i

combat and operational behavioral health 
ii

The Coat of Arms

1818

Medical Department of the Army

A 1976 etching by Vassil Ekimov of an

original color print that appeared in

The Military Surgeon, Vol XLI, No 2, 1917
iii

This book is dedicated to the many professionals committed to 

diagnosing and treating combat and operational stress casualties. 

These include our predecessors—Doctors Frank Jones, Kenneth 

Artiss, and Albert Glass—as well as the many who worked on this 

project, and those who will no doubt labor many years from now 

on the next volume in this series. All of these caregivers pursue 

this effort not just to conserve the nation’s fighting strength. They 

also believe, as do all military personnel, that we take care of our 

own—the service members who face the difficulties of combat and 

the families who support them.
iv

The TMM Series

Published Textbooks

 Medical Consequences of Nuclear Warfare (1989)

 Conventional Warfare: Ballistic, Blast, and Burn Injuries 

(1991)

 Occupational Health: The Soldier and the Industrial Base 

(1993)

 Military Dermatology (1994)

 Military Psychiatry: Preparing in Peace for War (1994)

 Anesthesia and Perioperative Care of the Combat 

Casualty (1995)

 War Psychiatry (1995)

 Medical Aspects of Chemical and Biological Warfare 

(1997)

 Rehabilitation of the Injured Soldier, Volume 1 (1998)

 Rehabilitation of the Injured Soldier, Volume 2 (1999)

 Medical Aspects of Harsh Environments, Volume 1 (2001)

 Medical Aspects of Harsh Environments, Volume 2 (2002)

 Ophthalmic Care of the Combat Casualty (2003)

 Military Medical Ethics, Volume 1 (2003)

 Military Medical Ethics, Volume 2 (2003)

 Military Preventive Medicine, Volume 1 (2003)

 Military Preventive Medicine, Volume 2 (2005)

 Recruit Medicine (2006)

 Medical Aspects of Biological Warfare (2007)

 Medical Aspects of Chemical Warfare (2008)

 Care of the Combat Amputee (2009)

 Combat and Operational Behavioral Health (2011)
v

Textbooks of Military Medicine

Published by the

Office of The Surgeon General

Department of the Army, United States of America

and 

US Army Medical Department Center and School

Fort Sam Houston, Texas

Editor in Chief

Martha K. Lenhart, MD, PhD

Colonel, MC, US Army

Director, Borden Institute

Assistant Professor of Surgery

F. Edward Hébert School of Medicine

Uniformed Services University of the Health Sciences
vi

Tracking Bin Laden, by Sergeant First Class Elzie Golden, oil on canvas, 2002. First place winner of the DINFOS 

MILGRAPH 2002 Military Graphic Competition, fine art category.

Art: Courtesy of the Army Art Collection, US Army Center of Military History.
vii

COMBAT and OPERATIONAL

BEHAVIORAL HEALTH

Senior Editor

Elspeth Cameron Ritchie, MD, MPH

Colonel, Medical Corps, US Army (Retired)

Chief Clinical Officer, District of Columbia Department of Mental Health

Former Psychiatry Consultant to The Army Surgeon General and Director,

Behavioral Health Proponency, Office of The Surgeon General

Office of The Surgeon General

United States Army

Falls Church, Virginia

Borden Institute

Fort Detrick, Maryland

2011
viii

Editorial Staff: Linette Sparacino

Volume Editor

Ronda Lindsay

Technical Editor

Douglas Wise

Illustrator

This volume was prepared for military medical educational use. The focus of the information is 

to foster discussion that may form the basis of doctrine and policy. The opinions or assertions 

contained herein are the private views of the authors and are not to be construed as official or as 

reflecting the views of the Department of the Army or the Department of Defense.

Dosage Selection:

The authors and publisher have made every effort to ensure the accuracy of dosages cited herein. 

However, it is the responsibility of every practitioner to consult appropriate information sources 

to ascertain correct dosages for each clinical situation, especially for new or unfamiliar drugs 

and procedures. The authors, editors, publisher, and the Department of Defense cannot be held 

responsible for any errors found in this book.

Use of Trade or Brand Names:

Use of trade or brand names in this publication is for illustrative purposes only and does not 

imply endorsement by the Department of Defense.

Neutral Language:

Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively 

to men.

certain parts of this publication pertain to copyright restrictions.

all rights reserved.

no copyrighted parts of this publication may be reproduced or

transmitted in any form or by any means, electronic or mechanical (including

photocopy, recording, or any information storage and retrieval system), without permission in writing from the publisher or copyright owner.

Published by the Office of The Surgeon General at TMM Publications 

Borden Institute

Walter Reed Army Medical Center

Washington, DC 20307-5001

Joan Redding

Senior Production Editor

Bruce Maston

Illustrator

printed in the united states of america

18, 17, 16, 15, 14, 13, 12, 11 5 4 3 2 1

 Library of Congress Cataloging-in-Publication Data

Combat and operational behavioral health / senior editor, Elspeth Cameron Ritchie.

 p. ; cm. -- (TMM series)

 Includes bibliographical references and index.

 1. Veterans--Mental health. 2. Post-traumatic stress disorder. 3. Combat--Psychological 

aspects. 4. War neuroses--Prevention. I. Ritchie, Elspeth Cameron. II. United States. 

Dept. of the Army. Office of the Surgeon General. III. Borden Institute (U.S.) IV. Series: 

Textbooks of military medicine.

 [DNLM: 1. Combat Disorders--prevention & control. 2. Combat Disorders--psychology. 3. Military Personnel--psychology. 4. Military Psychiatry. 5. Veterans--psychology. 

6. Veterans Health. WM 184]

 RC550.C653 2011

 616.85’212--dc23

 2011017013
ix

Contents

Contributors xiii

Foreword by The Surgeon General xxi

Preface xxiii

Section I: Setting the Stage 1

1. Combat and Operational Behavioral Health: An Update to an Old History 3

 Elspeth Cameron Ritchie and Christopher G. Ivany

2. US Army Psychiatry Legacies of the Vietnam War 9

 Norman M. Camp 

3. Preparation for Deployment: Improving Resilience 43

 Patricia Watson, Brett Litz, Steven Southwick, and Elspeth Cameron Ritchie

4. Combat and Operational Stress Control 59

 Edward A. Brusher

5. Walter Reed Army Institute of Research Contributions During Operations Iraqi Freedom and 75

 Enduring Freedom: From Research to Public Health Policy

 Charles W. Hoge, Amy B. Adler, Kathleen M. Wright, Paul D. Bliese, Anthony Cox, Dennis McGurk, 

Charles Milliken, and Carl A. Castro

Section II: In Theater 87

6. The Division Psychiatrist and Brigade Behavioral Health Officers 89

 Christopher H. Warner, George N. Appenzeller, Todd Yosick, Matthew J. Barry, Anthony J. Morton, 

Jill E. Breitbach, Gabrielle Bryen, Angela Mobbs, Amanda Robbins, Jessica Parker, and Thomas Grieger

7. US Marine Corps and Navy Combat and Operational Stress Continuum Model: A Tool for Leaders 107

 William P. Nash

8. Expeditionary Operational Stress Control in the US Navy 121

 Robert L. Koffman, Richard D. Bergthold, Justin S. Campbell, Richard J. Westphal, Paul Hammer, Thomas A. 

Gaskin, John Ralph, Edward Simmer, and William P. Nash

9. Provision of Mental Health Services in Operation Iraqi Freedom 05–07 137

 Marc A. Cooper, Sharon M. Newton, and Jeffrey S. Yarvis

10. Psychiatric Medications in Military Operations 151

 Brett J. Schneider, John C. Bradley, Christopher H. Warner, and David M. Benedek

11. The Role of Chaplains in the Operational Army 163

 Peter Frederich, Thomas C. Waynick, Jason E. Duckworth, and Jeff Voyles 

12. Psychiatric Consultation to Command 171

 Christopher H. Warner, George N. Appenzeller, Jill E. Breitbach, Jennifer T. Lange, Angela Mobbs, and 

Elspeth Cameron Ritchie

Section III: The Road Home 189

13. The Aeromedical Evacuation 191

 Alan L. Peterson, Kelly R. McCarthy, Daniel J. Busheme, Rick L. Campise, and Monty T. Baker
x

14. Behavioral Healthcare at Landstuhl Regional Medical Center 209

 Jeffrey V. Hill, David Reynolds, and Ronald Campbell

15. Traumatic Brain Injury in the Military Population 225

 Louis M. French, Katherine H. Taber, Kathy Helmick, Robin A. Hurley, and Deborah L. Warden

16. Psychiatric Intervention for the Battle-Injured Medical and Surgical Patient Following 243

 Traumatic Injuries

 Harold J. Wain, Scott C. Moran, Marvin Oleshansky, Andree Bouterie, and Christopher L. Lange

