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The Post-Traumatic Stress Connection

Vietnam Vets Battle Illness

LIVING added, These guys are 48 to 50 now. This is the point where you're going to start to see some serious diseases develop.

Dr. Terence Keane, National Center for Post-Traumatic Stress Disorder, It starts off as a psychological problem, but it eventually affects the whole body system."

Joseph Boscarino, study author, New evidence indicates that the severity of Vietnam veterans' later health problems depends on whether they were heavily involved in combat.


By John Dudley Miller,  Special to

To veterans of Vietnam and other wars, it's a statement of the obvious: The stress of battle can cause serious health problems in soldiers decades after they return home.  But the search for definitive evidence linking service in Vietnam to later illnesses has stymied researchers over the years and sparked numerous political battles.  A new study, published in the journal Psychosomatic Medicine, may begin to clear up some of the questions.    What the research found is that Vietnam veterans who survived heavy combat and were later diagnosed with post-traumatic stress syndrome (PTSD) are much more likely than other vets to suffer from a variety of  chronic physical diseases 15 to 20 years later.  Compared to GIs who saw little of the battlefields in Vietnam and did not develop PTSD, combat vets are 50 to 150 percent more likely to have had heart trouble, weakened immune systems, infections, arthritis and breathing and digestion problems.

Stress Factor,  Most or all of those problems may stem directly from PTSD, says study author Joseph Boscarino, an epidemiologist and social psychologist for Catholic Health Initiatives, a national chain of hospitals and nursing homes.  It starts off as a psychological phenomenon," Boscarino explains, "but it eventually affects the whole body system.  One of the classic symptoms of PTSD is over-arousal, a state of  being "on guard" mentally and physically, and constantly aware of combat memories. This unabated tension apparently causes the endocrine system to pour out a steady stream of hormones and other chemicals, attacking the body over a period of years and wearing it down.

Mind-Body Disconnect,  Boscarino concluded that battlefield experience and PTSD were pivotal factors in Vietnam vetsí post-war health after analyzing the results of medical exams done on veterans in the late 1980s. Most were in their late 30s at the time; itís not known what their health is like today because they haven't been re-examined as a group.

The original 1988 data was compiled by the U.S. Centers for Disease Control and Prevention, which did detailed physical exams on nearly 4,500 of the 4.9 million people in the military from 1965 to 1971. The original study found that many of the vets had psychological problems, and some had isolated medical problems.

But, says Boscarino, the CDC researchers never connected the mental and physical problems, probably because the agencyís medical investigators and social scientists worked in separate groups.

Boscarino contends that the CDC researchers also found fewer physical ailments among the men than really existed, because they didnít count anything but full-blown illnesses. For instance, for heart disease they counted heart attacks but not other significant problems, such as high blood pressure or abnormal heart rate.

The problem with that approach, he says, is that "many of these major diseases have not fully manifested themselves yet at the fourth decade of life."

Same Data, Different Approach In his reanalysis of the CDC data, Boscarino found that 25 percent of high-combat PTSD-diagnosed veterans had heart and circulatory problems, compared with only 12.9 percent of vets who had served in low- or non-combat areas and did not have PTSD.

Likewise, 22.9 percent of the high-combat veterans had digestive problems, 21.4 percent had urinary or genital problems, and 15.4 percent had arthritis, all significantly higher figures than for low-combat, non-PTSD vets.

In previous research, Boscarino found that high-combat Vietnam veterans also had lower levels of the chemical cortisol in their blood streams, a sign of a weakened immune system. They also had abnormally high white-blood-cell counts.

When your doctor finds you have (that high) a white blood cell count," he explains, "they want to take you in for more tests, to find out whether you have a chronic infection or a disease somewhere. It's a hallmark of disease.

Direct Evidence

Dr. Charles Figley, a professor at Florida State University and a leading PTSD expert, thinks Boscarino's findings are very important. "It clearly supports what those of us who have been rolling around in this field have said for a very long time," says Figley. "Because of his tenacity, we now have clear and direct evidence."

He and other PTSD experts think Vietnam vets should be re-examined now to see if their health has worsened in the last decade. "These guys are 48 to 50 now," notes Dr. Terence Keane, director of the National Center for Post-Traumatic Stress Disorder at the Boston Veterans Administration Health Center. "This is the point where you're going to start to see some serious diseases develop."

But the main organization representing Vietnam veterans isn't ready to accept that PTSD alone has made combat veterans ill. Vietnam Veterans of America (VVA) believes that exposure to the defoliant Agent Orange has caused many physical diseases, especially cancer and birth defects, and it may also have caused the increased instance of illnesses such as heart disease that Boscarino found.

It's a very difficult thing to determine," says Jacqueline Rector, chair of the group's PTSD/Substance Abuse Committee, "because for the most part, they were exposed to both things. "According to Boscarino, the effects of Agent Orange are impossible to assess from the data he analyzed, because the military's exposure records are inaccurate.

We know that combat veterans tend to report exposure and tend to have PTSD and these medical problems," he says. But without knowing exactly how much of the chemical each vet got, it's impossible to show whether it caused later problems.

So Boscarino's study won't provide the final answer for Vietnam veterans who suffer from poorly understood ill health, but it does make an important link that may send other researchers in different, more productive directions.

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