Veterans returning from combat have a unique challenge ahead of them – trying to reintegrate into American society while shedding the memories of battlefield horrors. PTSD, short for Post-Traumatic Stress Disorder, has always been a major issue among military personnel, but the way in which we deal with PTSD is now becoming problematic. Since the 2014 Veterans Affairs case that exposed VA hospitals for providing poor, and even neglectful care at times, private health care providers have realized their opportunity has arrived to make a difference. Anywhere between 11-20% of Iraqi War veterans have reported PTSD in a given year. If we go back to the Vietnam War, this figure skyrockets closer to 30%. In order to properly treat it, we must recognize the symptoms of post-traumatic stress disorder, then help our health care professionals understand their role in the recovery process.
- PTSD Among Veterans
- Clinical Classifications of PTSD
- PTSD Symptoms Within Patients
- Myths and Facts About PTSD
- Treatment and PTSD Best Practices
- Additional Resources
PTSD From A Nursing Perspective
Whether you’re new to nursing or an experienced RN, there’s always new information to learn regarding how to treat individuals suffering from PTSD. Thankfully, there are many helpful resources emerging, one of which is the PTSD Toolkit. Developed by Associate Professor Nancy Hanrahan in association with the American Nurses Foundation at the University of Pennsylvania, this resource provides actionable information that nurses can use to better identify the needs of their PTSD patients. This includes motivational interview techniques that help nurses get to the bottom of the problem and allocate resources more properly.
Additional efforts to raise awareness of PTSD have been made by the American Nurses Association (ANA) who has partnered with six major national nursing organizations to get behind a campaign for veterans, military service members and their families. Joining Forces successfully combined all of these bastions of support with that of the Obama White House, led by First Lady Michelle Obama. Together, they made a nursing pledge in support of further educating nurses and healthcare professionals in the ways of caring for all individuals afflicted with PTSD, brain injuries, depression, and other pressing issues.
PTSD Among Veterans
PTSD in veterans has become a growing problem following wars in Iraq and Afghanistan. Approximately one-third of returning veterans will experience some form of depression or mental health trauma thanks to combat stress, and it could possibly turn into full-blown PTSD. At any one time, upwards of 8% of the veteran population experiences PTSD, which is typically quantified using measures like length of time after combat, impact of PTSD on a person or family member, and specific instances on the battlefield that might have helped trigger the PTSD.
Veterans aren’t alone in the struggle. When we’re talking about PTSD in the entire U.S. population, the number climbs much higher. We’d include civilians who have suffered trauma – including car accidents, experiencing or witnessing a violent act, or losing a loved one. PTSD isn’t merely a ‘veteran problem,’ it’s something that resonates with many individuals in our society.
What War Does to You
We’ve established the clinical definition of PTSD and the need for health care professionals to improve their education and handling of patients. To better understand how to recognize and diagnose it, we must discuss PTSD’s most common symptoms. These are courtesy of the National Center for PTSD:
- Nightmares: Veterans will have vivid dreams relating to their experiences, resulting in them waking up in the middle of the night in a cold sweat.
- Triggers: They could hear, see, or even smell something that brings back the event in their minds. Triggers don’t have to be war related; they could be from something as innocuous as a car revving up, or a person yelling from afar.
- Flashbacks: Perhaps the most frightening symptom of PTSD, flashbacks generate all too real portraits of the tragic event in a veteran’s brain.
The common thread among these symptoms is the notion of being startled. PTSD sufferers can’t easily relax without having a sudden interruption brought on by their disorder. These interruptions cut like a knife through their daily life, disrupting relationships, jobs, and any semblance of normality.
Many soldiers feel as though they’ve never exited the battlefield, even while standing in their own backyard.
A lot of these fears stem from circumstances in the war zone but outside of combat itself. These include:
- Cleaning Up After Battle: Soldiers who are tasked with cleaning up the battleground can oftentimes experience worse levels of PTSD than soldiers who fought in combat. Their tasks might include moving picking up and moving bodies or examining the wounded.
- Anxiety Towards Fighting: Prior to World War II, many soldiers had been fed the illusion that advancements in military technology had alleviated any potential danger on the battlefield—that their only job would be to “mop up” the area. As a consequence of this mentality, many soldiers went into battle ill-prepared to fight. It’s quite likely that this same belief was felt by troops during Vietnam as well as in Iraq and Afghanistan. The anxiety towards fighting can be crippling, and for many, it never go away.
