METHOD VA medical centers were selected for participation in this survey if they had at least 4 psychiatrists, 4 clinical psychologists, and 4 psychiatric social workers on the staff of each respective service. We found 1 14 such 348 Am J Psychiatry I 40:3, March 1983 Clinical and Research Reports Survey Analysis of Combat-Related Stress Disorders in Viet Nam Veterans Terence M. Keane, Ph.D., and John A. Fairbank, Ph.D. Of 1,089 Veterans Administration mental health professionals responding to a survey, most reported that Viet Nam veterans were less well adjusted than veterans of previous wars, largely due to the specific experiences in Viet Nam and the lack of support on return home. (Am J Psychiatry 140:348-350, 1983) T here has been a great deal of interest in the psychological problems of Viet Nam veterans in the professional literature (1-3) and in the popular media. Although Viet Nam veterans may suffer the range of psychiatric and psychological problems, the constellation of presenting symptoms for many of them most appropriately falls within the DSM-III category of posttraumatic stress disorder. Information from a study by Penk and associates (4) validated the utility of this diagnosis for combat veterans who seek treatment for substance abuse and called for increased research on the conceptual basis of this stress disorder. To our knowledge, there are no studies thus fan that have examined the conceptual framework used by mental health professionals for understanding the pre- senting problems of Viet Nam veterans. These data are important because a number of alternative conceptual- izations of posttraumatic stress disorder secondary to combat exist and because the treatment that follows from each conceptualization might vary considerably. One theory proposes that precombat personality fac- tons play a major role in determining which combat- ants will develop a traumatic stress disorder (5). Still another conceptualization of posttraumatic stress dis- order presumes that biochemical, structural, or neuro- logical damage that is the direct result of combat is responsible for the observed behavioral and psycho- logical complaints (6). A third conceptualization of the disorder focuses on the aversive nature of the events themselves and in particular the fear of bodily injury or death that results in first an acute and then a chronic state of anxiety. For behaviorally oriented clinicians this process is viewed from an avoidance-conditioning paradigm (including both conditioning and instrumen- tal learning [7, 8]). For cognitively oriented clinicians the traumatic events are viewed as clashes with preex- isting self-concepts, expectations, and categories of meaning (1), while dynamically oriented clinicians conceptualize trauma as an experience associated with painful affects that are not properly processed (9). A fourth possible conceptualization presupposes the im- portance of social support systems that encompass the emotional support during the period of combat and that are available during the period following an individual’s return home (10). At present, the relative favor of these theoretical conceptualizations among diverse mental health prac- titioners is unknown. Accordingly, the present study was designed to gather information on the status of Viet Nam veterans seeking help at Veterans Adminis- tration (VA) medical centers and on the current con- ceptualizations of combat-related posttnaumatic stress disorder held by mental health professionals employed by the VA. Received June 1, 1982; revised Sept. 24, 1982; accepted Oct. 18, 1982. From the VA Medical Center and the University of Mississippi Medical Center, Jackson, Miss. Address reprint requests to Dr. Keane, Vietnam Stress Management Program (1 16B), VA Medical Center, 1500 East Woodrow Wilson Dr., Jackson, MS 39216. Supported by a VA merit review award to Dr. Keane. The authors thank Barbara Martin and Laura Wooten for their assistance in completing the study