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New label considered for post traumatic stress disorder

Calling it injury instead of disorder could nix stigma

WASHINGTON - It has been called shell shock, battle fatigue, soldier’s heart, and, most recently, post-traumatic stress disorder. Now, military officers and psychiatrists are embroiled in a heated debate over whether to change the name of a condition as old as combat.

The potential new moniker: post-traumatic stress injury.

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Military officers and some psychiatrists say that dropping the word disorder in favor of injury will reduce the stigma that stops troops from seeking treatment.

“No 19-year-old kid wants to be told he’s got a disorder,’’ said General Peter Chiarelli, who until his retirement in February led the US Army’s effort to reduce its suicide rate.

On Monday, a working group of a dozen psychiatrists will hold a public hearing in Philadelphia to debate the name change. The issue is up for consideration because the American Psychiatric Association is updating its bible of mental illnesses, the Diagnostic and Statistical Manual of Mental Disorders, for the first time since 2000.

The relatively straightforward request, which originated with the Army, has raised new questions over the causes of post-traumatic stress disorder, the best way to treat it, and the barriers that prevent troops from getting help for it. The change could also have major financial implications for health insurers and federal disability claims.

Chiarelli took on the problems of post-traumatic stress disorder and suicide after two tours in Iraq. He has pressed harder than any other officer to change the way service members view mental health problems. His efforts, however, have not resulted in a reduction in suicides.

Post-traumatic stress disorder refers to the intense and potentially crippling symptoms that some people experience after a traumatic event such as combat, a car accident, or rape.

To Chiarelli and the psychiatrists pressing for a change, the word injury suggests that people can heal with treatment, while disorder implies that something is permanently wrong.

Chiarelli was the first to drop the word disorder, referring to the condition as post-traumatic stress. The new name was adopted by officials at the highest levels of the Pentagon, including Defense Secretary Leon Panetta. But post-traumatic stress never caught on with the medical community because of concerns that insurers and government bureaucrats would not be willing to pay for a condition that is not explicitly labeled a disease, disorder, or injury.

Some psychiatrists suggested post-traumatic stress injury as an alternative, and Chiarelli heartily endorsed the idea.

The question for the working group of doctors debating the change in the Manual of Mental Disorders is whether the nightmares, mood swings, and flashbacks normally associated with post-traumatic stress disorder are best described as an injury.

Those in favor of the new name maintain that post-traumatic stress disorder is the only mental illness that must be caused by an outside force.

“There is a certain kind of shattering experience that changes the way our memory system works,’’ said Dr. Frank Ochberg, a professor of psychiatry at Michigan State University.

The intensity of the trauma is so overwhelming that it alters the physiology of the brain. In this sense, post-traumatic stress disorder is more like a bullet wound or a broken leg than a typical mental disorder or disease.

Psychiatrists who oppose the change argue that post-traumatic stress disorder has more in common with bipolar or depressive disorder than a bullet wound.

“The concept of injury usually implies a discrete time period. At some point, the bleeding will stop. Sometimes the wound heals quickly, sometimes not,’’ said Matthew Friedman, executive director of the Department of Veterans Affairs National Center for PTSD. A disorder can stretch on for decades.

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