Military spouses experience numerous struggles in the day to day to life. One of the problems is the unemployment due to deployment strategies in their career (Padden DL, 2017). If the husband is working in the military, the wife will be forced to keep watch of the children and vice versa. Sharing of family duties among the many spouses is quite ineffective, and this has contributed to a lot of separation. From the studies, they have identified that deployment is the key factor contributing to separation among the military spouses among other internal issues within the family (Padden DL, 2017). According to the deployment requirements, the military recruits at a minimum age of 17/18 years but the retirement age varies from the various departments in the military. Separation of the military has been experienced in the early youth stages or the newly married couples. Very few studies have focused on this issue depending on racial and ethnic backgrounds of the different families, and therefore the magnitude of separation according to races has lacked supportive data. According to Verdeli, et al., (2011), they conducted a study that focused on the experience and insights of spouses of military members and found that 28.5% of the participants responded to the survey questionnaire correctly and pointed the major issues that are experienced by this population. Some of the issues included; appraisal of experience, coping strategies, deployment impacts, lack of support agencies, and inadequate support. Most studies have also focused on the impact of the deployment such as spouse psychological health. Additionally, the most common complaint according to Verdeli, et al., (2011) was that many spouses complained of handling all the hardships of the family alone without the help of the other partner thus contributing to separation. This paper will, therefore, identify the specific psychiatric disorders experienced by this group and after that develop a prevention or pre-intervention strategy for this group.
Separation of the military spouses has been associated with various psychological disorders that include depression, PTSD, and separation anxiety disorder (de Burgh HT, 2017). For this discussion, it will focus on separation anxiety disorder. In this disorder, the victims experience uncontrolled anxiety concerning the separation from their partners or homes. Due to the strong emotional attachment, this is a natural experience that can manifest in every person including the older children, adolescents, and adults. According to the American Psychiatric Association, SAD (Separation anxiety disorder) is characterized by uncontrolled fear and distress due to the act of separating them from the specific attachment figures (Padden & Posey, 2013).
According to Padden & Posey, (2013) deployment of the military personnel contributed to psychological consequences. The above experience was facilitated by the existence of war such as the Iraq and Afghanistan. Psychological morbidity and social dysfunction are the most documented experiences by the military spouses of military partners are deployed to the various combat zones. The acute psychological morbidity experienced by the spouse following this separation is the Post-traumatic Stress Disorder (PTSD). There a significant association between SAD and longer or extended deployment thus making it the most common psychological disorder that spouses experience due to separation. During the period of separation, the spouses experience moments of loneliness, lack of control, and worry about their safety which is a burden. Extended deployments also contribute to changes and role overload among the military spouses since they are forced to take on responsibilities of all aspects to ensure the family and home are in the right condition. The straining forced caused by these roles is also intensified by the lack of resources or scarce resources such as financial difficulties. Stress is also among the psychological disorders, and it is highly attributed to lack of social support. Long term experience of the above emotional changes involving fear and distress then makes the victims susceptible to Separation Anxiety Disorder Padden & Posey, (2013).
Criteria for diagnosis of SAD
To diagnose separation anxiety disorder among the military spouses, a DSM-5 manual can be used. The DSM-5 manual (Diagnostic and Statistical Manual of Mental Disorders, 5th edition is effective and perfect for diagnosis of anxiety disorder (Barton, et al., 2017). Symptoms of anxiety disorder are traced in the DSM-5 manual where the specific symptoms include; the presence of uncontrolled anxiety and worry about the separation act even when there is nothing wrong, and it can last for at least six months, the experienced worry is extremely difficult to control and can shift from one topic to the other. The third feature associated with DSM-5 is that the anxiety and worry are associated with one of the following symptoms; restlessness, impaired concentration, and difficulty sleeping. From the DSM-5 standard assessment tool, the practitioner can assess and diagnoses the separation anxiety disorder (Barton, et al., 2017).
Psychotherapeutic and psychopharmacological treatment
Treatment of separation anxiety disorder involves a combination of pharmacotherapy and psychotherapy (Katzman, 2009). For the pharmacotherapy, antidepressants with minimal adverse effects are administered. Some of the common antidepressants include selective serotonin reuptake inhibitors (SSRIs) (Katzman, 2009). The combination of the pharmacotherapy and psychotherapy has shown efficacy according to findings from controlled studies. Concerning the psychotherapy, behavioral therapy combined with CBT is the commonly used treatment plans (Katzman, 2009). For the CBT therapy, it includes self-reward and problem-solving training. A combination of CBT and medication is used for the resistant cases. Additional psychotherapies include relaxation therapy and supportive psychotherapy which is used when the CBT intervention is not appropriate (Katzman, 2009). Additionally, if severe cases are experienced especially those involving suicide and severe functional impairment, hospitalization of the patient is the best option (Katzman, 2009).
