Mental disorders are common for stressful situations caused by combat. Military people are exposed to a variety of physical dangers during the military operations, but the aftermath can be as threating as the bullets flying over the head. Posttraumatic stress disorder (PTSD) is one of such dangers, it is unexpected and unpleasant outcome of war. The paper is aimed at exploring the issue of PTSD, evaluation of stress factors causing PTSD, assessment of the current situation with PTSD in returning military, comparison with other related disorders such as the mild traumatic brain injury (MTBI). The paper also evaluates differences between military men and women with PTSD, diagnosis of PTSD, and the exploration of the PTSD treatment plan peculiarities.
Keywords: mental disorders, combat, military, PTSD, MTBI, diagnosis, treatment.
PTSD in Returning Military
Injuries and traumas are inevitable for the military people who returned from combat. Soldiers and people who were involved into any action at war most probably get psychological and/or physical traumas. The most common are mild traumatic brain injury (MTBI) and posttraumatic stress disorder (PTSD). The first trauma is connected with blows or impacts on the head. It can be anything from a stone to a shock wave. Such trauma is also called “shell shock” and is well known from the First World War as the combat soldiers reported about anxiety, fatigue, and depression. However, in 1919, medicine was not able to offer any solution to this issue. Modern combat veterans returning from Iraq and Afghanistan are provided with the appropriate help aimed at relieving the aftermath of war (Williamson & Mulhall, 2009).
PTSD and Stress Factors
Friedman (2006) describes reasons of mental health disorders experienced by active duty military. The author explores the stressors common for war zones such as Iraq and Afghanistan. He states that feeling of helplessness in order to change some dramatic events leading to death of severe injury is one of the major source of stress for soldiers (Friedman, 2006). He adds that exposure to combat that took lives or health of friends can be utterly stressful as well. According to Friedman (2006), another substantial stress factor is killing enemy combatants and noncombatants by accident. Ambushes, postcombat experience (remains of friends, civilians, etc.), the environment filled with sounds, sights, smell of dying or dead people, refugees, destroyed homes, and other pictures of war – these are the factors contributing to the constant stress of active duty servicemembers and veterans (Friedman, 2006). Returnees experience a great feeling of anxiety and threats from the environment any moment. They have a constant sense of danger resulting in mental health issue known as PTSD (Friedman, 2006). Such stressful condition becomes the reason of inadequate reactions to various situations and ends up with avoidance of people, substance abuse, and constant mental suffering if not treated properly.
PTSD and Official Numbers
Military service is the major source of mental health disorders such as PTSD, depression, and anxiety. According to Blakeley and Jansen (2013), between 2001 and 2011, the rate of diagnoses related to mental health issues increased for about 65% among active duty military. Among other mental health issues (anxiety, depression), incidences of PTSD have grew from 170 diagnoses per group of 100.000 military people to over 1110. It means that the incidences of PTSD (reported) have demonstrated growth up to 650% from 2000 to 2011 (Blakeley & Jansen, 2013). The authors provide peculiar statistics of various disorders including PTSD. Figure 1 (Blakeley & Jansen, 2013) illustrates it:
Figure 1. Rate of Mental Health Incidents by Service, 2010
As it can be noticed, the Army servicemembers suffer the most from the variety of mental health issues, including PTSD. It should be also noted that hospitalizations for such cases of mental health disorders were normally distributed between 2000 and 2006. However, they have increased up to 50% from 2006 to 2009: the sources of such drastic increase were PTSD, substance abuse, and major depression (Blakeley & Jansen, 2013). Again, the Army has a sad statistics of hospitalizations of active duty military for disorders related to mental disorders such as PTSD.
PTSD and Other Similar Disorders
The above-mentioned MTBI is a physical condition while PTSD is psychological. They are closely related – PTSD usually coexists with MTBI. According to the research of Jones, Young, and Leppma (2010), “PTSD is characterized by the reexperiencing of an extremely traumatic event, usually by way of nightmares and intrusive thoughts of the incident.” In other words, PTSD is a disorder connected with some very vivid event causing trauma, would it be physical or psychological. The authors investigated the connection between MTBI and PTSD and concluded that both are common for combat soldiers returning from Iraq and Afghanistan in up to 20% of cases (Jones, Young, and Leppma, 2010). They also evaluated the symptoms of both traumas in order to find the distinguishing characteristics of MTBI and PTSD, because they have similar symptoms but different nature and thus different treatment. The major problem was described as the inability to find any unique symptoms of MTBI to brain injury – they could be called common for other medical conditions and issues related to mental health. The conclusion was as follows: professional counsellors have to be able to determine both traumas via being familiar with symptoms and signs of these disorders. It is the only possible way to make appropriate diagnoses and provide correct treatment (Jones, Young, & Leppma, 2010).