17. Oral Health Effects of Combat Stress 259

 Georgia dela Cruz and Paul Colthirst

Section IV: Reunion and Reintegration 273

18. Resetting the Force: Reentry and Redeployment 275

 Kris A. Peterson and Michael E. Doyle

19. Treatment of Deployment-Related Posttraumatic Stress Disorder 297

 Josef I. Ruzek, Jeffrey S. Yarvis, and Steven Lindley

20. The Continuum of Care for New Combat Veterans and Their Families: A Public Health Approach 325

 Harold Kudler, Alfonso R. Batres, Charles M. Flora, Terry C. Washam, Marshall J. Goby, and 

 Laurent S. Lehmann

21. Pain Management 339

 Frederick J. Stoddard, Robert L. Sheridan, Jeevendra Martyn, James E. Czarnik, and Virgil T. Deal

22. US Army Occupational Therapy: Promoting Optimal Performance 357

 Mary W. Erickson, Teresa L. Brininger, Sharon M. Newton, Amy M. Mattila, and James P. Burns

23. Provider Fatigue and Provider Resiliency Training 375

 Mary Ann Pechacek, Graeme C. Bicknell, and Lisa Landry

Section V: Surveillance and Intervention 391

24. Army Suicide Surveillance: A Prerequisite to Suicide Prevention 393

 Gregory A. Gahm and Mark A. Reger

25. Suicide Prevention in the Army: Lessons Learned and Future Directions 403

 Elspeth Cameron Ritchie, Walter Morales, Michael Russell, Bruce Crow, Wayne Boyd, Kelly Forys, and 

Steven Brewster

26. Suicide and Homicide Risk Management: Rationale and Suggestions for the Use of Unit Watch 423

 in Garrison and Deployed Settings

 Samuel E. Payne, Jeffrey V. Hill, and David E. Johnson

27. Severe Psychiatric Illness in the Military Healthcare System 441

 Geoffrey Grammer

28. Eating Disorders 449

 Gail H. Manos, Janis Carlton, and Aileen Kim 

29. Substance Use and Abuse in the Military 473

 R. Gregory Lande, Barbara A. Marin, James J. Staudenmeier, and Daryl Hawkins

Section VI. Military Children and Families 485

30. The Impact of Deployment on Military Families and Children 487

 Simon Pincus, Barbara Leiner, Nancy Black, and Tangeneare Ward Singh
xi

31. The Children and Families of Combat-Injured Service Members 503

 Stephen J. Cozza, Ryo S. Chun, and Corina Miller

32. Family Maltreatment and Military Deployment 535

 René J. Robichaux and James E. McCarroll

33. The Families and Children of Fallen Military Service Members 543

 Douglas H. Lehman and Stephen J. Cozza

34. Establishing an Integrated Behavioral Health System of Care at Schofield Barracks 563

 Michael E. Faran, Albert Y. Saito, Eileen U. Godinez, Wendi M. Waits, Victoria W. Olson, Christine M. Piper, 

Margaret A. McNulty, and Christopher G. Ivany

Section VII. Operational Behavioral Health 577

35. Disaster Psychiatry 579

 Artin Terhakopian, David M. Benedek, and Elspeth Cameron Ritchie

36. Terrorism and Chemical, Biological, Radiological, Nuclear, and Explosive Weapons 593

 Ross H. Pastel and Elspeth Cameron Ritchie

37. Operation Iraqi Freedom 05–07 Medical Civil-Military Operations: Lessons Learned in 609

 Humanitarian Assistance

 Jeffrey S. Yarvis

38. Behavioral Health Issues in Humanitarian and Military Relief Operations: The Special 619

 Problem of Complex Emergencies

 Thomas F. Ditzler

39. Population-Based Programs and Health Diplomacy Approaches of the US Public Health 633

 Service

 Jon T. Perez, Jeffrey Coady, Kevin McGuinness, and Merritt Schreiber

40. Behavioral Health Issues and Detained Individuals 645

 Richard Toye and Marshall Smith

41. Mental Healthcare in the United Kingdom Armed Forces 657

 Neil Greenberg, Jamie Hacker Hughes, Mark Earnshaw, and Simon Wessely

Section VIII. Other Military Issues 667

42. Military Psychiatry Graduate Medical Education 669

 Carroll J. Diebold, Wendi M. Waits, Millard D. Brown, and David M. Benedek

43. Military Forensic Mental Health 693

 Elspeth Cameron Ritchie

44. Women, Mental Health, and the Military 703

 Deborah Crowley, Trisha Bender, Ashley Chatigny, Tina Trudel, and Elspeth Cameron Ritchie

45. Mental Health Support to Operations Involving Death and the Dead 717

 James E. McCarroll and Robert J. Ursano

46. Ethics and Military Medicine: Core Contemporary Questions 727

 Edmund G. Howe, Robert C. McKenzie, and Chad Bradford

47. Combat and Operational Behavioral Health: Final Thoughts and Next Steps 747

 Elspeth Cameron Ritchie and Michael Doyle

Appendix 1: Provision of Behavioral Health Services During Operation Iraqi Freedom One 751

Robert D. Forsten, Brett J. Schneider, Sharette Kirsten Gray, Colin Daniels, and Gary J. Drouillard 
xii

Appendix 2: Operational Psychiatry in Operation Enduring Freedom 767

Bryan L. Bacon, Matthew J. Barry, and James Demer

Appendix 3: Good or Bad News? Media Coverage of Soldiers: Focus on Behavioral Health in Iraq 775

During Operation Iraqi Freedom 05-07

Jeffrey S. Yarvis and Elspeth Cameron Ritchie

Abbreviations and Acronyms xxv

Index xxxi
xiii

Contributors

AMY B. ADLER, PhD

Research Psychologist, US Army Research Unit—Europe, Walter 

Reed Army Institute of Research, CMR 442, APO AE 09042-1030

GEORGE N. APPENZELLER, MD

Lieutenant Colonel, Medical Corps, US Army; Commander, US 

Army Medical Activity, Alaska, 1060 Gaffney Road #7400, Fort 

Wainwright, Alaska 99703-7400; formerly, Deputy Commander 

for Clinical Services, Command Group, Winn Army Community 

Hospital, Fort Stewart, Georgia

BRYAN L. BACON, DO 

Major, Medical Corps, US Army; Disaster Psychiatry Fellow, 

Department of Psychiatry, Uniformed Services University of the 

Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 

20814; formerly, Chief, Behavioral Health, Bavaria Medical Department, Vilseck, Germany

MONTY T. BAKER, PhD

Major, Biomedical Sciences Corps, US Air Force; Director of Clinical Research, Warrior Resiliency Program, San Antonio Military 

Medical Center, 2200 Bergquist Drive, Suite 1, Lackland Air Force 

Base, Texas 78236; formerly, Element Leader, Mental Health Clinic, 59th Military Health System, Lackland Air Force Base, Texas

MATTHEW J. BARRY, DO

Major, Medical Corps, US Army Reserve; Staff Psychiatrist, 

Department of Behavioral Health, Rochester Veterans Affairs 

Outpatient Clinic, 465 Westfall Road, Rochester, New York 14620; 

formerly, Major, Medical Corps, US Army; Chief of Psychiatric 

Service USA MEDDAC and 10th Mountain Division Psychiatrist, 

Fort Drum, New York 

ALFONSO R. BATRES, PhD

Chief Officer and Director, Readjustment Counseling Service, 

Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420

TRISHA BENDER, MD

Major, Medical Corps, US Army; Division Psychiatrist, 25th Infantry Division Headquarters, Building 580, DIVSURG CELL, Schofield Barracks, Hawaii 95857-6000; formerly, Child and Adolescent 

Fellow, Tripler Army Medical Center, Honolulu, Hawaii

DAVID M. BENEDEK, MD

Colonel, Medical Corps, US Army; Professor and Deputy Chair, 

Department of Psychiatry, Uniformed Services University of the 

Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 

20814

RICHARD D. BERGTHOLD, PsyD

Commander, Medical Service Corps, US Navy; Chief of Staff, 

Wounded, Ill and Injured, Bureau of Medicine and Surgery, 2300 

E Street NW, Washington, DC 20372 

GRAEME C. BICKNELL, PhD, LISW 

Lieutenant Colonel, Medical Service Corps, US Army; Deputy 

Chief, Behavioral Health Division, US Medical Command, Building 2792, Room 112, 2050 Worth Road, Fort Sam Houston, San 

