The correlation between PTSD and criminogenic thinking in incarcerated veterans

The Correlation Between PTSD and Criminogenic Thinking in Incarcerated Veterans

MAJ Mark Fleming, Ph.D., Vice President Operations

Post-Traumatic Stress Disorder (PTSD) is a condition of persistent mental and emotional stress occurring when a traumatic stressor, such as injury or severe psychological shock, is so extreme that the adaptive capacities of most people are maximally taxed, if not exceeded.

Hundreds of thousands of service men and women and military veterans have seen combat. Many have been shot at, survived injuries, seen their buddies killed, or witnessed death up close. These are the types of events that may lead to PTSD.

The criteria for PTSD in the newly released Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), differs significantly from those in DSM-IV. The stressor criterion (Criterion A) is more explicit regarding how an individual experienced traumatic events and the subjective reaction criterion was eliminated. In addition, separate criteria were added for children six years and younger, and a dissociative sub-type was added.

There are now four symptom clusters – re-experience, avoidance, numbing and arousal – as a result of the avoidance/numbing cluster being divided into two distinct clusters: avoidance and persistent negative alterations in cognitions and mood.

PTSD may affect functioning in three ways:

  • Thoughts, including flashbacks, perceived threat, and beliefs about justice.
  • Level of arousal, including anger and irritability, reckless or self-destructive behavior, being hyper-alert, and exaggerated startle response.
  • Feelings, such as distress, negative feelings, feel numb

The dissociative sub-type of PTSD is defined primarily by symptoms of derealization, or feeling as if the world is not real, and depersonalization, or feeling as if oneself is not real.

Though PTSD is not restricted to combat veterans, veterans may share characteristics different from non-veterans that are important to understand. In addition, the prevalence of veterans in the corrections environment – as inmates and correctional officers – means correctional health providers must be attuned to the needs of this population.

The Bureau of Justice Statistics report “Veterans in Prison and Jail, 2011-12” estimated 181,500 US veterans are incarcerated in prisons and jails nationally. This is a drop to 8 percent of all inmates from a stunning 24 percent of the inmate population in 2004, but remains a significant population. (In the 2004 study, Vietnam-era veterans comprised the largest number of incarcerated wartime veterans, so some of the decrease in population may be due to mortality rates in this generation.)

Demographically, the BJS report found incarcerated veterans are more likely than nonveterans to be white, older, more educated, and to have been married. There were more white veterans in prison (50 percent) and jail (44 percent) than white nonveterans in prison (27 percent) and jail (31 percent). There also were fewer black and Hispanic veteran inmates than nonveteran inmates. The study also found veterans in prison were, on average, 12 years older than nonveterans in prison, and 11 years older in jail.

PTSD’s link to criminal behavior

In modern combat veterans – those deployed in Iraq and Afghanistan, PTSD is more likely to be accompanied by a history of Traumatic Brain Injury (TBI), most likely due to an increase in blast-related brain injuries and higher survival rates due to improvements in protective gear. There currently are no evidenced-based models of treatment to guide clinical practice for this population and there exists limited research on treating both PTSD and TBI, either psychologically or pharmacologically.

Due to this lack of guidance, it is incumbent upon us to be aware of the veterans in our patient population and ensure our process of care includes:

  • Developing knowledge about entry-to-case pathways for veterans with comorbidity,
  • Completing thorough assessments prior to making a positive diagnosis,
  • Coordinating assessment and diagnosis with specialty care clinicians treating this population, and
  • Identifying and utilizing potential best practice models.

by: MAJ Mark Fleming, Ph.D., Vice President of Operations, Corizon Health