Post Traumatic Stress Disorder in War Veterans

Introduction

Posttraumatic stress disorder (PTSD) is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. This event may involve the threat of death to oneself or to someone else, or to one's own or someone else's physical, sexual, or psychological integrity, overwhelming the individual's ability to cope.

As an effect of psychological trauma, PTSD is less frequent and more enduring than the more commonly seen acute stress response. Diagnostic symptoms for PTSD include re-experiencing the original trauma(s) through flashbacks or nightmares, avoidance of stimuli associated with the trauma, and increased arousal—such as difficulty falling or staying asleep, anger, and hypervigilance. Formal diagnostic criteria in DSM-IV-TR require that the symptoms last more than one month and cause significant impairment in social, occupational, or other important areas of functioning (American Psychological Association).

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Diagnosis

Criteria The diagnostic criteria for PTSD, stipulated in the Diagnostic and Statistical Manual of Mental Disorders IV (Text Revision) (DSM-IV-TR), may be summarized as A: Exposure to a traumatic event This must have involved both

• loss of "physical integrity," or risk of serious injury or death, to self or others, and
• a response to the event that involved intense fear, horror, or helplessness (or in children, the response must involve disorganized or agitated behavior).

The DSM-IV-TR criterion differs substantially from the previous DSM-III-R stressor criterion, which specified the traumatic event should be of a type that would cause "significant symptoms of distress in almost anyone" and that the event was "outside the range of usual human experience." B: Persistent re-experiencing One or more of these must be present in the victim: flashback memories, recurring distressing dreams, subjective re-experiencing of the traumatic event(s), or intense negative psychological or physiological response to any objective or subjective. C: Persistent avoidance and emotional numbing

This involves a sufficient level of:

• avoidance of stimuli associated with the trauma, such as certain thoughts or feelings or talking about the event(s);
• avoidance of behaviors, places, or people that might lead to distressing memories;
• inability to recall major parts of the trauma(s), or decreased involvement in significant life activities;
• decreased capacity (down to complete inability) to feel certain feelings;
• an expectation that one's future will be somehow constrained in ways not normal to other people. D: Persistent symptoms of increased arousal not present before

These are all physiological response issues, such as difficulty falling or staying asleep or problems with anger, concentration, or hypervigilance. E: Duration of symptoms for more than 1 month If all other criteria are present, but 30 days have not elapsed, the individual is diagnosed with Acute stress disorder. F: Significant impairment The symptoms reported must lead to "clinically significant distress or impairment" of major domains of life activity, such as social relations, occupational activities, or other "important areas of functioning." (DSM-IV-TR, American Psychiatric Association). Facts & Figures Operation Iraqi Freedom has become the deadliest American military conflict since the Vietnam War. Uto, 13 percent of the troops returning from the deployment have reported symptoms of post-traumatic stress disorder (PTSD). With the daily violence in this war-torn country, servicemen and women are subjected to increased levels of stress which can trigger PTSD. Fighting for their country and risking their lives, allowing them to return home only to be haunted by their actions, degrades everything they were sent to Iraq to accomplish.

Since the Vietnam War, methods of treating PTSD have developed and lowered the number of cases, but simply lowering the number of cases is not good enough. Unless service members can be prevented from experiencing these negative emotions, every one of them is engaged in a possible suicide mission. With the proper procedures introduced and carried out as proposed, not only the service members can be helped, but their families as well. Due to current operations in the Middle East and the recent combat operations in the past decade, many citizens have met somebody who has experienced their share of combat-related stress.

When you look at somebody who has been in combat, they may look like your average person on the outside, but on the inside lays memories of the violent scenes of war-torn countries. Their mental health may not be noticeably altered, but they could very well suffer from haunting memories, flashbacks, and even post-traumatic stress disorder. Post-traumatic stress disorder (PTSD) can produce emotional responses caused by the trauma endured during combat operations. It does not have to emerge immediately but can actually happen weeks, months, or even years after the traumatic event.

PTSD was often referred to as “combat fatigue” or “shell shock” until 1980, when it was given the name post-traumatic stress disorder. According to William Welch of USA Today, PTSD is produced from a traumatic event that provoked intense fear, helplessness, or horror. The events are sometimes re-experienced through intrusive memories, nightmares, hallucinations, or flashbacks. Symptoms of PTSD include troubled sleep, irritability, anger, poor concentration, hypervigilance, and exaggerated responses.

Emotions felt by victims of PTSD include depression, detachment or estrangement, guilt, intense anxiety, panic, and other negative emotions (2005). Out of over 240,000 veterans of Iraq and Afghanistan already discharged from the service, nearly 13,000 have been in U. S. Department of Veterans Affairs (VA) counseling centers for readjustment problems and symptoms associated with PTSD (Welch, 2005). Operation Iraqi Freedom has become the deadliest American conflict since the Vietnam War, and because of this, new data detailed by Cep79m. v shows that 12 to 13 percent of troops returning from Iraq reported PTSD symptoms, while about 3 to 4 percent reported other mental distress. A new Army study found that 11 percent of troops returning from Afghanistan reported symptoms of mental distress. Although wartime psychology was just beginning during the Vietnam War era, later studies showed that nearly 15 percent of troops who served there suffered PTSD. The most recent studies found that nearly 30 percent of Vietnam War veterans have developed physiological problems after returning from the war.

PTSD estimates for veterans of the first Gulf War range between 2 and 10 percent (2004). These numbers are based on several key factors. The amount of combat-related stress varies by unit and will determine the amount of emotional stress a soldier in that particular unit will experience. For example, according to The New England Journal of Medicine, out of 1709 Soldiers and Marines surveyed, those who returned from Iraq reported higher rates of combat experience and frequency than those returning from Afghanistan. It’s probable that those who experience more combat situations are more likely to suffer from PTSD.