Antonio, Texas 78234-6010

NANCY BLACK, MD

Colonel, Medical Corps, US Army; Training and Program 

Director, National Capital Consortium of Child and Adolescent 

Psychiatry Fellowships, Department of Psychiatry, Walter Reed 

Army Medical Center, Borden Pavilion, 6900 Georgia Avenue 

NW, Washington, DC 20307-5001

PAUL D. BLIESE, PhD

Colonel, Medical Service Corps, US Army; Director, Psychiatry 

and Neuroscience, Walter Reed Army Institute of Research, 503 

Robert Grant Avenue, Silver Spring, Maryland 20910

ANDREE BOUTERIE, MD

Staff Psychiatrist, Psychiatry Consultation Liaison Service, Walter 

Reed Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 20307-5100

WAYNE BOYD, MDiv

Colonel, Chaplain Corps, US Army; Staff Officer, Comprehensive 

Soldier Fitness, Headquarters, Department of the Army, Zachary 

Taylor Building (NC3), 2530 Crystal Drive, Room 512B, Arlington, 

Virginia 22202; formerly, Program Manager, Directorate of Health 

Promotion and Wellness, US Army Center for Health Promotion 

and Preventive Medicine, Aberdeen Proving Ground, Maryland

CHAD BRADFORD, MD

Commander, Medical Corps, US Navy; Division Psychiatrist, 2nd 

Marine Division, Division Surgeon’s Office, Attn: Division Psychiatry, HQBN 2MAR DIV, Camp Lejeune, North Carolina 28547; 

formerly, Forensic Psychiatry Fellow, National Capital Consortium, Washington, DC

JOHN C. BRADLEY, MD

Colonel, Medical Corps, US Army; Chair, Department of Psychiatry, Borden Pavilion, Room 2022, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 20307; Psychiatry 

Consultant, North Atlantic Regional Medical Command and Vice 

Chair, Department of Psychiatry, Uniformed Services University 

of the Health Sciences, Bethesda, Maryland

JILL E. BREITBACH, PsyD

Major, Medical Service Corps, US Army; Neuropsychologist, 

Department of Psychology, Evans Army Community Hospital, 

USAMEDDAC, 1650 Cochrane Circle, Fort Carson, Colorado 

80913; formerly, Group Psychologist, 1st Special Warfare Training 

Group, Fort Bragg, North Carolina

STEVEN BREWSTER, MD, MPH

Colonel, Medical Corps, US Army; Commander, US Army Medical Activity–Bavaria, Vilseck, Germany, Unit 28038, APO AE 

09112; formerly, Director, Epidemiology and Disease Surveillance, 

US Army Center for Health Promotion and Preventive Medicine, 

Public Health Command, Aberdeen Proving Ground, Maryland

SUSAN MILLER BRIGGS, MD, MPH

Associate Professor of Surgery, Harvard Medical School, Director, 

International Trauma and Disaster Institute, Massachusetts General Hospital, 55 Fruit Street, White 506, Boston, Massachusetts 

02114 
xiv

TERESA L. BRININGER, PhD, CHT, OTR/L 

Lieutenant Colonel, Medical Specialist Corps, US Army; Deputy 

for Rehabilitation and Reintegration, Telemedicine and Advanced 

Technology Research Center, Medical Research and Materiel 

Command, 504 Scott Street, Building 722, Room 30, Fort Detrick, 

Maryland 21702

MILLARD D. BROWN, MD

Major, Medical Corps, US Army; Psychiatry Residency Director, 

Department of Psychiatry, Tripler Army Medical Center, 1 Jarrett 

White Road, Honolulu, Hawaii 96859

EDWARD A. BRUSHER, LCSW, BCD

Lieutenant Colonel, Medical Service Corps, US Army; Deputy 

Director, Behavioral Health Proponency, Office of The Surgeon 

General, 5109 Leesburg Pike, Skyline 6, Suite 693, Falls Church, 

Virginia 22041-3258; formerly, Combat Operational Stress Control 

Program Manager, US Army Medical Command, Fort Sam Houston, Texas

GABRIELLE BRYEN, MSW, LCSW 

Major, Medical Service Corps, US Army; Deputy Chief, Department of Social Work, Womack Army Medical Center, Stop A, Fort 

Bragg, North Carolina 28310; formerly, Brigade Behavioral Health 

Officer, 3rd Brigade Combat Team, 4th Infantry Division, Fort 

Carson, Colorado

JAMES P. BURNS, OTR/L, MOT 

Major, Medical Specialist Corps, US Army; Occupational Therapist, Department of Orthopaedics and Rehabilitation, Building 

2, Room 3J04, Walter Reed Army Medical Center, 6900 Georgia 

Avenue, NW, Washington, DC 20307-5001; formerly, Chief Occupational Therapist, Department of Surgery, Fort Jackson, South 

Carolina

DANIEL J. BUSHEME, MA, LCDC 

Lieutenant Colonel, Nurse Corps, US Air Force; Chief, Mental 

Health Nursing, US Air Force Medical Operations Agency, 485 

Quentin Roosevelt Road, Suite 400, San Antonio, Texas 78226-

2017; formerly, Deputy Squadron Commander and Inpatient 

Mental Health Flight Commander, Travis Air Force Base, 

California

NORMAN M. CAMP, MD

Colonel, US Army (Retired); 3105-D Stony Point Road, Richmond, 

Virginia 23235; Clinical Professor of Psychiatry, Department of 

Psychiatry, Medical College of Virginia, Virginia Commonwealth 

University, Richmond, Virginia 23298

JUSTIN S. CAMPBELL, PhD

Lieutenant, Medical Service Corps, US Navy; Deployment Health 

Senior Analyst, Department of the Navy, Bureau of Medicine and 

Surgery, Deployment Health (M3C3), 2300 E Street NW, Washington, DC 20372

RONALD CAMPBELL, MD

Chief, Inpatient Psychiatry Service, Department of Behavioral 

Health, Landstuhl Regional Medical Center, CMR 462, APO AE 

09180

RICK L. CAMPISE, PhD, ABPP 

Colonel, Biomedical Sciences Corps, US Air Force; Commander, 

559th Medical Group, 1920 Biggs Avenue, Lackland Air Force 

Base, Texas 78236; formerly, Commander, 1st Medical Operations 

Squadron, Langley Air Force Base, Virginia

JANIS CARLTON, MD, PhD

Commander, Medical Corps, US Navy; Department Head, Psychological Health and Traumatic Brain Injury, Building 7, Room 

600, National Naval Medical Center, 8901 Wisconsin Avenue, 

Bethesda, Maryland 20889; formerly, Department Head, Mental 

Health, Naval Hospital, Camp Lejeune, North Carolina

CARL A. CASTRO, PhD

Colonel, Medical Service Corps, US Army; Director, Military Operational Medicine Research Program, US Army Medical Research 

and Materiel Command, 504 Scott Street, Fort Detrick, Maryland 

21702-5012; formerly, Chief, Department of Military Psychiatry 

and Chief, Soldier and Family Readiness, Walter Reed Army 

Institute of Research, Silver Spring, Maryland

ASHLEY CHATIGNY, DO 

Captain, Medical Corps, US Army; Fellow, Department of Child 

and Adolescent Psychiatry, Tripler Army Medical Center, 1 Jarrett 

White Road, Honolulu, Hawaii 96859-5000

RYO S. CHUN, MD

Colonel, US Army (Retired); Clinical Director, Child and Adolescent Psychiatry Service, Department of Psychiatry, Walter Reed 

Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 

20307; formerly, Chief, Child and Adolescent Psychiatry Service, 

Department of Psychiatry, Walter Reed Army Medical Center, 

Washington, DC

JEFFREY COADY, PsyD

Commander, Scientist Corps, US Public Health Service; Deputy 

Team Leader, US Public Health Service Disaster Mental Health 

Team II, Department of Health and Human Services, 233 North 

Michigan Avenue, Suite 600, Chicago, Illinois 60601

PAUL COLTHIRST, DDS, MS 

Major, Dental Corps, US Army; Dental Public Health, Department of Leadership Development, US Army Medical Department 

Center and School, 2250 Stanley Road, Fort Sam Houston, Texas 

78234-6100; formerly, Staff Officer, Dental Command Headquarters, Fort Sam Houston, Texas

MARC A. COOPER, MD

Chief, Community Mental Health Service, Moncrief Army Community Hospital, 4500 Stuart Street, Fort Jackson, South Carolina 

29207; formerly, Major, Medical Corps, US Army; OIF 05-07 Theater Mental Health Consultant, Task Force 30th Medical Brigade, 

Baghdad, Iraq

ANTHONY COX, MSW 

Lieutenant Colonel, Medical Service Corps, US Army; Social Work 

Consultant, Great Plains Regional Medical Command; Chief, 

Social Work, Brooke Army Medical Center, 3851 Roger Brooke 

Drive, Fort Sam Houston, Texas 78234

STEPHEN J. COZZA, MD

Colonel, US Army (Retired); Associate Director, Center for the 

Study of Traumatic Stress, and Professor, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 

Jones Bridge Road, Bethesda, Maryland 20814; formerly, Chief, 

Department of Psychiatry, Walter Reed Army Medical Center, 

Washington, DC

BRUCE E. CROW, PsyD

Colonel, Medical Service Corps, US Army; Clinical Psychology 

Consultant to The Surgeon General, US Army, and Director, Warrior Resiliency Program, Southern Regional Medical Command, 

