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September 2011, Volume 41 Number 9 , p 41 - 44


  • Joanne Lavin EdD, MEd, RN


MJ, 26, returned from combat in Afghanistan 6 months ago. He experiences daily feelings of anxiety and inexplicable anger. His wife and children are afraid of his mood swings and his employer has counseled him about his reactions to fellow employees. He has difficulty sleeping, concentrating, and connecting emotionally with family and friends.At the insistence of his employer, MJ has been meeting with a therapist. He's expressed feelings of guilt for having survived his combat experience, as well as vague feelings of wishing he'd died along with some of his fellow soldiers. MJ says he can't remember details about his war experience and just wants to forget it. He's been drinking alcohol every night to relax and get to sleep. MJ is diagnosed with posttraumatic stress disorder (PTSD).PTSD IS AN ANXIETY DISORDER that develops after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Patients with PTSD experience significant emotional distress and recurrent, intrusive thoughts, dreams, and flashbacks resulting in avoidance of certain situations and difficulties with relationships, work, and, in some cases, daily functioning.1Traumatic events that may trigger PTSD include rape and other personal assaults, natural or human-caused disasters, violent accidents, terrorism, or military combat. Studies have shown that second-hand experiences can also cause PTSD.1PTSD was first recognized in the Vietnam War era. The great difficulty many returning veterans had adjusting to life at home was attributed to combat exposure. It became a formal diagnosis in 1980.2,3When someone is in danger, feeling afraid is natural. This fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. This "fight-or-flight" response is a normal reaction meant to protect a person from harm. Normally this reaction dissipates when the danger is past, but people who have PTSD continue to feel anxious or frightened

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