The Few, The Proud, The Afflicted:

Risk Factors of Posttraumatic Stress Disorder in Veterans

Abstract

In the current research paper, an analysis of posttraumatic stress disorder (PTSD) in veterans was conducted. It is evident that many veterans suffer from PTSD and many cases result in alcohol abuse, drug abuse, a failing family life, domestic violence, extreme aggression, withdrawal, detachment, homelessness, and an alarming rate of suicide. This paper looks at current issues that veterans are experiencing due to PTSD, possible risk factors that my increase the manifestation of PTSD, and possible treatments.

Chapter 1: The Few

Post-Traumatic Stress Disorder (PTSD) has been a part of many of our U.S. wars throughout history, but never had a true clinical diagnosis for it. During each war; PTSD had many different names such as “soldier’s heart” during the Civil War, “shell shock” World War I, and World War II and Korean war known as “combat fatigue” (Langer pg. 50). It wasn’t until 1980 that The American Psychiatric Association introduced the proper terminology as Post-Traumatic Stress Disorder (Langer pg. 51). There are three different ways states that PTSD can manifest. One is intrusive recollection; it’s where the sufferer is constantly reliving the traumatic event or events. They suffer from hallucinations, illusions, and flash back episodes daily. Second is avoidance and numbing are when the sufferer is avoiding any stimuli that would remind them of their traumatic event. They also avoid remembering the important parts of their trauma. Third is hyper-arousal; is where the sufferer is extremely irritable, has anger issues, outburst, and difficulties with sleep (Langer pgs. 51-52)

A 28-year-old veteran Justin Michael Crowley-Smilek from Maine was convicted of assault after he battered someone over the head with a flashlight. He was then court ordered to undergo a psychological exam to address his reoccurring mental issues after returning from Afghanistan as a U.S. Army Ranger. The day after his court appearance, the Justin returned to the courthouse, threatened a police officer with a knife, and was shot to death (Hannon, 2011). This man was my sister in laws brother’s best friend throughout is childhood and my sister in laws best friend’s brother. The four of them used to catch frogs in the pond, watch Saturday cartoons, and stay up late and eat junk food at sleepovers together. His family said he did not know how to ask for help and sadly, this may have been his way.

A 46-year-old veteran

It is crucial that PTSD in veterans be addressed so that the search for proactive measures, encouragements to come forward, and better treatments continue.

Chapter 2: The Proud: The Battle Within

Symptoms of Posttraumatic Stress Disorder

The American Psychiatric Association defines posttraumatic stress disorder (PTSD) as “a psychiatric condition that is experienced by a subset of individuals after exposure to an event that involved life threat and elicited feelings of fear, helplessness, and/or horror in the individual” (American Psychiatric Association, 2000). According to a recent study on PTSD in veterans, research shows that 16% of deployed veterans suffer from PTSD whereas only 7% of the United States suffers from PTSD (Gates, Holowka, Vasterling, Keane, Marx, & Rosen, 2012). It is important to note that these 16% are those veterans and active duty members that come forward to seek help; there may be an unrepresented amount that does not come forward for fear of stigma, embarrassment, shame, or other consequences.

The DSM-IV states that when a person suffers from PTSD, they must have experienced a traumatic event and their response to this event included immense fear (American Psychiatric Association, 2000). It is obvious that when an individual goes to war, they are more likely going to experience a situation with these factors. After the event has been experienced, a minimum of one symptom from the category of “intrusive recollection”, three symptoms from “avoidant/numbing symptoms,” and two symptoms from “hyper arousal symptoms” must be present for the diagnosis of PTSD (American Psychiatric Association, 2000). The category of “intrusive recollection” has symptoms such as stressing over the past event through thoughts or pictures, dreams of the event, a feeling that the event is reoccurring, psychological stress over verbal or visual reminders of the event, and physical reaction to reminders of the event. “Avoidant/numbing” symptoms are considered any attempt to avoid talking about the event, avoiding people, places and activates, detaching, and others. “Hyper arousal” has such symptoms as problems with sleep, irritability, and easily startled. These symptoms must all last more than one month (American Psychiatric Association, 2000).

PTSD can increase a person’s dependency on alcohol and drugs. A study showed that people who suffer from PTSD or experienced any traumatic event were more likely to be dependent on alcohol than those who did not. The study also indicated that people who suffer from alcohol dependency have probably been exposed to a traumatic event in their lives (Fetzner, McMillan, Sareen, & Asmundson, 2011). This substance abuse dependency can cause physical harm, emotional harm, and over time destroy one’s life.