Brooke Army Medical Center, Fort Sam Houston, Texas 78234
xv

DEBORAH CROWLEY, MD

Captain, Medical Corps, US Army; Child Psychiatry Fellow, 

Department of Psychiatry, 1 Jarrett White Road, Tripler Army 

Medical Center, Hawaii 96859

JAMES E. CZARNIK, MD

Colonel, Medical Corps, US Army; Command Surgeon, Joint 

Special Operations Command, PO Box 70239, Fort Bragg, North 

Carolina 28307-5000; formerly, Deputy Command Surgeon, US 

Army Special Operations Command, Fort Bragg, North Carolina

COLIN DANIELS, MD, MBA

Lieutenant Colonel, Medical Corps, US Army; Psychiatrist, 

Department of Psychiatry, Madigan Army Medical Center, 9040 

Fitzsimmons Drive, 7BLM, Tacoma, Washington 98431; formerly, 

Chief, Behavioral Health Services, 28th Combat Support Hospital, 

Operation Iraqi Freedom 2003

VIRGIL T. DEAL, MD

Colonel, Medical Corps, US Army; Surgeon, United States Special 

Operations Command, 7701 Tampa Point Boulevard, MacDill 

Air Force Base, Florida 33621-5323; formerly, Commander, Walter 

Reed Health Care System, Washington, DC

GEORGIA DELA CRUZ, DMD, MPH

Lieutenant Colonel, Dental Corps, US Army; Dental Staff Officer, 

Dental Corps Office, Office of The Surgeon General, US Army, 

5109 Leesburg Pike, Suite 682, Falls Church, Virginia 22041; 

formerly, Army Dental Representative, TriService Center for Oral 

Health Studies, Uniformed Services University of the Health Sciences, Bethesda, Maryland

JAMES DEMER, MD

Attending Child Psychiatrist, Inpatient Child Psychiatry Service, 

Hutchings Psychiatric Center, 7682 Warrior’s Path, Baldwinsville, 

New York 13027; formerly, Major, Medical Corps, US Army; Division Psychiatrist, 10th Mountain Division, Fort Drum, New York

CARROLL J. DIEBOLD, MD

Colonel, Medical Corps, US Army; Chief, Department of Psychiatry, 1 Jarrett White Road, Tripler Army Medical Center, Honolulu, 

Hawaii 96859

THOMAS F. DITZLER, PhD

Director of Research, Department of Psychiatry, Tripler Army 

Medical Center, 1 Jarrett White Road, Honolulu, Hawaii 96859

MICHAEL E. DOYLE, MD

Lieutenant Colonel, Medical Corps, US Army; Deputy Commander for Clinical Services, USAMEDDAC West Point, 900 Washington Road, West Point, New York 10996; formerly, Commander, US 

Army Health Clinic, Wiesbaden, Germany

GARY J. DROUILLARD, MD

Lieutenant Colonel, Medical Corps, US Army; Chief, Chemical Addiction Treatment Service, Department of Psychiatry 1 

Jarrett White Road, Tripler Army Medical Center, Hawaii 96859; 

formerly, Chief, Consultation Liaison Psychiatry, Tripler Army 

Medical Center, Honolulu, Hawaii

JASON E. DUCKWORTH, DMin, MDiv

Lieutenant Colonel, Chaplain Corps, US Army; Garrison Chaplain, Religious Support Office, US Army Garrison, Heidelberg, 

Germany, CMR 419 Box 1876, APO AE 09102; formerly, Training 

Developer, Chaplain Basic Officer Leader Course, US Army Chaplain Center and School, Fort Jackson, South Carolina 

MARK EARNSHAW, BA(Hons), MSc

Lieutenant Colonel, QARANC, Ministry of Defence, St Georges 

Court, Bloomsbury Way, London, WC1A 2SH, United Kingdom; 

formerly, Research Fellow, Academic Centre for Defence Mental 

Health, London, United Kingdom

MARY W. ERICKSON, MAOL, OTR/L 

Colonel, US Army (Retired); formerly, Reintegration Branch Chief, 

Proponency Office for Rehabilitation and Reintegeration, The Office of The Surgeon General, US Army, 5109 Leesburg Pike, Suite 

684, Falls Church, Virginia

MICHAEL E. FARAN, MD, PhD

Colonel, US Army (Retired); Director, Child, Adolescent, and 

Family Behavior Health Proponency, Madigan Army Medical 

Center, Madigan Annex Building 9913A, Ramp 2, McKinnley 

Road, Tacoma, Washington 98431; Director, School Based Mental 

Health, Child and Adolescent Psychiatry Service, Department of 

Psychiatry, Tripler Army Medical Center, Honolulu, Hawaii

CHARLES M. FLORA, MSW

Associate Director, Readjustment Counseling Service, Department 

of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 

20420

ROBERT D. FORSTEN, DO

Colonel, Medical Corps, US Army; Command Psychiatrist, US 

Army Special Operations Command (AOMD), 2929 Desert Storm 

Drive (Stop A), Fort Bragg, North Carolina 28310-9110; formerly, 

Staff Psychiatrist, Department of Psychiatry, Walter Reed Army 

Medical Center, Washington, DC

KELLY FORYS, PhD

Psychologist, Department of Outpatient Behavioral Health, 

Landstuhl Regional Medical Center, CMR 402, Box 1045, APO 

AE 09180; formerly, Psychologist, US Army Center for Health 

Promotion and Preventive Medicine, Aberdeen Proving Ground, 

Maryland

PETER FREDERICH, MDiv

Lieutenant Colonel, Chaplain Corps, US Army; Family Ministries Officer, Directorate of Ministry Initiatives, US Army Chief 

of Chaplains Office, 1421 Jefferson Davis Highway, Suite 10600, 

Arlington, Virginia 22202; formerly, Director, US Army Family 

Life Chaplain Training Center, Fort Benning, Georgia

LOUIS M. FRENCH, PsyD

Director, Traumatic Brain Injury Service, Defense and Veterans Brain Injury Center and Department of Orthopaedics and 

Rehabilitation, Walter Reed Army Medical Center, 6900 Georgia 

Avenue NW, Washington, DC 20307; Department of Neurology, 

Uniformed Services University of the Health Sciences, Bethesda, 

Maryland 

GREGORY A. GAHM, PhD

Colonel, Medical Service Corps, US Army; Chief, Department of 

Psychology, Madigan Army Medical Center, 9933C West Hayes 

Street, Fort Lewis, Washington 98431

THOMAS A. GASKIN, PhD

Commander, US Navy (Retired); Director of Combat Operational 

Stress Control, US Marine Corps, Manpower and Reserve Affairs, 

Personal and Family Readiness Division, 3280 Russell Road, 

Quantico, Virginia 22134; formerly, Head, Combat and Operational Stress Control Program, Headquarters, US Marine Corps, 

Quantico, Virginia
xvi

MARSHALL J. GOBY, PhD

Colonel, US Army (Retired); Team Leader/Supervisory Psychologist, Veterans Affairs Readjustment Counseling Service, Palm 

Beach Veterans Center, 2311 10th Avenue North, #13, Lake Worth, 

Florida 33461; formerly, Reserve Psychology Consultant, Office of 

The Surgeon General, US Army, Falls Church, Virginia

EILEEN U. GODINEZ, PhD

Inspector General Chief, Inspections and Outreach Branch, 

US European Command, CMR 480, Box 1865, APO AE 09128; 

formerly, Chief, Plans Analysis and Integration Office, US Army 

Garrison, Hawaii

GEOFFREY GRAMMER, MD

Lieutenant Colonel, Medical Corps, US Army; Chief, Inpatient 

Psychiatry, Department of Psychiatry, Walter Reed Army Medical 

Center, 6900 Georgia Avenue NW, Washington, DC 20307 

SHARETTE KIRSTEN GRAY, MD

Lieutenant Colonel, Medical Corps, US Army; Chief, Hospital and 

Administrative Psychiatry Services, Department of Behavioral 

Health, Carl R. Darnell Army Medical Center, Building 36000, 

Darnell Loop, Fort Hood, Texas 76544; formerly, Division Psychiatrist, 4th Infantry Division, Fort Hood, Texas 

NEIL GREENBERG, MD

Commander, Medical Corps, United Kingdom Armed Forces; Defence Professor of Mental Health, King’s College, London, Weston 

Education Centre, Cutcombe Road, London SE5 9RJ; formerly, Senior Lecturer in Military Psychiatry, Academic Center for Defence 

Mental Health, King’s College, London

THOMAS GRIEGER, MD

Captain, US Navy (Retired); Associate Professor, Department of 

Psychiatry, Uniformed Services University of the Health Sciences, 

4301 Jones Bridge Road, Bethesda, Maryland 20814

PAUL HAMMER, MD

Captain, Medical Corps, US Navy; Director, Naval Center for 

Combat and Operational Stress Control, 34960 Bob Wilson Drive, 

Suite 400, San Diego, California 92134-6400

DARYL HAWKINS, PhD

Alcohol and Drug Control Officer, Army Substance Abuse Program, Building 6, Room 2066, Walter Reed Army Medical Center, 

6900 Georgia Avenue NW, Washington, DC 20307-5001

KATHY HELMICK, MS, CNRN, CRNP 

Senior Executive Director, Traumatic Brain Injury, Defense Center 

of Excellence for Psychological Health and Traumatic Brain Injury, 

1335 East-West Highway, 9th Floor, Suite 700, Silver Spring, MD 

20910; formerly, Deputy Director, Defense and Veterans Brain Injury Center, Walter Reed Army Medical Center, Washington, DC

