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The Variety of War-Zone Stress Effects

In public and professional discussions, there is a strong temptation to categorize all post-deployment stress effects as posttraumatic stress disorder (PTSD), or to consider diagnosable PTSD the only clinical challenge worth discussing.  Both of these temptations are dangerous, because they:

  • Apply diagnostic labels in some situations that would be better served by individual human descriptions of individual human experience
  • Increase the stigma by over-pathologizing reactions that may be milder, or may simply be different
  • Minimize the importance of serious conditions such as anxiety disorders and depressive disorders
  • Ignore a number of other serious conditions, such as complex PTSD or DESNOS (Disorders of Extreme Stress Not Otherwise Specified), that deserve attention and treatment
  • Ignore the synergistic effects of combining post-deployment stress responses with other physical injuries, especially traumatic brain injuries (TBI) and the mild TBI so often caused by blast concussion

“Even among those veterans who will need psychological services post-deployment, ASD and PTSD represent only two of a myriad of psychological presentations that are likely.  Veterans of the Iraq war are likely to have been exposed to a wide variety of war-zone related stressors that can impact psychological functioning in a number of ways” (VA, 2004, p. 32).

These pages cannot do justice to the array of combat stress injuries and effects, but a number of conditions deserve at least brief mention as direct effects of the chemical processes discussed in the earlier pages on resilience and vulnerability to stress.  These include:

  • Posttraumatic stress disorder
  • Substance use disorders (SUD), including substance abuse and substance dependence
  • Depressive disorders
  • Complex PTSD or DESNOS
  • Somatic effects of stress and trauma
  • Traumatic brain injuries

What is the role of emotion in post-deployment stress effects?  Opinions range from the traditional misconception that these disorders are merely “emotional problems” to a dismissal of the emotional experience in favor of the mechanics of the body’s survival systems.  Certainly the post-deployment physical processes and chemical reactions in the brain are fueling and adding great force to the natural human emotions that people bring home from the war zone.

It may also be necessary to acknowledge that the emotions themselves interact with those physical processes in ways that we do not have the means to map out or measure.  For example, some studies of Vietnam veterans have associated higher levels of guilt with stronger PTSD symptoms and suicidal tendencies (Hendin and Haas, 1992;  Kubany et al., 2005;  Henning and Frueh, 1997).  Perhaps the best one can hope to do is to respect all the roles of body, mind, and spirit—and all the things about them that we do not know.

And our most important task—as always—is to keep in mind the strengths, resources, and resiliencies of the individual human beings who struggle with these effects, and the reality of recovery and a return to balance.


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The material on all of the Clinical Pages is taken directly from the draft version of Finding Balance After the War Zone:  Considerations in the Treatment of Post-Deployment Stress Effects, a manual under development for the Great Lakes Addiction Technology Transfer Center and Human Priorities.  This draft is copyright © 2008, Pamela Woll.  Reprint permission is universally granted, but attribution is requested.
Click here for References and Other Resources.
Click here to link to a PDF file of the current version of the clinician’s manual draft.
Click here to link to a PDF file of the accompanying booklet for veterans.

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