PTSD
a fifteen minute
guide to combat related
post-traumatic stress disorder
A Project of FamilyOfaVet.com
A non-profit organization dedicated to helping veterans and their families learn how to cope with PTSD (post-traumatic stress disorder), TBI (traumatic brain injury) and life after combat through real-world, plain language education and resources for heroes, families, and communities.
written by Brannan P. Vines & Heather A. Hummert
Copyright 2011 by Family Of a Vet, Inc.
FamilyOfaVet.com welcomes and encourages the off-line distribution of content from its publications through appropriate channels but no use is granted without our specific permission. Please contact us by e-mail at Permissions@FamilyOfaVet.com stating the specific content to be used and place and means of off-line distribution. Webmasters, bloggers, etc., wishing to use a limited amount of content from this publication for non-commercial, on-line purposes may do so as long as a backlink to our site is provided. All rights reserved.
Smashwords Edition
Cover Image Credit: Department of Defense
Table of Contents
How does PTSD change the brain?
Where can I get more information & support?
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What’s the deal about PTSD?
PTSD is becoming a national topic of conversation. It’s all over the news, internet, and sometimes even the radio. It is being called (along with TBI) one of the “hallmark” injuries of the wars in Iraq and Afghanistan. Unfortunately, though, even with so much discussion, many veterans and members of the military are ignoring the signs that they are suffering from this potentially life-altering disorder. They ignore the signs because of concern about its impact on their career, because they’re somehow afraid it will make them look weak, or simply out of denial that a problem even exists.
It is incredibly important, though, for our heroes to move past these concerns and seek treatment. Why does seeking help matter? Simply put, because the longer you go without treatment, the worse your PTSD is going to become, the more damage it is going to do to you and those who love you, and the more opportunity it has to infect and destroy every part of your life.
For more information about PTSD, visit http://www.familyofavet.com/PTSD.html.
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What is Combat PTSD?
THE “JEFF FOXWORTHY” DEFINITION OF PTSD
If your wife has to wake you up by tapping on your feet with a long stick to keep from getting punched… you might have PTSD.
If you are convinced that every crowded situation is dangerous and must be avoided… you might have PTSD.
If you've ever met a delivery guy at the door with a loaded weapon… you might have PTSD.
If a car backfiring causes you to jump ten feet and dive for cover… you might have PTSD.
If your "temper tantrums" are more impressive than your three-year-old's… you might have PTSD.If a lonely McDonald’s bag in the middle of the road makes you drive off of the road and go into combat mode… you might have PTSD.
A REAL WORLD LOOK AT PTSD
All joking aside... if you want a plain English definition of PTSD, here it is: Combat PTSD is a mental condition that affects people who have gone to war. It does not mean you're crazy. It just means you're having a normal reaction to living in a bad situation.
Combat PTSD occurs when:
You spend too much time surrounded by generally rude people (yes, that's sarcasm) who are trying to kill you, blow you up, and basically make your daily life hell.
You see your buddies killed or wounded.
You see a few or a whole lot of dead bodies.
You have to help clean up one or more dead bodies.
You spend a while in a place where dying is a constant possibility.
You have to kill one or more combatants.
For more information about the “What is PTSD?” question, visit this link http://www.familyofavet.com/what_is_ptsd.html. Or, to find out more about how PTSD impacts Veterans, visit http://www.familyofavet.com/ptsd_in_veterans.html.
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What does PTSD “look” like?
Indications that you may have PTSD are:
Persistent nightmares about combat or other situations in Iraq or Afghanistan.
Losing your temper over small things - things that wouldn't have mattered in the past.
Not being able to react to other people's emotions (your wife is crying, and you're standing there staring at her).
Hating to go into crowded or unfamiliar situations.
Having flashbacks - suddenly being back in Iraq or Afghanistan (in your head) in the middle of a firefight, etc.
Feeling threatened by everything (you're driving down the road and get boxed in between two cars and you feel like running them off the road).
Automatically ducking for cover when a loud noise occurs.