JEFFREY V. HILL, MD

Lieutenant Colonel, Medical Corps, US Army; Chief, Child and 

Adolescent Psychiatry, Landstuhl Regional Medical Center, CMR 

402 Box 1356, APO AE 09180; formerly, Chief, Outpatient Psychiatry, Landstuhl Regional Medical Center, Landstuhl, Germany

CHARLES W. HOGE, MD

Colonel, US Army (Retired); formerly, Director, Division of 

Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, Maryland 20910

EDMUND G. HOWE, MD, JD

Professor of Psychiatry, Associate Professor of Medicine, and 

Director, Programs in Medical Ethics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, 

Maryland 20814; and Senior Scientist, Center for the Study of 

Traumatic Stress, Bethesda, Maryland; formerly, Major, Medical 

Corps, US Army

JAMIE HACKER HUGHES, PsychD

Head of Defence Clinical Psychology, Ministry of Defence, Joint 

Medical Command, Coltman House, Whittington Barracks, Lichfield, United Kingdom WS14 9PY; formerly, Senior Lecturer in 

Military Psychology, Academic Center for Defence Mental Health, 

London, United Kingdom

ROBIN A. HURLEY, MD

Associate Director, Education, WG Hefner Veterans Affairs Medical Center (Mailcode 11F), 1601 Brenner Avenue, Salisbury, North 

Carolina 28144; formerly, Associate Director, Mental Health, WG 

Hefner Veterans Affairs Medical Center, Salisbury, North Carolina

CHRISTOPHER G. IVANY, MD

Major, Medical Corps, US Army; Psychiatrist, Department of 

Behavioral Health, Evans Army Community Hospital, Building 

7500, 1650 Cochrane Circle, Fort Carson, Colorado 80913; formerly, Division Psychiatrist, 4th Infantry Division, Fort Hood, Texas

DAVID E. JOHNSON, MD

Major, Medical Corps, US Army; Chief, Behavioral Health, Department of Psychiatry, US Army MEDDAC Bavaria, IMEU-SFTDHR, ATTN: OMDC Schweinfurt, Unit 25850, APO AE 09033

AILEEN KIM, MD

Lieutenant Commander, Medical Corps, US Navy; Staff Psychiatrist, Department of Behavioral Health, Building 7, 3rd 

Floor, National Naval Medical Center, 8901 Wisconsin Avenue, 

Bethesda, Maryland 20889; formerly, Chief Resident, Department 

of Psychiatry, Naval Medical Center Portsmouth, Portsmouth, 

Virginia

ROBERT L. KOFFMAN, MD, MPH

Captain, Medical Corps, US Navy; Director of Deployment 

Health, Department of the Navy, Bureau of Medicine and Surgery, 

Deployment Health, 2300 E Street NW, Washington, DC, 20372

HAROLD KUDLER, MD

Associate Clinical Professor, Department of Psychiatry, Duke 

University Medical Center, Durham, North Carolina; Associate 

Director, Mental Illness Research, Education and Clinical Center, 

Mid-Atlantic Veterans Integrated Service Network (VISN 6), VA 

Medical Center, 508 Fulton Street, #166A, Durham, North Carolina 27705 

R. GREGORY LANDE, DO 

Chief, Psychiatry Continuity Service, Department of Psychiatry, 

Walter Reed Army Medical Center, 6900 Georgia Avenue NW, 

Building 2, Room 5343, Washington, DC 20307; Clinical Consultant, Walter Reed Army Medical Center Substance Abuse 

Program, Washington, DC 

LISA LANDRY, PhD

Instructor/Writer, Department of Behavioral Health Sciences, 

Army Medical Department Center and School, 3151 Scott Road, 

Building 2840, Office 32, Fort Sam Houston, Texas 78234
xvii

CHRISTOPHER L. LANGE, MD

Lieutenant Colonel, Medical Corps, US Army; Program Director, National Capital Consortium Forsenic Psychiatry Fellowship 

Program, Department of Psychiatry, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Building 6, Room 3038, 

Washington, DC 20307; formerly, Staff Psychiatrist, Psychiatry 

Consultation Liaison Service, Walter Reed Army Medical Center, 

Washington, DC

JENNIFER T. LANGE, MD

Lieutenant Colonel, Medical Corps, US Army; Medical Director, 

Behavioral Health Clinic, Department of Psychiatry, Walter Reed 

Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 

20307-5001

DOUGLAS H. LEHMAN, MSW, LCSW

Treatment Provider, Department of Behavioral Health and Family 

Advocacy, Evans Army Community Hospital, 7500 Cochrane 

Circle, Fort Carson, Colorado 80913

LAURENT S. LEHMANN, MD

Associate Chief Consultant in Mental Health, Office of Mental 

Health Services, Department of Veterans Affairs, 810 Vermont 

Avenue NW, Room 966, Washington, DC 20420

BARBARA LEINER, MSW, LCSW-C 

Psychiatric Social Worker, Department of Child Psychiatry, 

Walter Reed Army Medical Center, Borden Pavilion, 6900 Georgia 

Avenue NW, Washington, DC 20307-5001; formerly, Clinical Case 

Manager, Department of Child Psychiatry, Kaiser Permanente 

Mid-Atlantic States, Rockville, Maryland

STEVEN LINDLEY, MD, PhD

Director of Outpatient Mental Health, Department of Veterans 

Affairs Palo Alto Health Care System, 795 Willow Road, 116R/

MHC, Menlo Park, California 94025; and, Associate Professor, Department of Psychiatry, Stanford University, Palo Alto, California

BRETT LITZ, PhD

Professor, Department of Psychiatry, Boston University School of 

Medicine, 77 East Concord Street, Boston, Massachusetts 02118; 

Associate Director, Behavioral Sciences Division, Department 

of Veterans Affairs National Center for Posttraumatic Stress Disorder, White River Junction, Vermont

GAIL H. MANOS, MD

Captain, Medical Corps, US Navy; Navy Psychiatry Specialty 

Leader and Senior Medical Officer, Director of Mental Health, 

Naval Medical Center Portsmouth, 620 John Paul Jones Road, 

Portsmouth, Virginia 23708; formerly, Psychiatry Residency Training Director, Department of Psychiatry, Naval Medical Center 

Portsmouth, Portsmouth, Virginia 

BARBARA A. MARIN, PhD

Integrated Chief, Department of Addictions Treatment and 

Clinical Director, Army Substance Abuse Program, Walter Reed 

Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 

20307-5001

JEEVENDRA MARTYN, MD

Professor/Chief, Department of Anesthesiology and Critical Care, 

Harvard Medical School/Shriners Hospital for Children, 51 Blossom Street, Room 206, Boston, Massachusetts 02114

AMY M. MATTILA, MS, MBA

Captain, Medical Specialist Corps, US Army; Chief, Department 

of Occupational Therapy, Reynolds Army Community Hospital, 

4301 Wilson Street, Fort Sill, Oklahoma 73503; formerly, Chief, 

Occupational Therapy, 254th Medical Detachment (Combat Operational Stress Control), Germany

JAMES E. McCARROLL, PhD, MPH

Colonel, US Army (Retired); Psychologist, Center for the Study 

of Traumatic Stress and Department of Psychiatry, Room B3068, 

Uniformed Services University of the Health Sciences, 4301 Jones 

Bridge Road, Bethesda, Maryland 20814; formerly, Psychologist, 

Walter Reed Army Institute of Research, Silver Spring, Maryland

KELLY R. McCARTHY, MA

Captain, Nurse Corps, US Air Force; Historian, Peterson Air 

Force Base, 150 Vandenberg, Suite 110S, Peterson Air Force Base, 

Colorado 80914; formerly, Chief, Behavioral Health Nursing 

Management, Life Skills Center, United States Air Force Academy, 

Colorado Springs, Colorado

KEVIN M. McGUINNESS, PhD

Captain, Scientist Corps, US Public Health Service; Director and 

Medical Psychologist, HRSA/BCRS National Health Service 

Corps, Ready Responder Program, Department of Health and 

Human Services, c/o La Clinica de Familia, 510 East Lisa Drive, 

Chaparral, New Mexico 88081; formerly, Senior Clinical Scientist, 

Health and Human Services, US Department of Justice, Bureau of 

Prisons, Federal Correctional Institution La Tuna, New Mexico

DENNIS McGURK, PhD

Major, Medical Service Corps, US Army; Commander, US Army 

Medical Research Unit—Europe, Walter Reed Army Institute of 

Research, CMR 442, Box 777, APO AE 09042

ROBERT C. McKENZIE, DO 

Lieutenant Colonel, Medical Corps, US Army; Department of Behavioral Health, US Army Health Clinic-Vicenza, Caserma Ederle, 

