When compared with the general population, veterans experiencing post traumatic stress disorder (PTSD) are at increased risk of sexual dysfunction. Since 2012, numerous research projects have been conducted and published in major medical and mental health journals. All of them agree and cross validate the fact that male combat veterans experiencing PTSD are at a very elevated risk of developing erectile dysfunction (ED).
Although scarce, data on women with PTSD, especially survivors of sexual assault, also show increased percentages and risk of developing sexual health related dysfunction. Given the negative impact of PTSD on physical and emotional health, it isn't surprising that veterans with PTSD experience increased rates of sexual dysfunction. What is surprising is the rate at which dysfunction appears.
"PTSD impairs sexual functioning across multiple domains: Desire, arousal, orgasm, activity, and satisfaction," writes one group of researchers. The most commonly reported problems were erectile dysfunction, premature ejaculation, and overall sexual disinterest. One study of male combat veterans diagnosed with PTSD discovered that 85% reported ED compared with 22% of combat veterans without PTSD. Another study that involved the examination ninety combat veterans found that 80% of the study subjects were experiencing sexual dysfunction.
by: John M. Duffey, MA, NCC
According to a major study reported in 2008, 6.2% of the U.S. adult population has Narcissistic Personality Disorder (NPD) (Stinson, F., et al, 2008). An earlier wave of the same study reported that 3.6% have the condition of Antisocial Personality Disorder (ASPD), an equivalent the common term and definition for sociopath (Grant, B., et al, 2004). Nearly 20% of those with ASPD also have NPD (Stinson, F., et al, 2008), a powerful combination.
These statistics indicate that a very large number, some 32,000 people with either NPD or ASPD and about 2,400 people with both NPD and ASPD. This is a high number of potentially dangerous people within American society at-large. This makes being able to identify the warning signs very important for everyone in order to avoid becoming the next victim to manipulation, deception, and abuse. It is equally important to know the differences and similarities fo the two conditions and in understanding the damage each can do and how much more exacerbated the danger is when encountering a person with both conditions.
During my time of working with women and men survivors of narcissistic partners I have noticed a pattern of the survivor not recognizing, or being able to recognize, the warning signs of NPD and completely miss the warning signs of ASPD. First to know is that these mental illnesses exist on a spectrum of severity and tend to present in slightly variable but quite similar ways. None of use want to be roped into a business or romantic relationship that ends in our being used, manipulated, abused, and abandoned. So, let’s start with the Narcissist.
Narcissistic Personality Disorder (The Narcissist)
Most people know that narcissists can be initially charming and exciting. They pay intense attention during the seduction process, lavishing praise and gifts, and making grandiose promises. This is so in all settings, too - dating, hiring, and electing leaders. They exaggerate their abilities, their friends, their histories, and their plans. They boost your self-esteem by telling you how wonderful you are - over and over again.
In dating, they want fast intimacy. In the workplace, they want the spotlight and lots of credit for minor (if any) accomplishments. In business and political leadership, they have the best grandiose plans for changing the world, with no basis for accomplishing them. Yet their belief in themselves can be blinding and contagious. That is what makes them dangerous.
However, reality is far from what the narcissist presents. Narcissists are self-absorbed and see themselves as superior to others - including those around them whom they may have initially seduced with their charm. At first, this seems irritating but tolerable. BUT, these are also warning signs of potential danger ahead.
Antisocial Personality Disorder (The Sociopath)
Sociopaths can also be extremely charming and seductive until they get what they want (money, sex, connections, sense of power over someone). Then, they may disappear, or stick around and become extremely cruel or manipulative. Those with ASPD may be extremely aggressive and reckless, or skilled con artists, or engage in criminal behavior. Above all they lack remorse for what they do to others. In fact, some enjoy humiliating and hurting other people.
It is important to remember that ASPD is also on a spectrum of severity and manifests in a number of variable behavioral characteristics. Many sociopaths are not involved in the criminal justice system and instead are active in business, politics, or even community leadership. When they are in romantic relationships, they can be very deceptive about where they’re going and what they’re doing when they are away from their partners. This can also be true in the workplace with endless excuses to to supervisors and co-workers. They are constantly conning and lying, so that very little of what they say may be true. Words are just a tool to them and they use them well to get what they want. Their theme is dominance.