A study was conducted to see the relationship between physical aggression, non-physical aggression, and Iraq and Afghanistan war veterans. The study assessed questionnaires taken by 337 veterans and found that for non-physical aggression, rates were much high in veterans with symptoms of PTSD and when combined with alcohol abuse. This abuse in alcohol combined with PTSD symptoms also increased the rate of physical aggression (Stappenbeck, Hellmuth, Simpson, & Jakupcak, 2013). It is not surprising that PTSD raises the dependency of alcohol and increases overall aggression.

In a study conducted to show the relationship strain that veterans with PTSD have with their significant others, the more symptoms a service member reported of PTSD (especially numbing and withdrawal), the higher level of relationship stress the significant other reported. It was suggested that much of the stress is due to the perception that the significant other has about these numbing and withdrawing feelings. Many feel that they are directed towards them on a personal level where as the reality is that these feelings have nothing to do with the relationship, they are just symptoms of the PTSD. Simply put, “it’s not you, it’s me” (Renshaw & Campbell, 2011). The Department of Veterans Affairs reported that almost 40% of Vietnam veteran marriages failed within six months after returning from war (Department of Veterans Affairs, 2013). They also reported a study with 50 Vietnam veteran participants where 42% reported physical domestic abuse and 92% reported verbal abuse in the year after their return from war (Department of Veterans Affairs, 2013). These studies show that PTSD is not only an issue for the veteran who is suffering, but also for their families.

In a study that showed a relationship between PTSD and suicide it was reported that people with PTSD are twice as likely than those without PTSD to attempt suicide (Sher, 2009). In a report from the Department of Veterans Affairs, the number of veterans who participated in Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn and now suffer from PTSD were totaled to 286,134 veterans from October 2001 until September 2012 (Department of Veterans Affairs, 2012). According to the Department of Veteran’s Affairs, a total of 27,062 veterans committed suicide between the years of 2009 through 2012. This is an average of 22 veterans per day committing suicide (Department of Veterans Affairs, 2012). In a report on Operation Iraqi Freedom veterans and Operation Enduring Freedom veterans there was a reported 490,346 suicides (Lee, 2012). This is a horrendous amount of suicides.

It is evident that there is a significant amount of posttraumatic stress in veterans and active duty service members. Many of these veterans suffer from alcohol and drug dependencies, family issues with spouses and children, many homeless veterans suffer from PTSD, and many veterans are aggressive and prone to domestic violence and suicide.

Chapter 3: The Afflicted

Risk Factors

Risk factors are any sort of attribute that can increase the likelihood of a disease or disorder.

According to the National Institute for Mental Health, some common risk factors for PTSD are “living through dangerous events and traumas, having a history of mental illness, getting hurt, seeing people hurt or killed, feeling horror, helplessness, or extreme fear, having little or no social support after the event, and dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home” (National Institute for Mental Health, 2012). These

risk factors can increase an individual’s chance of suffering from PTSD. Many of these risk factors are experienced daily by service members and sadly some of these risk factors are what military members sign up to experience. Many members look for the adventure and excitement of the soldier life but may not realize what they are actually committing to.

The first risk factor listed, living through dangerous events and trauma, is a daily occurrence on a deployment, and many service members have been on more than one deployment. According to study conducted in 2005, the average service member will deploy 14 times in a 20-year career (Adler & Huffman, 2005). This means that a service member could possibly be exposed to traumatic events for 14 years.

The second and third risk factors are getting hurt or seeing someone get hurt. As of February 5, 2013, there have been a total of 4,409 deaths and 31,925 wounded in Operation Iraqi Freedom, 2,165 deaths and 18,230 wounded in Operation Enduring Freedom, and 66 deaths and 295 wounded in Operation New Dawn (Fischer, 2013). This is an enormous risk factor for PTSD in veterans. This data also shows that as of December 2012, there are a total of 103,792 veterans who suffer from PTSD that have deployed and 27,549 veterans that suffer from PTSD and did not deploy, meaning a service member does not have to be on a deployment to experience trauma and experience PTSD (Fischer, 2013).

A study conducted to see the relationship between prior brain trauma, PTSD, and suicide showed that veterans who suffer from PTSD will be more likely to commit suicide as well as those who have had prior brain trauma. The combination together (brain trauma and PTSD) show that there is an increased risk factor in suicide when both PTSD and brain trauma are present (Barnes, Walter, & Chard, 2012). In Fischer’s 2013 report on U.S. Military Casualty Statistics in Operation

New Dawn, Operation Iraqi Freedom, and Operation Enduring Freedom, there was a total of 253,330 reported traumatic brain injuries.

Feeling horror, helplessness, or extreme fear is again very common on any deployment. When a person is literally fighting for his or her life, there will be extreme fear and horror. When a person witnesses’ death of a comrade or a friend, there is an immense feeling of helplessness and even survivor’s guilt. The risk factors listed only require one to enhance the appearance of PTSD, most veterans experience five or six of these in a given setting, not to mention they experience them multiple times. It is obvious why the numbers of PTSD in veterans and service members are so high but what can we do to help? How can we lower the suicide rates and increase the number of veterans who seek help?

