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What is Combat PTSD?

Many Vietnam veterans returned home to a troubled period of readjustment from their wartime experiences. Their emotional problems were characterized initially as post-Vietnam syndrome. It took mainstream psychiatry till the mid-1980’s to finally codify symptoms that have been associated with returning combat veterans since time immemorial. What had been dubbed "homesickness" after the Civil War, shell shock in WWI, and combat neurosis during WWII, was finally recognized by the American Psychiatric Association as an anxiety disorder in its own right, and termed post traumatic stress disorder — or PTSD.

Among veterans of Vietnam, PTSD can express itself in a variety of ways, as depression, in episodes of rage or violence — often accompanied by substance abuse problems, and/or as an inability to relate appropriately to friends, co-workers, and family. These and other symptoms of PTSD develop following exposure to traumatic events and actions in combat that shatter one's basic sense of meaning and security.

PTSD can also be brought on by non-combat acts of brutality or violence toward enemy combatants or civilians. There are many PTSD vets that have never been aggressive towards others, but who may suffer feelings of profound guilt by mere association with such acts of violence. In any case, PTSD is clearly triggered by violence in warfare, and is therefore an outcome of the reality of war, a reality that is far different and more horrible than the portrayal of war by politicians and entertainment media.

An onset of PTSD is often accompanied by bouts of intense fear, helplessness, or horror. Characteristic symptoms may include

• persistent re-experiencing of the traumatic event(s).
• avoiding experiences or people that trigger memories of such event(s).
• increased arousal, to include nervousness, over-reaction to sudden noises, (are you jumpy?), difficulty sleeping (night sweats), and nightmares (ever hit your wife, girlfriend in your sleep, or are they scared to wake you up?).
• bouts of "inappropriate" rage and-or depression.
• difficulty relating emotionally to others.
• feelings of extreme alienation and meaninglessness.
• isolation from others (do others see you as cold, unfeeling?).
• in the most extreme cases, persistent thoughts of murder and-or suicide.

PTSD behaviors take many forms, including, inability to trust others, fear around others (sitting with back against the wall, watching others' hands, etc), illusions (looking at objects and thinking they are something else), doing perimeter checks, using alcohol or drugs to numb out, not being able to remember what happened, or not wanting to remember, classic anxiety symptoms (sweating, chest pain, chest tightness, dizziness, shortness of breath, hot or cold flashes, things feel like they're closing in, tingling or numbing sensations, all for no apparent reason), feeling that you need to leave NOW, zoning out, or not being able to concentrate, being irritable all the time, suffering chronic fatigue, muscle tightness (particularly in neck and shoulders), restlessness (feelings or inability to sit still), depression (increase or decrease in appetite, sleep, sex drive and/or weight, decrease in energy, motivation, self-esteem, persistent memories and/or feelings of sadness).

PTSD is a potentially life-destroying disorder, which in the most severe instances has lead to individuals taking their own lives. It is not true, however, that those with PTSD can be characterized as sociopaths. True sociopaths (antisocial personality disorder) are prone to not develop PTSD, because of their personality structure. It is true that individuals with PTSD may display antisocial behaviors, or behave violently, but they are not sociopaths.

PTSD is difficult to diagnose, because soldiers are socialized to believe that complaining of the symptoms is weak and un-masculine, that they are "sniveling." The disorder can be particularly insidious within the active or inactive military, because soldiers who are suffering from it, and are as yet undiagnosed, are constantly exposed to training and operations related to the preparedness for the exact situation with which the disorder is associated — warfare.

Your loved ones with PTSD are suffering from a disorder related to what the military exposed them to, and, given the military mission, the services are unequipped to take responsibility for this disorder, or to provide care to assist soldiers and families in adjusting and learning to manage constructively the symptoms of PTSD. It is likely you will have to seek professional help outside the military system. (Note that the VA may pay for treatment through the Vet Centers which tend to be much more Vet friendly.)

If your military loved one is re-experiencing combat through recurrent and intrusive recollections, recurrent distressing dreams during which the event is replayed, or in extreme instances, as psychotic (extremely irrational) states that last from few seconds to several hours, or even days, during which combat is re-lived and the person behaves as though experiencing combat, seek help. DO NOT allow anyone to approach your loved one from a return-to-duty orientation. Every aspect of normal military duty will serve as a potential trigger for acute PTSD episodes.

When the service member is diagnosed, she/he should immediately call 1-800-827-1000, and ask to be connected to the Veterans Administration Regional Office. Once connected, ask for instructions on how to apply for services related to PTSD. Do not take no for an answer. Depending on the VA facility, or even a given individual VA employee, you may be discouraged from filing a claim. Even if they tell you that you are not entitled, demand the application paperwork and file it.

Service agencies like the DAV, VFW, American Legion, AMVETS, VVA and others, exist, in part, to aid you in filing these claims. They are generally located on the premises of most VA regional offices and medical centers. Seek their help. And, don't underestimate the importance of getting copies of all your military records, records of service in theater, as well as evaluation reports, letters, and commendations. This should be done by every person leaving the service, since vets may not begin to develop symptoms until years after they first experience the trauma in question. Late on-set PTSD is quite common. The hardest part of getting service connection is not the diagnosis of PTSD, but linking your disorder to a documented account of wartime actions you experienced or participated in. Combat records that would confirm your accounts can literally take years to obtain. But you can provide your own record with the help of witnesses. Take a picture of your combat buddies in the theater of war. Write down their first and last names, SS#, DOB, and get their addresses, in particular the addresses of a stable relative. This material could provide you with the vital information you may require in later years.