Haven't been there, still done that: Non-deployed members suffering combat PTSD

by Dr. (Maj.) Dennis P. Tansley
8th Medical Operation Squadron Mental Health Flight commander

11/30/2012 - KUNSAN AIR BASE, Republic of Korea -- -- "They can't have Post-traumatic Stress Disorder, they haven't really deployed!" a supervisor said in disbelief when discussing a member who had deployed to a country far from any combat action.

A commander at another base once insisted, "no way, they haven't even been downrange" when one of their members was diagnosed with PTSD.

Some believe that an individual must actually be near a combat zone in order to develop PTSD symptoms. That's not necessarily true. I have worked with members at multiple installations who were diagnosed with combat-related PTSD, yet hadn't physically been to combat zones.

There's also a good amount of research showing that it's possible to develop PTSD by watching videos, such as Predator reconnaissance and combat feeds, seeing photos, hearing or reading stories of traumatic events from downrange.

Bottom line: someone could be half way around the world when they're exposed to a combat situation and still develop PTSD symptoms. It's the exposure to the traumatic stressors, events, or situations and not necessarily actually being there that's key to understanding the potential for personnel to develop PTSD symptoms. Additionally, repeated or continuous exposure to traumatic events could also heighten the chances of developing PTSD.

One of the most researched cases where people have developed PTSD symptoms while being geographically removed from an actual traumatic event occurred on Sept. 11, 2001. After 9/11, multiple research studies, to include those by the Veterans Affairs' National Center for PTSD, showed that the more people in the general population watched the attacks on TV, no matter where they were in the U.S., the more they experienced anxiety and PTSD symptoms.

It's important to understand some degree of PTSD symptoms, such as avoidance, emotional numbing, and being on guard are normal and adaptive survival reactions to extremely abnormal situations. Personally, I tend to be a little hyper-vigilant when I'm downrange.

We may see some kind of stress reaction in returning members because war is stressful business. It doesn't matter if they saw combat while in Afghanistan, were deployed away from the action, or even at their home station. We also expect them to recover over time and see their symptoms fade away when removed from the stressful situation.

However, this doesn't always happen. There are times when the symptoms remain or worsen over time. Some symptoms to look out for include: disturbing memories, avoiding things that trigger painful memories, nightmares, flashbacks, intense anxiety or anger, irritability, and jumpiness. This can be thought of as members not being able to recover from their extremely abnormal experiences.

Doctors Patricia Resick, Candice Monson, and Kathleen Chard described it in their 2011 manual for treating PTSD, "Because we know that PTSD symptoms are nearly universal immediately following very serious traumatic stressors and that recovery takes a few months under normal circumstances, it may be best to think about diagnosable PTSD as a disruption or stalling out of a normal recovery process, rather than the development of a unique psychopathology."

On Treatment
I have worked with members diagnosed with PTSD related to Operation Iraqi Freedom and Operation Enduring Freedom - without even being in the Middle East; they were exposed to live or recorded combat, torture and beheadings by the enemy and other similar events from a distance.

The most effective treatments shown time and again for helping personnel recover from their traumatic experiences, embrace the concepts of exposure therapy, or desensitization. With this kind of treatment, people recover by first talking and or writing about the traumatic events, and going through a guided process to help them learn ways to recover from the PTSD.

Members cannot fully recover from their traumatic experiences unless they deal with them. Avoiding or "suppressing" the memories does not work - it's like putting a band-aid on an arterial wound...ineffective - and will likely lead to other problems in a person's life.

Treatment helps them better understand what's going on in their lives and why. Through therapy and support, our military members can learn skills to recover from PTSD in order to live a fuller life.

A few of the more widely used research-based treatments in today's military include Cognitive Processing Therapy and Prolonged Exposure Therapy, both individual modes of treatment, and Conjoint Couples Therapy, which treats both PTSD symptoms and relationship dysfunction in couples. The U.S. military has also adopted using virtual reality software to help simulate combat situations in psychotherapy sessions.

In conclusion, members don't have to actually go to war to experience PTSD symptoms. It's the exposure to traumatic events that precipitates or exacerbates these symptoms. If you or someone you know is suffering from war-related experiences, please seek help.

Even if you've never set foot in a combat zone, but have been exposed to war in some fashion - torture and beheadings by the enemy or other similar events, you could still be suffering from PTSD. I suggest you visit your local military and family life consultant, chaplain or mental health provider and take the first step into a better future for you and your family. If you are feeling overwhelmed or suicidal, call DSN: 118 to be connected to a crisis hotline.