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Understanding the impact of post-traumatic stress disorder (PTSD) In the last eighty years or so, it seems there has been a war for each generation in the American family. Gramps fought in World War I, dad fought in World War II, and sons served in Korea, Vietnam, and so on. In recent decades it seems that the world situation has gotten to the point that it can't seem to make it through a decade without some sort of "conflict". More and more men and women in our armed forces are returning home from foreign wars that are becoming more and more unconventional with each passing generation; we are seeing an increase in the number of veterans with both physical and mental health problems. These veterans deserve our gratitude and compassion, but most of all our understanding of the real problems resulting from their generous service to our country. I'm sure that almost everyone has heard the term Post Traumatic Stress Disorder (PTSD), but how many of us really understand what's behind the terminology' The definition of PTSD first appeared in the Diagnostic and Statistical Manual of Mental Health Disorders, Third Edition (DSM III). The manual has since been through several more revisions, the latest of which is the DSM IVTR, Fourth Edition For the sake of brevity, since newer editions reveal a much more wordy and complex definition, the following definition is taken from the DSM III, Third Edition309.81 Post-traumatic Stress Disorder, Chronic or Delayed. "The essential feature is the development of characteristic symptoms following a psychologically traumatic event that is generally outside the range of usual human experience." 1. What this means is the stressor producing this syndrome could come from such things as military combat, a car accident, bombing, torture, rape, and airplane crashes just to mention a few. It is misleading to think that PTSD is limited to military combat. The symptoms of PTSD can manifest themselves almost immediately or remain dormant for years after the causative event. Often there may be an accompanying physical component to the trauma. Some of the symptoms experienced by persons with PTSD may include diminished responsiveness to the external world, estrangement from others, a marked decrease in closeness and sexual interest. Symptoms of depression and anxiety are common. The affected person may worry in excess about such things as being prepared for any kind of perceived disaster. Hyper-reflexes are often seen. The person with PTSD may fly into a rage over someone approaching from behind without giving warning of his or her presence. This comes from spending many months in an area where the slightest mistake of not being alert to ones surroundings could mean the difference between life and death. In response to situations like this some have isolated themselves from family and loved ones to avoid confrontation. What results is an overwhelming feeling of guilt and loneliness. Over time, marital problems may even set in. Many of the veterans with PTSD feel ashamed to talk about their feelings. They try to hide the outward signs of nervousness around others, and may bottle it up inside. We all like to feel "normal". Any sign that indicates to others that one might be otherwise is distressing. Men in particular have the added burden of being cultured not show weakness of any kind. Physical problems can manifest themselves as skin disorders, nerve degeneration, pulmonary disorders, and sexual dysfunction, just to name a few. Some veterans have turned to drugs and alcohol for relief from the constant mental trauma and physical aches and pains. All of this leads to a downward spiral into despair and isolation. Another component that deserves attention here is the financial crises that are caused by PTSD. Perceived or real problems while on the job interacting with coworkers may lead to missed work time, or at worst job loss and job hopping. Even with free care given by the Veteran's Administration (VA), frequent time off for treatments may be difficult for some individuals to arrange, depending on how cooperative the employer may be. It should also be mentioned here that many veterans have a distorted view of the treatment offered by the VA. After using private insurance obtained from an employer, many individuals feel that they might not get as good a standard of care at a VA facility. Word of mouth is not always a good indicator to make such judgments. The VA facilities in our country have been rated along side the private sector and have come out on the top of the list for quality of care. Often times, there is a failure to understand, research, and follow-up on the benefits and aid offered by the VA. There is a wealth of resources available to PTSD sufferers and their families. Nurses are in a good position to teach patients and families where to find help and assistance. Local veteran's organizations would be one of the primary assets readily available that would have a knowledgeable staff to assist in making the proper connections. The Internet also contains a large accumulation of information such as support groups, treatment options, and aid organizations all too numerous to mention here. 2. The main thing to remember is that PTSD is not just a term. It goes much deeper than most of us think. The symptoms can be misleading and misunderstood, causing deeper problems. PTSD sufferers often go to extreme lengths to hide their anxiety out of shame and fear of being misunderstood. The diagnosis can have a physical component as well as a mental aspect. Failure to understand the problem and seek treatment can lead to financial crises, family breakdown, complete isolation, and even suicide on the part of the sufferer. You, as the nurse, in any type hospital, should be aware of the symptoms. A recent discharge from military service could be a tip-off to the problem. Try to get the patient to talk about his or her feelings. Offer information on where to find the proper resources for help. REFERENCES 1. Endicott J., PhD., et al. Diagnostic and Statistical Manual of Mental Health Disorders, Third Edition: Anxiety Disorders, 309.81 Post-traumatic Stress Disorder, Acute. Washington, D.C., APA 1980 2. http://www.ncptsd.org/facts/in dex.html Accessed January 17, 2007 Updated July 20, 2006 3. Ansorge S., PhD., et al National Center for PTSD Clinical Quarterly 6(2): Spring 1996