Italy, Unit 31401, Box 13, APO AE 09042

MARGARET A. McNULTY, DrPH

Captain, US Navy (Retired); Assistant Professor, Department of 

Nursing, Kapiolani Community College, 4303 Diamond Head 

Road, Honolulu, Hawaii 96816

CORINA MILLER, MSW 

Clinical Social Worker, Department of Psychiatry, Walter Reed 

Army Medical Center, Building 2, Office #6317, 6900 Georgia 

Avenue NW, Washington, DC 20307-5001; formerly, Clinical Social 

Worker, National Naval Medical Center, Bethesda, Maryland

CHARLES MILLIKEN, MD

Colonel, Medical Corps, US Army; Program Director, National 

Capital Consortium Psychosomatic Medicine/Geriatric Psychiatry Fellowship, Walter Reed Army Medical Center, 6900 Georgia 

Avenue NW, Washington, DC; formerly, Principal Investigator, 

Division of Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Grant Avenue, Silver Spring, Maryland

ANGELA MOBBS, PsyD

Captain, Medical Service Corps, US Army; Special Forces Assignment and Selection Psychologist, Special Warfare Center 

and School, Rowe Training Facility, Building T-5167, 1500 Camp 

Mackall Place, Marston, North Carolina 28363; formerly, Brigade 

Psychologist, 3rd Brigade Combat Team, 3rd Infantry Division, 

Fort Benning, Georgia
xviii

WALTER MORALES, MSA

Sergeant Major, US Army (Retired); Program Manager, Army Suicide Prevention Program, Army G-1, Headquarters, Department 

of the Army, 300 Army Pentagon, ATTN: Army G-1 (DAPE-HR), 

Washington, DC 20310-0300

SCOTT C. MORAN, MD

Major (P), Medical Corps, US Army; Psychiatry Residency Training Program Director, Psychiatry Consultation Liaison Service, 

Department of Psychiatry, Building 6, Room 2060, Walter Reed 

Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 

20307-5100

ANTHONY J. MORTON, MD

Major, Medical Corps, US Army; Medical Director, Department 

of Behavioral Health, Moncrief Army Community Hospital, 4500 

Stuart Street, Fort Jackson, South Carolina 29207-5720; formerly, 

Division Psychiatrist, 1st Armored Division, Wiesbaden, Germany

WILLIAM P. NASH, MD

Captain, US Navy (Retired); Assistant Clinical Professor, Department of Psychiatry, University of California at San Diego, 6326 

Timarron Cove Lane, Burke, Virginia 22015; formerly, Senior Consultant, Defense Centers of Excellence for Psychological Health 

and Traumatic Brain Injury, Rosslyn, Virginia

SHARON M. NEWTON, OTR/L, MHS 

Lieutenant Colonel, Medical Specialist Corps, US Army; Command Inspector General, 30th Medical Command, CMR 442, APO 

AE 09042; formerly, Theater Consultant for Combat and Operational Stress Control, Iraq

MARVIN OLESHANSKY, MD

Colonel, US Army (Retired); Staff Psychiatrist, Psychiatric Outpatient Service, Department of Psychiatry, Tripler Army Medical 

Center, 1 Jarrett White Road, Honolulu, Hawaii 96822; formerly, 

Staff Psychiatrist, Psychiatry Consultation Liaison Service, Walter 

Reed Army Medical Center, 6900 Georgia Avenue NW, Washington, DC

VICTORIA W. OLSON, MBA

Executive Director, Hawai’i Army Museum Society, Post Office 

Box 8064, Honolulu, Hawaii 96830-0064

JESSICA PARKER, PsyD

Captain, Medical Service Corps, US Army; Chief, Warrior Restoration Center, Department of Behavioral Medicine, Winn Army 

Community Hospital, 541 East 9th Street, Building 359, Fort Stewart, Georgia 31314-5674; formerly, Psychology Resident, Traumatic 

Brain Injury, Brooke Army Medical Center, San Antonio, Texas

ROSS H. PASTEL, PhD

Lieutenant Colonel, Medical Service Corps, US Army; Chief, 

Division of Traumatic Brain Injury, Research Directorate, Defense 

Centers of Excellence for Psychological Health and Traumatic 

Brain Injury, 1335 East-West Highway, Suite 900, Silver Spring, 

Maryland 20910; formerly, Assistant Professor, Department of 

Medical and Clinical Psychology, Uniformed Services University 

of the Health Sciences, Bethesda, Maryland

SAMUEL E. PAYNE, MD

Colonel, Medical Corps, US Army; Chief, Outpatient Behavioral 

Health Services, Dwight D. Eisenhower Army Medical Center, 

Building 300, Room 13A-15, 300 South Hospital Road, Fort Gordon, Georgia 30905 

MARY ANN PECHACEK, PsyD, LMFT 

Psychologist and Instructor/Writer, Department of Behavioral 

Health Sciences, Special Subjects Branch, Army Medical Department Center and School, 3151 Scott Road, Building 2840, Office 

#033-B9, Fort Sam Houston, Texas 78234; formerly, Psychologist 

and Instructor/Writer, Soldier and Family Support Branch/Special Subjects, Fort Sam Houston, Texas

JON T. PEREZ, PhD

Captain, Scientist Corps, US Public Health Service; Team Leader, 

US Public Health Service Disaster Mental Health Team II, Department of Health and Human Services, Indian Health Service Headquarters, 801 Thompson Avenue, Suite 300, Rockville, Maryland 

20852

ALAN L. PETERSON, PhD, ABPP 

Professor, Department of Psychiatry, Mail Code 7792, University 

of Texas Health Science Center at San Antonio, 7703 Floyd Curl 

Drive, San Antonio, Texas 78229; formerly, Chair, Department of 

Psychology, Wilford Hall Medical Center, San Antonio, Texas

KRIS A. PETERSON, MD

Colonel, Medical Corps, US Army; Chief, Department of Psychiatry, Madigan Army Medical Center, Building 9040, Fitzsimmons 

Drive, Tacoma, Washington 98431; formerly, Child and Adolescent Psychiatry Consultant to The Surgeon General, US Army

SIMON PINCUS, MD

Colonel, US Army (Retired); Clinical Director, Department of 

Mental Health, McChord Medical Clinic, 690 Barnes Boulevard, 

Joint Base Lewis-McChord (McChord Field), Washington 98438; 

formerly, Chief, Inpatient Psychiatry, Madigan Army Medical 

Center, Tacoma, Washington

CHRISTINE M. PIPER, APRN, BC

Colonel, US Army (Retired); Coaching Trainer/Instructor, LivingWorks, Inc.; formerly, Chief, Soldier and Family Assistance 

Center, Schofield Barracks, Hawaii

JOHN RALPH, PhD

Commander, Medical Service Corps, US Navy; Director, Department of Mental Health, National Naval Medical Center, 8901 

Wisconsin Avenue, Bethesda, Maryland 20889; formerly, Officerin-Command, Presidential Support Program, Marine Barracks, 

Washington, DC

MARK A. REGER, PhD

Research Psychologist, Department of Psychology, Madigan 

Army Medical Center, 9933C West Hayes Street, Fort Lewis, 

Washington 98431; and Affiliate Assistant Professor, Department 

of Psychiatry and Behavioral Sciences, University of Washington 

School of Medicine, 1925 NE Pacific Street, Seattle, Washington 

98195-6340

DAVID REYNOLDS, PhD

Major, Biomedical Sciences Corps, US Air Force; Mental Health 

Element Leader, Department of Psychology, Malcolm Grow 

Medical Center, 1050 West Perimeter Road, 779 MDOS/SGOH, 

Andrews Air Force Base, Maryland 20762; formerly, Chief, 

Department of Health Psychology, Landstuhl Regional Medical 

Center, Landstuhl, Germany
xix

ELSPETH CAMERON RITCHIE, MD, MPH

Colonel, US Army (Retired); formerly, Psychiatry Consultant 

to The Surgeon General, US Army, and Director, Behavioral 

Health Proponency, Office of The Surgeon General, Falls Church, 

Virginia; currently, Chief Clinical Officer, District of Columbia Department of Mental Health, 64 New York Avenue NE, 4th Floor, 

Washington, DC 20002

AMANDA ROBBINS, PsyD

Captain, Medical Service Corps, US Army; Brigade Combat Team 

Behavioral Health Officer, 4th Brigade Combat Team, 10th Mountain Division, Fort Polk, Louisiana 71459

RENÉ J. ROBICHAUX, PhD, LCSW 

Colonel, US Army (Retired); Social Work Programs Manager, 

Behavioral Health Division, US Army Medical Command, 2050 

Worth Road, Suite 10, Fort Sam Houston, Texas 78234; formerly, 

Chief, Department of Social Work, Brooke Army Medical Center, 

Fort Sam Houston, Texas

MICHAEL RUSSELL, PhD

Lieutenant Colonel, Medical Service Corps, US Army; Army 

Medical Department Neuropsychology Consultant, Warrior Resiliency Program, Lincoln Center, Suite 300, 7800 Interstate 10 West, 

