After the United States’ withdrawal from Afghanistan in 2021, many veterans were reminded of their own trauma experiences. Mindpath Health’s Sandeep Vaishnavi, MD, PhD, and Summer Thompson, DNP, PMHNP-BC, explore the impact of PTSD on veterans and treatments to help them cope in this Psychiatric Times article.
When the United States withdrew from Afghanistan earlier this year, clinicians noted a sharp increase in calls to veteran crisis center hotlines.
For veterans with post-traumatic stress disorder (PTSD), news about Afghanistan brought back powerful memories of traumas many of them were trying to forget. Nightmares invaded their sleep, intrusive thoughts distracted them from work and family, and flashbacks were so powerful there was no place to hide.
The prevalence of PTSD and comorbid disorders
Civil War General William Tecumseh Sherman put it bluntly when he said, “War is hell.” For veterans with PTSD, that hell can seem inescapable. Between the Iraq and Afghanistan wars, an estimated 500,000 US troops, about 20%, have been diagnosed with PTSD.
However, less than half of veterans in need of mental health services receive treatment. Of those who do get help, less than one-third receive evidence-based care. And of the 5 million service members being cared for by the US Department of Veterans Affairs (VA), only 8% have been diagnosed with PTSD. Left untreated, PTSD can lead to hospitalization, unemployment, and poverty.
When the bullets stop flying and service members return home, the horrors they hoped to forget often follow. These unprocessed traumas bang on the door of their subconscious, demanding attention. However, talking about traumas can be an extremely uncomfortable experience, one that threatens to trigger retraumatization.
History of PTSD
PTSD has gone by many names over the years. During the Civil War, it was called irritable heart. During World War I, soldiers called it shell shock. After the Vietnam War, when almost 25% of soldiers required some kind of psychiatric care, it was known as post-Vietnam syndrome.
PTSD is expressed by 4 main clusters of symptoms: reexperiencing the trauma in the form of intrusive memories, flashbacks, or nightmares; avoidance of anything that reminds an individual of the event; arousal and hyperreactivity, such as being easily startled or feeling tense; and effects on cognition and mood that include negative thoughts, feelings of guilt or blame, or a loss of interest. To receive a diagnosis of PTSD, these symptoms have to last more than a month and be functionally impairing.
Veterans from the Afghanistan theater
Since the 9/11 terrorist attacks in 2001, 775,000 troops have served in Afghanistan on a mission to retaliate and stabilize the region. More than 2400 died, about 20,000 were wounded, and countless others have been haunted by what they have seen and experienced.
About 70% of veterans have struggled with mental health issues since serving in the Afghanistan war. Since August 2021, 90% of Afghanistan service members have experienced new or worsening mental health issues. About 75% are experiencing new or worsening symptoms of depression, 58% have started or increased drug or alcohol use, and 64% have new or worsening thoughts of suicide.
Although anyone can develop PTSD, combat veterans tend to experience more severe symptoms and lower remission rates compared to noncombat-related PTSD. Indeed, the kind of warfare experienced in Afghanistan is likely to put anyone on edge. This includes guerrilla attacks, roadside and suicide explosives, and a wary uncertainty about safe zones and battlegrounds. When an attack can come from anywhere at any time, the amygdala will be more active, and PTSD may be more likely.
A holistic approach to treatment
Since the fall of Afghanistan, 31% of veterans have sought professional mental health services for the first time. It is a sign of hope that barriers to treatment are softening. Telemedicine has become a useful way to reach patients who are either hesitant to engage in treatment or live in remote places.
Close to 60% of those with PTSD do not achieve remission, and although treatment-resistant PTSD is hard to define, up to one-third of patients do not find relief with current therapies. Chronic PTSD can lead to decreased life satisfaction and increased suicide risk and depression rates.
The attitude toward PTSD in veterans has come a long way since it was first viewed as an issue of cowardice. Medicine recognizes it as neurobiological disorder with a strong environmental component. Advances in research and a growing acceptance of alternative treatment options seem to be opening new doors. This growing knowledge around PTSD may even help reduce its stigma and encourage more service members to step forward and seek help.
The best treatment may involve addressing multiple components of the brain-environment interaction that leads to the disorder. This can include cognitive and behavioral therapies to address distorted thoughts and process the trauma, medications such as SSRIs to reduce amygdala activity, breathing and meditation-based therapies to calm the effects of excessive amygdala activity, and hopefully, in the future, brain stimulation techniques to stimulate the prefrontal cortex.
Read the full Psychiatric Times article with sources.