Not enjoying, being happy, or looking forward to anything.
Not feeling close to anyone.
Not being able to fall asleep or not being able to stay asleep.
This is not by any means an exhaustive list. Post-Traumatic Stress Disorder effects every person differently. But, if some or a lot of the things above sound familiar, you (or your Vet), may have PTSD. Seek help as soon as possible!
For more information about PTSD symptoms, visit http://www.familyofavet.com/ptsd_symptoms.html.
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How does PTSD change the brain?
Combat-Related Post Traumatic Stress Disorder (or Combat PTSD) is not just something that happens to a soldier when they have to kill someone (though that can play a part). It’s about what happens, physically and psychologically, inside of a soldier’s brain when they are faced with weeks, months, and years of constant fear, death, adrenaline, and danger. This enormous, prolonged stress literally changes the way their brain looks and functions.
Physical Changes
HIPPOCAMPUS - The hippocampus is a section of our brain that plays an important part in short-term memory and the regulation of our emotions. Researchers, using Magnetic Resonance Imaging (MRI’s), have been able to determine that the hippocampus of veterans with PTSD has actually suffered damage. They believe this damage may be caused by repeated exposure to cortisol, the hormone our body releases when we’re under stress.
PREFRONTAL CORTEX – Our Prefrontal Cortex helps us decide how we experience and react to an emotion and resolve conflicts. It also tells our brain when a threat has passed. People with PTSD have altered blood flow to this area of their brain (the more change in flow, the more severe the symptoms of PTSD). This decrease in function causes their brain to sort of be stuck in a permanent fear mode, because it doesn’t relay the “all clear” message.
ADRENALINE RESPONSE – When we’re in danger, our brain flips into “fight or flight” mode, a place where it is primed to decide whether or not we should run or engage a threat. Our bodies make two handy hormones that cause this response: noradrenaline that handles fight, and adrenaline which is responsible flight. In “normal” brains, these hormones are released by a current threat (i.e., when someone is standing face to face with a bear). But, in a brain affected by PTSD, these hormones are triggered not by actual threats but by reminders of threats that occurred months or years before.
GRAY MATTER – The gray matter section of our brain is responsible for processing information from our body (sensory neurons) and sending information to our body (motor neurons). Veterans have 5% - 10% less gray matter after developing PTSD. This means their neurons (their communication signals) have been damaged.
Psychological / Mental Changes
HOSTILITY / AGGRESSION – Veterans with PTSD exhibit significantly higher levels of hostility and aggression than the general public, or even than other soldiers who have experienced combat. Since they have lived for a long period of time where they needed to aggressively react at a moment’s notice in order to stay alive, this way of acting has become an ingrained habit. Spouses often joke that it is not safe to wake a sleeping veteran from anywhere close by. This is because, when startled awake, the vet can react with an unbelievably strong amount of aggression because he believes he is responding to an unknown threat. On a wider scale, it is very common for individuals with PTSD to get into fights, drive aggressively, become angry at insignificant things, and drastically overreact to any sort of challenge.
GUILT – The guilt associated with post-traumatic stress disorder is often called survivor’s guilt. The veteran feels a great deal of guilt because he survived an attack when a comrade did not. He feels guilty because a friend lost his legs in an explosion while he remained mostly untouched. He feels guilty that he is at home in safe surrounding while others he fought with are in harm’s way.
DEPRESSION / SUICIDE – People with post-traumatic stress disorder are seven times more likely to be depressed than someone in the general population. It is one of the most complaints associated with PTSD. And, unfortunately, this depression goes hand in hand with high rates of suicide among our nation’s returning heroes. As of April, 2010 (the last time data was published), eighteen of our nation’s heroes were committing suicide each day.
PARANOIA – In Iraq, a paranoid soldier is a soldier who stays alive. Every item in his environment, from a pothole to a child carrying a backpack, must be regarded as a potential threat. When that same soldier, whose mind has been changed by PTSD, returns home, he is often unable to shut off his vigilant behavior. Veterans will often almost constantly “patrol” their homes to check for intruders, insist that they sit with their backs to a wall and facing the door so that they can analyze every person who enters a room, or even drive off the road in order to avoid discarded trash (because this often indicated an Improvised Explosive Device or IED in combat).