San Antonio, Texas 78230 

JOSEF I. RUZEK, PhD

Director, Dissemination and Training Division, National Center 

for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto 

Health Care System, 795 Willow Road, Menlo Park, California 

94025

ALBERT Y. SAITO, MD

Clinical Director, Child and Adolescent Psychiatry Service, 

Department of Psychiatry, Tripler Army Medical Center, 1 Jarrett 

White Road, Honolulu, Hawaii 96859-5000; formerly, Staff Psychiatrist, Department of Child Psychiatry, Tripler Army Medical 

Center, Honolulu, Hawaii

BRETT J. SCHNEIDER, MD

Lieutenant Colonel, Medical Corps, US Army; Deputy Chief, 

Department of Psychiatry, Building 61, Child and Adolescent Psychiatry Clinic, Walter Reed Army Medical Center, 6900 Georgia 

Avenue NW, Washington, DC 20307

MERRITT SCHREIBER, PhD

Captain, Scientist Corps, US Public Health Service (Inactive Reserve Corps); Senior Program Manager, Center for Public Health 

and Disasters, University of California at Los Angeles Center for 

the Health Sciences, 1145 Gayley Avenue, Suite 304, Los Angeles, 

California 90024; and Operations Lead, USPHS Mental Health 

Team II

ROBERT L. SHERIDAN, MD

Associate Director, Department of Surgery, Harvard Medical 

School at the Massachusetts General Hospital; Assistant Chief of 

Staff, Shriners Burn Hospital, 51 Blossom Street, Boston, Massachusetts 02114; formerly, Lieutenant Colonel, Medical Corps, 

US Army; US Army Institute of Surgical Research, Brooke Army 

Medical Center, San Antonio, Texas

EDWARD SIMMER, MD, MPH

Captain, Medical Corps, US Navy; Executive Officer, Naval Hospital, 1 Pinckney, Beaufort, South Carolina 29902; formerly, Senior 

Executive Director for Psychological Health, Defense Centers of 

Excellence for Psychological Health and Traumatic Brain Injury, 

Silver Spring, Maryland

TANGENEARE WARD SINGH, MD

Major, Medical Corps, US Army; Chief, Department of Behavioral 

Health, Blanchfield Army Community Hospital, 650 Joel Drive, 

Fort Campbell, Kentucky 42223

MARSHALL SMITH, MD

Lieutenant Colonel, Medical Corps, US Army; Chief, Behavioral 

Health, Landstuhl Regional Medical Center, CMR 402, Box 1357, 

APO AE 09180; formerly, Chief, Outpatient Behavioral Health, 

Landstuhl Regional Medical Center, Landstuhl, Germany

STEVEN SOUTHWICK, MD

Professor, Department of Psychiatry, Yale University School of 

Medicine and Yale Child Study Center, 333 Cedar Street, New 

Haven, Connecticut 06510; Adjunct Professor, Department of 

Psychiatry, Mount Sinai School of Medicine, One Gustave L. 

Levy Place, New York, New York 10029; Deputy Director, Clinical 

Neurosciences Division, Department of Veterans Affairs National 

Center for Posttraumatic Stress Disorder, White River Junction, 

Vermont 

JAMES J. STAUDENMEIER, MD, MPH

Colonel, Medical Corps, US Army; Consultant, Army Substance 

Abuse Program, Department of Psychiatry, USAMEDDAC, 11050 

Mount Belvedere Boulevard, BMD (Wilcox), Fort Drum, New 

York 13602; formerly, Fellow in Geriatric Psychiatry, Walter Reed 

Army Medical Center, Washington, DC

FREDERICK J. STODDARD Jr, MD

Associate Clinical Professor, Department of Psychiatry, Harvard 

Medical School at the Massachusetts General Hospital; and Chief 

of Psychiatry, Shriners Burn Hospital, 51 Blossom Street, Boston, 

Massachusetts 02114; formerly, Senior Surgeon, US Public Health 

Service 

KATHERINE H. TABER, PhD

Research Health Scientist, Department of Research and Education, WG Hefner Veterans Affairs Medical Center, Mailstation 

11M, 1601 Brenner Avenue, Salisbury, North Carolina 28144; 

formerly, Research Fellow, School of Health Information Sciences, 

University of Texas at Houston

ARTIN TERHAKOPIAN, MD, MPH

Major, Medical Corps, US Army; Chief, Inpatient Psychiatry, Department of Behavioral Health, William Beaumont Army Medical 

Center, 5005 North Piedras Street, El Paso, Texas 79920; formerly, 

Chief, Behavioral Health, 10th Combat Support Hospital, Baghdad, Iraq

RICHARD TOYE, PhD

Lieutenant Colonel, Medical Service Corps, US Army Reserve; 

Company Commander, 883rd Medical Company (Combat Stress 

Control), 495 Summer Street, Boston, Massachusetts 02210; 

formerly, Brigade Behavioral Health Consultant, 804th Medical 

Brigade, Fort Devens, Massachusetts

TINA TRUDEL, PhD

Site Director, Defense and Veterans Brain Injury Center at Virginia 

NeuroCare, 1101-B East High Street, Charlottesville, Virginia 

22902; Assistant Clinical Professor of Psychiatry and Behavioral 

Neurobehavioral Sciences, University of Virginia Medical School, 

Charlottesville, Virginia 22902; formerly, Executive Director, 

Lakeview NeuroRehabilitation Center, Effingham Falls, New 

Hampshire 
xx

ROBERT J. URSANO, MD

Colonel, US Air Force (Retired); Director, Center for the Study 

of Traumatic Stress, and Chair, Department of Psychiatry, Room 

B3068, Uniformed Services University of the Health Sciences, 4301 

Jones Bridge Road, Bethesda, Maryland 20814 

JEFFREY L. VOYLES, MDiv

Lieutenant Colonel, Chaplain Corps, US Army; Director and 

Clinical Supervisor, Chaplain Family Life Training Program, 

Building 2606 Collins Loop, Fort Benning, Georgia 31905

HAROLD J. WAIN, PhD

Chief, Psychiatry Consultation Liaison Service, Department of 

Psychiatry, Building 2, Room 6238, Walter Reed Army Medical 

Center, 6900 Georgia Avenue NW, Washington, DC 20307-5100

WENDI M. WAITS, MD

Lieutenant Colonel, Medical Corps, US Army; Chief, Inpatient 

Psychiatry Service, Department of Psychiatry, Tripler Army Medical Center, 1 Jarrett White Road, Room 4B106, Honolulu, Hawaii 

96859-5000; formerly, Child and Adolescent Psychiatry Fellow, 

Tripler Army Medical Center, Honolulu, Hawaii

DEBORAH L. WARDEN, MD

Formerly, National Director, Defense and Veterans Brain Injury 

Center Headquarters; Departments of Neurology and Psychiatry, 

Walter Reed Army Medical Center, 6900 Georgia Avenue NW, 

Washington, DC 20307; Departments of Neurology and Psychiatry, Walter Reed Army Medical Center, 6900 Georgia

Avenue NW, Washington, DC 20307-5001

CHRISTOPHER H. WARNER, MD

Major, Medical Corps, US Army; Chief, Department of Behavioral 

Medicine, Winn Army Community Hospital, Building 9242, Room 

20, 1083 Worcester Drive, Fort Stewart, Georgia 31324; formerly, 

Division Psychiatrist, 3rd Infantry Division, Fort Stewart, Georgia

TERRY C. WASHAM, MSSA, LISW 

Colonel, Medical Service Corps, US Army Reserve; Military 

Liaison Coordinator, Office of Seamless Transition, Department 

of Veterans Affairs, VA Medical Center, 10000 Brecksville Road, 

Brecksville, Ohio 44141

PATRICIA WATSON, PhD

Assistant Professor, Dartmouth Medical School, 1 Rope Ferry 

Road, Hanover, New Hampshire 03755-1404; Senior Educational 

Specialist, Executive Division, Department of Veterans Affairs 

National Center for Posttraumatic Stress Disorder, White River 

Junction, Vermont

THOMAS C. WAYNICK, MDiv

Lieutenant Colonel, Chaplain Corps, US Army; Command 

Chaplain, Family, Morale, Welfare, and Recreation Command, 

4700 King Street, Alexandria, Virginia 22301; formerly, Director 

and Clinical Supervisor, US Army Family Life Chaplain Training 

Program, Fort Benning, Georgia

SIMON WESSELY, MD

Department Head, Department of Psychological Medicine, King’s 

Centre for Military Health Research, King’s College, Weston 

Education Centre, 10 Cutcombe Road, London SE5 9RJ United 

Kingdom; formerly, Honorary Lecturer in Forensic Psychiatry, 

Institute of Psychiatry, London, United Kingdom

RICHARD J. WESTPHAL, PhD, RN

Captain, Nurse Corps, US Navy; Psychological Health Promotion Programs, Department of the Navy, Bureau of Medicine and 

Surgery, Deployment Health, 2300 E Street NW, Washington, DC 

20372

KATHLEEN M. WRIGHT, PhD

Research Psychologist, US Army Medical Research-Europe, Walter Reed Army Institute of Research, CMR 442, Box 94, APO AE 

