Life is full of stresses, and what now is called “post traumatic stress syndrome” is actually quite widespread in the general population.

Abused children, battered wives, those living through life threatening illnesses or accidents all may suffer variations of the syndrome.

. As many as 70% of adults in the United States have experienced at least one major trauma in their lives, and many of them have suffered from the emotional reactions that are called PTSD. It is estimated that 5% of the population currently have PTSD and that 8% have had PTSD at some point in their lives.

Most of my experience with the “syndrome” has been with abused women. But often the women don’t present with abuse: they present with fatigue, or stomach pain, or headaches and often have signs and symptoms of depression on examination.

Usually we docs treat the symptoms while making sure of follow up: we stress the symptoms aren’t “in their heads” but that you can’t remove the body from the head, so stress and depression make these things worse. Usually the abuse comes to light by the second or third visit, at which point the person feels comfortable enough to start to open up. It is at this point we often add anti depressant medicines (if we haven’t already started them) and make sure they get referred to counseling by the appropriate organization (battered women, AA or Alanon, Drug Rehab, etc.)

The ability to tolorate stress, including the stress of combat, is partly genetic, and partly depends on how bad the stress is. And there are few stresses as bad as being a soldier in a war zone.

The following is a description from a World War II Army Medical manual:

Their faces were expressionless, their eyes blank and unseeing, and they tended to go to sleep wherever they were. The sick, injured, lightly wounded, and psychiatric cases were usually indistinguishable on the basis of their appearance. Even casual observation made it evident that these men were fatigued to the point of exhaustion….. In spite of this lack of sleep he must undergo long periods of severe exertion, more often than not on a diet that is at best deficient in calories. Often the food is there for him, but he either cannot carry enough of it with him or is too frightened to eat the proper amount. Sometimes the type available has become distasteful through monotony.

If the stress is severe enough, people will break. And some will remain with psychiatric problems.

Yet most of the soldiers described recovered, simply by removing them from the combat situation for a rest.

The Manual then goes on to discuss how combat stress often causes somatic (regular illness) type symptoms, especially symptoms of peptic ulcer or dyspepsia, and stresses that soldiers should remain on limited duty while they recovered. One paradoxical lesson learned early in World War II was that hospitalizing milder cases resulted in what is now called “survivor guilt”, resulting in a worse disability than if they were allowed time to recover on their own and regain their self esteem.

But wars are about as high stress a situation as anything humankind suffers, so the problem remains.

From StrategyPage:

It was during World War II that researchers began compiling lots of data on troop stress and its effects. It was discovered that most troops were likely to develop debilitating PTSD after about 200 days of combat (that is, the stress of having your life threatened by enemy fire). But today there are other factors.

In Iraq, army combat troops often get 200 days of combat in one 12 month tour, which is more than their grandfathers got during all of World War II….. A recent survey of troops who had served in Iraq and Afghanistan, found half of them still had some mental or physical health problems six months after returning from overseas.

Again, like what was observed in World War II, simply having a safe place to rest (including decent beds and airconditioning), and contact with family (nowadays that means email) are doing a lot toward keeping morale high in Iraq.

One complicating problem in Iraq: IED’s.

Body Armour has proven life saving, especially in combat, but the head trauma due to explosions have many suffering from a poorly defined post concussion syndrome, whose symptoms overlap with that of stress related illnesses.

So what happens when the soldiers go home? This is especially worrisome, since many are National Guards troops who might see their local doctors rather than a military health care worker or a VA physician.

So the military has encouraged physicians and the families to learn about these problems.

For families whose family members might suffer from problems, a good place for information would be this link, which includes a film for family members.

For those who might be involved in treating cases, the core module for diagnosis and treatment can be found HERE. And there are PDF and palmpocket downloads of the core module HERE.

No one hates war more than soldiers, but too many politicians are spinning the war for political gain, and one worries that, like Vietnam veterans, the soldiers will be made a scapegoat. Of course, one advantage here is that, unlike VietNam, the war in Iraq has been successful.  But those who “hate war” on principal or because of political beliefs, need to know that the Army is aware of the problem, and trying to address it, by screening, by treatment, including counseling and medications, and by trying to lower stress during rotations in Afghanistan or Iraq.

Of course, like any government bureaucracy, these things take forever, and are enmeshed in bureaucracy, but that’s a government systematic problem, which is inherent in any federal hospital.

In a later post, I will summarize various treatments being used to help control symptoms for PTSS

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Addendum:

Symptoms of mild traumatic brain injury

A person with a mild TBI may remain conscious
or may experience a loss of consciousness for a few
seconds or minutes. Other symptoms of mild TBI
may include:
v Headache
v Mental confusion
v Lightheadedness
v Dizziness
v Blurred vision, double vision, or tired eyes
v Ringing in the ears
v Bad taste in the mouth
v Fatigue or lethargy
v Changes in sleep patterns
v Behavioral or mood changes
v Trouble with memory, concentration,
attention, or thinking.

Symptoms of Moderate to Severe Post Traumatic Brain Injury

A person with moderate or severe TBI may show the

same symptoms as someone with mild TBI but may
also experience the following symptoms:
v Severe, persistent, or worsening headache
v Repeated vomiting or nausea
v Convulsions or seizures
v Inability to awaken from sleep
v Dilation of one or both pupils of the eyes
v Slurred speech
v Weakness or numbness in the extremities
v Loss of coordination
v Increased confusion
v Restlessness
v Agitation

 Symptoms of stress suggesting treatment needed, including screening for Post Traumatic Stress symptoms:

Physical: Chronic pain migrains or vague bodily symptoms

Mental: Substance abuse, anxiety or depression

Behavior: irritability, avoidence, anger, non compliance, self risk.

Evokes aversion or fear in health care provider.

Change in ability to function.

Symptoms suggesting Post Traumatic Stress syndrome:

Re-experiencing: Intrusive memories, images or perceptions

Flashbacks

Nightmares

Exaggerated emotions and physical reactions

Avoidence/emotional numbness (avoids activity, loss of interest, restrictive emotions)

Increased arousal: Difficulty sleeping, Anger outbursts, Difficulty concentrating, hypervigilance, exaggerated Startle Response.

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Nancy Reyes is a physician living in the rural Philippines. She writes medical essays at HeyDoc Xanga Blog.

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