crisis-driven, with little planning devoted to the development of a long-range approach to obtaining desired outcomes,” the IOM report says. While the VA’s programs are “more unified,” they both lack records of what treatments work, meaning they “have no way of knowing whether the care they are providing is effective.”

The Pentagon PTSD bill grew 10-fold between 2004 and 2012. IOM

“Given that the DOD and VA are responsible for serving millions of service members, families, and veterans, we found it surprising that no PTSD outcome measures are used consistently to know if these treatments are working or not,” says committee chair Sandro Galea of Columbia University’s Mailman School of Public Health. The report is a follow-up to an initial IOM assessment of PTSD treatment released in 2012 that only surveyed what was available; Friday’s study was to find out if they work.

The number of veterans of all eras who sought care for PTSD from the VA more than doubled from 2003 to 2012—from approximately 190,000 veterans (4.3% of all VA users) in 2003 to more than a half million veterans (9.2% of all VA users) in 2012. For those treated for PTSD in the VA system in 2012, 23.6 percent (119,500) were veterans of the Iraq and Afghanistan wars.

PTSD can happen when someone experiences a traumatic event, on the battlefield or elsewhere. It can lead to anxiety, depression, sleeplessness and other symptoms that can interfere with life, sometimes contributing to domestic violence, divorce and suicide. The multiple deployments required by a force too small to support the wars fought has played a major role in the PTSD increase among recent vets.

Unfortunately, even if the government begins tracking outcomes, the results may be what the IOM calls “modest,” at best. The only program that routinely conducts such assessments is the VA’s small specialized intensive PTSD program (SIPP). “In 2012, the 39 SIPPs had 3,792 entrants for a total cost of $88,572,953, or $23,578 per patient,” the study found. “The average PTSD Checklist (PCL) scores for veterans at admission to the programs and 4 months after discharge were 65.9 and 60.2, respectively. That indicates that most program graduates met the criteria for clinically significant PTSD after discharge on the basis of a PCL cutoff score of 50.”

TIME Veterans

Veterans Offer Each Other Help as Iraq Falls Apart

A US marine from the 3/5 Lima company po
A U.S. Marine in Fallujah in November 2004. PATRICK BAZ / AFP / Getty Images

One group warns of “frustration” that could lead to suicide

More than 1.5 million Americans served in Iraq between 2003 and 2011. More than a few of them are upset with what’s happened to that country, where they fought and their friends died, over the past week.

That’s why the Wounded Warrior Project sent an email Tuesday to its 50,000 members acknowledging their sacrifices and offering mental-health services if they find the latest happenings from Iraq depressing.

“Your feelings are justified,” Ryan Kules, 
the project’s national alumni director and a double amputee, said. “If you feel frustration watching the news, remember that we did our duty and served admirably, coming home with the visible and invisible scars of that service.”

The reaction of those who fought, and whose friends died, in Iraq has been somber. There wasn’t so much bitter anger as a palpable sadness. Those who thought the invasion was a mistake consoled themselves by blaming President George W. Bush; others blamed President Obama for not fighting harder to keep some U.S. forces in the country after 2011 to try to ensure the lives of the 4,486 Americans who died there didn’t end in vain.

“So many of my friends died in a war that didn’t need to be fought, but that did ultimately provide a reasonable chance for a democratic Iraq in the center of the Middle East,” retired Army officer John Nagl says. “It now appears that all those lives have been squandered because of an unwillingness to pay an insurance premium of a few thousand advisers and some airpower.”

Such grim tidings can lead to despair, which is why Kules of the Wounded Warrior Project reached out. He urged troubled vets to seek help “if you are dealing with PTSD triggers because of current media coverage,” and gave a phone number—1-800-273-8255—for any veterans “struggling with thoughts of suicide.”

Michelle Roberts, the communications chief at the project, says the group reaches out when an event—like last year’s Boston Marathon bombing—might trigger adverse reactions among those who served. “We’re very aware of the conversations our alumni are having with each other, and our staff, about the recent developments and how they affect them,” she says. “We just felt it was a really appropriate time to communicate with them.”

Interviews with veterans echo that view. “I’m just heartbroken, tired and nearing mute,” says Alex Lemons, an Iraq vet and former Marine sergeant. “I never saw a concrete objective and, in consequence, a willingness to win on our part.”

Lemons pulled three tours in Iraq, and says the goal shifted with each:

I was told this at the beginning: `And our mission is to clear, to disarm Iraq of weapons of mass destruction, to end Saddam Hussein’s support for terrorism, and to free the Iraqi people.’ WMD? Nothing. Fiction. Al Qaeda and indigenous terrorism? Terrorists entered the country after we invaded and then recruited heavily amongst those Iraqis we alienated with de-Baathification and firings throughout the army. Even during the surge, we could not crush every insurgent group. Regime change? We mishandled the trial and subsequent execution of President Hussein. In some ways, the Maliki government is another Baath party in Shiite garb.

