War-Zone-Related Stress Reactions: What Veterans Need
to Know
Traumas are events in which a person has the feeling that he
or she may die or be seriously injured or harmed, or events in
which he or she witnesses such things happening to others.
Traumatic events are of course common in the war zone, but they
are common in the civilian world too, so that in addition to war
zone experiences, many military personnel will have experienced
one or more traumatic events in their civilian lives.
When they are happening, traumas often create feelings of
intense fear, helplessness, or horror. Often in the days and
weeks that follow trauma, there are longer-lasting stress
reactions that can be surprising, distressing, and difficult to
understand. By understanding their traumatic stress reactions
better, Iraq War veterans can become less fearful of them and
better able to cope with them. While reviewing the list of
effects of trauma below, keep in mind several facts about trauma
and its effects:
It is very common to have problems
following exposure to war or other trauma. But traumatic stress
reactions often become less frequent or distressing as time
passes, even without treatment.
Veterans with PTSD often worry that they
are going crazy. This is not true. Rather, what is
happening is that they are experiencing a set of common
symptoms and problems that are connected with
trauma.
Problems that result from trauma are
not a sign of personal weakness. Many mentally and
physically healthy people experience stress reactions that are
distressing and interfere with their daily lives at
times.
If traumatic stress reactions continue to
cause problems for more than a few weeks or months, treatment
can help reduce them.
Traumatic war experiences often cause many of the following kinds of (often
temporary) reactions in veterans:
Unwanted remembering or re-experiencing
Almost all veterans experience difficulty controlling distressing memories
of war. Although these memories are upsetting, on the positive
side, the memories provide an opportunity for the person to make
sense of what happened and gain mastery over the event. The
experience of these memories can include:
Unwanted distressing memories as images or other thoughts
Feeling like it is happening again (flashbacks)
Dreams and nightmares
Distress and physical reactions (e.g., heart pounding,
shaking) when reminded of the trauma
Physical activation or arousal
The body's fight-or-flight reaction to a life-threatening situation
continues long after the event is over. It is upsetting to feel
like your body is overreacting or out of control. However, on the
positive side, these fight-or-flight reactions help prepare a
person in a dangerous situation for quick response and emergency
action. Signs of continuing physical activation, common following
participation in war, can include:
Difficulty falling or staying asleep
Irritability, anger, and rage
Difficulty concentrating
Being constantly on the lookout for danger
(hyper-vigilance)
Being startled easily for example, when hearing a loud noise
(exaggerated startle response)
Anxiety and panic
Shutting down: Emotional numbing
When overwhelmed by strong emotions, the body and mind
sometimes react by shutting down and becoming numb. As a result,
veterans may have difficulty experiencing loving feelings or
feeling some emotions, especially when upset by traumatic
memories. Like many of the other reactions to trauma, this
emotional numbing reaction is not something the veteran is doing
on purpose.
Active avoidance of trauma-related thoughts and
feelings
Painful memories and physical sensations of fear can be
frightening, so it is only natural to try to find ways to prevent
them from happening. One way that most veterans do this is by
avoiding anything people, places, conversations, thoughts,
emotions and feelings, physical sensations that might act as a
reminder of the trauma. This can be very helpful if it is used
once in a while (e.g., avoiding upsetting news or television
programs). But when avoidance is used too much, it can have two
big negative effects. First, it can reduce veterans abilities to
live their lives and enjoy themselves, because they can become
isolated and limited in where they go and what they do. Second,
avoiding thoughts and emotions connected with the trauma may
reduce veterans abilities to recover from it. It is through
thinking about what happened, and particularly through talking
about it with trusted others, that survivors may best deal with
what has happened. By constantly avoiding thoughts,
feelings, and discussions about the trauma, this potentially
helpful process can be short-circuited.
Depression
Most persons who have been traumatized experience depression.
Feelings of depression then lead a person to think very
negatively and feel hopeless. There is a sense of having lost
things: one's previous self (I'm not the same person I was), a
sense of optimism and hope, self-esteem, and self-confidence.
With time, and sometimes with the help of counseling, the trauma
survivor can regain self-esteem, self-confidence, and hope. It is
important to let others know about feelings of depression and, of
course, about any suicidal thoughts and feelings, which are
sometimes a part of feeling depressed.
Self-blame, guilt, and shame
Many veterans, in trying to make sense of their traumatic war
experiences, blame themselves or feel guilty in some way. They
may feel bad about some thing(s) they did or didn't do in the war
zone. Feelings of guilt or self-blame cause much distress and can
prevent a person from reaching out for help. Therefore, even
thought it is hard, it is very important to talk about guilt
feelings with a counselor or doctor.
Interpersonal problems
Not surprisingly, the many changes noted above can affect
relationships with other people. Trauma may cause difficulties
between a veteran and his or her partner, family, friends, or
co-workers. Particularly in close relationships, the emotional numbing and
feeling of disconnection that are common after traumatic events
may create distress and drive a wedge between the survivor and
his or her family or close friends. The survivor's avoidance of different kinds of social activities may frustrate family members. Sometimes, this
avoidance results in social isolation that hurts
relationships.
Others may respond in ways that worsen the problem rather than
help recovery. They may have difficulty understanding, become
angry with the veteran, communicate poorly, and fail to provide
support. Partners and families need to participate in treatment;
by learning more about traumatic stress, they can often become
more understanding of the veteran and feel more able to help. Some kinds of traumatic experiences (e.g., sexual assault) can
make it hard to trust other people.
These problems in relationships are upsetting. Just as the
veteran needs to learn about trauma and its effects, people who
are important to him or her also need to learn more. As the
survivor becomes more aware of trauma reactions and how to cope
with them, he or she will be able to reduce the harm they cause
to relationships.
Physical symptoms and health problems
Because many traumas result in physical injury, pain is often
part of the experience of survivors. This physical pain often
causes emotional distress, because in addition to causing pain
and discomfort, the injury also reminds them of their trauma.
Because traumas stress the body, they can sometimes affect
physical health, and survivors may experience stress-related
physical symptoms such as headaches, nausea or other stomach
problems, and skin problems. The veteran with PTSD will need to
care for his or her health, seek medical care when appropriate,
and inform the doctor or nurse about his or her traumas, in
order to limit the effects of the trauma.