According to the Diagnostic and Statistics Manual for Mental Disorders version 5 (DSM-5) NPD does not include characteristics of impulsivity, aggression, and deceit. These characteristics are actually part of ASPD. So, if someone is highly aggressive, and lies all the time they are more likely to be ASPD than NPD. These are predictive characteristics of more severe trouble ahead.
Narcissists on the other hand are more likely to exaggerate, although they occasionally lie. Narcissists also care about what other people think of them. Their image is of prime import to them - especially in regard to admiration. This is not so much the case with a sociopath. Narcissists are more likely to stick around in relationships longer than sociopaths who tend to take off when things get inconvenient or difficult for them. The Sociopath seems to enjoy the fighting and violence while the narcissist would prefer the fruits of superiority without having to fight for it.
Both narcissists and sociopaths invest a lot of energy in creating a false image of themselves for others—and themselves—to see. Thus, the charm and persuasive skills they have are the best in the world. They both are essentially con artists: narcissists con people about who they are and their incredible abilities, whereas sociopaths con people by playing on their weaknesses and desires (through charm and intimidation) to get what they want. They both have a lot of secrets and their words cannot be trusted.
They both demand loyalty, while not giving it in return. Narcissists, from cases I have worked with, often pursue 2 or 3 romantic relationships at the same time. They have an excessive need for “narcissistic supply,” which often takes more than one partner. This pattern of behavior can be devastating for their primary partner and, despite numerous promises, may never go away.
Sociopaths, on the other hand, seem to have the most promiscuous personality, even more than most narcissists. They may be more sexually abusive and irresponsible. According to the DSM-5: “They may have a history of many sexual partners and may never have sustained a monogamous relationship.” However, occasionally they do have long-term relationships, but mostly for convenience, such as being supported in a comfortable lifestyle.
Those with narcissistic personality disorder can seriously exploit others and lack empathy. This means that they are willing to invest a lot of energy in maintaining their superior image, even if it means repeatedly insulting you and putting you down, even in public.
In the workplace, they may become indifferent to your career or even use you as a Target of Blame to deflect from their inadequacies. Sometimes a narcissistic manager or academic advisor will give you a negative evaluation out of spite or try to harm your career because you didn’t kiss up to them enough or caused them a “narcissistic injury” (when they’re exposed for not being superior at all).
In business and politics, narcissists are notorious for gaining allies through flattery, then abandoning them or walking on them to get to a higher position. Yet many of these allies don’t see it coming, because they think they are special to the narcissist, because of how they were charmed at the beginning. But their personality is based on being superior: they are a “winner” and eventually, everyone else will be a “loser.”
Sociopaths, on the other hand, may be much more likely to seek revenge or use violence or destruction of valued property to settle their perceived betrayals in romantic, business or political relationships. They invest a lot of energy and resources in keeping secret their abusive past behavior and may seriously harm those who try to expose them.
Cases of Co-Morbidity ASPD & NPD
As mentioned above, a percentage of sociopaths (ASPDs) also have narcissistic personality disorder. This is equivalent to about 1% of the U.S. population. This combination and percentage fit the criteria for psychopaths, who have their own checklist of characteristics including pathological lying, criminal versatility and parasitic lifestyle, in addition to some of the traits of ASPD and NPD.
Likewise, this combination was identified over fifty years ago by Erich Fromm, who defined "malignant narcissism" as including this combination in powerful dictators, from the Egyptian Pharaohs and Roman Ceasars to Hitler and Stalin. He also said there were traits of increasing paranoia and sadism for malignant narcissists, who became increasingly dangerous the longer they stayed in power—thus, the term malignant meant expanding like a cancer.