- Sexual Abuse: Another topic that isn’t discussed enough is the problem of sexual harassment in the military for both men and women. In 2017, soldiers are reporting incidents at record high rates.
- Concerns At Home: Whenever a member of the military gets deployed, it’s typically for no shorter than 6 months. Being away from their homes, families, and possessions for that long can be extremely disconcerting. It only gets worse if something tragic happens to a loved one while they’re away, making them feel completely powerless.
- Weather and Environmental Conditions: It doesn’t require a meteorology degree to know that the Middle East gets really hot. Couple the 100+ degree temperatures with having to wear heavy clothing, then add the element of stress into the mix and you have a recipe for poor health. A soldier could very well pass out from this combination of factors alone.
Clinical Classifications of PTSD
According to the Mayo Clinic, PTSD is classified as the mind’s prolonged difficulty in dealing with a traumatic event. If the effects are temporary and the person is able to readjust in a matter of days or weeks, this wouldn’t classify as PTSD.
If you believe that an individual you know might have PTSD, it’s wise to consult the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). The manual has been updated as of 2013 to incorporate new information regarding PTSD that you will find helpful. If you find any possible characteristics that could connect your individual to PTSD, please see a physician right away for a proper diagnosis.
Physicians will ask about when the traumatic event happened in the patient’s life, what were the circumstances surrounding that event, and how long have they been suffering since the occurrence.
Here are the varying symptom groups of PTSD, as laid out in the DSM-IV.
PTSD Symptom Clusters, Criteria & Descriptions
|Criterion A||Exposure to Trauma||Has suffered direct or indirect exposure to a trauma involving death, serious injury or sexual violence
|Criterion B||Re-Experiencing Trauma||Is unable to suppress memories of the trauma; suffers from intrusive thoughts, nightmares and flashbacks
|Criterion C||Avoidant Behavior||Actively avoids thoughts, people and situations that trigger traumatic memories|
|Criterion D||Depression||Suffers from feelings of helplessness, despair, and isolation; experiences reduced memory and cognitive function
|Criterion E||Anxiety||Feels constantly on edge and hyper-alert, has difficulty concentrating, managing emotions, and suffers from sleep disorders and overactive startle reflexes
|Criterion F, G & H||Incidence||These criterion assess the extent to which the first five criteria interfere with an individual’s ability to function on a day-to-day basis
PTSD Symptoms Within Patients
PTSD is the catch-all term we use to describe the mental conditions of these patients; however, there are often several underlying mental disorders found in PTSD sufferers. These include the following:
- OCD: Obsessive-compulsive disorder is found in anywhere between 4-22% of people with PTSD. Many of these individuals become compulsive about hoarding in their later years.
- Panic Disorder: A large component of PTSD involves panic on a consistent basis, regardless of whether there’s an actual imminent threat.
- Depression: A lot of people who have PTSD also suffer from some form of depression, caused by persisting memories of the traumatic event.
- Separation Anxiety: PTSD can even manifest itself in the form of separation anxiety. Soldiers often become upset, or threatened when they are forced apart from loved ones because it reminds them of their time served overseas.
- Issues Giving Birth: Researchers have found that the likelihood of preterm births is four times higher in women who have PTSD.
- Secondary Effects: Beyond the supplemental disorders and potential birthing issues associated with PTSD, there are a number of secondary medical conditions that can occur. These include the skin, heart, gut and musculoskeletal system.
It’s important to reiterate the fact that while not all trauma victims have experienced PTSD, there’s still a high percentage who have experienced some form of trauma in general. and many of them could find that it morphs into PTSD. Many sufferers could find issues with memory loss as well, due to the fact that trauma victims having a smaller hippocampus than the average person.
Approximately 70% of adults in America have experienced a traumatic event in their lives, out of which 20% continue to develop PTSD.
What To Watch For
On the most basic level, there are four changes in behavior that you should watch for and monitor. They include the following:
- Uncontrollable Temper: PTSD patients will get angry for no apparent reason, then find themselves unable to turn off their anger even after the alleged “threat” has passed. Irritability remains an issue for these individuals indefinitely.
- Sleep Interruptions: When soldiers are overseas, they have to train themselves to stay awake and alert and unnatural hours. For many, this behavior follows them back home. Nightmares and general bouts of sleeplessness plague potential PTSD candidates.
