tions (e.g., angina, hypertension, or myocardial infarction), neurological impairment, psychotic thought processes, and extremely poor impulse control. Inexperienced clinicians attempting this type of intervention are urged to seek supervision from a fully qualified peer.
We also urge clinicians dealing with PGW veterans, and in fact veterans of all military conflicts, to give full attention to descriptions of physical symptoms, even those that seem vague or suggestive of psychosomatic manifestations of anxiety. Whereas the present findings suggest that there are high rates of somatic concerns among Persian Gulf returnees, and that these physical complaints are often related to self-reported levels of stress, these data do not disconfirm the existence of a physical etiology to some subset of veterans' health complaints. Current empirical investigations regarding the existence and etiology of a PGW syndrome have proven inconclusive. We echo the reservations expressed in a recent Journal of the American Medical Association editorial, which suggests that "the findings on risk factors should instill a sense of etiologic caution in medical practitioners. Clinicians need to recognize that the precise causation of illness in most Persian Gulf War veterans may never be known with certainty" ( Landrigan, 1997, p. 260). This state of uncertainty dictates that mental health professionals make special efforts to remain sensitive to Gulf War veterans' fears of the unknown and avoid reaching premature conclusions regarding the nature of somatic complaints.
This research was supported by special funding from Mental Health and Behavioral Sciences Service, Department of Veterans Affairs Headquarters for evaluation, debriefing and treatment of ODS returnees and veterans of other wars affected by this military action, and by a Veterans Affairs Medical Research Award to Jennifer J. Vasterling and Patricia B. Sutker. Special appreciation is expressed to Drs. Paul Errera, Laurent Lehmann and Robert Rosenheck and to Gay Koerber and Robert Murphy for their guidance in project design and implementation. Grateful thanks go to the armed forces personnel who gave of their time to provide us with the information that forms the basis of this chapter.
Baker M. S., & Strunk H. K. ( 1991). "Medical aspects of Persian Gulf operations: Environmental hazards". Mililary Medicine, 156, 381-385.
Bartone P. T., Ursano R. J., Wright K. M., & Ingraham L. H. ( 1989). "The impact of a military air disaster on the health of assistance workers: A prospective study". Journal of? Nervous and Mental Disease, 177, 317-328.