Prevalence of PTSD in Military Personnel
The prevalence of PTSD in the military is the proportion that has the condition at a given time. It shows the existing cases of PTSD in the group which can be influenced by the duration and occurrence of the disorder. According to the National Center for PTSD, there are significant differences in the number of military personnel with PTSD depending on the service area. Operation Iraqi Freedom and Enduring Freedom have a prevalence rate of 11-20% per year. The Gulf war has a prevalence rate of 12% and the Vietnam War is 15%. There are other factors in combat that can increase the stress level. Some of the factors include the politics surrounding the war, the fighting ground, where the war is fought, what to do at the war and the type of enemy faced. The military can also be exposed to sexual trauma during training, peacetime and even war. The National Center for PTSD data shows that the veterans who use veteran Affairs health care have been assaulted sexually as follows. 23% of women had sexual assault in the military whereas 55% of men and 38% of men have encountered sexual harassment in the military (Gradus, 2017). The statistics, however, indicate that more men than women have been through military sexual trauma given that there are more male veterans compared to women.
Types of Military Trauma
Military personnel are faced with traumatic events in the course of their work. Such events can trigger different types of trauma. Some of the traumatic harms include life threat to others, life threat to self, traumatic loss, the aftermath of violence, moral injury by self-aftermath of violence and moral injury by others (Litz et al., 2018). Traumatic events can either be physical or sexual abuse, community-based violence, neglect, bullying, disaster war, and terrorism. Trauma in the military can be as a result of the impact of deployment and the stress on individuals who are deployed as well as their families. Most of the returning service men and women are exposed to mental or substance use disorder which can be related to military trauma.
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Neurobiological Underpinnings/Processes Occurring the Body or Brain
PTSD is associated with an incident or incidences that keep on recurring where a person is exposed to an event that can be life-threatening causing the development of symptoms associated with PTSD. Scientists have developed models that explain the neurobiology of PTSD as they try to build on the literature using different approaches in an effort to understand the topic. An individual who is exposed to a stressor responds to fear, horror or helplessness. The adaptive and maladaptive stress response tries to understand PTSD. There are different neurobiological systems that explain the pathologic and protective response to a stressor. The sympathetic nervous system, hypothalamic-pituitary-adrenal (HPA) axis, serotonin system, sex steroidal system and opiate systems explain the adaptive and maladaptive stress responses (Disorder & Medicine, 2012).
The sympathetic nervous system (SNS) activates flight or fight response through interconnected neurons. The neurons constitute part of the peripheral nervous system. The SNS is active at the basal level and maintains homeostasis and its work is to mobilize the resources of the body. The norepinephrine in the brain causes arousal, vigilance and selective attention. Patients with PTSD have an increased urinary norepinephrine level which is also the case in cerebrospinal fluid and correlate with how severe PTSD is (Lipov, 2013).
The HPA axis is a system where several hormones are releases successively and the adrenal gland releases cortisol which leads to the elevation of glucose in circulation ending up activating the immune cell migration to the injured section. Elevated cortisol can impair memory favoring memories that can trigger fear. Life-threatening events can trigger a series of HPA axis reactions. The systems consist of reciprocal connections with the structures that lead to fear conditioning and consolidate memory. Future exposure to the conditioned sensory cues reactivates traumatic memories (Disorder & Medicine, 2012). The body can experience chronic pain, headache, muscle cramps, lower back pain, muscle contraction which can be seen through trembling, twitching and shaking.
Case Example
The American Psychiatric Association revised the criteria for diagnosing PTSD in DSM 5 to include it in the category Trauma and Stressor-Related Disorders. An individual must be exposed to a stressful or traumatic event for them to be placed in the diagnostic criteria. According to DSM 5, a person should have been exposed to a life-threatening event through direct exposure, as a witness, knowledge of the exposure of a close relative to trauma and indirect exposure to the details of a trauma. The traumatic event should be re-experienced in the form of either upsetting memories, flashbacks, nightmares, emotional distress and physical reactivity. The victim also tries to avoid trauma-related stimuli following the incidence. They also face negative feelings that emerged or worsened after the event (Smith, Perrin, Yule & Clark, 2014). The symptoms for PTSD last for over a month and create functional impairment or distress. The symptoms, in this case, are not a result of other illnesses or substance use.
Military-related trauma can emerge from a .wound sustained in active duty, military sexual trauma and witnessing others' trauma. Military personnel who witness the death of a close friend in combat can face PTSD where they keep on remembering the incidence. The personnel responds to the trauma through fear and anxiety. The memories of a dying friend are worsened when other veterans discuss how so and so did not make it. An individual in PTSD is likely to dislike such talk and prefer being alone. The condition worsens as they try to avoid even their loved ones. They spend most of their times alone probably sleeping and get disconnected from their friends (Smith, Perrin, Yule & Clark, 2014). An individual, in this case, is not bothered by the combat but the guilt of being alive and not dead like the friend. The diagnosis of such a condition involves efforts aimed at helping such a person to face the reality and stop blaming themselves for what happened. It involves erasing the bad memories so that the person can appreciate life again.
Nursing Interventions
A veteran can have feelings of anger, shock, fear, anxiety, and guilt which affect their social life. Patients might not manifest the symptoms immediately and can take months or even years. Nurses should conduct a background check and history of an individual including their physical health. They should use DSM 5 to assess the symptoms where they ask pointed questions on the history and physical health of the patient. Nurses should be able to spot symptoms that relate to PTSD due to their one on one encounter with the patient. The nurse should help the patient to develop a sense of empowerment and therefore assume the control of their symptoms. A thorough understanding of PTSD and its effects on the patient in addition to establishing a trust-based relationship enhances communication and the patient will open up and therefore it is possible to address the problem.
The use of cognitive behavioral therapy can be helpful in enabling patients to realize negative feelings and thoughts and other behavioral patterns. The technique will help the patient to replace such patterns with healthy ones. Another technique is the use of cognitive restructuring where the patient is encouraged to discard negative thoughts that lead to behavior problems. Lastly, exposure therapy can be used to address the situation where the patient is exposed to a situation that is similar to their past trauma to help them manage anxiety and negative symptoms. There are two major drugs that can be used to treat the condition under the SSRIs which include paroxetine and sentaline. In addition to the therapies and drugs, other options include establishing therapeutic objectives and involving family members in therapy.
References
Disorder, C., & Medicine, I. (2012). Treatment for posttraumatic stress disorder in military and veteran populations: Initial Assessment. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK201096/
Gradus, J. (2017). Epidemiology of PTSD - PTSD: National Center for PTSD. Retrieved from https://www.ptsd.va.gov/professional/PTSD-overview/epidemiological-facts-ptsd.asp
Lipov, E. (2013). Post Traumatic Stress Disorder (PTSD) as an over-activation of the sympathetic nervous system: An Alternative View. Trauma & Treatment , 03 (01). doi: 10.4172/2167-1222.1000181
Litz, B., Contractor, A., Rhodes, C., Dondanville, K., Jordan, A., & Resick, P. et al. (2018). Distinct trauma types in military service members seeking treatment for a posttraumatic stress disorder. Journal Of Traumatic Stress , 31 (2), 286-295. doi: 10.1002/jts.22276
Smith, P., Perrin, S., Yule, W., & Clark, D. (2014). Post Traumatic Stress Disorder . Hoboken: Taylor and Francis.
