tions (e.g., angina, hypertension, or myocardial infarction), neurological
impairment, psychotic thought processes, and extremely poor impulse con-
trol. 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 re-
garding the existence and etiology of a PGW syndrome have proven in-
conclusive. 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 practitio-
ners. Clinicians need to recognize that the precise causation of illness in
most Persian Gulf War veterans may never be known with certainty" ( Lan-
drigan, 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.

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