PTSD and Military Women
A woman in combat is a rather new and unexplored area. In 2008, there were about 200.000 women serving in the U.S. military on active duty. It constituted more than about 14% of all deployed forces. Society for Women’s Health Research (2010) explored the issues related to PTSD in women returning from active duty after being exposed to severe combat action. The participants of workshop on the above-mentioned issues determined that gender influences the effects of PTSD. The animal models only supported the fact that males and females perceive stress differently. Therefore, they react to stress in a different manner, as well (SWHR, 2010). Series of tests showed that men react to stressors more accurately and quicker than women do. It is explained by the peculiarity of men’s and women’s memorizing the stressors – women tend to remember stressors much better and for longer period while men are more “forgettable” in this matter. Research showed that men tend to avoid stressful memories unconsciously while women cannot do so. It can be connected with the natural mechanism of protecting from PTSD (SWHR, 2010). The area is to be explored further in order to develop more effective methods of PTSD’ treatment for women in military.
PTSD and Diagnosis
Mental health issues are hard to diagnose if the diagnosis procedure is performed by non-mental health professionals. According to Reeves (2006), “Returning veterans will often seek care from physicians or other clinicians who are not mental health professionals”. It can be connected with the fact that the active duty military often do not recognize the presence of such a problem as PTSD. Therefore, the author states that it is highly important for the physicians to be able to detect the symptoms of PTSD and determine the issue correctly. The solution of the problem was proposed by the United States Department of Veteran Affairs’ National Center for PTSD: it has developed such tool as a Primary Care PTSD Screen consisting of four questions (Reeves, 2006). The questions are aimed at determining the core of the issue, its nature, source, and repetitiveness. It should be noted that diagnosis of PTSD could be rather traumatic for patients. Therefore, physicians were offered to start the assessment with stabilization and proceed as follows: determine the symptoms that require immediate intervention (suicidal/homicidal thoughts, etc.); pay first attention to the symptoms disturbing patient now the most; and develop the appropriate plan of treatment, involving psychological and pharmacologic interventions (Reeves, 2006).
Treatment of PTSD
The treatment of PTSD is a complex process involving both psychology and pharmacology. According to Richardson, Sareen, and Stein (2012), “Once a firm diagnosis has been established, psychoeducation in group format or individually regarding diagnosis and treatment is critical for both patient and family.” The authors state that only the clear understanding of the plan of treatment by the patient can lead to the positive effects. Considering the nature of the mental issue, the first stage of treatment is aimed as stabilization of co-morbid conditions (depression, addictions, anxiety disorders, etc.) (Richardson, Sareen, & Stein, 2012). These conditions can be treated pharmacologically. Then, psychological tools are used to master anxiety and anger. Only when the most threatening symptoms are treated to the safe level (avoidance of suicidal and/or homicidal thoughts), the therapy of actual source of PTSD starts via psychotherapy (Richardson, Sareen, & Stein, 2012). Thus, pharmacologic intervention is an important step to prepare patient to group or individual psychotherapy. The authors state that = remission is not always possible, but the condition can be improved pharmacologically.
PTSD is a very dangerous disorder – it is not easy to determine and hard to treat. Moreover, the military men tend to keep it inside due to the confidence that they can deal with it on their own. About 20% of all returnees from active duty who experienced combat action have PTSD. It has rather obvious stress factors and often comes with physical injuries such as MTBI. Military men and women experience PTSD differently and require different approaches to its diagnosis and treatment. The diagnosis of PTSD by non-mental professionals can be facilitated by the use of Primary Care PTSD Screen: the answers to its four questions can provide a clear picture of the situation with PTSD. Finally, the treatment plan should be performed using the combination of pharmacological and psychological interventions.