29 Dev. Mental Health L. 23 (2010)
Exit Wounds: Current Issues Pertaining to Combat-Related PTSD of Relevance to the Legal System

handle is hein.journals/dvmnhlt29 and id is 23 raw text is: Exit Wounds:
Current Issues Pertaining to Combat-Related PTSD
of Relevance to the Legal System
By Mary Tramontin*

1Abstract
Written for those in the mental health and
legal communities dealing with war veterans
embroiled in the criminal justice system, this
Article presents an overview of current issues
pertaining to the diagnosis, assessment, and
treatment of combat-related post-traumatic
stress disorder (PTSD). The objective is to
provide information that can assist the legal
system when addressing PTSD-related issues
of combat veterans charged with crimes, with
a specific focus on those returning from
Operations Enduring Freedom and Iraqi
Freedom (OEF/OIF). As part of this
discussion, insights from clinical practice for
assessing and treating combat veterans are
offered and considered in light of state of the
art trends from the complex and evolving field
of traumatic stress studies.
I. Introduction
The damaging psychological and moral
impact of battle is now well documented
(Marx, 2009), making it imperative in a time of
war to strive to understand and lessen this
harm on returning service members and
society. Equally critical to appreciate is that a
trauma such as combat is a shared
experience. For the soldier, this begins in the
battlefield with the trauma of warfare shared
amongst comrades in arms, though its impact
does not end there. As these soldiers come
home with war, family members affected by
the changes in their returning loved ones will
* Psy.D., Clinical Psychologist; United States
Department of Defense.
1 Correspondence may be addressed to
Mary.Tramontin@NGA.MIL. The author would like
to thank Professor Thomas Hafemeister of the
University of Virginia Law School for his expertise
and editorial guidance.

themselves change as a result (Gavaloski &
Lyons, 2004).
The ripple effect of the war experience
extends well beyond the immediate family.
Disparate communities across America will be
impacted by these returning soldiers-an
impact that often extends to the criminal
justice system. As Judge Robert T. Russell
(2009) of the Erie County Court wrote, The
potential problems facing our nation's
veterans are numerous. These issues will
likely require assistance and collaboration
from countless professionals within our
communities, including the courts, to even
begin to combat them (p. 132).
This Article will look at issues pertaining to
PTSD that surface when the legal/judicial
community deals with service members and
veterans returning from deployment to a
combat zone. It is written from the
perspective of a psychologist who assesses
and treats war returnees with the goal of
mining this direct clinical experience for
insights pertaining to the lived experience of
returning service members.
II. PTSD: An Evolving and Dynamic
Diagnosis
PTSD is a complicated and controversial
psychiatric diagnosis. As Judith Herman
(1992) describes in her classic text, Trauma
and Recovery, there has been long-standing
historical ambivalence and debate regarding
how to best understand and interpret the
impact of traumatic experiences on the human
psyche. And this debate has accompanied
the continuing evolution of this diagnosis,
which has only been officially recognized for
thirty years now (Summerfield, 2001). The
following brief outline concerning the changes
in the diagnosis of PTSD since its inception is

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