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PTSD may be overdiagnosed, but PTSD deniers are 'wrong,' psychologists say

Why do some people reject the existence of PTSD?

The topic is touchy. Even asking the question is slammed as irresponsible.

“Why on Earth would you try to put out something that states combat PTSD isn't a true affliction? Or even try to debunk it? Or to put questions into the minds of society? In the first 155 days of 2012, we lost 154 men,” Amy Cotta, an author and the mother of a Marine wrote in an email to NBC News. Her message arrived minutes after she learned NBC News was seeking to interview a PTSD denier.

Despite exhaustive scientific studies that have explored the symptoms, causes, diagnoses, and prevalence of post-traumatic stress disorder, hardcore skeptics remain.

They exist within the military, where some leaders openly call PTSD a mental weakness, according to mental health advocates. David Weidman, who did two tours in Afghanistan and was diagnosed with PTSD, said all of his senior non-commissioned officers advised him not to seek treatment, instead suggesting he “just put your head down and keep going” in order to maintain any chance at a promotion.

They exist within the veteran community. Kevin R.C. “Hognose” O’Brien, who operates a blog called “WeaponsMan” and identifies himself as “a former Special Forces weapons man,” wrote in July that PTSD was a “quack” diagnosis, “invented” to clump “any odd and many normal behaviors.” He added: “If a vet is wound up tight? PTSD! If he or she is calm? Hypercontrolling due to PTSD! Lose weight, gain weight, maintain weight, those are all PTSD markers. Get in fights? PTSD, natch. And avoid fights? Well, clearly it's .... are you starting to get the idea?” O’Brien declined to be interviewed for this story.

And they exist within medicine. In late September, Washington, D.C. psychiatrist Dr. Joseph Tarantolo authored an op-ed piece titled: “PTSD, The Grand Scapegoat.” In it, Tarantolo described PTSD as a “pseudo-diagnosis” and held that “the PTSDer gets an enormous amount of pseudo-sympathy.” On Friday, Tarantolo’s voicemail message said he was out of the country on vacation.

To Afghanistan veteran Weidman, most people who so stridently dismiss PTSD have simply failed to read the available scientific literature on the subject and are, he said, “uneducated.”

But Weidman acknowledged that different people possess varying degrees of mental “resiliency,” underscoring the slippery nature of diagnosing anxiety disorders. That means, he added, that if an entire platoon collectively endures the same moment of extreme combat violence, not every platoon member will ultimately feel the symptoms of post-traumatic stress. According to the Mayo Clinic, those signs can include “flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.”

“There are people who can experience something who have no side effects. It could be that person (who ends up being a denier),” said Weidman, a student at Penn State-Lehigh Valley. “Or it could be the person who is extremely uneducated and chauvinistic, who says a guy who gets diagnosed with PTSD ‘is not being a man.’ You’re going to have a perfect storm within the individual who’s going to be that outlier, who says: ‘It doesn’t exist.’

“Or, it could be the person who actually has post-traumatic stress, who is not seeking help, who is more living up to society’s ideal male image of being strong and being resilient,” he added. “Those people going to make even more noise.”

Mental health experts say the occasional repudiation of PTSD is merely an extension of the larger societal taint associated with anxiety or mood disorders.

Click here for more military-related coverage from NBC News.

“It comes back down to the stigma of mental illness,” said Jean Teichroew, spokeswoman for the Anxiety and Depression Association of America. “Military members also are afraid to speak out because it’s seen as a weakness. The VA has programs to try to combat that, too. But when you have a sergeant who doesn’t think you should be afraid of a bomb going off near you or seeing a dead body, that’s another issue.”

Still, the rate of diagnosed PTSD cases among Iraq and Afghanistan veterans is higher than the rate of cases associated with men and women who served in past conflicts. That abrupt spike has sparked an ongoing debate within American and British academia as to how common PTSD truly is among military personnel and veterans.

“The suffering of people with PTSD is very real whether we label it an ‘anxiety disorder’ or not. As for the skeptics, some of them may believe that a proportion of veterans without the disorder may report symptoms to secure service-connected disability compensation payments for PTSD,” said Harvard University psychology professor Richard J. McNally. He has penned more then 320 publications on anxiety disorders, including PTSD.

“According to (Department of Veterans Affairs) data reported late last spring, 45 percent of all veterans from Iraq and Afghanistan have applied for service-connected disability compensation, and 31 percent have secured it already. This figure includes all forms of medical problems, however, not just PTSD," McNally said. "The percentage of veterans of World War II and Vietnam who obtained disability compensation is 11 percent and 16 percent, respectively.”

In 2011, the VA listed the three most common service-connected disabilities among veterans receiving federal compensation that year: tinnitus (ringing in the ears) at 10.9 percent, hearing loss at 7.5 percent, and PTSD at 5.3 percent.

Is PTSD being over-diagnosed in post-9/11 veterans?

“Yes. I think it is,” said Simon Wessely, vice dean of academic psychiatry at King’s College in London. “I think that despite the formal criteria, there is a confusion sometimes (about) the normal emotional responses to war — my father still has nightmares about his World War II service in Royal Navy and he is 87, but he doesn't have PTSD.

“I also think that, for example, depression often gets under diagnosed, and substance misuse also,” Wessely said. “Our evidence also shows, for example, that quite often the triggers for what becomes labeled as PTSD is not combat exposure but actually a reflection of problems back home. It is important that we remember that not every mental health problem in theater is PTSD."

Despite the loose diagnoses or cases of outright PTSD fraud, to those in medicine and the military (post and present) who deny PTSD altogether, Wessely offers three final words: “They are wrong.”

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