“All Americans who fought there want Iraq to succeed so that we can have personal closure and know our sacrifices were worth it even as the rest of America, like the Vietnam experience, wants to forget,” Lemons says. “But Iraq will never give us that.”

Even Army Gen. Martin Dempsey, chairman of the Joint Chiefs of Staff, feels the sting. “Many of you have served in Iraq or know friends and family who made great sacrifices there,” he said in a message sent to troops Thursday. “Like many of you, I was disappointed at how quickly the situation in Iraq deteriorated as well as the rapid collapse of many Iraqi units.”

“It was somewhat expected, yet still disappointing, says Rob Kumpf, who served in Iraq as an Army non-commissioned officer. “Fighting an asymmetric war with one hand tied behind your back, with poor planning and unengaged leadership, led to the current situation Iraq’s security forces face. We screwed up the end game when we withdrew, and will soon do the same in Afghanistan.”

But other veterans have shrugged off what is happening. “Iraq’s political situation is not the concern of individual veterans of the war,” says William Treseder, who deployed to Iraq and Afghanistan as a Marine sergeant. “Combat veterans should value their service based on what they did, not on what happened after the fact or in some larger international context.”

Those who haven’t fought don’t know how combat can change one’s perspective. “Love, loyalty, sweat, and blood are the currency of service—its beating heart. Politics is a dry husk that tries to cover and limit that vitality,” Treseder says. “I wish Iraq and Afghanistan the best as countries, but I do not give them the power to determine how I feel about my service to the United States of America. Nor do I think it’s wise for any other combat veteran to do so.”

But some plainly do. “Your examples of valor and strength educate and inspire those around us,” Kules of the Wounded Warrior Project told them in his email. “Remember, you are not alone. Many of your fellow warriors make themselves available to help others…and WWP remains by your side to provide whatever support and assistance you need.
”

TIME PTSD

Here’s What Happens To The Mind After 5 Years of Captivity

Captured US Solider
Sgt. Bowe Bergdahl in an undated image provided by the U.S. Army. U.S. Army/AP

Sgt. Bowe Bergdahl has a lot of healing to do after five years of captivity. The physical scars may fade, but the emotional ones can sometimes be too deep to heal completely

U.S. Army Sergeant Bowe Bergdahl, the last known American POW, was finally returned home over the weekend after five years held in captivity in Afghanistan. Since Bergdahl’s return, curious details have emerged about his mental state before and after capture. And it all begs the question: What does five years in captivity do to the human mind?

Bergdahl’s repatriation is going to be a challenge, and piecing together the psychologically and physically broken veteran is a delicate process. After all, an abduction is the ultimate exchange of power, spurring the start of a complicated relationship based on both deep distrust and reliance, say experts. “He’s to some degree merged with those who held him,” says Brian Engdahl, professor of PTSD Research and Neuroscience at the University of Minnesota. “He was totally dependent on them for food, shelter, clothing. It can reduce a person to a weak state where their entire life revolves around how their captors are treating them.” A morsel of food becomes a generous gift, only to be withheld at the next feeding.

Many POWs find physical and mental strength by relying on their fellow captured soldiers, but Bergdahl was alone. Speculation about whether he suffered from Stockholm Syndrome—the phenomenon where captives identify with their captors—are not unwarranted, though so far evidence hasn’t suggested this to be true.

Studies of POWs from the Korean War show that the psychological injuries from captivity stem from two types of trauma. The first is physical and usually short-term, caused by malnutrition and injury. The more persisting trauma is, of course, psychological. At Landstuhl Regional Medical Center in Germany, which treats U.S. vets from Afghanistan and Iraq, Bergdahl is likely being tested for depression, anxiety, and PTSD, says Engdahl. “Beyond that, he could be feeling deep guilt, shame, bewilderment, and a lost sense of identity,” says Engdahl. If his English is poor, as has been reported, it’s likely from lack of speaking.

Once home, psychological challenges won’t likely abate overnight, says Barbara Rothbaum, the associate vice chair of clinical research in the department of psychiatry at Emory School of Medicine. “But even if the trauma is over, it’s not really over,” she says. POWs often experience flashbacks, and will wake up in the middle of the night thinking they are still in captivity. Many victims become avoidant and don’t want to talk about their experience because they are afraid it will trigger memories, she says. It’s one of the reasons many will forgo treatment.

“I’ve had veterans tell me they were drunk for a year,” says Rothbaum. But avoidance is one of the worst ways to deal with the harsh return, and Rothbaum’s research has shown that talking about experiences early can actually help prevent the onset of PTSD.

