War-Zone-Related Stress Reactions: What Veterans Need to Know

A National Center for PTSD Fact Sheet

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 <I style="mso-bidi-font-style: normal">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 <I style="mso-bidi-font-style: normal">often cause many of the following kinds of (often temporary) reactions in veterans:

1. 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

2. 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

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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 <I style="mso-bidi-font-style: normal">inform the doctor or nurse about his or her traumas, in order to limit the effects of the trauma.