Table 2

Clinical Guide for Review of PTSD/TBI Combat Exposure and Civilian Violence

(Each item is marked present or absent by the evaluator)
Combat Exposure: Severity of Experience
    Mortar and rocket-propelled grenade attacks
    Indirect IED/VBED blast hits
    IED/VBED direct hits
    Witnessing injury or death of military personnel and near misses
    Witnessing civilian injury or death
    Combat duties: search and listen missions in field; medic duties
    Aircraft duty over warzone/crashes due to enemy fire or mechanical failure in enemy territory
War-zone deployment exposure: severity of trauma
    Mortar/gunfire while on base
    Witnessing of dead bodies or morgue duty on base
    Treating battlefield injuries on base (witnessing the severely injured)
    Knowledge of death of fellow military personnel
    Warnings of incoming enemy mortar attacks
Battlemind Conditioning in Combat Zone
    High alert-high adrenaline combat duty (night time raids, home raids/village raids for intelligence gathering or capture of enemy insurgents)
    Several documented instances of instant actions to perceived threat or threat (e.g., discharging weapon)
    Erratic driving to avoid IEDs
    Encounters with hostile civilians in combat zone
    Deployment to high-density urban areas where there are enemy insurgents
    Travel on routes known to be highly mined with IEDs
    Security duty at entry and exit points of base and base perimeter
    Flight crew hazardous flights over hostile territory
    Security duty at entry and exit points of base
Postdeployment erratic behavior
    Reckless driving
    Explosive temper loss with family and friends
    Severe isolation, detachment, refusal to communicate with family and friends
    Heavy drinking; drug use
    Physical confrontations with others
    Irrational suspicion of others
    Severe rage leading to destruction of property (e.g. punching walls, breaking furniture)
    Physical violence towards family and spouse
    Self-harm (suicide attempts)
    Carries weapon at all times for safety
    Frustration and inability to cope with stress
PTSD symptoms with potential links to aggression
    Severe insomnia impairing judgment
    Survivor guilt and remorse-related anxiety and depression
    Dissociative flashbacks
TBI symptoms with potential links to aggression
    Sleep disturbance and headache leading to easy frustration/loss of temper
    Impairments in judgment (misinterpretation of others motives)
    Mood lability
    Impulsivity (spending sprees, terminating relationships)
    Angry outbursts that are out of proportion to precipitant