PTSD

(This was written by a clinical psychologist specialising in PTSD in Vietnam Vets,working in Brisbane.Thank you Doc for taking the time to write this for us.)

It Might Not Be PTSD

There are many responses to major traumatic events such those encountered in a war zone. Post Traumatic Stress Disorder (PTSD) is perhaps the most commonly mentioned syndrome in current times but there are a number of other disorders which can also be directly or indirectly related to, or precipitated by, trauma, including

  • substance (alcohol or drug) abuse/dependence;
  • adjustment disorder with depressed or anxious mood;
  • major depression,
  • generalised anxiety disorder and
  • obsessive- compulsive behaviours.

What Happens?

Depending on a range of factors, some people’s reactions may last for a short time while others may experience long-lasting effects. Furthermore, some people may show the symptoms soon after the event/s while others may have a delay of months or years before they are aware of any symptoms.

It is also common for symptoms to vary in intensity over time. Some people go for long periods without significant problems, only to relapse when they have to deal with other major life stresses.

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Coping Strategies

It is not uncommon for servicemen / ex-servicemen (and women) to have used a combination of strategies including alcoholism, workaholism and/or emotional numbing to keep symptoms at bay for many years only to discover that these strategies become less effective over time and to have symptoms break through as the reach their fifties and sixties or encounter a major change in lifestyle, such as retirement.

Some people only have a few of the common symptoms while others will meet the criteria for a diagnosable condition.

Why Some Vets Are Affected More

Why some people are affected more than others has no simple answer and is likely to reflect a combination of factors including:

  • genetics;
  • psychobiological development during childhood and adolescence (determining the brain’s capacity to re-regulate itself after hyper-arousal);
  • the nature and number of traumas and their personal meaning for the individual (especially whether the individual felt powerless or overwhelmed),
  • the response of others at the time and afterwards and exposure to other life stressors.
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Why Does it Happen?

It is not a question of character or courage and no-one is immune. Traumatic stress can be seen as part of a normal human response to intense experience. Whether it reduces or disappears over time, has a delayed onset or becomes chronic is a complicated interaction of multiple factors, many of which are out of the person’s control.

Human beings have a natural tendency to try to make sense of things that happen to them. When people experience a trauma, the event keeps coming back into their mind in an attempt to make sense of what happened. This is a natural way to deal with or come to terms with difficult experiences and seems to work well for many stressful life events.
However, due to the high level of distress associated with memories of severe trauma and/or difficulty finding any way to make sense of them, the thoughts and feelings tend to be pushed away to protect the person from this distress. The result is that, whilst the memory may go away for a while, the need for it to be dealt with has not been addressed and it keeps coming back (or is triggered back by a reminder in the current environment).

Addressing PTSD

The movement backwards and forward from intrusive thoughts and feelings about trauma to avoidance and numbing can then continue almost indefinitely unless the cycle is addressed in some way. Furthermore, throughout this cycle of short bursts of painful memories (or nightmares) and periods of avoidance and numbing, the sense of feeling keyed-up and on edge persists.

The traumatised person has been through an event that potentially threatened their life or the life of someone else and their mind and body remain on alert to ensure it doesn’t miss any sign in the future that such an event is recurring. The persistent activation of this threat-detecting system, however, leaves the person’s reaction to current events on a ‘hair trigger’ and predisposes them to feelings of anxiety or panic or to sudden explosive outbursts of anger.

This often results in feelings of guilt and/or embarrassment and the person can become increasingly avoidant of such situations. In some cases, this can lead to almost total social withdrawal, with a resultant increase in anxiety and vigilance when they do have to go out.
Of course, this no longer becomes an individual problem but will impact on all family members. Often, those with chronic, untreated PSTD have a history of shattered family relationships and family members showing signs of distress or estrangement over time.

Good News – Better Understanding and Treatment

The good news is that there is now a much better understanding of the responses of human beings to trauma and treatment is becoming increasingly effective.
Treatment needs to be conducted by qualified mental health professionals (clinical psychologists and psychiatrists) who specialise in the diagnosis and treatment of posttraumatic syndromes.

Treatment will be individually tailored for the major symptoms presenting in each individual and in the context of a detailed understanding of their strengths and vulnerabilities, their current life circumstances and their own goals.

Treatment Approaches

Different treatment approaches are suitable for the different people and the nature of the presenting symptoms. Medication may or may not play a part and treatment is often conducted in phases. A strong trusting relationship with the treating professional is an essential component before any intensive work can be conducted.

Early treatment usually involves education of the client and their families so they understand the symptoms better, followed by stabilisation and symptom management strategies, including anger management and dealing with panic attacks.
If intrusive, disturbing memories are prominent, exposure therapy may be conducted to finally make peace and sense of what happened. Assistance with re-building a positive lifestyle in which there is not a constant concern about over-reacting to triggers is also addressed, as well as problems with associated disorders such as alcohol dependence and sleep difficulties.

What to Do

To find out treatment options in your area, you may wish to talk with your GP or contact any of the following organisations:
Vietnam Veterans Counselling Service (VVCS): veterans of any conflict and their families are welcome. Services include: crisis counselling (face to face or telephone); emergency after hours toll free telephone service; individual, family and group counselling; health and fitness gym courses; country outreach programs; educational and information resources and courses; case management and referral to other treatment services. VVCS is available in all states (see your local yellow pages); 24 hour emergency toll free service is available on 1800 043 503 in Sydney, Lismore and Newcastle and 1800 011 046 in all other areas.

Australian Psychological Society (APS) referral service: Service includes referral to a local clinical psychologist with expertise in the treatment of specific conditions. Tel: 03 8662 3300 or www.psychology.org.au

Australian Centre for Posttraumatic Mental Health (ACPMH): promotes mental health for Australian Veteran and Defence Force communities. Services include consultancy and advice to treatment and research programs. Has a range of educational and informational resources. Tel: 03 9496 2922. web: www.acpmh.unimelb.edu.au
There are also numerous regional veteran support services available including welfare assistance and advocacy, drop-in centres, partner support groups and so on. Contact your local RSL or VVCS.