In today’s news, we often hear about people who are self-centered, lie a lot and have harmed others, including their own friends, family members and other people who thought they cared about them. Often people are very surprised. With personality awareness about narcissists and sociopaths, we should be more able to predict trouble and protect ourselves. We need to develop a healthy skepticism so that we look past the charming false images and recognize the personality patterns which indicate that serious behavior problems have been covered up and/or lie ahead.
By: John M. Duffey, MA, NCC
There are a number of ways to apply for veteran disability benefits from the U.S. Dept. of Veterans Affairs. One is to directly submit an application for benefits to the VA and another is to submit an application through a representative. Both routes lead to success but there are some distinctions between the two routes in terms of time and money.
Completing and filing a claim directly with Veterans Affairs can be done through the e-file system. To accomplish this the veteran or the veteran’s helper will need to open an e-file account and manually complete the disability benefits application and manually upload any and all supportive documents. In this method the veteran is on his/her own to ensure that the forms are completed properly and that the appropriate evidentiary documentation is submitted. This can be a long and confusing route to take and requires a significant amount of regulatory and process knowledge related to filing and qualifying for a VA disability rating and compensation award.
In more cases than not, direct manual and self-represented filing for VA disability benefits results in a denial of benefits for the veteran. Nearly 95% of pro se submitted claims will be denied on initial filing. It is usually wise to go another route where professionals and trained representatives can navigate the mess for the veteran.
One of the other routes is to hire a law office that specializes in applying for and acquiring award of VA disability benefits for veterans. VA disability rules and processes are entirely different than those that apply to the Social Security Administration. It is vitally important that the veteran choose a law firm that is experienced in handling disability cases for veterans before the Veterans Administration. Lacking VA experience can also result in failure to achieve a rating and compensation from the VA for the veteran’s disability.
Law firms are for profit and a contract for representation must usually be signed. However, statutes require that attorneys charge on contingency only. This means that they can not collect any amount for their services unless you receive a compensation award for your disability. This amounts to no more than 35% of back amounts paid to the veteran for the awarded disability - that can be quite a lot but is removed from the award amount and not from the veteran ahead of time.
Another route is to seek out the help of a Service Officer of a Veterans Organization. Organizations such as the American Legion, VFW, and DAV have service officers who are volunteers trained to help veterans with filing their claims for VA benefits. This is usually the most recommended route to follow. Having sponsorship by one of these organizations carry a lot of weight and often results in faster turn around with positive outcomes if the evidence submitted is strong and sufficient for the claim.
The State of Alabama has its own Department of Veterans Affairs with Service Officers paid full-time to assist veterans with filing their claims. The ADVA has offices in almost every county and can be found in the county courthouse of each county. They are chartered for the sole purpose of assisting veterans with their benefits. If at all possible the veteran should approach one of these offices and start their claim there. They are fully committed and know the rules and system very well. Positive outcomes for veterans are very high when they go through the VA with American Legion sponsorship.
When applying for VA Disability Benefits it is of great importance to understand what the VA looks for when determining disability for a veteran applicant. The basic criteria are that the veteran is currently disabled, disabled because of a diagnosable physical or mental health condition, and the condition and resultant disability are service connected. These three things must be met in order for the veteran to be determined service-connected disabled. The percentage of disability is determined based on the percent of disability evaluated by professional clinicians and practitioners.
The veteran must demonstrate that he/she is significantly hindrance in their daily functioning by their condition. Daily functioning includes ability to perform employment, maintain employment, form and maintain work relationships, family relationships, paying bills, getting around, etc. the more severe the disruption of normal functioning the more disabled the person. Documentation for this would be showing short terms of employment with long terms of unemployment. Discharge documents showing person was fired due to lack of performance, write-ups at work that show lack of focus, concentration or inability to follow instructions or perform the job due to condition.
The veteran must have a diagnosed condition that is causatory to his/her disability. This can be physical ailments such as spinal injury, joint injury or disease, traumatic brain injury, organ degeneration or illness, or mental health issues such as PTSD. This must be documented in the veteran’s military, VA, or civilian medical or mental health records. Letters of diagnosis and disability are permissible documents of evidence from doctors.
