PTSD: What You Need to Know

Brad Johnson | November 03, 2005

As the wars in Iraq and Afghanistan wear on, hundreds of thousands of veterans are at significant risk for a particularly distressing and impairing mental health syndrome: Posttraumatic Stress Disorder. First documented in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders in 1980, PTSD becomes a serious risk when a service member experiences, witnesses, or is confronted with an event involving actual or threatened death or serious injury, or a threat to the physical integrity of self or others -- welcome to any day in the Global War of Terror.

What does PTSD look like? As members of the military community, each of us should be alert to the following key symptoms among the combat veterans we care for:

• Recurrent and intrusive distressing recollections of the event, including images, thoughts and perceptions (seeing a comrade's dead body or experiencing flashbacks of the sounds of explosions and screaming)
• Recurrent and distressing nightmares of the traumatic event
• Intense psychological distress when exposed to cues or reminders of any aspect of the trauma
• Extreme physical reactivity (e.g., racing pulse, sweating, intense fear) when exposed to any cues or reminders of the trauma
• Persistent avoidance of any reminder (e.g., conversations, thoughts, activities, places, and people) of the traumatic event
• A general numbing in responsiveness; the person feels detached and estranged from others and may have little range in emotion and few strong feelings
• A sense of a foreshortened future; having come close to death, the person sees it as immanent
• Hypervigilance (constantly scanning the environment for danger)
• Exaggerated startle response (especially to sudden movement or loud noises)
• Poor concentration
• Irritability/anger
• Disturbances in one's ability to sleep

Keep in mind that not all of the symptoms will be present in every case, and veterans may mask the symptoms through nondisclosure or self-medication with alcohol and other drugs. Further, some service personnel are at greater risk for developing PTSD than others. Beyond the severity of the traumatic event itself, key risk factors include poor social support after the trauma, additional life stressors, adverse childhood events, lower education, prior traumatic exposure, and gender -- women are at greater risk. One particularly malignant feature of PTSD is a sense of shame or guilt associated with beliefs that one should have or could have done more during the traumatic period. If comrades died, then survivor guilt can add powerful fuel to PTSD fire.

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