LACK OF TRUST – This change in a veteran with PTSD is also caused by his time in combat. While in Iraq or Afghanistan he had to assume that everyone he met, even those who were called allies, were possible enemies. The only people he knew he could rely on in order to stay alive were himself and those in his immediate group - people who had proven themselves to each other in combat. After that same Veteran returns home, he feels alone and without the protection of his battle-tested counterparts. He doesn’t trust anyone else (even people he’s known for his entire life) to be able to watch out for him. He feels that he, alone, is the only one he can count on or trust.
POOR COPING SKILLS - Due to the physical and mental changes Veteran with PTSD has, they are often unable to cope in what most people would consider “normal” circumstances. They are easily overwhelmed by too much noise, too many people, too many changes, or too much stimuli of any sort. Dealing with post-traumatic stress disorder and all of its symptoms takes most of their energy and concentration. Anything else, especially something that is unexpected, can cause a violent reaction or simply cause the Veteran to shut down.
Understanding these changes helps many people understand for the first time just how “real” post-traumatic stress disorder is. Unfortunately, hidden wounds (like PTSD), are often hard for people to grasp and empathize with. Hopefully, after learning more about the “mechanics” behind PTSD, you will be better able to talk about PTSD and the real impact it can have on the life of a Veteran and on those who love and care for him or her.
You can view an online version of this information about how Combat PTSD impacts the brain at http://www.familyofavet.com/understanding_combat_ptsd.html.
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How is PTSD treated?
Thankfully, as the nationwide awareness of PTSD (Post Traumatic Stress Disorder) grows, so does the list of available treatments and treatment locations. When looking for a way to help yourself (or your Veteran) learn to cope and live successfully with PTSD, you have to keep an open mind and know that every method won't work for every person. It often takes a while to find out what is going to work for you and your family. Don't let yourself get discouraged!! Keep going... the efforts will pay off!!
Please note, we are not "experts" nor do we have medical degrees of any kind. The explanations offered are simply our "takes" on each therapy. You'll want to do your own research or ask your health care professional about any treatments you're considering!
Traditional PTSD Treatments
COGNITIVE BEHAVIORAL THERAPY
Cognitive Behavioral Therapy (CBT), also known as Cognitive Therapy, is the longest used treatment for Post-Traumatic Stress Disorder. Probably the simplest way to explain it, is a CBT therapist helps you change how you look at the world around you. They help you figure out what negative thought processes, reactions, or patterns are making your life worse and then give you tools to help you change that.
Some Types of Cognitive Therapy used to treat PTSD are:
Exposure Therapy
- This therapy actually gets you to confront the situation(s) that
caused your PTSD. The idea is that by dealing with the traumatic
event again in a controlled environment you can gradually get a
handle on how it makes you react and feel.
Cognitive
Restructuring - This is a process based on the idea that how you
think as a big impact on how you feel and behave in life.
Eye
Movement Desensitization and Reprocessing (EMDR) - Involves
recalling memories related to a traumatic event while also
"reprogramming" the brain with rapid movements or lights in
front of the patients eyes. Sounds strange, but there is plenty of
research to back it up.
PSYCHODYNAMIC PSYCHOTHERAPY
Psychodynamic Psychotherapy basically looks at the unconscious issues (normally things that happened in your childhood) that are affecting someone's motives, actions or reactions and causing them to act in a way that's unhealthy For example, something that happened to you as a child that now causes you to be afraid of strangers or unfamiliar places. After the issue is identified, the therapist works with the patient to replace that unhealthy response with a more "normal" one. This type of therapy isn't usually used by itself to treat PTSD, but instead it's used as part of a treatment plan.