The veteran absolutely must demonstrate that the diagnosed condition and current disability are connected to his/her service in the military. This can be demonstrated through the veteran’s service records and military medical records. Formal Buddy Statements made on VA forms are also good sources for establishing military connectedness.
The evidentiary documentation must be submitted with the application in support of the veteran’s claim. Without supportive evidence the claim will be denied.
How AIBHR Helps
The Alabama Institute performs diagnostic assessments that include diagnosis, disability and level of disability determination, and military service and medical records review for service connection for mental health related VA disability claims. Claims for VA Disability compensation for PTSD, Depression, Anxiety and Panic Disorder, and other issues of mental health are assessed. We then write and issue a formal DBQ Form that reports all of what is discovered and determined with the appropriate forms being listed for the veteran to submit with the app.
After the Application and supportive evidence are received by the VA the veteran receives notification of receipt. Following that an appointment is scheduled with a VA contracted psychologist to perform an examination. This appointment lasts for about an hour and usually includes some very direct questions concerning the individual’s symptoms of type and level of disability.
The VA contracted psychologist completes a VA DBQ Form and forwards that to the VA for determination of disability, rating, and award determination. The VA, once the physical and/or mental health reports are received, will then make a determination of disability, condition, and service connection.
Based on the evidence available to the VA evaluators a determination will be made. If it is determined, in accordance with VA regulations and guidelines, that the veteran is disabled and disabled by a diagnosed condition with that condition being linked directly to his/her military service then an evaluation of the degree of disability is made.
A letter is sent to the veteran that includes the determination made by the VA. It will accompany an explanation for the determination and the degree of disability rated for each claimed condition. If the VA is denying the claim it will also explain the reason for the denial.
To Appeal or Not to Appeal?
If the veteran receives a denial of benefits letter from the VA he/she has several options for a reevaluation of the evidence and the claim. One is to make an appeal and the other is to reopen the claim with new evidence.
The appellate process for denied claims is very time consuming. It can take years for an appeal of a claim to take place. On the other hand, a re-opened case is more immediate. So, what is the difference between them?
An appeal is a request that the VA re-review the claim at a higher level using the same claim and supportive evidence. This is to review the reviewers and see if an error has been made in the formation of the initial determination. New evidence is usually not introduced or considered and the focus is on whether or not the initial determination is in error and justified in being reversed with a determination being awarded in the case.
When a case is reopened there is new evidence to be provided for review that may serve to change the determination of the claim. The introduction of nexus letters, other doctoral diagnoses, etc are introduced which shed more light on the veteran’s claim of service connected disability.
Alabama Institute Helps
The Alabama Institute for Behavioral Health and Research provides mental health evaluation services for both the initial claim and re-opening evidentiary documentation. We do this by performing thorough mental health assessments, rendering diagnoses, and providing appropriate documentation (Disability Benefits Questionnaire and Nexus letters).
We help veterans go through their military service records, military medical records, VA health records, and civilian health records to find evidence to support military connectedness.
Call us today.
By: John M. Duffey, MAC, NCC, ALC
The 2019 Veterans Affairs Suicide and Prevention Report indicates that between 17 and 22 veterans commit suicide in the United States every day. Veteran Suicide comprises 18.1% of the total suicides committed throughout the United States each year and the number appears to be increasing annually. The causes or factors leading up to suicide behavior among veterans are broad and there is no singular causation factor that can be used to predict suicidal ideation or intent. The greater majority of veterans who attempted and those who completed suicide were all previously diagnosed and had, at some point, received treatment for, mental illness. Suicide most often occurs when stressors and health issues converge to create an experience of hopelessness and helplessness.
Physical Health problems, especially chronic disabling or life disrupting, increase the risk of suicide. Serious chronic physical pain, disability, immobility, and traumatic brain injury are factors that increase the risk of suicide. This is especially so if the person sees him/herself as a burden on loved ones or friends.
Mental health issues, as listed earlier also increase the risk of suicide attempt or completion. Conditions such as PTSD, MDD, GAD, PD, Bi-Polar One Disorder, Conduct Disorders, and Schizophrenia present factors that increase the risk for suicide. When combined with substance abuse disorder the risks are exacerbated. Abusing alcohol, cannabis, and opioids (all depressants) significantly increase the risk of suicide over other drugs.
