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The Army is reviewing how it screens soldiers for post-traumatic stress disorder. That's after Staff Sergeant Robert Bales was charged with killing 17 Afghans. The Pentagon and the Department of Veterans Affairs say they have already invested heavily in the treatment of PTSD as the caseload grows.

But as NPR's Larry Abramson reports, their efforts are complicated by the stigma associated with the disorder.

LARRY ABRAMSON, BYLINE: Right now, there's no evidence that Staff Sergeant Bales was ever diagnosed with PTSD, but he is part of a generation that's wrestling with the fallout from repeat exposures to combat. One hundred thousand vets who served in Iraq and Afghanistan received treatment for post-traumatic stress just last year. Bales was on his fourth combat tour when the shooting occurred. According to Lisa Jaycox, a behavioral scientist with the Rand Corporation, multiple deployments are a red flag.

DR. LISA JAYCOX: Definitely, the more exposure to combat trauma, the more likely people are to develop post-traumatic stress disorder.

ABRAMSON: And as the wars in Iraq and Afghanistan dragged on, diagnoses of PTSD have become more common. That's improved our understanding of this disorder; so has the investment of hundreds of millions of dollars in treatment by the Army. Research shows that PTSD can make you irritable, it can mess up your sleep, it can make you hypervigilant. But Lisa Jaycox says there are behaviors that PTSD has not been tied to.

JAYCOX: There's no good data linking PTSD to acts of extreme violence like the kinds that have been in the news.

ABRAMSON: Nevertheless, news coverage of this shooting and other incidents paint a picture of returning vets as ticking time bombs. You see the same picture when you turn on the TV or go to the movies.

(SOUNDBITE OF JET PLANES)

ABRAMSON: The 2006 movie "Home of the Brave" focuses on a group of Iraq vets tormented by images of the war. One vet, who can't forget the Iraqi woman he accidentally shot, takes a bunch of hostages in a diner. A SWAT team surrounds the place while a friend tries to talk him down.

(SOUNDBITE OF MOVIE, "HOME OF THE BRAVE")

BRIAN PRESLEY: First, you got to give me that gun.

CURTIS "50 CENT" JACKSON: I like my gun.

PRESLEY: I know you like your gun. But come on, man. You don't want to do this.

ABRAMSON: Vets say these connections make it tougher for them to get jobs and return to normal life, and there's a paradox: the outside world assumes vets are broken, while in the military, they're told to deny their problems.

Navy Reservist Virginia Cruse was in Iraq three times and was diagnosed with PTSD in 2006. She asked for help even though she feared it would kill her career.

VIRGINIA CRUSE: And all of my experience in Iraq was instantly degraded to the level of, you know, just some woman with menstrual cramps and migraines who can't hack it.

ABRAMSON: Cruse is now a story coordinator with the Vets PTSD Project. She says many vets and active duty personnel post stories on her website about the stigma they face inside and outside the military. They complained about the media coverage of the shooting of a park ranger in Washington State earlier this year. The culprit was regularly identified as a troubled vet. It turned out he'd never been in combat and had never been diagnosed with PTSD.

Matt Friedman, the executive director of the VA's National Center for PTSD, says public understanding of this disorder is confused because PTSD seldom appears alone.

DR. MATT FRIEDMAN: Most of the people with PTSD that we see in the VA, you know, have at least one other problem. It might be a psychiatric problem. It might be a TBI. It might be a medical problem like diabetes or heart disease.

ABRAMSON: Friedman says those issues might well be the real cause of psychological problems a vet is facing. That complexity, of course, does not help the vet or soldier who just wants relief. Elspeth Ritchie, a former Army psychiatrist who now works in public health, worries that the Bales case will make it harder for vets to admit they need help.

DR. ELSPETH RITCHIE: I'm worried that there will be other events that take people backwards in their understanding of PTSD rather than trying to understand it and help promote early treatment.

ABRAMSON: Military doctors say early treatment of PTSD has a high success rate. But servicemen and women still have to ask themselves whether seeking treatment will threaten their career in the service or haunt them once they get out. Larry Abramson, NPR News.

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