- Acute Stress Disorder: Also known as ASD, Acute Stress Disorder is common within the first month after a traumatic event. Characterized by a sense of confusion, these individuals simply have no idea where they are at times—almost like a temporary form of dementia.
- Alcohol or Drug Abuse: There’s a scourge of alcohol and drug abuse among PTSD patients, oftentimes resulting in homelessness or even death.
Early detection is critical as suicide rates among PTSD sufferers are high.
- PTSD related suicide is the 10th leading cause of death in the United States.
- In 2012, more active duty military members died by their own doing than by committing suicide.
- Veterans account for 20% of suicides in the United States.
Addressing and seeking treatment of PTSD is a team effort. Spouses, parents, family and friends need to keep their eyes open and recognize when loved ones are exhibiting dangerous behavior. They then need to take these individuals to seek treatment from qualified professionals, hence the name Joining Forces.
Myths and Facts About PTSD
To understand how to confront and deal with PTSD, one must sift through the loads of misinformation circulating the internet. Publications will frequently insuate that PTSD sufferers are extremely violent, psychotic, and criminals. This is untrue. The last thing society needs to do is ostracize PTSD patients by broadly labeling them with these monikers; all it will do is scare them out of receiving the necessary help.
Here are some of the most common PTSD myths being promulgated today:
MYTH #1: PTSD Can Be Overcome Alone
Soldiers are strong, and strong-willed people can overcome anything, right? Wrong. PTSD doesn’t magically disappear without proper treatment. The longer it’s allowed to linger, the worse it becomes. It requires professional guidance in order to be overcome.
MYTH #2: PTSD Only Affects Soldiers
Since 7.8% of Americans suffer from PTSD at a point in their lives, it’s easy to see that there must be many patients who never served in the U.S. military. These include abuse victims, those who have experienced neglect or sexual assault, or those who have a family history of mental illness.
Another demographic that tends to be overlooked are those who work in high-risk professionals—these could include police, firefighters, loggers, and roofers.
MYTH #3: Everyone Has Trauma in Their Lives
Yes, there’s some truth to this. However, few experience such a significant trauma that it develops to a level that would constitute PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), this includes two main criteria:
- Exposure to threatened death, a serious injury or sexual violence.
- Experiencing or witnessing an event in person—in the military, this is common among drone pilots. Although they aren’t flying into danger themselves, they are affected by the act of dropping weapons.
MYTH #4: PTSD Can Happen Immediately After An Event
Though you may experience significant stress right after a frightening incident, it isn’t yet PTSD. Within the first month, this would be considered “acute stress.” Although similar to PTSD, it manifests itself mostly in the feeling of altered reality.
MYTH #5: PTSD Sufferers Can No Longer Function in a Proper Work Environment
Perhaps the most damaging PTSD myth going around is that sufferers are no longer able to work a real job. While this may have been true a very long time ago, advancements in medication and the treatment of PTSD have made patients able to assimilate in the workplace more smoothly.
Treatment and PTSD Best Practices
The 2014 VA situation revealed some serious problems in the way that national care facilities treated people with PTSD. An inadequate amount of professionals and resources were being delivered by both private sector facilities and VA-funded hospitals, and updates were needed.
The VA maintains a standard-of-care minimum for the therapy and treatment process—8 hour long sessions finished within 14 weeks. Currently, just 53% of returning Afghanistan and Iraq War veterans have finished their 14 week programs.
Proper treatment requires undergoing psychotherapy sessions, oftentimes combined with medications.
Psychotherapeutic Methods and Medications
Stress Inoculation Training
In addition to taking anti-anxiety medications, therapists provide stress inoculation training which teaches coping skills as well as overall anxiety reduction.
- Exposure Therapy: Sometimes it benefits patients to be exposed to the traumatic scene. This happens via mental imagery.
- Cognitive Restructuring: Therapists attempt to reframe a person’s tragic memories of the trauma in a way that makes it less upsetting to recall.
- Beta Blockers: Historically known as a way of relaxing people for big occasions—intense social settings, public speaking engagements, etc.- beta blockers can help remove the effects of adrenaline, causing individuals to experience reduced blood pressure and slower heartbeats. While not the best solution for everyone, it can certainly help combat the effects of PTSD.
