Posttraumatic stress disorder (PTSD) is a disorder that in many cases is misunderstood by much of society. When one hears of a PTSD diagnosis, the stereotypical image that comes to many individuals’ minds is a male military veteran who has experienced a large number of traumatic events related to gunfire and deaths. This disorder is widely misunderstood in regards to those impacted and the impact it has on these individuals. Financial impacts stemming from employment or lack of, maintaining relationships, undergoing treatment, and controlling anger and aggression are all aspects of a posttraumatic stress disorder diagnosis. This disorder is detrimental to the quality of life of military personnel holding combat roles (Raab, Mackintosh, Gross, and Morland, 2015). Although many people are aware of complexities surrounding PTSD, there is much more for society to learn in regards to treatment and limited societal perception. Typically, PTSD is associated with male combat veterans, but should be widened to include female and non-combat military personnel.
Many people have at least heard the term “posttraumatic stress disorder” before, but some people do not truly know what all this disorder entails. In order for a diagnosis to be made, the patient must meet the criteria set by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition also referred to as the DSM-5 (2013). There are eight criterions with additional sublevels that must be met for a diagnosis to be made. Only one area in each of the first three criterion must be met for a diagnosis. First, one must come in direct contact with a direct threat of death, serious bodily injury, or sexual violence. Secondly, one must continue to experience the trauma after it has occurred. Third, one must try to avoid related stimuli from experienced trauma. Fourth, thinking and feeling negatively beginning or increasing after trauma has been experienced. Fifth, worsened arousal and reactivity after experiencing trauma must occur. Two of the previous criteria in each area must be met. Sixth, symptoms must last at least one month. Seventh, symptoms create functional impairment. Lastly, experienced symptoms must not be caused by medication, either prescription or illicit, and not caused by other illnesses (PTSD: National Center for PTSD, 2018).
There are numerous military personnel who are impacted by this traumatic disorder. In 2018, Dondanville, Borah, Bottera, and Molino presented studies illustrating 5 to 45 percent of military members suffer from PTSD; however, only 23 to 45 percent of the members seek professional treatment (p. 15). Additionally, Dondanville, Borah, Bottera, and Molino (2018) discuss comparing general population to veteran population presenting information stating less than 30 percent of general population seek treatment (p. 16). Reasoning behind not seeking professional treatment in most cases is some form of stigma (Dondanville, Borah, Bottera, & Molino, 2018; Lee, 2012). Even in PTSD cases involving the general public, stigma is a major factor in non-treatment seeking patients. It is important that society understand the immense impact PTSD bears on an individual. By broadening our perspective, society can come to understand the importance of treatment and healing.
Clearly, PTSD is an issue that affects many of our military service members as they are deployed and experience psychological trauma. While posttraumatic stress disorder has recently gained a fair amount of attention as a result of street crime and violent acts in society, unfortunately, it has been around for some time. Shell shock was the first form of PTSD experienced by our veterans during World War I in 1914-1918. According to Dr. Edgar Jones in his article Shell shocked, shell shock became one critical issue medical professionals faced during this time of war. Soldiers began to experience “fatigue, tremor, confusion, nightmares and impaired sight and hearing” (p. 18). No other explanation could be formed; therefore, shell shock became the reference term. With additional research and education on psychological trauma, shell shock was renamed posttraumatic stress disorder and research continues. Through the work of physicians during this time, they determined cognitive and reintegration treatment were the best option; these same ideas are utilized today in the management of PTSD symptoms.
