Introduction to Trauma
Adult Onset PTSD
Following an acute stress reaction the personal meaning of the experience as determined by the individual's past experiences and the psychological characteristics and status of the person at the time, may well determine the probability of the onset of PTSD. The onset of PTSD is characterized by a loss of coping mechanisms and by the overpowering of such mechanisms by the pathophysiological symptoms of anxiety, phobias, hyperarousal as well as flashbacks and sleep disturbances with nightmares.
The possible combinations of these two defects have been illustrated with clinical cases, their treatment and outcomes in the four treatment settings where the faculty members work. The reciprocal roles of psychological, neurological, psychiatric and sleep interventions have been identified as the most effective combined approach in reducing, if not alleviating, chronic or recurrent PTSD symptoms in adults, particularly so military veterans.
Different stages of especially military PTSD require different assessment and treatment emphasis, whether psychopharmacology, psychotherapy, neuropharmacology, or any combination thereof. This is because the symptoms of PTSD, as redefined in our work with veterans and serving military personnel, represent the progressive failure of various biological, functional and emotional systems. These respective systems become selectively impaired in PTSD and lose their ability to preserve the previously established conditions of relative safety after confrontation with stressful environmental challenges that had overwhelmed these individual system(s). Because of the emotionally charged memories and psychobiological changes, particularly physical changes in the brain as demonstrated in the most recent research, the assessment and treatment of particularly military service related, adult-onset PTSD is incredibly complex.
Military PTSD
Understanding military service related, adult-onset PTSD requires a specialized knowledge of the world of the soldier. The primary characteristic of the military environment is the uniquely violent milieu where soldiers are expected to perform abnormal, contra-societal value tasks with a manner of "normality" when they are deployed in offensive, defensive and peace keeping operations. When soldiers first join the military, they are enchanted by a societal image of the military as both a macho and romantic institution serving the country's highest ethic of protector of sovereignty, territory, life, and property. Once deployed in battle and other military operations, the contrast of the reality of the operational assignment versus the idealized values of valor create unique stressors that bring about extremes of traumatic exposure and personal sacrifices that few people outside the military, including health care providers, can fully comprehend. Soldiers in treatment mostly complain that civilian health care providers are often ignorant and dismissive of their complaints because they have no understanding of the military psyche.
The nature of modern warfare and in particular peacekeeping operations, has brought about a significant increase in the incidence of what is commonly diagnosed as Combat-related Posttraumatic Stress Disorder. In Canada, as in other countries, a training modality to provide both theoretical and practical components to military health care professionals has become an imperative. In an era where increasing numbers of Canadian soldiers are exposed to severe operational theatre trauma, soldiers who may exhibit reduced deployment readiness, often leave the Armed Forces. When they re-enter civilian life they may pose risks to their and others' welfare. When not identified or diagnosed early on, some soldiers may continue in their careers, but with marked decrease in efficiency and productivity, diminished morale, and risk of developing dysfunctional lifestyles in efforts to self-treat and self-medicate their condition.
A pro-active, preventative approach, based on successful models implemented in some countries, is recommended. While pre-deployment stress inoculation, frontline care, and Combat-related Posttraumatic Stress Disorder prevention following exposure to severe trauma are the key ingredients for assisting serving soldiers, those who had left the Canadian Forces are often left to their devices. They seek care from community-based facilities where there is little or no comprehension of the fact that for these veterans, their condition cannot be considered as primarily a medical psychiatric disorder.
Their PTSD, or however it may manifest as an Operational Stress Injury, includes also moral, social, philosophical and spiritual aspects. Healing therefore has to take place in the psychological, social, and spiritual spheres, but seldom, if ever, would occur at purely biological level. The healing process of Combat Posttraumatic Stress Disorder means the creation and building of a new life with others that can be embraced despite the horrors the veteran may have seen and experienced. Even so, there is an unmistakable biological component that must be considered at all times when working with any form of military stress related reaction. Often overlooked is the issue of exposure to various environmental and chemical agents that may complicate the presentation, as well as physical injuries that may have been sustained.
Consequently, traditional PTSD treatment modalities and approaches with military-service related PTSD in both psychology and psychiatry require extensive review. In the fast-developing field of sleep disorders, neurological and neuropsychiatric assessment of mental health disorders, health care professionals can no longer acquire the specialist knowledge to treat Adult-onset PTSD from generalist academic approaches.