As noted in The New England Journal of Medicine, out of those surveyed, 71 to 86 percent deployed to Iraq reported engaging in a firefight, as opposed to only 31 percent in Afghanistan. Soldiers and Marines returning from Iraq were significantly more likely to report that they were currently experiencing a mental health problem, were interested in receiving help for their mental problems, and actually used mental health services (Hoge et al., 2004). As noted earlier, according to William Welch of USA Today, PTSD is produced by a traumatic event that provoked intense fear, helplessness, or horror (2005).

Being wounded while in combat is a perfect example of an event that provokes intense fear. Among those who participated in a recent survey, 11. 6 percent reported being wounded or injured while in Iraq compared to 4. 6 percent of those in Afghanistan (Hoge et al., 2004). This is a clear indication that the events a soldier experiences during deployment will have an influence on the possibility of PTSD after redeploying to the United States. Intense situations do not revolve around being wounded or injured. Operation Iraqi Freedom has become the deadliest American conflict since the Vietnam War.

As a result, CNN notes that 90 percent of those who served in Iraq reported being shot at. A high percentage also reported killing an enemy combatant or knowing somebody who was injured or killed. Approximately half said they handled a body while serving in Iraq (2004). In addition to CNN’s article, Cep79m. tv announced amazing data showing one in four Marines reported killing an Iraqi civilian while one in four Army soldiers reported engaging in hand-to-hand combat. More than 85 percent of those surveyed know somebody who has been injured or killed. More than half claimed handling corpses or human remains (2004). 3. Treatment and Prevention There is help available to those returning from war-torn countries. Almost 17 percent of the troops surveyed, who served in Iraq, suffered from mental health problems, while less than half of them looked for professional help after ending their tours (Cep79m. tv, 2004). Sergeant First Class (SFC) Doug Sample of the American Forces Press Service reports that “service members can get confidential counseling through the military services’ ‘One Source’ program. The 24-hour-a-day service is for service members and their families and provides quick, professional assistance with problems” (2004).

The reason only half of them are seeking help could be the possibility of negative attention from their unit. Dr. William Winkenwerder says that a main barrier preventing soldiers from getting help “is the perception of the stigma that some individuals have about coming forward to get that care and counseling” (Gilmore, 2004). CNN interviewed Staff Sergeant (SSG) Georg-Andreas Pogany, who saw an Iraqi body that had suffered severe trauma on his second day in Iraq. Suffering from a nervous breakdown and struggling to sleep that night, he decided to tell his superior officer.

He was afraid he would freeze up on patrol and was worried about the consequences. Instead of being given help, he was told to reconsider his concerns for the sake of his career. A translator attached to the 10th Special Forces Group was sent back and charged with cowardice after experiencing the same type of emotional stress. Though his charge was dropped, his record is still uncertain (2004). Post-traumatic stress disorder may not be preventable in every individual who steps foot inside a combat zone, but things can be done to lower the number of cases that occur after deployment.

The army, for example, works under a “tough and realistic training” motto. They train their soldiers during peacetime as if they were actually in a combat zone. Live-fire ranges, along with tough and realistic training, have helped soldiers prepare for combat, and the numbers developed from the data are surprisingly low. But that doesn’t surprise many people because, according to Gilmore, they have used information from former prisoners of war to help train today’s service members to be ready for combat (2004). The military works on a schedule allowing units to use live fire range at certain times with a certain number of live rounds.

A possibility to help lower the amount of PTSD cases related to intense combat situations would be allowing soldiers to use live fire ranges more often. If this means raising taxes a little more to allow for a larger budget, then by all means, it’s worth it. Before, during, and after deployment, service members are given counseling sessions to prepare them for intense situations as well as to teach them about the possibility of mental health damage. This has been a change since the Vietnam War, which could be another factor that has helped lower the amount of PTSD cases throughout the military.

Another possible solution to PTSD would be to brief soldiers throughout their entire careers. Before Operation Enduring Freedom, it had been nearly 10 years since the last major conflict, which involved ground forces. In those 10 years, if soldiers had been given briefings on the possibility of mental health damage after combat, there is a chance they would have been more prepared to deal with those situations. The Department of Defense could easily make it mandatory that each service member receives several briefings each year during their entire military career, including during deployments.

Citing recent Centers for Disease Control and Prevention research, Winkenwerder noted some people seem more predisposed to develop depression, anxiety, or post-traumatic stress disorders as a result of negative childhood experiences” (Gilmore, 2004). Apparently, the better the life a child has while growing up, the more ready for combat they will be. The Department of Defense requires each applicant for the armed forces to take a test that allows them to qualify for a certain job within the military.

Another possibility would be adding a section to the test which measures the type of childhood an applicant experienced. They could then choose only those who did not have many negative childhood experiences, if that statement is at all accurate, to fill their combat-oriented positions.

Conclusion

According to the data gathered during recent surveys, it is clear that although the violence of war will remain the same, it is possible to lower the percentage of service members who experience mental disturbance such as post-traumatic stress disorder from combat situations. It may be impossible o completely rid the volunteer force of the possibility of PTSD, but with enough counseling before, during, and after combat operations, the percentage of those who suffer from it may be lowered dramatically. More tough and realistic training will also help set soldiers into the mindset of what it takes to survive a combat situation. The treatment and prevention are there but do not seem to be used quite enough. Not using the prevention methods is almost like sending our troops on a suicide mission.

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