Combat-Related Posttraumatic Stress Disorder

Those who serve in a war zone are exposed to events that are extremely stressful and threatening to life and health. They may be injured physically and/or mentally, and they may be confronted with terror, helplessness, hopelessness, and feeling out of control. Some of those who have served in combat zones continue having strong reactions afterward, and their bodies and minds fail to adapt to the absence of such threatening events. In such cases, we refer to a particular type of posttraumatic stress disorder (PTSD), the so-called combat-related PTSD. This disorder can occur not only in combatants but also in anyone else who serves in the combat zone (e.g., reserve personnel). Historically, combat-related PTSD used to be identified as war neurosis and shell shock. In 1980, some years after the war in Vietnam, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III) included, for the first time, PTSD. According to a more recent edition, DSM-IV-TR, the main clusters of symptoms formulating PTSD are reexperiencing of the traumatic event(s), avoidance or numbing of the event(s), and hyperarousal. Analytically, reexperiencing of the traumatic event(s) might include intrusive thoughts, nightmares, flashbacks, emotional and physical upset reminding one of the traumatic event(s), and so on. For instance, a veteran might have nightmares and flashbacks of a loss of a comrade on the battlefield. Avoidance or numbing of the event can be characterized by, but is not restricted to, avoidance of thoughts and feelings about the event(s), avoidance of places, activities, and people related to the event, and the individual's inability to recall parts of the traumatic event. Furthermore, hyperarousal may encompass sleep disturbance, irritability, outbursts of anger, hyper-vigilance, and so on. Thus, a veteran might have conflicts with family members because of an inability to control his or her outbursts of anger.

Data show that, in the general U.S. population, more than half of all men (61%) and women (51%) experience a traumatic event in their lives. From those experiencing a traumatic event, epidemiologic data highlights that the lifetime (at some point during their life) prevalence of PTSD is 9.7% for women and 3.6% for men. Also, the current (the time when the study was conducted) prevalence of PTSD is 5.2% for women and 1.8% for men. Research data points out that the lifetime prevalence of PTSD for male combat veterans is 39%. Moreover, 8.6% of combat veterans might have a delayed onset of combat-related PTSD for up to 20 years after the exposure to the traumatic event. Other epidemiologic studies show that almost 15% of Iraq and Afghanistan war veterans have been diagnosed with PTSD; the lifetime prevalence of PTSD for male Vietnam veterans is 30.9% and for female Vietnam veterans 26.9%. A 2005 study mentions that almost 15% of Gulf War veterans have been diagnosed with PTSD. Current research shows that the current prevalence of PTSD for World War II veterans is 1% to 3%. The low rates of the current prevalence of PTSD of World War II veterans might be explained by the fact that older veterans probably consider mental health issues as a weakness and stigma and, hence, underreport it. What differentiates combat-related PTSD from other types of PTSD is that combat veterans suffering from combat-related PTSD, compared with those suffering from other forms of PTSD, have higher rates of unemployment, being fired, divorce or separation, and violence perpetration. From the aforementioned research data, it seems that combat-related PTSD is characterized by higher lifetime prevalence of PTSD and greater likelihood of delayed onset and unresolved symptoms.

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