Environmental conditions can also serve to increase a person’s risk of suicide. Prolonged stress such as harassment, bullying, relationship problems, or unemployment contribute to depressive and anxiety symptoms and heighten a person’s sense of hopelessness and helplessness. Significantly stressful or traumatic life events like near death incidents, combat, rejections, divorce, financial crisis, or life changing events also contribute to an elevated risk of suicide.
Historical factors also play a considerable role in a person’s predisposition for the development of suicidal ideation and behavior. Of course, a person who has previously attempted suicide is immediately at increased risk of competing suicide in the future. If a person has a family history that includes suicide attempts or completed behaviors there is also an increased risk for the individual under certain conditions of health, mental health, and environment.
Just as there are factors that increase the risk of suicide there are also factors that strengthen a person’s resistance to it. These are often referred to as, “Protective Factors,” because they serve to protect the individual from thinking in and acting in that direction. These include Family and community connection and support, effective problem-solving and coping skills, and limited or restricted access to the means of committing suicide. Chief among the protective factors is ACCESS TO MENTAL HEALTH CARE. Not just care but quality mental health care.
A person with strong cultural and religious beliefs that discourage suicide is also strengthened and less likely to choose suicide when confronted with overwhelming environmental, conditional, and mental challenges and stressors. Church membership and participation also affords the individual a means of receiving support and assistance in dealing with conditional and environmental challenges through community togetherness and mutual helpfulness.
Something to look for when concerned that a person may be suicidal is a change in behavior or the presence of new behaviors:
1. Talk. If a person talks about Killing themselves, feeling hopeless, having no reason to live, being a burden to others, feeling trapped, or unbearable pain.
2. Behavior. Behaviors that signal a risk are increased use of alcohol or drugs, researching a way to end their life such as looking on the internet for ways to commit suicide, withdrawing from activities, isolating from family and friends, sleeping too much or too little, visiting or calling people to say goodbye, giving away prized possessions, Aggression, and fatigue.
3. Mood. People who are considering suicide often display one or more of the following moods: Depression, Anxiety, Loss of Interest, Irritability, Shame, Agitation/anger, Relief or sudden improvement in symptoms.
Many people hope that once they leave home, they will leave their family and childhood problems behind. However, many find that they experience similar problems, as well as similar feelings and relationship patterns, long after they have left the family environment. Ideally, children grow up in family environments which help them feel worthwhile and valuable. They learn that their feelings and needs are important and can be expressed. Children growing up in such supportive environments are likely to form healthy, open relationships in adulthood. However, families may fail to provide for many of their children’s emotional and physical needs. In addition, the families’ communication patterns may severely limit the child’s expressions of feelings and needs. Children growing up in such families are likely to develop low self-esteem and feel that their needs are not important or perhaps should not be taken seriously by others. As a result, they may form unsatisfying relationships as adults.
Common Patterns Seen in Dysfunctional Families
The following are some examples of patterns that frequently occur in dysfunctional families.
In common with other people, abused and neglected family members often struggle to interpret their families as “normal.” The more they have to accommodate to make the situation seem normal (e.g., “No, I wasn’t beaten, I was just spanked. My father isn’t violent, it’s just his way”), the greater is their likelihood of misinterpreting themselves and developing negative self concepts (e.g., “I had it coming; I’m a rotten kid”).
Achieving Change in Your Life Sometimes we continue in our roles because we are waiting for our parents to give us “permission”; to change. But that permission can come only from you. Like most people, parents in dysfunctional families often feel threatened by changes in their children. As a result, they may thwart your efforts to change and insist that you “change back.” That’s why it’s so important for you to trust your own perceptions and feelings. Change begins with you. Some specific things you can do include:
For Counseling Help: Alabama Institute for Behavioral Health
Col(H) John M. Duffey, MC, NCC, ALC
1211 7th Avenue, Suite A
Phenix City, AL 36867