Case Study #2: Back from the War

Ben is a veteran of the OIF/OEF conflict, 15 months status post return from his
second deployment. He is currently an active-duty member of the US Army
Reserves. While he was deployed, Ben served as an interpreter between warring
tribal factions in Afghanistan. He reports that one of the most challenging aspects of
this experience was when a suicide bomber entered his base and detonated a
deadly blast that killed several of Bens friends. After the incident, one of Bens
duties was picking up dismembered body parts that had scattered all over the base.
He recalls another time when villagers brought a dying Afghan child to the base for
medical treatment. The child, who had accidentally ingested gasoline, was
approximately the same age as one of his sons. Ben says, When I close my eyes at
night, I can picture the frothing around that kids mouth, and the smell of the gas is
so strong.

After returning from his second deployment, Ben attempted suicide by overdosing
on medication and hanging himself in a closet in his house in Hawaii. His wife found
him and called 911, who transported him to the hospital and then the VA for follow-
up therapy. After 6 months of treatment, Ben and his family (his two boys are 6 and
8, and his daughter is 3) moved to the Baltimore area. After the move, Ben reported
a great deal of difficulty reintegrating into civilian society. He has reported the
following incident to therapists:

Upon hearing a loud noise coming from outside in the middle of the night,
Ben awoke his entire family. His first reaction was to protect the children, so
he locked them in a hallway closet. He then became frantic that the children
were locked in the closet and attempted to tear the door down, bloodying his
fingers in the process, screaming, and terrifying the children. His older son
reported that Ben was in a daze after this event and it took him some time
to snap out of it.

Shortly after the above event, Bens wife confided that she had been cheating on
him with his best friend, and left him. She took their daughter with her, but left him
with the two boys. The two boys are now in therapy as the older has been accused
of bullying at his school, while the younger has been observed by teachers to curl
up in a ball and rock himself when faced with conflict. Ben has verbalized that he
has a concern about trying to keep his family overly-safe and feels his reactions
have negatively impacted the children. He wonders how his symptoms have
affected his relationships. He has confided in his therapist, I never had anyone
looking out for me when I was a kid. My dad wasnt around and my mom was
working. I had to take care of my sisters. Joining the army was the best way out of a
bad neighborhood and dead-end life.

Ben notices everything about every room he is in, from how the furniture is
arranged to the body language of the people sitting down. On the phone, he can tell
 if a therapist is calling from home simply by the sound of her feet on the wooden
floor, versus the muffled sound of her feet on the carpet. Though initially guarded,
Ben has a terrific sense of humor and is very charming. This differs drastically from
when he becomes angry, fearful, or feels unsafe. He either becomes dazed or
very violent. Ben is also usually late for his appointments because he says he takes
the long way to the VA. He does not like driving in the city and therefore avoids
major traffic routes.

Ben is currently on a multitude of psychotropic medications to address his

symptoms. He is on two different kinds of antidepressants and a hypnotic drug for
sleep, in addition to a benzodiazepine for anxiety. He is also in family therapy with
his two boys.

Case Study #2: Back from the War

1) PTSD = Anxiety, dissociative, and other symptoms that last for more than a
month and that occur as a result of exposure to extreme trauma. How does
Ben fulfill this definition of PTSD? (Be specific!) 0.5 for 2 examples = 1
point total

2) Consider the DSM-IV criteria for Post-Traumatic Stress Disorder. Outline

Criterion A through F and explain/provide an example for how Ben meets
criteria. If you do not have enough information, specify what questions you
might ask to gather the information you need to make a firm diagnosis. 0.5
points for each example from each criterion = 3 points.

Criterion A)

Example:
Criterion B)

Example:

Criterion C)

Example:

Criterion D)

Example:

Criterion E)

Example:

Criterion F)

Example:
1. What factors about Ben may have placed him at increased risk for developing
a stress disorder? 0.5 points for at least 2 examples = 1 point

2. What might your recommendations for treatment be, and why? 0.5 points
to identify treatment and 0.5 points for one sentence explaining why
=1 pt