There have been major conflicts since World War I that has led to major developments in the treatment, awareness and impact on PTSD. Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) occurred between the years of 2001 to 2014; as a result of these traumatic conflicts, much research has been conducted with these military veterans. These two military combat deployments resulted in a large amount of research regarding PTSD because it was the longest combat operation since the Vietnam War. It is estimated that 10 to 18 percent of Operation Iraqi Freedom and Operation Enduring Freedom veterans developed PTSD while deployed (U.S. Department of Veterans Affairs, 2015). In the case of these OIF/OEF veterans, stigma was one major barrier to seeking professional mental health treatment although PTSD was the most common diagnosis made regarding mental health in service members (Lee, 2012, p. 109). Due to fear of having an impact on their military career, many chose to not seek treatment (Dondanville, Borah, Bottera, & Molino, 2018). OIF/OEF combat veterans are likely to develop other health issues, too (Lee, 2012, p. 109-110). Not only does PTSD present a psychological issue, it also presents medical issues as other conditions occur as a result; some of these issues include hypertension and tobacco use. As an increasing number of female service member seek treatment, advanced practice psychiatric nurses (APPNs) play a crucial role in the diagnosis, treatment, and education surrounding female PTSD (Feczer & Bjorklund, 2009). Understanding PTSD and its effects on combat veterans is critical to ensure society can help foster healing and broaden perception of psychological trauma.
Gender perception is widely misunderstood in regards to PTSD. Stereotypically, men are primarily affected by PTSD as portrayed in multiple television shows and media outlets. PTSD is not an illness impacting one gender or type of employment. In fact, women are at an increased risk for developing posttraumatic stress disorder after a deployment because of vulnerability to psychological trauma. Presented by Feczer and Bjorklund (2009), female veterans are far less likely to receive a diagnosis and same level of care, although controversial, as men (p. 280) In fact, research presented by the authors demonstrates that men are 3.4 times more likely to be diagnosed with PTSD compared to women; however, women illustrated more symptoms than men, (p. 280). Because of their decrease in diagnosis, professional mental health treatment is increasingly difficult for females to receive both in private and Veterans Affairs clinics. There are additional steps being taken for women due to their susceptibility to psychological trauma. Building strong relationships and participating in “simulated training” prior to deployment have proven to be a key factor in reducing PTSD; simulation allows military service members an opportunity to experience the situation that will be more than likely seen in the combat field (Feczer & Bjorklund, 2009, p. 282). Although many women do not serve in combat roles, it is still extremely important to understand how trauma they are exposed to in their various fields impacts them. Additionally, gender gaps in treatment experienced by females in mental health clinics must be bridges to prove the psychological stabilization needed to transition into a normal life post-service.
Combat veterans lead much research conducted regarding posttraumatic stress disorder and even other disorders. Many of these veterans experience the qualifications set forth by the DSM-5. These combat service members are exposed to severe psychological distress through various means including intended physical harm and death. Women are two times more likely to develop PTSD and are at an increased risk of “assaultive and sexual trauma” (Feczer & Bjorklund, 2009, p. 279). Gunfire eruption, exposure to death, and perceived and actual life threats are encounters had by veterans in their respective life of duty. It is important to understand the causes of PTSD and how it can negatively affect the life they experience during times of war and once they face reintegration into society. The trauma experienced by these veterans in their daily task is contributing to PTSD development.
While an abundance of research is conducted with combat veteran samples, other military service members are at an increased risk of developing PTSD. The military offers other jobs to be held by service personnel who do not go to combat or are not exposed to combat zone conditions; this does not mean that they do not develop PTSD. They experience the same range of symptoms combat veterans face despite not being active in combat. Continuously experiencing trauma, arousal, numbing, and isolation are all symptoms non-combat veterans experience (Wong, Kennedy, Marshall, & Gaillot, 2011, p. 67). While working in combat zones, it is clear to see that service members are introduced to numerous factors associated with combat veteran PTSD. Why is this? Non-combat service members are exposed to trauma and events experienced by combat service members through direct communication with these service members. Medical service personnel (nurses, medics, physicians), spiritual providers (chaplains, priest), mental health professionals (psychologist, psychiatrist, counselors), and even non-combat employees are at increased risk (Feczer & Bjorklund, 2009, p. 282). Because these service members are in communication and contact with veterans during their combat operations, they are often exposed to discussion about what occurred and detailed accounts of the morbidity experienced in these operations. Ultimately, non-combat members care and oversee missions with military service members involved in very high trauma and stress situations. It is important they are able to seek the care they need in order to provide the highest level of care for combat members.
