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

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    SUMMARY
    The physical effects of PTSD on the body are indistinguishable from what
happens as a result of extreme stress, but continue long after the source
of the stress has passed. PTSD is essentially a manifestation of the natural mechanisms for survival and functioning under extremely threatening
situations. Everything we label a "symptom" of PTSD is an adaptive and
beneficial response when there is a threat to your personal welfare or that
of others, and the persistence of these reactions is the body's effort to
ensure that you're immediately ready if the danger occurs again.
    However, the reactions of PTSD can also seriously interfere with life
after coming home. These include symptoms related to how memories of
traumatic events are processed in the brain, the body's natural defense
to shut down emotions and cope with what's happening, and the body's "fight-or-flight" physiological responses related to heart rate, breathing,
and physical reflexes. All of these are interrelated. PTSD is also strongly
associated with other conditions, including depression, cognitive problems, and physical health problems. Understanding the nature of what
mental health professionals call "PTSD," and learning what is unique
about a warrior's experience, is essential to learning how to address these
reactions after combat.

     

The wars in Iraq and Afghanistan have led to increased awareness of
the impact of traumatic brain injury (TBI) on troops. The availability of
modern protective equipment and advances in battlefield medicine have
resulted in many warriors surviving injuries from IEDs (improvised explosive devices), RPGs (rocket-propelled grenades), rockets, mortars, EFPs
(explosively formed projectiles), and other munitions that would have
been fatal in prior wars. Some of these injured warriors have experienced
serious brain injuries resulting in long-term impairment in physical, cognitive, and behavioral functioning.
    Unfortunately, there has been very poor education about the distinction between mild traumatic brain injury (mTBI), also known as "concussion," and moderate or severe TBI, where damage to the brain is usually
apparent on clinical evaluation and brain scans (CTs and MRIs). All TBIs
(concussions/mild, moderate, and severe) have been grouped together
by medical professionals and in educational materials given to warriors
and their families. In 2008, investigators from the RAND Corporation
reported that 20 percent of all Iraq and Afghanistan war veterans (more
than 300,000) experienced a "probable traumatic brain injury" while
deployed, without clarifying that over 99 percent of these cases were concussions and that their study was based on an inadequately validated survey administered months or years after the warriors had returned from
deployment. Concussions/mTBIs have also become entangled and confused with PTSD, and these two conditions have been described as "silent"
wounds, affecting hundreds of thousands of OIF and OEF warriors.
    When a warrior experiences a moderate or severe TBI on the Iraq or
Afghanistan battlefields, this almost always results in rapid air transportation to one of the large military hospitals in Germany or the United States for
neurosurgical, neurological, and rehabilitation services. Some of these warriors experience severe disability and require long-term treatment.

    In contrast, when a warrior experiences a concussion/mTBI on the
battlefield, which may involve being briefly knocked out, or getting their
"bell rung" from a blast or other injury, this almost never results in evacuation from the combat theater. Concussions/mTBIs are very common in
the military (as in nonmilitary settings) from sports injuries, motor vehicle
accidents, hand-to-hand combatives training, and combat. Although concussions can occasionally lead to long-term health effects-such as headaches, irritability, sleep disturbance, memory problems, or fatigue-most
warriors who