By DR ALISON HAWKS

A recent Guardian article with the headline “Many military veterans’ PTSD claims ‘fabricated or exaggerated’” argued that fraudulent claims of PTSD take away valuable resources from those that genuinely do suffer. Professor Edgar Jones, of King’s College London, explained the problem:

‘‘The pressing issue of ‘stolen trauma’, that is the elaboration or falsification of traumatic experiences and the symptoms of post-traumatic stress disorder, is important because it has the potential to undermine the validity of genuine cases and dilute scarce resources.”

A case of someone who does not suffer any symptoms of PTSD yet seeks help under its guise is certainly worrying, although perhaps not for the reasons stated in The Guardian. The following are some issues I argue are important to consider in light of Palmer’s statistic that 42% of PTSD cases had no firm link to military service, and a further 10% ‘exaggerated or fabricated’ their claims of PTSD.

This post will briefly look at how the transition from the military to civilian life and thus becoming a veteran may affect those who fraudulently claim PTSD.

Most veterans do well after service. However, all service leavers to some degree experience the transition from the military to civilian life, ranging from the benign to the traumatic (homelessness, for example). Those that experience a difficult transition are the minority of all service leavers, but tend to figure largely in the media (for example, see here, here and here), and as such capture the imagination that all military veterans suffer as the result of the past two wars in Iraq and Afghanistan.

There are a wide array of issues that can occur during one’s transition from the military to civilian life: a change in identity, geographic relocation, new civilian employment or the search for new civilian employment, adjusting to family life where one parent may now be at home more, the change from a highly structured environment to one less so, among others. Bergman et al found reintegration to be akin to ‘culture shock.’ A physical manifestation of the stressors of transition is not unknown to happen. In Vietnam veterans this was labelled ‘Retirement Syndrome’ that included night-sweats, heart palpitations and anxiety, amongst other symptoms.

Other factors have also been found to influence the transition to civilian life, including alcohol and substance abuse, depression, and PTSD. However, it has also been found that those with issues such as alcohol abuse and depression tend to have worse treatment outcomes with those who have PTSD. The question in relation to The Guardian article is how do you weed out those who experience a difficult transition that may manifest itself with physical symptoms and/or be complicated by issues such as alcohol misuse, from those who simply have PTSD? PTSD is not always a stand-alone issue.

I don’t believe anyone who has PTSD wants it or wills it. Yet The Guardian article suggests that some people are willing to fake it. Below are some issues* I believe important to consider when asking what motivates a military veteran to claim PTSD when they don’t have it.

1. ACCESS TO SCARCE RESOURCES

When resources are scarce and NHS wait-times long, claiming PTSD may be a way for the service leaver to access scarce resources. With an abundance of information available on what symptoms meet the criteria for a PTSD diagnosis, it is not unreasonable to consider claiming PTSD as a way to gain entry into the NHS to address issues other than PTSD.

2. COMPENSATION

In the US, fraudulent claims for PTSD have been long reported (for example, see here.) As The Guardian article shows, the UK is experiencing the same trend. This point may be related to those who struggle to transfer their skills and competencies from the military to employment in the civilian job market. Again, most service leavers do well and find civilian employment upon exiting the military. However, these fraudulent claims of PTSD may indicate that some military veterans are seeking to compensate for employment shortfalls in civilian life. I believe this possibility sheds more light on government provided transition services than it does about the individuals claiming PTSD. The Career Transition Partnership, the MoD’s transition service for service leavers, provides varying levels of support and services to military veterans. Yet, it has been found to be out of balance. Those who serve four years or less are shown to be in the greatest need of transition services. However, it is those that serve the longest who receive the greatest amount of support for the longest time (a service I do not dispute here). Could this in-balance be a factor in those fraudulent claims of PTSD? If so, how to address this discrepancy is worthy of consideration.

3. INTENT TO DECEIVE

In my own research I found that the loss of belonging was a major factor in experiencing difficultly in the transition to civilian life (here). Leaving an environment as close-knit as the military for many is one of the most traumatic aspects of the transition to civilian life. It prompts questions such as ‘Who am I?’ and ‘Where do I belong?’ One hypothesis – that might rankle a few – is that claiming PTSD is an expression of belonging. There are good reasons to believe this suggestion. Media coverage has been unfailing in consistently reporting the fluctuating (often ascending) rates of PTSD in UK service personnel and military veterans. I argue that coverage such as ‘armed forces cuts could see thousands more combat veterans needing help to cope with range of mental illnesses’ communicates to civilian society that all veterans suffer from some issue related to their military service. PTSD conveys confirmation of experience. If a veteran does not have PTSD, did they not experience what everyone else did? Were they not brave enough? Are they not a hero? These are questions the media perpetuates in civilian society, although not outright. Therefore, it is not unreasonable to see people claim PTSD in order to belong to a group. It might be an uncomfortable thought, yet with names of charities like ‘Help for Heroes’ society makes the correlation between military service and heroism. This relationship is intensified when someone shows trauma associated with service. Some may see PTSD as a badge they want to wear as a result.

Then again, some might have no other agenda than to deceive. I am willing to accept there are a percentage of those among the 10% reported in the article. Even so, Palmer said of the fabrications ‘they range from outright fraud through to the fantastic and even delusional,’ the latter being psychological diagnoses in their own right. Those who are ‘tough and resilient in the military’ as Professor Christopher Dandeker wrote to me regarding this issue (I cite with his permission) can suffer from ‘loss of dependence and fear in civilian life.’ Might a claim of PTSD go some way to ameliorate this fear and gain entry back into a familiar group of people?

This post has raised some thorny issues and questions of why some military veterans might fraudulently claim PTSD. Both those who fraudulently claim PTSD and those who genuinely suffer and are subsequently denied a greater share of services are extremely worrying in their own right. The former should not be forsaken for the latter. They may not have PTSD, but they may still suffer. What, then, do we do?

*The category names of ‘access to scarce resources’ and ‘intent to deceive’ are attributed to Professor Christopher Dandeker, with whom a conversation about The Guardian article served as the basis for this blog post.

Image: Rosco, a post-traumatic stress disorder companion animal lays at the feet of his owner, Sgt. 1st Class Jason Syriac, a military police officer with the North Carolina National Guard’s Headquarters and Headquarters Company, 130th Maneuver Enhancement Brigade, at his unit’s armory in Charlotte, N.C., Jan. 11. Syriac took time to talk to other soldiers at the armory about the benefits of a companion animal for service members with PTSD and how he rescues dogs from high-kill shelters to be trained for other service members. (U.S. Army National Guard Photo by Staff Sgt. Mary Junell, 130th Maneuver Enhanced Brigade Public Affairs/Released). Courtesy of Wikimedia Commons.