In order for society to broaden its perspective on psychological trauma and specifically posttraumatic stress disorder, it is important to understand the influence it has on veterans’ lives. Much of PTSD research focuses on retroactive PTSD because much of the research is not completed until returning from deployments; in some cases, research occurs after discharge from service. Upon return home from military service, veterans face numerous obstacles and health issues because of their PTSD. Additional medical conditions are common in these military service members due to the elements and high stress situations they are exposed to via combat zones or third-party sources.
One of the most common methods of PTSD coping among service members is self-medication with alcohol and similar substances. According to Blakey, Love, Lindquist, Beckham, and Elbogen (2018), anger after experiencing a traumatic event paired with alcohol self-medication has shown to result in one engaging in violent behavior (p. 176). Increased alcohol consumption long-term carries its own set of health problems; consumption of alcohol adds more risk factors to a PTSD patients likelihood of developing health issues. Suicide is another issue veterans face after experiencing a traumatic event. More veterans are choosing violent means of suicide; 70% of OIF and OEF veterans choose violent methods to commit suicide (Lee, 2012). Additionally, Lee (2012) discusses long-term health issues as a result of PTSD (p. 110). Tobacco use, hypertension, diabetes, dementia, and cardiac conditions are consequences of being a combat veteran or exposed through non-combat roles.
There are treatment options available for veterans and other service members suffering from this detrimental disorder. Various types of treatments have been researched on their effectiveness at treating PTSD. Overall, therapy and treatment options are about controlling PTSD contrary to common belief of curing the impact of a stress disorder. Strategies vary slightly, but effective treatment contains ultimately the same components. Gentry, Baranowsky, and Rhoton (2015) evaluate the effective components of treating PTSD and four factors have been identified. These factors are: building relationships, education and self-regulation, recovery and resolution, and resilience (Gentry, Baranowsky, & Rhoton, 2015, p. 283-284). No matter the type of psychotherapy chosen, these sectors are proven to be critical in effectively managing the effects of this stress disorder. Education and exposure have been proven in multiple research studies in controlling PTSD (Gentry, Baranowsky, & Rhoton, 2015; Dondanville, Borah, Bottera, & Molino, 2018). Close knit and well-educated relationships and education are proven to also be a key ingredient to PTSD treatment (Gentry, Baranowsky, & Rhoton, 2015; Feczer & Bjorklund, 2009; Dondanville, Borah, Bottera, & Molino, 2018). Since veterans and other military service personnel are with other members such as family and friends, it is important for these individuals to understand how to aid diagnosed patients if the need arises. Utilizing techniques to decrease anger such as relaxation in high stress situation where hyperarousal may occur, controlling symptoms associated with a life changing mental illness will likely be reduced. Exposure is another critical aspect of controlling PTSD symptom severity. With service members exposed to similar conditions prior to deployment, they will be better prepared for conditions experienced in war zones.
Many military service members are hesitant to receive mental health care during and after deployments to war torn areas. Barriers to receiving treatment negatively impact healing and treatment that so many veterans need in order to better integrate into society post service. Untreated and undiagnosed PTSD impacts veterans because of the unseen impacts PTSD bares on their life’s once returning home. Maintaining and locating employment is one of the multiple hidden factors of a PTSD diagnosis (Lu et al., 2017). There are many barriers to receiving important treatment especially for military personnel. In the military, veterans are trained to be tough and because of this, many refuse to get treatment. They are afraid of being viewed as weak and therefore forego receiving mental health treatment. Not only does stigma surrounding strength affect the rate at which veterans seek treatment, many are afraid of the potential employment hurdles that they will face (Dondanville, Borah, Bottera, & Molino, 2018). Having documented mental health treatment could disqualify soldiers from holding certain jobs and receiving security clearances needed. Stigma and career-related concerns are often barriers to seeking treatment for both combat and non-combat veteran service members.
