Free B0038M1ADS EBOK by Charles W. Hoge M.D. Page A

to
respond instantly if needed-the "fight-or-flight" response. Small things
can trigger large physical reactions, including rapid heart rate and breathing, heightened sense of fear or anxiety, jumpiness, irritability, and muscle
tension. There may also be stomach queasiness or nausea, because during times of stress intestinal function shuts down so that blood can be
shunted off for more important purposes like keeping muscles going. The
increased physiological reactivity can lead to sleep disturbance, concentration problems, memory problems, and the feeling of never being able to
shut down.

    Mental health professionals label criterion D symptoms hypervigilance, but in combat this state of being revved up and on high alert is
a very useful and necessary skill-what warriors call "situational awareness" or "tactical awareness."
    Criteria B, C, and D symptoms can combine in various ways and have
different levels of severity. In the most severe cases (which are relatively
rare), the flashbacks, intrusive thoughts, feelings, and hypervigilance can
progress to obsessiveness, paranoia, delusions, and even hallucinations concerning threat and safety, with the warrior checking everything repeatedly,
convinced that an attack on their loved ones or themselves is imminent.
    OTHER MENTAL AND PHYSICAL HEALTH PROBLEMS
EXPERIENCED BY WARRIORS
    Although this chapter focuses on PTSD, this isn't the only mental health
concern experienced by warriors returning from combat. There are a
number of other problems listed in the DSM that warriors struggle with
after returning from war, which many spouses and significant others do as
well. These often coexist with PTSD, or can occur independently.
    Depression-characterized by a low mood, loss of interest in activities,
hopelessness, guilt, sleep disturbance, appetite disturbance, concentration
problems, low energy, and sometimes suicidal thinking-is one of the morecommon conditions besides PTSD.
    Panic attacks are also relatively frequent, characterized by a sudden
feeling of fear or anxiety (such as a fear of dying or going crazy), along
with a pounding heart, sweating, shaking, feeling of choking, nausea,
dizziness, and other physical symptoms. Generalized anxiety-characterized by excessive worry, restlessness, fatigue, sleep disturbance, anger, and
muscle tension-is common. Alcohol and substance abuse also frequently
coexist with PTSD.
    These conditions overlap with and have many similarities to PTSD.
For example, when a warrior wants to hole up and avoid the world, this
could be considered by a mental health professional as one of the hallmark
PTSD criterion C symptoms, or as one of the main criteria for depression, loss of interest in activities. Symptoms like sleep disturbance, concentration problems, anger, and anxiety run through all of these conditions. It
also turns out that many of the same treatments are used for these different conditions.

    Service in a combat zone and PTSD are both strongly associated with
physical health problems related to prolonged changes in stress hormone
and adrenaline levels. These include high blood pressure, chronic headaches, concentration or memory difficulties, gastroesophageal reflux disease (GERD), cardiovascular disease, joint or back pain, sexual problems
(e.g., impotence, loss of interest), and other health problems. Warriors
sometimes experience flashbacks involving wartime memories or aggressive images brought on by sexual arousal, a result of physiological changes
resulting from wartime service.
    The bottom line is that these are all part of the larger range of reactions that warriors experience after coming back from combat, and therefore, for purposes of this book, separate chapters for each condition are
not required. The focus of this book is on helping you learn to navigate
the broad range of reactions that warriors experience after returning from
combat, and how to most effectively make the transition back