As a Psychiatric Nurse Practitioner, you will care for veterans due to the invisible wounds of war. We have a special guest, Mr. Samuel Walley, an Army Veteran who shares his experiences during Operation Enduring Freedom (OEF), Mr. Walley, an infantry soldier of the 82nd Airborne division who at the age of 19 years old was deployed in Zhari district near Kandahar in southern Afghanistan.

He recounts numerous intimate stories of bravery, courage, valor and fear and what its like to be in combat. Being a foot soldier on patrol, he vividly remembers moments during firefights as they go “out the wire.” On 6 June 2012, his Platoon, headed north into the countryside. Speaking Poshtun, they were trying to communicate as they asked questions to the locals. He vividly recalls that he was running after the target and an improvised explosive device (IED) detonated.

He was lifted off the ground from the IED blast. After the dust settled, his colleagues dug him out of the ground and administered important life sustaining medical care by using tourniquets, as Sgt Williams called a “9-Line.” He sustained a TBI,

multiple injuries to his left upper extremity and right lower extremity.

He was transported to Kandahar Airfield Hospital and vividly remembers seeing the medical team as he laid on the surgical table. He was transported to Landstuhl Regional Medical Center in Germany. He was flown Stateside to Walter Reed Medical Center in Bethesda, Maryland where he received intensive physical, medical, mental health care for 3 years. He now has a right leg prosthesis, his left arm was amputated. His left lower extremity shows extensive surgical scars.

He was not open to the psychiatric plans from his health care teams until a therapeutic alliance from his therapist who showed empathy to Mr Walley.

He went through the different Stages of Grief from denial to anger, bargaining, depression, and acceptance. He also went through, Prochaska’s Stages of Change as he battled the demons in his mind and self medicated with alcohol. he battled, grief, anger, depression, anxiety, PTSD. He felt hopeless and helpless. He contemplated suicide.

He fondly speaks about his fellow soldiers and his military family. He shares his pain to those peers who have passed away due to illness. He talks about the pain he suffered from losing his battle buddies to suicide. He talks about the bond that is formed during battle.

He survived from all these tragedies. He graduated from the University of North Georgia. He collaborated with book author, Annie Jacobson, “First Platoon” that is published and available now online. He shows his resiliency and found his passion again and continues his service to the veteran community.

Racial disparities in mental and medical care are understood within the context of racial inequities in societal institutions. Systematic discrimination is is often supported by institutional policies and unconscious bias based on negative stereotypes. As a Psychiatric Nurse Practitioner, we need to address disparities in the quality of care disadvantaged minority backgrounds. We need to eliminate racial inequities in mental health and medical care for marginalized communities. Self-awareness of our implicit bias and knowledge of structural racism leads to negative outcomes for those who are in marginalized communities.

Avoidant personality disorder or AVPD have chronic feelings of inadequacy, have feelings of extreme social inhibition, and sensitivity to negative criticism and rejection. It is more than being shy or socially awkward. Avoidant personality disorder causes significant problems that affect the ability to interact with others and maintain relationships in day-to-day life. About 1.5 to 2.5 % of the general population has avoidant personality disorder.

Histrionic personality disorder is one of a group of conditions called "Cluster B" or "dramatic" personality disorders. They have an intense, unstable emotions and distorted self-images and have an intense need for the approval of others. They have an overwhelming desire to be noticed, and often behave dramatically and may be sexually inappropriate to get attention. The word histrionic means "dramatic or theatrical."

This disorder is more common in women than in men and usually is evident by adolescence or early adulthood.

Antisocial personality disorder (ASPD) is dysfunctional rigid thought processes, a pattern of socially irresponsible, delinquent, exploitative, guiltless & criminal behavior that begins in childhood or early adolescence and into adulthood. It is manifested by disturbances in many areas of life from family, school, work, military service that is usually a lifelong disorder.

Transtheoretical Model of Change is a biopsychosocial model of change for intentional behavior change. It is integrative and can be applied to a variety of behaviors, settings and populations.

Less than 1% of the general population have Dependent Personality Disorder (DPD). Those with DPD are not able to make decisions, are clingy and very needy. They are pessimistic and has lack self-confidence. They have intense fear of abandonment. They avoid disagreements and will tolerate abuse for fear of the relationship ending. Those with DPD are at higher risk for depression, anxiety, PTSD and substance abuse.

Intimate interview about Postpartum Depression with Army Veteran Theresa Thomas, now a Licensed Professional Counselor. She discussed her suicidal thoughts, bad thoughts to her baby, her symptoms, her fears, her multiple stressors that exacerbated her symptoms. She talked about the importance of her support system from her family, husband, church, spirituality and prayer. Her Christian counselor assisted her with her coping skills and also reinforced to her the importance with medication management during the acute phase in her Postpartum depression. She talked about her strengths and resiliency and her gratitude regarding the diagnosis that helped her find her purpose in life. she went on to receiving her Master’s degree and is now a professional counselor. She states that she is a better counselor because she can empathize with her patients in mental health.

Dan Solla, is a veteran of the United States Army Infantry served as rifleman in the 1st Armored Divisions 1/36 Infantry Battalion from Ray Barracks Friedberg, Germany. He served as a rifleman in Iraq for 15 months during the Iraqi Invasion in 2003-2004 where he was actively engaged in ground combat. He was awarded the Combat Infantryman’s Badge. He has struggled with with PTSD symptoms, addiction, and how he self-medicated his symptoms, his overdose and needing help for long-term treatment. He talks about his experiences, triggers, symptoms and “even being afraid of my own shadow” from being a young man signing up after 9/11. He is able to overcome all of these challenges as a veteran. He is resilient and received his Bachelor’s of Arts in Political Science from the University of Tennessee and a Doctor of Jurisprudence from University of Tennessee College of Law. He is very active helping his fellow veterans through PTSD Foundation & Camp Hope. He helps veterans navigate the local VA, residential treatment programs, Veteran Court System, in several counties in the State of Georgia. He partners with local veteran groups Vetlanta, Hope Center for Veterans, American Legion and local hospitals.

Narcissistic Personality Disorder (NPD) affects more males at 7.7% and females at 4.8%. There is a high rate of mood disorders, substance use disorder with those who have NPD. The patient will have an inflated and grandiose self-importance. They need to be the center of attention all the time and thrive with admiration. Those with NPD have unfulfilling and failed relationships, sense of entitlement and have fantasies about being powerful, successful and brilliant even with many failed businesses. Those with NPD are very arrogant, pretentious and conceited. They do not have empathy for others and will lash out at others because they are not able to handle criticism and will belittle others in order to make themselves feel superior.