Obsessive compulsive disorder (OCD) is a type of neuropsychiatric anxiety disorder associated with disabling and irrational obsessions and/ or compulsion. The disorder is usually caused by chemical imbalance in the brain triggered by conscious and un-conscious event in the memory. While obsessions include repetitive, intrusive and unpleasant thoughts, images, fears, doubts and words that can take various forms. On the other hand compulsions are repetitive actions such as cleaning, checking and counting performed routinely so as to ease their anxiety. People with OCD feel overwhelmed by a sense of powerlessness with regard to stopping the feelings although they are aware the obsessions and compulsions are irrational. This mental disorder is often associated with in that intrusive thoughts that produces anxiety resulting in repetitive action. These symptoms can interfere with and affect a person's normal routine, schoolwork, job, programs and social life as many hours every day may be wasted on in obsessions and compulsive activities. In addition concentrating on simple activities become unusually difficult.
OCD is often accompanied by post-traumatic stress disorder (PSTD) which is defined as anxiety often following and resulting from physical and/ or psychological trauma hence the name. The symptoms of PSTD may appear immediately after the traumatic event or may appear later especially following an event that reminds the victim of the actual traumatic event. The symptoms often come and go over a prolonged period of time and include reliving the traumatic event, feeling numb, avoiding things, places or people that remind the victim of the traumatic event and hyperarousal. These symptoms interfere with the victims life and relationship.
2.0 History and statistics of OCD and PTSD among veterans of war
The symptoms of OCD and PTSD were first associated with battles in the 6th BC and have been seen in many veterans of war ever since. The current understanding of OCD and PTSD dates back to the early and mid-1970s due to symptoms experienced by Vietnam veterans. In fact the term PTSD was first used in the mid-1970s to describe the signs seen in Vietnam veterans and was first formally acknowledged by the American Psychiatric Association in 1980 in the 3rd edition of the Diagnosis and Statistical Manual of Mental Disorders.
According to the National Institute of Mental Health (NIMH) approximately 7.7 adults in America are currently affected by PTSD and about 7-8% of the American population will be affected by the disorder at some point in life. The prevalence of PTSD is higher (at about 67%) in people who have experienced mass violence (as in war) than those who have experienced other forms of traumatic events. This explains the common and many incidences of PTSD among veterans of war.
A study on the readjustment of Vietnam veterans carried out between the mid and late 80s established that up to 31% of men and 28% women who fought in the Vietnam War suffer from PTSD. In addition 23% men and 21% women suffered from PTSD partially at some point in their life. Therefore up to 50% of the Vietnam veterans either suffered from partial or lifetime PTSD and other related anxiety disorders as a result of their experiences in war. The study that was mandated by the congress in 1983 also established that at the time up to 9% of women and 15% of men (Vietnam veterans) had PTSD. Suffice to say that veterans of other wars have also been affected by PTSD and OCD.
In April 2008 a study released by the Rand Corporation and the California Community Foundation evaluated the mental condition of 1.65 million soldiers deployed in Afghanistan and Iraq revealed that about 20% (approximately 300,000) of the subject of the study had reported symptoms of PTSD or depression. This prevalence is higher than among those who have experienced physical trauma yet despite the high prevalence very few soldiers (slightly more than 50 %) have sought help because of fear of negative effects on their careers. This study also established that the highest prevalence of symptoms of PTSD and other neuropsychiatric anxiety disorders were among service men and women who were no longer in active service due to various reasons ranging from being retired to being discharged from the military.
There are few studies and limited data with regard to the prevalence of OCD in veterans (compared to PTSD) but it has generally been established that the two conditions often occur together. Albeit the limited data on OCD among veterans; one study reported between 0.5% and 5.5% lifetime prevalence among Vietnam veterans. The prevalence rate varies with the seriousness of the war related stress. However the study did not establish whether the disorder existed before the war. Given the high prevalence of both OCD and PTSD it is vital to evaluate and understand the factors that may have contributed to this situation.
3.0 Factors contributing to high prevalence of OCD and PTSD among veterans
It has already been established that both OCD and PTSD are often as a result of physical and/ or psychological trauma. There is definitely no other event that can cause physical and/or psychological than a war. Therefore it is logical to conclude that the veterans of war, who may not avoid the inevitable physical and psychological trauma associated with the battle field, are more likely to suffer OCD and/or PTSD than the general population who may only be exposed to trauma by chance. In other word service men and women are more likely to experience trauma hence have higher probability to have the two disorders. It is in recognition of this fact that the US government has established several policies to help veterans readjust to normal life after war. One such policy is the disability compensation for veterans for health conditions resulting from war. In this policy the Department of Veterans Affairs provides free diagnosis and subsequent free healthcare and compensation for veterans found to have PTSD. The compensation is provided for veterans that got the disorder during the war or whose condition was exacerbated by their service in war. Another such policy is the Veterans Healthcare Act of 2005 that allocated 95 million dollars in 2006 and 2007 for the expansion of the healthcare services and alternatives to veterans requiring treatment for mental conditions and prioritized PTSD as a disorder to be considered. The Kyle Barthel Veterans and Service Members Mental Health Screening Act introduced by the New Mexico representative, Harry Teague, provided for mandatory and confidential screening of all service men and women are screened for mental disorders before and after being sent to war and before being discharged. The 2010 Caregivers and Veterans Omnibus Health Service Act was established to increase accessibility of mental health services to veterans. These policies are a clear indication and acknowledgement of the vulnerability of veterans to OCD, PTSD and/or other mental disorders.
Another factor that may contribute to the higher PTSD and/or OCD among veterans is exposure to certain chemicals during the war. Some veterans have also have reported being exposed to chemicals after being captured and tortured by enemy soldiers. Some of the chemicals that the veterans were exposed to during their service have been found to interfere with brain biochemistry resulting in mental disorders including OCD and PTSD.
The psychological effects of the scenes of war have also been found to contribute to the high incidences of PTSD and OCD among veterans of war. These factors are as a result of two major factors. Some veterans are affected by what they saw during the war. It must be noted that war does not discriminate, therefore children and women are often brutally assaulted during war scenarios that leave the service men and women with symptoms of PTSD and/or OCD. Some veterans that were captured and tortured experienced symptoms of PTSD.
4.0 The impacts of OCD and/or PTSD among the veterans
The diagnosis of OCD and/ or PTSD among veterans has major effects on the life of the veterans as well as the society at large. OCD and/or PTSD have been associated with the high suicide rates among veterans . Another effect of OCD and PTSD is the disintegration of families of affected veterans. Most of the veterans of war develop mistrust during the war, where they adopt the attitude of trusting no one, resulting in social conflicts. In addition there have been reports of increased domestic violence in the families of veterans as a result of symptoms associated with PTSD and OCD. Finally the diagnosis of OCD and/ or PTSD has great impact on the economy. Some studies estimate that PSTD and OCD among veterans cost the united states between 4 to 6.2 billion dollars every two years after deployment.
In conclusion the prevalence of OCD and PTSD among veterans is higher than in the general population as a result of physical and psychological trauma experienced during their service days. The symptoms of OCD and PTSD among veterans have many negative socioeconomic effects.
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