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PTSD doesn’t always start in combat

Servicemembers can experience PTSD even when they have not been in a combat situation.  Complex PTSD involves exposure to a trauma that is either repeated exposure or a trauma perpetrated against an individual by someone who is in a trusting or care-giving position.  (U.S. Air Force illustration by Alex Pena/Released)

Servicemembers can experience PTSD even when they have not been in a combat situation. Complex PTSD involves exposure to a trauma that is either repeated exposure or a trauma perpetrated against an individual by someone who is in a trusting or care-giving position. (U.S. Air Force illustration by Alex Pena/Released)

JOINT BASE ELMENDORF-RICHARDSON, Alaska -- "Don't talk to me that way."

"Why are you looking at me like that?"

"Just leave me alone."

Everyone else is confused about what just happened, but he feels like he was just attacked by his entire family.

The effects of post-traumatic stress disorder can have long-lasting effects. But how can someone have PTSD if they have never been in active combat? Military personnel, like any person, can experience PTSD in any of its many forms.

According to the Center for Deployment Psychology, a trauma may include an event in which a person is exposed to actual or threatened death, serious injury, or sexual violation, or a happening in which the person witnesses the situation first-hand.

"A majority of people go through a trauma at some point in their life," said Capt. Chad Killpack, 673rd Medical Operations Squadron director of psychological health. "Most tend to recover just fine.  But when people have PTSD, it implies there is a disorder to their ability to recover from the trauma, so they basically don't recover the way they should. That's when we need to intervene in order to help them get through that. "

There is no one description for the type of event that causes PTSD -- and not every trauma causes it.

"It can be a number of scenarios that happen which are somewhat traumatizing," Killpack said.  "Afterwards, there is usually a period of time in which it bothers you.  I have had a lot of people come in after having a car wreck and for the first month or two they say, 'every time I get in a car I get anxious and concerned. I don't know if that is messed up or what is going on'.

"The response is typically that you are fine, it's normal, it's okay," he continued. "Most likely it is not PTSD, but more of a natural response to trauma. PTSD doesn't start to exist until time has passed and the individual is not getting better or not recovering."

One sign that there may be an issue is when an individual starts avoiding normal activities, Killpack said.

If a person haven't driven their car in a long time and has to hitchhike to work or goes to extreme means to avoid using their vehicle, even at the expense of annoying friends or incurring financial hardship, then that is a problem, Killpack said.

"That signifies there is a disorder," he said. "If a patient is concerned with whether they are 'avoiding,' I would say they should be looking to see if the concerns that they are having is making their life worse. If the activities that you stop doing aren't a part of your life and you don't want to do it again, then it's not such a big deal. But if your average life activities, such as social connections with other people, are becoming impaired because you can't get over the incident ... well, that really is the line."

One disorder the clinic helps patients deal with is complex PTSD.

"Complex PTSD involves exposure to a trauma that is either repeated exposure or a trauma perpetrated against an individual by someone who is in a trusting or care-giving position," Killpack said.  "So if you are an adult and your spouse is beating you, or a parental or military sexual assault took place in your past, then it would be considered complex PTSD."

Airman 1st Class Alyssa Caselli, 673rd MDOS mental health technician, has been at the clinic for approximately a year.  She said when she used to think of PTSD, a war-tested veteran is typically what comes to mind.  The sessions she witnessed and the training she received led to at least one revelation.

"Anybody can experience PTSD, no matter if they have been to war or not," Caselli said. "More than half of our battle is functioning in everyday life. Every single one of us goes home and takes off the uniform. We are human and life happens. So, when something like sexual, physical or emotional abuse or an accident or the loss of a loved one happens, PTSD can occur."

Not all traumatic experiences take place during a service member's time in the Department of Defense, however.

"There are people who come into the military with prior traumas that they thought were at bay," Killpack said. "They thought they had worked through it. But when they got into the high-stress environment of the military, it all of a sudden came back. Or someone may be totally recovered from a previous trauma, come into the military and be exposed to another one. In those cases, when the next trauma comes the two have kind of a cumulative effect and the patient may struggle to recover. Therefore, when they come in for treatment we must address both in some way ... it's actually more common than you might think."

Regardless whether PTSD happens during or before service, one common hurdle to treatment is the tendency of patients to have developed trust concerns.

"They don't like feeling vulnerable," Killpack said. "When the trauma happens it is usually an event so significant that they feel extremely vulnerable. It's overwhelming to them. They will frequently do everything they can do to avoid feeling vulnerable again, including not trusting people. To combat this, the therapist trains to help develop trust.

"Our staff trains routinely to stay up to date on the latest procedures, techniques and protocols for treatment and trust building.  We keep the treatment consistent and try to ensure that if we have to adjust an appointment we talk to them and make sure they aren't surprised by anything. We strive to maintain that trust and credibility."

In addition to staff's diligence in the office, Killpack said there are things a patient can do to help in their own treatment.

"One big thing that contributes to PTSD is that they don't allow themselves to feel the feelings," Killpack said. "I'm in the military, so it's not looked at as positive if I am off crying about this or that.  So, although work may not be the most appropriate place, they have got to take a moment to allow themselves to feel uncomfortable.  Allow themselves to cry. They must feel their feelings because they are there for a reason.

"The other thing that can be done is not avoiding the trauma", he continued. "That involves talking about what happened to them or not avoid situations that remind them of the trauma. An example would be if somebody was involved in a theater shooting and has the concern that if they ever went into that theater again then they would be shot. 

"My recommendation would be to start working up to going back to the theater. The chances of it happening again are very slim.  They need to challenge themselves to get back out there and get going again. Don't allow yourself to avoid ... allow yourself to feel. It will allow them to get involved in the healing process. "

Killpack said if a servicemember has serious concerns, they should address it.

"If someone were to start to have odd experiences ... if past trauma all of a sudden started coming up for whatever reason they should look into it with a concept similar to finding a new mole on their arm," Killpack said. "That is the thought that it is probably nothing, but I ought to just get it checked out anyway.

"Come on in, we will look at it and if it's a concern we will let you know."
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