Numerous things can be done as a society to widen the perspective and outlook on a life-altering disease like posttraumatic stress disorder. Ultimately, it is up to society to broaden their understanding of PTSD in order to aid in fostering healing and treatment for veterans. Relationships have been proven to be crucial in controlling and lowering the severity of PTSD symptoms. Encouraging resilience is another factor is nurturing healing after experiencing psychological trauma. As mentioned in a previous section, gender equality is a key issue female veterans face. We must work to bridge this gap, diagnose PTSD when DSM-5 criteria are met, and offer equal treatment for women. When these issues are addressed, society is broadening its limited view on PTSD. After all, we are responsible for veteran reintegration and contribution upon return after a deployment. Once addressed, more military service members are likely to willingly accept treatment for PTSD symptoms. Also, one of the most important results of societal aid to veterans is decreasing the number of veteran suicide, so they will be more comfortable asking for mental health help.
Overall, societal perception of psychological trauma is limited due to a lack of available education, limited exposure, and fear of discussing such debilitating disorders. There are organizations established such as the Wounded Warrior Project (WWP) who target veterans and provide services and programs to allow them to transition back into civilian life after experiencing trauma. The WWP provides services to physically or mentally injured veterans and also to family members of veterans. Additionally, communities should establish local support groups for returning veterans allowing them to host group therapy and other treatment options. Also, this would allow service members with similar interests and backgrounds the opportunity to network and develop relationships that have proven to be critical in fostering healing. Our job as a society is to love, to care for, to support, to be educated, and to understand the internal struggles military service members face no matter if they are female, male, combat, or non-combat service members. The ultimate question is: are you, as a member of society, actively contributing to a welcoming and understanding environment surrounding mental health awareness and treatment? After all, it is our job, too.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Blakey, S. M., Love, H., Lindquist, L., Beckham, J. C., & Elbogen, E. B. (2018). Disentangling the link between posttraumatic stress disorder and violent behavior: Findings from a nationally representative sample. Journal of Consulting and Clinical Psychology, 86(2), 169-178. doi:10.1037/ccp0000253
Dondanville, K. A., Borah, E. V., Bottera, A. R., & Molino, A. T. (2018). Reducing stigma in PTSD treatment seeking among service members: Pilot intervention for military leaders. Best Practices in Mental Health, 14(1), 15-26. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,sso&db=a9h&AN=127462858&site=eds-live&scope=site&custid=s8356098
Feczer, D., & Bjorklund, P. (2009). Forever changed: Posttraumatic stress disorder in female military veterans, a case report. Perspectives in Psychiatric Care, 45(4), 278-291. doi:10.1111/j.1744-6163.2009.00230.x
Jones, E. (2012). Shell shocked. Monitor on Psychology, 43(6), 18. Retrieved from http://www.apa.org/monitor/2012/06/shell-shocked.aspx
Lee, E. A. 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. doi:10.1111/j.1744-6163.2011.00312.x
Lu, W., Yanos, P. T., Stone, B., Giocobbe, G. R., Waynor, W., Reilly, A., & Bazan, C. (2017). The hidden barrier to employment: untreated and undiagnosed post-traumatic stress disorder. Journal of Rehabilitation, 83(2), 11-16. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,sso&db=ccm&AN=124079961&site=eds-live&scope=site&custid=s8356098
PTSD: National Center for PTSD. (2018, February 22). Retrieved April 17, 2018, from https://www.ptsd.va.gov/professional/ptsd-overview/dsm5_criteria_ptsd.asp
Raab, P. A., Mackintosh, M., Gross, D. F., & Morland, L. A. (2015). Impact of comorbid depression on quality of life in male combat Veterans with posttraumatic stress disorder. Journal of Rehabilitation Research & Development, 52(5), 563-576. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,sso&db=s3h&AN=110306342&site=eds-live&scope=site&custid=s8356098
U.S. Department of Veterans Affairs. (2015, August 13). Mental health effects of serving in Afghanistan and Iraq. Retrieved from https://www.ptsd.va.gov/public/ptsd-overview/reintegration/overview-mental-health-effects.asp
Wong, E. C., Kennedy, D., Marshall, G. N., & Gaillot, S. (2011). Making sense of posttraumatic stress disorder: Illness perceptions among traumatic injury survivors. Psychological Trauma: Theory, Research, Practice, and Policy, 3(1), 67-76. doi:10.1037/a0020587