15 WARRIOR IDENTITY PROBLEM

Adolescent Psychiatry,  2004  by Sugar, Max

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TREATMENT CONSIDERATIONS

There often is a comorbid condition such as major depression, substance abuse, or combat PTSD in veterans, along with WIP symptoms. Individual supportive and insight-oriented dynamic psychotherapy and concomitant group psychotherapy appear to be helpful for veterans with WIP. Pharmacotherapy should be provided for the comorbid condition(s). In the course of such combined therapy, many of those with WIP may stabilize, improve significantly, and have further development of their identity.

In an open-ended therapy group, these patients may experience acceptance and have some of their dependency needs met through group support. In addition, as veterans, they may feel that they are back with their band of brother warriors. They may become loyal and strong supporters of their fellow patients and therapy. From this base, they often develop some new and lasting relationships outside therapy.

Some have resumed their education, and others have moved into stable vocations and relationships in the course of their therapy. As they made progress with their interrupted development, some had marked improvement in their moral values and acceptance of themselves, and some further character synthesis. In some cases, their improved superego functioning led to expressions of pacificism; and others had a need for spirituality and they became devoted members of a religion.

CONCLUSIONS

Warrior identity problem (WIP) is proposed as a further development of identity problem, which is a precursor for it, and it is a subcategory of identity problem. It occurs among late adolescents in the military who have identity problem, and it is a solution to the identity problem. It may be masked and may be taken as the presentation of a good soldier-warrior in the military for a time. But it is a pathological identity, carries a high risk, and may be fixated for many decades after military service. Warrior identity problem has special significance for adolescent and military psychiatry because most military personnel are late adolescents or young adults.

Differential diagnosis should rule out personality disorders. Warrior identity problem often has a comorbid diagnosis such as substance abuse, major depression, or combat PTSD. On further scrutiny, some of those diagnosed as PDNOS may have WIP. It may be very useful to consider resuming the diagnosis of identity disorder by removing the unnecessary limitation of subjective distress. In that case, warrior identity problem would become warrior identity disorder and would be a subcategory of identity disorder.

If the concept of WIP is accepted, it may be very useful in student mental health clinics, the military, and in VA hospitals. With therapy (especially combined individual and group therapy), there may be significant further development in identity and improved function in many spheres.

REFERENCES

American Psychiatrie Association (1987), Diagnostic and Statistical Manual (3rd ed., rev.). Washington, DC: American Psychiatric Press.