Nursing Best Practices
Nurses play an instrumental role throughout an individual’s PTSD treatment process. With a little adherence to best practices, they can serve their patients with even more precision.
- Supporting Joining Forces: Pledging your support to Joining Forces is largely symbolic, but it demonstrates that you have the desire and passion to learn and train for improved caretaking of PTSD.
- Understanding Diagnostic Criteria: We’ve alluded to this at length, but understanding what symptoms are associated with PTSD is extremely important to recognizing and diagnosing the disorder appropriately. This includes cross sections where multiple symptoms might become intertwined.
- Continued Education: A nurse’s learning should never stop, especially when aiming to treat a complex disorder like PTSD. There are a number of high-quality RN to BSN programs available to help nurses improve their skill set in all areas.
- Promoting a Certain Standard of Health: This might seem obvious. After all, a large part of a nurse’s job is encouraging patients to adhere to healthy living standards. The message can be even more impactful when talking about PTSD, because of the cognitive component. Remember, good health isn’t just about a person’s actions, it’s largely about the inner workings of the brain. For PTSD sufferers, shedding their traumatic memories is a major part of winning the struggle.
Self-Treatment Best Practices
Self-treatment is not to be used on its own. It should only be tried in conjunction with professional treatment efforts.
- Joining Support Groups: Any affliction is easier to conquer with the help of those around us, assuming those around us have quality intentions. In a support group setting, you’ll meet many other individuals who understand exactly what you’re going through and can offer useful advice.
- Being Social: When PTSD patients stop conversing, negative outcomes can occur. It’s important to maintain an open dialogue with other PTSD sufferers to a) learn from each other’s experiences, and b) avoid feelings of isolation.
- Stay Active: Exercise regularly, partake in athletic events, and most importantly volunteer. By taking part in a valuable cause, you will push aside feelings of helplessness and have something to work towards.
- Never Self-Medicate: Sure, feeling better is important. Doing it through excessive alcohol drinking or taking of drugs is never the answer though. If you’re living in a region of the country that has opiate issues, this can get especially dangerous.
Friends and Family Best Practices
How can loved ones properly treat those individuals who suffer from PTSD? By understanding how results won’t come overnight.
- A Long Road: There’s no quick fix to such a serious disorder. Loved ones need to be willing to work hard for a PTSD patient over many weeks, months, and even years.
- Recognize Triggers: If there’s a specific scenario that sets your loved one off, be sure to help them avoid such potentially damaging environments.
- Be Patient: Part of understanding the journey of a PTSD patient is knowing how hard it will be to help them achieve results. This means you’ll need to listen closely to them and remain attentive, even when they are making your life stressful. It’s also important to encourage them to start talking about their experiences, but only if they are willing. If speaking about the trauma makes the individual uncomfortable, they should stop.
Regardless of your capacity—whether you’re a loved one, a nurse, or a PTSD sufferer yourself—understanding the truth about PTSD will help us realize what are the best methods for solving the problem. It is a very complex disorder that can be expressed through a multitude of symptoms and behaviors, but it is easier to recognize when we know what to look for. Programs like Joining Forces indicate a bright future for PTSD recovery, but it starts with you. Do your due diligence for the people you love.
- U.S. Veterans Affairs PTSD: Find all the government publications related to PTSD and other types of traumatic stress.
- PTSD Overview Online Course: This is a 45 minute course to better educate yourself on PTSD.
- Mental Health Screening Test: MilitaryMentalHealth.org offers free screening for PTSD and mental health disorders.
- PTSD Alliance E-Books: This is a free book you can download on PTSD.
- American Nurse Today: This is a great article for nurses who are or plan to treat PTSD military veterans.
- Military Mental Health: This resource guide was put together by the American Psychiatric Nurses Association for patients and practitioners.
- Iraq War Clinician’s Guide: Developed by the Department of Defense, this manual hits on the unique needs of Veterans of the Iraq and Afghanistan wars.
Department of Veterans Affairs: State Offices and VHA Locations
VA offices are beginning to amp up their efforts to provide quality care for PTSD patients, coming on the heels of the 2014 fiasco that exposed the Department of Veterans Affairs as underachievers on this front. Since this shake-up, there’s been a shift in focus towards addressing PTSD and providing comprehensive resources to veterans and their families. If you know someone who might be affected, this is the perfect time to call your local VA.