A 28-year-old military veteran with nightmares and insomnia.

Given the patient’s military background and the symptoms of insomnia and nightmares, which are consistent with posttraumatic stress disorder (PTSD), this diagnosis should be considered. Further inquiry indicates that this patient returned from deployment in Afghanistan two years earlier. Previous exposure to potentially traumatic events in the military (e.g., combat, witnessing injury or death of comrades, witnessing atrocity) should prompt screening for the presence of this disorder. Among civilians, exposure to events that may have resulted in fear of death or bodily injury, or witnessing death or bodily injury, also indicate a need to screen for psychological distress or trauma. – 3 Many patients will not spontaneously offer this information. The Primary Care PTSD screen (Box 1) is a brief, validated instrument (sensitivity 0.78, specificity 0.87) for use in primary care settings, including with combat veterans. There is no clear evidence of an elevated risk of mental health problems related to military deployment per se. However, there is evidence of a strong link between exposure to combat and/or the witnessing of atrocities and the development of mental health disorders, including PTSD. A dose–response relationship has been shown, with greater exposure to combat or atro city more likely to lead to PTSD.