GROUP THERAPY
Many Veterans find it extremely helpful to be able to sit in a room with others who have also been in combat. However, other Veterans find that this type of therapy is too much to handle. Many VAMC's (VA Medical Centers) and Vet Centers offer Group Therapy.
FAMILY or MARRIAGE COUNSELING
The idea of family counseling is that when one person in a family is struggling with PTSD, that struggle affects everyone else. And, the only way to get things "back on track" is to treat the family as a whole. Family Counseling can help everyone develop coping skills, learn to resolve conflicts (often an all too frequent occurrence in PTSD world!), and work through pent-up feelings. Family counseling is usually started after a Veteran is already receiving individual treatment for PTSD.
MEDICATION
There is a wide variety of medication available to treat PTSD. They typically fall into one of four categories: Anti-Depressant, Anti-Anxiety, Sleep-Related, or Other.
Non-Traditional Treatments for PTSD
PTSD Service Dogs
Yoga
Reiki
Meditation
Pilates
Massage
Acupuncture
Art & Music Therapy
Drama Therapy
Exercise
EFT / Tapping Technique
Qi Gong
For more info about PTSD Treatments, visit http://www.familyofavet.com/ptsd_treatments.html.
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Where can I get help?
For many heroes, reaching out for help can be an incredibly hard first step. If you are struggling with any of these symptoms, please know that PTSD doesn’t make you “weak” or “broken”… it simply means you’re having a NATURAL reaction to a very UN-NATURAL situation. And, the longer you wait to seek help, the more time post-traumatic stress disorder is going to have to destroy you and the things you love. Being in combat takes courage and SO DOES SEEKING HELP.
If you love a hero who is showing signs and symptoms of post-traumatic stress disorder, you can help GENTLY encourage him or her to seek help. For many, figuring out how to get the help they need can be overwhelming. Go ahead and do the “leg work” for your veteran… contact your local resources, ask questions about their programs, get as much information as you can so that you can help your hero get comfortable and make an informed decision.
After the lists of options for each group (current military, veterans, and loved ones), you will find a short description of most of the programs. Hopefully these will help you (or your veteran) find somewhere to get started! (Believe me, I know that getting started can be REALLY hard, but once you do it, you’ll be SO glad that you did!)
OPTIONS for CURRENT MILITARY
Mental Health Services on your military installation
OPTIONS for VETERANS
Mental Health Services at your local VA facility
OPTIONS for FAMILY MEMBERS
Local VA Vet Center *only family / marriage counseling is available for spouses & loved ones*
DESCRIPTIONS OF PROGRAMS
VA Vet Centers are located throughout the country and are devoted to serving the men and women who have combat-related mental health issues as a result of their military service. Many veterans find the Vet Centers much less overwhelming than “typical” VA facilities. They are often much more relaxed, require less paperwork, have more flexible hours, and a high percentage of those who work at the centers around the country have prior combat experience themselves.
Give An Hour is a non-profit organization that offers free counseling to members of the military, veterans, and their loved ones through a nationwide network of mental health professional who have donated time to support the needs of our nation’s heroes and families. Their website has a search function which will let you find a provider close to you. If there isn’t anyone available, there are also counselors who have offered to schedule sessions by phone.
Not Alone is a steadily growing organization that is part of CenterStone (the nation’s largest non-profit provider of behavioral health services). The have a 24 hour call-line and online support center as well as a free referral program for counseling in 17 states through a network of 350 counselors.
Clayton Stress is an online, fee-based program, (as little as $10 per month) that offers a way for military, veterans and family members to participate in a proven, EMDR-based therapy (see information under treatments) from the privacy of their own homes. We’ve partnered with them to spread the word because so many of our volunteers and friends have had such good results in finding relief from PTSD symptoms. Details about the program and our partnership are available by clicking the hyperlink above.
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Where can I get more information & support?
General PTSD Pages
Secondary PTSD
PTSD Coping Skills, Information & Tips
PTSD & Relationships
PTSD & Domestic Violence
PTSD & Children
PTSD Resources
Technology & PTSD
VA Claims & PTSD