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Obsessional thought disturbance in a gainfully employed PTSD patient.

This is a single case study of obsessional thought disturbance in a currently employed Vietnam veteran who experienced traumatic stress during and subsequent to his tour of duty in Vietnam. It was hypothesized that with the diagnostic indicators present a systematic desensitization model with muscle relaxation, covert imagery, cognitive disputation and self-monitoring would offer relief to the patient's obsessive-compulsive features and allow maintenance of employment. Cognitive disputation, especially with spouse participation addressing the irrational belief system, proved to be a very effective component in the treatment program. The patient learned effective coping skills to guard against future obsessional thought disturbance and has been able to maintain gainful employment. INTRODUCTION Symptomatology manifested in Vietnam Veterans and directly associated with post traumatic stress include psychophysiological disorders (Blanchard, The Locus of Controt which measures the extent to which a person perceives theycontrol their own destiny or they are controlled by others or by circumstance, was used to Obtain an estimate of the patient's perceived level of internal control. Kolb & Pallmeyer, 1982), depression, rage, guilt, sleep disturbance and obsessional thought disturbance (Blum, Kelly & Meyer1984; DeFazio & Pascucci, 1984; Shatan, 1983). Patients who lack good internal control and who are placed in very stressful situations seem to develop obsessive-compulsive traits as a means of coping with the stress (Miller & Feibelman, 1986). The case study which follows exemplifies the process and complexity of obsessive-compulsive symptomatology as a part of delayed stress. BACKGROUND AND CARE REVIEW At the time of referral, the patient is a 33-year-old gainfullyemployed married male veteran who was referred for behavioral treatment due to recurrent flashbacks of specific Vietnam experiences. He is a full-time employee of public utilities company and is classified as an electronics specialist. He enlisted in the army at age18and served in Vietnam as a combat infantryman. During his26 months in the country, he was continually exposed to ambushes, search and destroy missions, and intense destructive activity Following Vietnam, he served for one year as a combat instructor to the troops being prepared to serve in Vietnam. It was during this time that he initially began to suffer from the symptoms which included: (1) restlessness and tension, (2) sleep disturAAOHN JOURNAL, FEBRUARY 1987, VOL. 35, NO. 2 69 State anxiety is viewed as a transitory emotional state characterized by subjective consciously perceived tension and heightened autonomic nervous system