Early Intervention plan
For the early intervention plan regarding the separation anxiety disorder, a screening plan is the best intervention. In the screening plan, it will help in detecting the early signs of this disorder as well as promoting early treatment plan.
When screening for the early symptoms of separation anxiety disorder in the military spouses, the specialists can locate the specific signs and symptoms by using a questionnaire chart or an examination chart. In the screening tool, the following questions can be used for early detection of anxiety disorder.
Question Yes No
Is the spouse experiencing a continuous fear concerning a social situation? Does the spouse have worries about the act of separation due to deployment? Does the victim experience episodes of restless and increased heartbeat or breaths for no apparent reason? Does the spouse appear anxious when interacting with the therapists? Has the spouse experienced events of decreased performance since the separation regarding the home duties? Are there events of confusion when doing the duties? Does the victim experience episodes of nightmares, and headaches? (Barton, et al., 2017)
After obtaining the results of the screening chart, the next step is the confirmatory stage using the DSM-5 manual. The manual has been used in many mental disorders and therefore, it is reliable for making diagnosis concerning separation anxiety disorder. In the DSM-5 manual, the screening criteria will confirm the magnitude of the symptoms.
a. How long has the client experienced the anxiety and the events that contribute to the experience?
b. The presence of difficulties in controlling the worries.
c. The spouses anxiety and worry are associated with the above symptoms.
d. The anxiety and worry are not associated with other psychological disorders such as PTSD.
e. The anxiety and worry contribute to clinical symptoms such as distress and impaired social interactions.
f. The symptoms are not caused by other effects of drugs and substances or medications.
From the DSM-5 manual, it is a confirmatory screening tool for anxiety disorders, and it is used to differentiate the disorder from other related disorders that may present with similar disorders. In the screening stage of this plan, the therapist can detect the level or the magnitude of the problem in the spouse (Barton, et al., 2017). Again, the plan provides a better position if ruling out possible allegations that the client is suffering from anxiety disorder. Differential diagnosis is an essential step in screening and it is useful in making final judgments. After a confirmatory step using the DSM-5 manual, the next step in this early intervention plan is to put the client under therapy. Since it is an early intervention, CBT or any other psychotherapy will be appropriate to help the client in recovering from the disorder.
In conclusion, separation anxiety disorder among the military spouses is very common due to various reasons in the career such as deployment, hardship, and lack of employment for the spouses. Separation anxiety should, therefore, be screened for military spouses following the events of separation. Early intervention is the best prevention strategy to overcome chronic symptoms of anxiety and worry especially in the cases of extended deployment.
Barton, S., Karner, C., Salih, F., Baldwin, D., & Edwards, S. (2017). Diagnostic criteria for anxiety disorders set out in DSM-IV and ICD-10 classification systems. Ncbi.nlm.nih.gov. Retrieved 20 July 2017, from https://www.ncbi.nlm.nih.gov/books/NBK262332/
de Burgh HT, e. (2017). The impact of deployment to Iraq or Afghanistan on partners and wives of military personnel. - PubMed - NCBI. Ncbi.nlm.nih.gov. Retrieved 20 July 2017, from https://www.ncbi.nlm.nih.gov/pubmed/21521089/
Katzman, M. A. (February 01, 2009). Current Considerations in the Treatment of Generalized Anxiety Disorder. Cns Drugs, 23, 2, 103-120.
Padden DL, e. (2017). Stress, coping, and well-being in military spouses during deployment separation. - PubMed - NCBI. Ncbi.nlm.nih.gov. Retrieved 20 July 2017, from https://www.ncbi.nlm.nih.gov/pubmed/20647551/
Padden, D., & Posey, S. M. (March 01, 2013). Caring for military spouses in primary care. Journal of the American Academy of Nurse Practitioners, 25, 3, 141-146.
Verdeli, H., Baily, C., Vousoura, E., Belser, A., Singla, D., & Manos, G. (January 01, 2011). The case for treating depression in military spouses. Journal of Family Psychology : Jfp : Journal of the Division of Family Psychology of the American Psychological Association (division 43), 25, 4, 488-96.
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