“People want to avoid talking about the worst parts, the most shameful, the most embarrassing,” says Rothbaum. “But it will help.”

TIME Parenting

How News Coverage of the Boston Marathon Manhunt Affected Local Kids

Explosions At 117th Boston Marathon
Women and children are evacuated from the scene on Boylston Street after two explosions went off near the finish line of the 117th Boston Marathon on April 15, 2013. Bill Greene—Boston Globe/Getty Images

You may not be surprised to learn that children who attended the 2013 Boston Marathon were six times more likely than non-attendees to suffer from PTSD. Given the carnage and panic wrought by the bombs, which caused 3 deaths and 264 injuries, you’d expect more trauma symptoms from those on the scene. But a new study reports that kids who had up-close views of the ensuing manhunt were just as likely to suffer PTSD as those with near exposure to the bombing. And kids who may not have had first-hand experience of either—well, the more news coverage they watched, the more mental health disturbances they suffered.

The study, published online June 2 in Pediatrics, surveyed 460 parents of children who lived within 25 miles of the marathon or of Watertown, where the manhunt took place. They were asked about their children’s experiences during the week of the attack and about their psychological and social functioning in the following six months. The investigators, led by psychologist Jonathan Comer, formerly of Boston University and now at Florida International University, were interested in the impact both of the bombing and of its ripple effects afterward. They also wanted to measure both PTSD and less severe mental health issues such as conduct and peer problems, hyperactivity and inattention. Interestingly, they found an even stronger link between broad mental health problems among the kids with dramatic exposure to the manhunt (hearing shots, having their house searched, for example) than among kids with similar sensory experience of the bombing itself.

The investigators also measured both the time the children spent glued to the set and whether parents had tried to limit their news viewing. Overall, the kids watched an average of 1.5 hours of attack coverage and more than 20% watched for over three hours. “Two thirds of the parents did not attempt to restrict their children’s viewing at all,” Comer says. “Yet we saw after Oklahoma City and 911 that TV exposure can have negative mental health effects on children, both near and far.”

Experts on children and media tend to agree that restricting children’s media exposure to violent events is critical. Casey Jordan, a criminologist and justice professor at Western Connecticut State University, says that adults can put in context the sensationalism of media coverage designed to create a sense of danger. But children generally cannot. “The best rule,” he says, “is TURN IT OFF unless you really have a suspect on the lam in your neighborhood.” Just get the basic facts, he suggests, and do so by Internet if possible.

Parents can help their children through these scary times by speaking to them honestly but calmly about what is happening and letting them express their reactions and fears. “It’s important to reassure them that they are safe,” says psychologist Daniel J. Flannery, who directs the Begun Center for Violence Prevention Research and Education at Case Western Reserve University. “Explain,” he says, “that the event was very unusual, and sometimes bad people do bad things but not everybody is like that. Their sense of normalcy has been taken away from them, and they need to get that back. “

Calm matters, agrees Jordan. “Do not go off on a tangent about ‘those people’ or a rant about who is to blame,” he says. “Children are sponges, they will learn from parents’ own reaction to crime and chaos, and absorb all the fall-out from what they hear and see.”

This new study suggests that parents be alert to changes in their kids even months after—and miles away from—a violent incident. Are they eating or sleeping less—or more? Are they more withdrawn or anxious, acting out at school or with friends? The children may not have been personally involved in the traumatic event, suggests this research, but they may still be suffering trauma. “The reach of terror and associated fear,” write the authors, “is not confined to the boundaries of an attack itself.”

TIME U.K.

British Charity Sees Rise in Afghanistan Vets Seeking Mental Health Help

A U.K. veterans mental health charity reported a 57% increase over one year in Afghanistan veterans seeking support

The number of British veterans of the war in Afghanistan seeking help for mental health issues increased sharply from 2012 to 2013, a charity group said Monday, warning that need would continue to rise as the country ends its involvement in the war.

Combat Stress, a U.K. veterans mental health charity, said the number of veterans seeking its help went up 57% in the course of a year. The group received referrals for 358 veterans last year, compared to 228 in 2012. Its caseload now includes more than 660 veterans. The increase is linked to the withdrawal of British troops in Afghanistan from all but two bases in Helmand province.

The charity said it found that veterans wait an average of 13 years after serving before seeking help, but the average time has now fallen to 18 months for Afghanistan veterans. Combat Stress also reported that their total caseload of 5,400 veterans across the country was the highest number in its 95-year history.

“We have had great support from the Government and the public over recent years and we simply could not operate without the generosity we have experienced, ” said Commodore Andrew Cameron, chief executive of Combat Stress. “We cannot allow the ex-Service men and women who suffer from the invisible injuries of war to go unnoticed and untreated.”

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