How to recognise the symptoms of PTSD

The term post-traumatic stress disorder (PTSD) was first used by veterans of the Vietnam War, but the problem has existed a lot longer and been known as shell shock, battle fatigue and soldier’s heart.
 
According to Dr Manveer Kaur, senior clinical psychologist with Combat Stress, the condition is often based on an ‘I could have died – that could have been it for me’ memory.
 
In civilian life, a traumatic event such as being involved in an accident or assault can lead to PTSD. A key difference with war veterans is that they usually present with multiple traumatic experiences. ‘Many also have a feeling of guilt or shame based on survivors’ guilt – they have seen colleagues maimed and killed and there is a sense of ‘I should have done more – I’ve let the side down,’ says Dr Kaur.
 
– Veterans present with cluster symptoms. The first involves re-experiencing. They have one or more memories in which they feared for their life and those memories haven’t been processed and stored properly. Consequently random triggers can make them pop out unpredictably. Examples of common triggers are fireworks – a reminder of explosions and gunfire – and barbecues, the smell of burning flesh. ‘When a veteran has a trigger moment, he or she may suddenly zone out, glaze over, stop talking mid-sentence or lose track of a conversation,’ says Dr Kaur. ‘They may also start breathing rapidly and even adopt a body position, such as crouching down, that is part of the re-experiencing process.’
 
– The second set of symptoms is connected to mood swings – veterans with PTSD may be more irritable, snappy or critical. Disturbed sleep caused by nightmares and flashbacks can exacerbate black moods. They may be hyper-vigilant and unable to cope with crowds, confined spaces and loud noises.
 
–  The third set of symptoms is connected to avoidance. ‘If you are having flashbacks triggered by random experiences it makes sense that you will withdraw to avoid the triggers,’ Dr Kaur explains. ‘Veterans may become reclusive, avoiding shopping trips or meals out for fear of something unpredictable happening. If they do go to a restaurant, they may want to sit close to the door in case they need to get out in a hurry.’

Studio portrait of American actor and comedian Whoopi Goldberg leaning on a chair, 1988. (Photo by Nancy R. Schiff/Getty Images)

 
Comedienne and actress Whoopie Goldberg, saw two planes crash in midair when she was a child, which resulted in giving her severe panic attacks when boarding planes. Goldberg has spoken publicly about receiving therapy for her PTSD.
 
–  As well as physical avoidance, veterans with PTSD may become emotionally withdrawn. Their minds and bodies go into a state of numbness. They appear to be cold and cut off, which can be particularly hard for partners and children to understand.
 
–  Veterans can be highly self-critical. They may feel that PTSD is a sign of weakness, that they should be coping, working, caring for their families – and that makes them harder on themselves.
 
– Self-medication is common, particularly with alcohol. Drinking is socially acceptable and encouraged in military circles – it is perceived as a reward after a hard day’s work or a long tour. Veterans with PTSD may use alcohol to shut off emotionally and numb painful memories.
 
– Less common, but also used as avoidance tools, are drugs such as cannabis and cocaine, eating disorders and self-harm.
 
–  Seeking prompt treatment is key to maximising the chances of recovery from PTSD. ‘If the sufferer receives the right treatment in the right environment, rates of recovery are very positive. Veterans can live normal, fulfilling lives, are able to work with the condition and generally become symptom-free for long periods,’ says Dr Kaur.
 
Where to find further help
 
Combat Stress runs proven treatment programmes that are funded by the NHS. Its 24-hour helpline is open to veterans and families. 0800 138 1619, combatstress.org.uk.
 
PTSD Resolution offers treatment through a network of 200 accredited therapists nationwide. Unlike many charities, it will treat those who have alcohol-related problems or who have ended up in prison. Its helpline takes calls from veterans and families during office hours. 0300 302 0551, ptsdresolution.org.
 
Supporting Wounded Veterans helps wounded ex-Iraq and Afghanistan campaign soldiers, including those with PTSD, back into employment through a ski-based induction and mentoring programme. It has also recently set up a family support network. supportingwoundedveterans.com.