09042; formerly, Deputy Chief, Department of Military Psychiatry, 

Walter Reed Army Institute of Research, Silver Spring, Maryland

JEFFREY S. YARVIS, MSW, PhD

Lieutenant Colonel, Medical Service Corps, US Army; Chief, 

Behavioral Health, Department of Psychiatry, Borden Pavilion, Walter Reed Army Medical Center, 6900 Georgia Avenue 

NW, Washington, DC 20307; formerly, Director of Social Work, 

Uniformed Services University of the Health Sciences, Bethesda, 

Maryland

TODD YOSICK, LISW 

Major, Medical Service Corps, US Army; Deputy Director, Resilience and Prevention Directorate, Office of the Assistant Secretary 

of Defense for Health Affairs, Defense Centers of Excellence for 

Psychological Health and Traumatic Brain Injury, 1335 EastWest Highway, Silver Spring, Maryland 20910; formerly, Chief, 

Battlemind Training Office/Chief, Combat and Operational Stress 

Control, Army Medical Department Center and School, Fort Sam 

Houston, Texas
xxi

Foreword

Military healthcare has the unique opportunity of truly addressing the full continuum of illness, injury, disease, 

and health. Just as military healthcare professionals have made significant contributions to the improvement of 

physical health and lessening of injury and disease over the history of the United States, we are now a leading 

proponent of changes in prevention, recognition, and treatment in multiple areas of behavioral health.

Essential to progress in this arena is developing awareness of behavioral health needs and educating our 

beneficiaries about the appropriateness of receiving care for what are often “invisible” diseases or injuries. The 

need for this education and developing a toolkit of successful skills, techniques, and strategies for resilience have 

never been more apparent than during what has become a persistent state of conflict. We are committed to leading the Nation in eliminating the stigma of behavioral health problems. Men and women within our militaries 

and across America must learn that it is just as acceptable and appropriate to seek behavioral healthcare as it is 

to seek treatment for a broken bone.

Since the publication of the two Textbooks of Military Medicine psychiatry volumes—Military Psychiatry: Preparing in Peace for War (1994) and War Psychiatry (1995)—we have made tremendous strides. This volume, Combat 

and Operational Behavioral Health, expands on these previous two volumes, covering the full breadth of the 

psychological and behavioral health continuum. Important contributions include preparation for deployment 

and resiliency training; the provision of services in theater; recovery after physical or emotional injury due to 

combat; reunion and reintegration; military children and families; operational psychiatry; and the daunting 

challenge to prevent suicide.

I see our effect on social attitudes toward behavioral and/or psychological health as potentially substantial. 

Our prospects are good for a better understanding of the neurochemistry and basic pathophysiology of many 

common stress-related problems, and our grasp and management of millennia-old problems of armed conflict are 

much improved. However, major challenges remain. One may think the diagnosis of posttraumatic stress disorder 

(PTSD), for example, would be straightforward. On the contrary, it varies widely among different stakeholders. 

The more complex issues of the etiology of PTSD and traumatic brain injury, and effective treatments for these 

conditions, as well as their interaction with age, gender, and other medical issues, are far more daunting. 

This new textbook is an excellent resource for all healthcare professionals as they strive to provide the finest 

quality and most compassionate care of the men and women in uniform and their spouses, significant others, 

and children. Every person who is in contact with a military member struggling to cope with the emotional 

trauma of war, disease, or injury needs our support and best efforts. 

The contributions of the exceptional civilian and military professionals in this outstanding text can raise the 

quality of behavioral healthcare across our land and help eliminate the stigma of requesting this care. Although 

we talk a lot about the reduction of stigma, to actually reduce it and improve Soldiers’ willingness to seek treatment is a Herculean task. Therefore, let us all participate in this essential step forward for the health and wellbeing of those who have often suffered in silence and alone.

 Lieutenant General Eric B. Schoomaker, MD, PhD

The Surgeon General and

Commanding General, US Army Medical Command

Washington, DC

February 2010
xxii
xxiii

Preface

This book was begun in 2005 when it became apparent that an update to the previous volumes on military 

psychiatry—Military Psychiatry: Preparing in Peace for War (1994) and War Psychiatry (1995)—was needed. In the 

almost 20 years since the chapters in those two volumes were drafted, enormous changes and advancements 

in classification, diagnosis, and treatment of combat stress have occurred. The pace of change has accelerated 

with the wars in Afghanistan and Iraq. These wars have become known by many names: Operations Enduring 

Freedom and Iraqi Freedom, the Long War, and continuous overseas contingency operations, among others. 

In the early years of the operations in Afghanistan (2001) and Iraq (2003), changes in operational tempo and 

resulting extended deployments were extremely taxing for military families. What was problematic in these 

early years (tempo and deployment) because of the change from past experience has now become problematic 

because it is the norm. The murders and murder/suicides at Fort Bragg, North Carolina, in 2002 highlighted 

the perils of soldiers’ rapid return from Afghanistan battlefields to civilian life. The investigations at Fort Bragg 

and other installations revealed continuing problems with access to care, as well as reluctance of career-minded 

soldiers to seek treatment. 

In response to these and other events, training and systems were put into place to prepare soldiers for “redeployment” (return to garrison). One of the earlier approaches, “Battlemind,” was designed to help reintegrate 

service members and families. Battlemind recently evolved into the Comprehensive Soldier Fitness program, 

which is focused on enhancing resiliency. Despite these various new programs, many soldiers remain reluctant 

to seek behavioral healthcare for many reasons, perhaps the greatest of which is worry about its effects on 

their careers. Stigma is a persistent problem, despite numerous efforts to reduce its prevalence. Often it is the 

soldiers’ families who try to get these service members in for treatment. To improve access to care, the Army 

and other services have dramatically increased their number of mental health providers, up about 70% between 

2007 and 2010. 

To assist this growing population of service members, the military behavioral health community has added 

many new systems of evaluation and care. The Post-Deployment Health Assessment (PDHA), which screens 

soldiers on return from theater, was implemented after the Persian Gulf War (1990–1991). However, soldiers 

often did not admit to symptoms after deployment because they wanted to get home as soon as possible. Beginning in 2005, the PDHA was joined by the Post-Deployment Health Re-Assessment (PDHRA), administered at 

3 to 6 months after return. It was designed to connect with service members after “the honeymoon” of returning 

home was over. 

Family programs have been expanded to help with issues that arise during both deployment and redeployment. There are specialized programs at Walter Reed Army Medical Center and other facilities for families of 

the wounded that attempt to prepare children to see parents missing a limb or disfigured from a blast. Another 

difficult area has been support to families of the deceased. US military families have not faced these numbers 

of service-connected fatalities since the Vietnam War. In the past, spouses and children were required to leave 

base housing and service-centered support systems relatively soon after their loved one’s death. This policy has 

changed over time, with longer access to housing and healthcare afforded these families. 

Traumatic brain injury (TBI) is another major concern and affects families as well as service members. The 

sources of these injuries are varied: blasts, gunshot wounds, accidents. TBI can present with many symptoms, 

some similar to posttraumatic stress disorder, including irritability, impulsiveness, and personality changes.

The rising suicide rate has been a major concern for all in the Army. The combination of unit and individual 

risk factors include high operations tempo, feelings of disconnectedness on return home, problems at work 

or home, pain and disability, alcohol, and easy access to weapons. Consistent and high-profile attempts have 

been made to reduce suicide with numerous training programs for service members, focusing on buddy aid 

and gatekeepers. However, thus far these efforts have been only partially successful. The prolonged effects of 

exposure to violence and death are not easy to change.

New efforts to assist service members continue. The Defense Center of Excellence was stood up in November 2007, with a focus on best practices and reducing stigma. Other programs are the Comprehensive Behavioral Health Campaign Plan, the Department of Defense–Department of Veterans Affairs Integrated Mental 

Health Plan, and the National Intrepid Center of Excellence. 

An ongoing concern is the long-term effects of the Long War, for the next 20, 30, or 50 years. After the Viet-
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nam War, far too many veterans ended up on the streets—unemployed, homeless, and addicted. By examining 

the potential causes of combat stress and emotional trauma, the various approaches to diagnosis and treatment, 

the roles of providers (and their own resiliency), and the many programs available to help, this volume seeks to 

reduce the difficulties faced by veterans as they reenter civilian life. However, success in this area will require 

a concerted effort by all on the home front, including the Army, other branches of the military, the Department 

of Veterans Affairs, other federal agencies, and state and local agencies, as well as civilian and private organizations. It is hoped that the interventions described in this volume will contribute to that effort by informing 

and guiding military and civilian healthcare providers, the public, and both active duty service members and 

veterans of these most recent conflicts.

Elspeth Cameron Ritchie, MD, MPH, Colonel, US Army (Retired) 

Chief Clinical Officer, District of Columbia Department of Mental Health 

Formerly, Psychiatry Consultant to The Army Surgeon General, and Director, Behavioral Health Proponency, 

Office of The Surgeon General

Washington, DC

December 2010