Defense Health Care: Status of Efforts to Address Lack of Compliance with Personality Disorder Separation Requirements

This testimony discusses the Department of Defense's (DOD) separation requirements for enlisted servicemembers diagnosed with personality disorders and the military services' compliance with these requirements. DOD requires that all enlisted servicemembers, including those serving in support of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), be physically and psychologically suitable for military service. Enlisted servicemembers who fail to meet this standard may be involuntarily separated from the military. One psychological condition that can render an enlisted servicemember unsuitable for military service is a personality disorder, which is defined as a long-standing, inflexible pattern of behavior that deviates markedly from expected behavior, has an onset in adolescence or early adulthood, and leads to distress or impairment. Although a personality disorder by itself does not make enlisted servicemembers unsuitable for military service, DOD policy allows for involuntary separation from the military if a servicemember's disorder is severe enough that it interferes with his or her ability to function in the military. DOD data show that from November 1, 2001, through June 30, 2007, about 26,000 enlisted servicemembers were separated from the military because of a personality disorder. Of these 26,000 servicemembers, about 2,800 had deployed at least once in support of OEF/OIF. Accurately diagnosing enlisted servicemembers who have served in combat with a personality disorder can be challenging. Specifically, some personality disorder symptoms--irritability, feelings of detachment or estrangement from others, and aggressiveness--are similar to the symptoms of post-traumatic stress disorder (PTSD), a condition for which OEF/OIF enlisted servicemembers may also be at risk. According to mental health experts and military mental health providers, one important difference between a personality disorder and PTSD is that a personality disorder is a long-standing condition, whereas PTSD is a condition that follows exposure to a traumatic event. According to the American Psychiatric Association and the American Psychological Association, the only way to distinguish a personality disorder from a combat-related mental health condition, such as PTSD, is by obtaining an in-depth medical and personal history from the enlisted servicemember that is corroborated, if possible, by others such as family members and friends. DOD has three key requirements that the military services--Army, Air Force, Marine Corps, and Navy--must follow when separating enlisted servicemembers because of a personality disorder. Specifically, before they are separated because of a personality disorder, enlisted servicemembers 1) must receive notification of their impending separation because of a personality disorder; 2) must receive, prior to the notification, a diagnosis of personality disorder by a psychiatrist or psychologist who determines that the personality disorder interferes with the enlisted servicemember's ability to function in the military; and 3) must receive formal counseling about their problem with functioning in the military. This statement provides information from a report we issued in 2008 on our review of personality disorder separations in the military services. It also provides an update on the actions DOD has taken since August 2008 related to the recommendations we made in that report.