Battle Field Related Post Traumatic Stress Disorder

I barely have an inkling of what it’s like to be a soldier enduring battle field conditions. However, I was a Corporal in the Royal Winnipeg Rifles, Canadian Armed Forces Reserves. I marched, slept in slit trenches while resisting hypothermia, fired machine guns, traveled in APC’s, viewed real war time movies and became a sharpshooter. I’m also a history buff and have read dozens of military novels and watched dozens of wartime movies. I have also assessed and treated dozens of people with PTSD. This is my take on battlefield PTSD.

The Setup

The mind/brain is designed is to react rapidly to potential danger – a stick in the grass could be a poisonous snake; a shadow moving in the dark might be an attacking wolf.  Adrenaline and other hormones are pumped into the bloodstream triggering the fight or flight reaction – increased muscle tension; blood pressure, oxygen consumption, and blood sugar production.  Over time the brain adapts to battlefield conditions where failing to recognize and react to danger can lead to instant death.

Battlefield conditions are described under section (A) of the DSM-IV P.T.S.D. symptom criteria. A soldier can be exposed to horrible events over and over for weeks, months or even years.

A. The person has been exposed to a traumatic event in which both of the following were present:

(1)  the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.

(2)  the person's response involved intense fear, helplessness, or horror. Painfully learned battle memories are deliberately kept at the edge of consciousness at all times; day and night. Hair trigger responses are safer in battle. You are at all times ready to attack, freeze (in flare light), or indelible resulting in the following symptoms.

B. The traumatic event is persistently re-experienced in one (or more) of the following ways:

(1)  recurrent and intrusive distressing recollections of the event, including images, thoughts, and/or perceptions.

(2)  recurrent distressing dreams of the event.

(3)  acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and/or dissociative flashback episodes, including those that occur on awakening or when intoxicated).

(4)  intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

Characteristics as outlined in (C) below are a safer way to be on the battle field. However, upon returning home to the safety of family and friends the mind has difficulty adjusting to a duller more “normal” state of alertness.

C.  Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:

(1)  efforts to avoid thoughts, feelings, and/or conversations associated with the trauma. (Not the time for grief; too distracting.)

(2)  efforts to avoid activities, places, and/or people that arouse recollections of the trauma. (Recognize danger before being shot at.)

(3)  inability to recall an important aspect of the trauma. (Limit painfully distracting memories.)

(4)  markedly diminished interest or participation in significant activities. (Avoid wasting precious mental energy on non-life preserving activities.) 

(5)  feeling of detachment or estrangement from others. (Minimize shock and grief when someone dear to you dies.)

(6)  restricted range of affect e.g., inability to have loving feelings. (More attempts to limit strong emotions from distracting attention needed to detect and adapt to danger.)

(7)  sense of a foreshortened future e.g., does not expect to have a career, marriage, children, or a normal life span. (Attention remains in the present undiluted by fantasy.)

D.  Persistent symptoms of increased arousal (not present before the trauma), as indicated by at least two of the following:

(1)  difficulty falling or staying asleep. (Sleep lets your guard down giving your enemy an advantage.)

(2)  irritability or outbursts of anger. (Ready to attack when attacked.)

(3)  difficulty concentrating. (May be open to a wider range of dangers versus being focused on one or two.)

(4)  hypervigilance. (Enhanced awareness of potential danger.)

(5) exaggerated startle response.(Instant reaction to threat.)

E.  Duration of the disturbance (symptoms in criteria B, C, and D) is more than one (1) month.

F. The disturbance causes clinically significant distress and/or impairment in social, occupational, and/or other important areas of functioning.

Acute:  Duration of symptoms is less than three (3) months
Chronic: Duration of symptoms is more than three (3) months
Delayed: Onset of symptoms is at least six (6) months after the incident

Internet Resources:

Canadian Veterans Affairs – on-line booklet - PTSD and War Related Stress – an excellent resource!

U.S. Department of Veteran’s Affairs - PTSD information.

B.C. Partners for Mental Health – PTSD information

Background Information:

Mental Health Treatment Seeking by Military Members with Posttraumatic Stress Disorder: Findings on Rates, Characteristics, and Predictors From a Nationally Representative Canadian Military Sample

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