Chapter 4: Finding a way

Treatment

Currently the suggested treatment for PTSD is psychotherapy and medications, or a combination of both

(National Institute of Mental Health, 2013). It has been encouraged that the sooner a person addresses their PTSD and seeks help, the more likely they are to overcome it.

Psychotherapy:

Much of the psychotherapy used will encourage the individual to confront the traumatic event or events and address the feelings he or she might have associated with the trauma. This technique allows the individual to work through these feelings and work on healing. Other types of talk therapy could include cognitive behavioral therapy. This is where the individual will again confront his or her feelings about the trauma and try to identify the cause of their current feelings. Once these negative feelings have been identified, the individual can move forward and try to control them by rationalizing. Family therapy is also encouraged for people with PTSD. As mentioned before, PTSD can not only affect the one suffering but also that person’s family and friends. It is important to have family involved in this healing process so that they can address issues that may be causing stress on the family and work through them together. This will also help with the sense of disconnection and encourage feelings of partnership and embracement (Helpguide.org, 2013).

When it comes to veterans and service members, talk therapy is also detrimental for overall progress. For service members it can be difficult to move forward from a past event when they might be en route to experience another. Multiple deployments can have a significant effect on service members’ mental state, especially on those who are already suffering from PTSD. So how are they supposed to get over one event when the possibility of another is in their near future? Lee

(2012) suggests that it is an important step to be self-aware and for the service member to be open to finding help. Several branches of the military have started campaigns for suicide prevention where service members are encouraged to seek help if they are having symptoms of suicide or depression. The campaigns not only encourage members to come forward but there is also training for members to be supportive of those who need help on many levels. The Department of Veteran’s Affairs also offers many programs and support channels for veterans and family members with PTSD. According to a study about the Department of Veterans Affairs’ “REACH” program (Reaching out to Educate and Assist Caring, Healthy Families), veterans showed significant improvement in their overall lives and family lives (Fischer, Sherman, Han & Bowen, 2013).

Grouped Delivered Cognitive Behavioral Therapy:

Pharmacologic Treatments:

Types of medications that are sometimes used to treat PTSD are forms of antidepressants like Prozac or Zoloft. It has been recommended by many sources that talk therapy be the first type of treatment for PTSD and then if needed, a medication can be prescribed with it. Some medications are recommended to address any biological issues that might be present in PTSD.

A study conducted a test to see how soldiers that were deployed to Iraq reacted to different kinds of treatment for PTSD. The results showed that the soldiers reacted significantly higher to exposure therapy than they did to medications. As suggested in previously stated studies, medication is really the last step for PTSD treatment (Reger, Durham, Tarantino, Luxton, Holloway, & Lee, 2012).

Animal-Assisted Therapy:

Conclusion

There is a significant number of veterans and active duty service members who suffer from PTSD. This disorder not only affects them on a psychological level but also on a physical, emotional, and relational level. The symptoms not only harm the veteran, but it can also take a tremendous toll on the family and friends. Whether it is alcohol or substance abuse, heighten levels of aggression, failing marriages, or suicide, these veterans are suffering in many ways. These symptoms are brought on by such risk factors as experiencing dangerous events, getting hurt, seeing people killed, and feeling extreme fear which can be somewhat near impossible to avoid as a deployed soldier, but what is most important is that these people seek assistance and support after going through the trauma. There have been incredible advances in the past 10 years for support and treatments for PTSD in service members and veterans that are encouraging more and more to come forward, address their issues, and start the healing processes. These people sacrifice their lives, their family, their time, their everything so that this country can sleep peacefully at night, the least we could do is ensure they share that same luxury. If you are a veteran struggling with PTSD, the greatest display of strength you can show is to

reach out for help

.

References

• 
  Alder,
  
  A.B., Bliese, P.D., Castro, C.A., & Huffman, A.H. (2005). The Impact of Deployment Length and Experience on the Well-Being of Male and Female Soldiers.
  
  Journal of Occupational Health Psychology 10
  
  (2), 121-137.
• American Psychiatric Association. (2000).
  
  Diagnostic and statistical manual of mental disorders
  
  (Revised 4th ed.).
• Aragon, D Living with Post-Traumatic Stress Disorder; A Veteran’s Story Retrieved from
  
  https://www.military.com/benefits/veterans-health-care/ptsd/living-post-traumatic-stress-
  
  
  disorder-veterans-story.html
  
• Barnes, S. M., Walter, K. H., & Chard, K. M. (2012). Does a history of mild traumatic brain injury increase suicide risk in veterans with PTSD?
  
