IMMEDIATE AND LATER PSYCHOLOGICAL EFFECTS OF SEVERE LIFE TRAUMAS
Use and Misuse of PTSD diagnoses
Post Stress Syndrome
A syndrome seen in most everyone exposed to intensely dangerous life situations with physical and/or psychological repercussions. Examples include childhood abuse/neglect, rape, hurricanes, earthquakes, and military combat. Symptoms include intense anxiety, psychological depression, sleep disturbances, trauma dreams, and low frustration tolerance. Depression symptoms include low energy, constipation, loss of appetite, loss life pleasures, and worst cases include feelings of helplessness and hopelessness. Thoughts of suicide can occur, but are rare.
The time span for a resolution of these symptoms is from one to four years following a return to safety. This time span can be years longer if the person uses alcohol and/or other addicting drugs often and in high amounts. However, this time span can be shortened by one to two years if the individual seeks mental health treatment and receives medications such as prazosin to restore sleep and eliminate trauma dreams, along with an antidepressant medication such as fluoxetine.
What about the diagnosis of PTSD? The symptom picture described above would often fulfill the diagnostic criteria for Acute PTSD. However, several other psychological diagnoses are also comprised of these same, or closely related, symptoms. The most accurate diagnosis would be Adjustment Disorder, with depression and anxiety, or an Acute Stress Disorder. With resolution of these symptoms these persons should not be labeled as having Chronic PTSD.
Battle Shock (Israeli military term)
Battle Shock may occur during a soldier’s initial combat exposure. Most susceptible are young and inexperienced soldiers, who become extremely fearful, disoriented, and prone to separation from their buddies. They become unable to function. Treatment by knowledgeable medical personnel usually includes sedation, rest, replenishment of fluids and food, followed by mild to moderate physical exercise. The time span for resolution of Battle Shock is between several hours to a few days. There is a very low incidence of recurrence – even in subsequent combat operations.
What about the diagnosis of PTSD? The diagnosis of PTSD is not appropriate in Battle Shock. The most appropriate psychiatric diagnosis is Acute Stress Disorder.
Prolonged and/or Repeated Combat Stress
Prolonged and/or repeated combat exposure, from many months to years, was experienced by many veterans of Worlds Wars I and II, Korea, and Vietnam. The stresses included killing of enemy combatants, significant loss of life, wounding and/or deaths of buddies, physical exhaustion (heat, dehydration, poor nutrition, and inadequate sleep). Symptoms of sustained combat include depression, sleep disturbances, trauma dreaming, loss of a sense of humor, feelings of helplessness and hopelessness, and overwhelming exhaustion. The well-known drawing of a Marine with a “thousand yard stare” is an accurate portrait of such an individual.
Symptoms secondary to these experiences often persist for years to decades. Medications may help with depression, anxiety, sleep disorders and trauma dreaming, but long term group therapy, carried out by dedicated and talented therapists, can be extremely helpful.
What about the diagnosis of PTSD? This disorder is accurately labeled Chronic PTSD. These veterans are most frequently encountered in hospital and clinical programs conducted and managed in the United States by the Department of Veteran Affairs.
Stress Symptoms Secondary to Physical Injuries and Pain
Prolonged psychological distress can also result from chronic physical disabilities, often secondary to military trauma, especially when disabilities also cause severe pain. When a medical history documents trouble sleeping, frequent awakenings, poor job history, marital problems, financial difficulties, and depression - chronic physical disabilities and pain can be the cause.
What about the diagnosis of PTSD? As this symptom picture is similar to that for PTSD, this diagnosis is often made. But until significant pain management is in place, a clear assessment of the individual’s psychological diagnosis independent of their physical distress is extremely difficult.
An extremely common physical disability encountered by returning soldiers from Iraq and Afghanistan is Traumatic Brain Injury, or TBI. Persons with significant brain injuries very frequently become depressed by their eroded mental skills, difficulties finding employment, and social relationship difficulties. Therefore, psychological depression secondary to disabilities from physical injuries and chronic pain may be a more accurate primary diagnosis. Acute or Chronic PTSD may apply as a secondary diagnosis.
Recent Life Traumas bringing back memories of Early Life Stresses
An often unrecognized aspect of memory is that very significant early life traumas, such as abuse, natural disasters, rape, and military experiences, may return in a person’s dreams following new life traumas experienced years later. Apparently these initial trauma memories are stored in one’s long-term memory and “release” when new major life stress events occur later in life - such as retirement from work, the death of a close friend, and/or a spouse developing a major illness. Veterans may re-experience trauma dreams of early combat stresses. After they adjust to their later life stresses, combat trauma dreaming usually resolves.
What about the diagnosis of PTSD? Re-experiencing dreaming of early military stresses during stressful later life new stresses should not be labeled Late Onset PTSD.
Life Experiences that Mitigate or Promote a diagnosis of PTSD
Why do some persons recover fully from a Post Stress Syndrome, while others, exposed to similar life stress situations, develop disturbing and long-lasting symptoms? Important answers to this question can sometimes be found through information concerning the persons’ exposures and responses to early life challenges. Particularly important are individuals’ degrees of success in dealing with these events. Poorly managed early life stresses appear to create lifelong vulnerabilities for handling life challenges experienced later in life.
Biological assets that render excellent help with life stress management include: excellent physical and psychological health; good physical strength and coordination; high intelligence; and limited exposures to environmental toxins (including tobacco and alcohol). Absence of these helpers are called biological liabilities.
Biographical assets helpful for early life stress management include: being raised in an intact and supportive family setting; doing well socially and scholastically in school; High School graduation; frequent socialization experiences - such as participation in school activities; and avoidance of problems with the law. Biographical liabilities would be the opposites of these life qualities.
In sum, the higher the number of biological and biographical assets a person has, the more successful they will be in managing stressful life challenges later in life. The higher the number of biological and biographical liabilities, the more vulnerable these individuals will be in managing major life challenges later in life. Many studies of persons with diagnoses of PTSD found that these persons’ biological and biographical liabilities greatly outnumbered their assets.
Sleep Apnea - a Medical Condition that can Mimic Trauma Dreaming
When the person awakens as they experience being “starved for oxygen” he, or she, is likely to thrash, shout, and even hit their bed mate. These behaviors closely resemble trauma dreaming! As surgical and/or medical remedies for sleep apnea exist, it is important to properly assess this condition and pursue treatment.
Stress Training
Stress training has been extremely successful in helping Prisoners of War, as well as hostage victims, to endure and reduce their suffering from torture. Stress training for rescue personnel has also proven to be helpful in assisting their recoveries following traumatic work experiences.
Stress training programs have only recently been devised for soldiers prior to being deployed to duty stations where they will likely experience significant combat stresses. This should become an area of highest priority for psychological health maintenance of our combat-bound men and women!