  Rehabilitation Psychology, 57
  
  (1), 18-26.
• Fetzner MG, McMillan KA, Sareen J, & Asmundson GJ. (2011). What is the association between traumatic life events and alcohol abuse/dependence in people with and without PTSD? Findings from a nationally representative sample.
  
  Depression & Anxiety (1091-4269)
  
  ,
  
  28
  
  (8), 632–638.
  
  https://doi.org/10.1002/da.20852
  
• Fischer, E. P., Sherman, M. D., Han, X., & Owen, R. R., Jr. (2013). Outcomes of participation in the REACH multifamily group program for veterans with PTSD and their families.
  
  Professional Psychology: Research and Practice
  
  ,
  
  44
  
  (3), 127–134.
  
  https://doi.org/10.1037/a0032024
  
• Gates, M. A., Holowka, D. W., Vasterling, J. J., Keane, T. M., Marx, B. P., & Rosen, R. C. (2012). Posttraumatic stress disorder in veterans and military personnel: Epidemiology, screening, and case recognition.
  
  Psychological Services
  
  ,
  
  9
  
  (4), 361–382.
  
  https://doi.org/10.1037/a0027649
  
• Hannon, A. (2011, November 21). Day before he was shot by police, troubled veteran was ordered to seek help.
  
  Bangor Daily News
  
  . Retrieved from
  
  http://bangordailynews.com/2011/11/21/news/mid-maine/day-before-he-was-shot-by
  
  police-troubled-veteran-ordered-to-seek-help/.
• Institute of Medicine (U.S.). (2014).
  
  Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Final Assessment
  
  . Washington, D.C.: National Academies Press. Retrieved from http://ezproxy.libdb.dc.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=867969&site=eds-live&scope=site
• LANGER, R. (2011). Combat Trauma, Memory, and the World War II Veteran.
  
  War, Literature & the Arts: An International Journal of the Humanities
  
  ,
  
  23
  
  (1), 50–58. Retrieved from
  
  http://ezproxy.libdb.dc.edu/login?url=https://search.ebscohost.com/login.aspx?direct=tru
  
  e&db=afh&AN=67660076&site=eds-live&scope=site
• Lee, E. D. (2012). Complex contribution of combat‐related post‐traumatic stress disorder to veteran suicide: Facing an increasing challenge.
  
  Perspectives in Psychiatric Care, 48
  
  (2), 108-115.
• Price, J.L, & Stevens, S.P. (2005). Partners of Veterans with PTSD: Research Findings.
  
  Department of Veterans Affairs.
  
  Retrieved from http://www.ptsd.va.gov/professional/pages/partners_of_vets_research_findings.asp.
• Reger, G. M., Durham, T. L., Tarantino, K. A., Luxton, D. D., Holloway, K. M., & Lee, J. A. (2013). Deployed soldiers’ reactions to exposure and medication treatments for PTSD.
  
  Psychological Trauma: Theory, Research, Practice, and Policy
  
  ,
  
  5
  
  (4), 309–316.
  
  https://doi.org/10.1037/a0028409
  
• Renshaw, K. D., & Campbell, S. B. (2011). Combat veterans’ symptoms of PTSD and partners’ distress: The role of partners’ perceptions of veterans’ deployment experiences.
  
  Journal of Family Psychology
  
  ,
  
  25
  
  (6), 953–962.
  
  https://doi.org/10.1037/a0025871
  
• Richards Nichols, K. Losing Mark: My Story of Military Suicide
  
  Stop Soldiers Suicide
  
  . Retrieved from
  
  https://stopsoldiersuicide.org/losing-mark-my-story-of-military-suicide/
  
• Sher, L. (2009). Preventing suicide in post-traumatic stress disorder.
  
  The Australian And New Zealand Journal Of Psychiatry
  
  ,
  
  43
  
  (7), 691–692. Retrieved from
  
  http://ezproxy.libdb.dc.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true
  
  &db=mnh&AN=19534032&site=eds-live&scope=site
• Stappenbeck, C. A., Hellmuth, J. C., Simpson, T., & Jakupcak, M. (2013). The Effects of Alcohol Problems, PTSD, and Combat Exposure on Nonphysical and Physical Aggression Among Iraq and Afghanistan War Veterans.
  
  Psychological Trauma: Theory, Research, Practice, And Policy
  
  ,
  
  6
  
  (1), 65–72. https://doi-org.libdb.dc.edu/10.1037/a0031468
• United States Department of Veterans Affairs. (2012).
  
  Report on VA Facility Specific Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans Coded with Potential PTSD.
  
  Retrieved from
  
  http://www.publichealth.va.gov/epidemiology/reports/oefoifond/ptsd/index.asp
  
  .
• United States Department of Veterans Affairs. (2012).
  
  Suicide Data Report 2012.
  
  Retrieved from
  
  http://www.va.gov/opa/docs/Suicide-Data-Report-2012-final.pdf
  
  .