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Recognizing the 'Silent Killer' of the Military: PTSD

Combat-related traumatic stress disorder is the "silent killer" of the military. The good news is that veterans can take control of PTSD with the right help.
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They served our country proud and fought for our freedom, but now many are paying a price they shouldn't have to pay. One in five veterans suffers with combat-related post-traumatic Stress Disorder (PTSD) and struggles to reintegrate back into society. Help is available, but many veterans continue to needlessly suffer for a number of reasons. Many veterans go to their civilian primary care physician (PCP) than to the doctors at the VA for treatment of their PTSD symptoms. What's needed is increased education for both primary care physicians and veterans when it comes to PTSD.

Commonly experienced symptoms of military PTSD include: inappropriate anger or irritability; insomnia; problems on the job and at home; acting detached or distant; having trouble with social events such as weddings, funerals and other family gatherings; and being easily startled or hyper vigilant.

Once the veteran is seen by his family doctor, a PTSD diagnosis is often missed for two reasons:

First, primary care physicians simply don't have the specific training to recognize or treat combat-related PTSD. It's not uncommon for the physician to write the patient a script for an antidepressant or anti-anxiety medication and send him on his way, failing to recognize there is a deeper underlying issue. In addition, many doctors have little time to spend with patients, and therefore are simply unable to fully explore all symptoms and give adequate information about the best treatment options.

Second, the patient fails to inform his doctor that he is a veteran and spent time in the combat theatre, and more than likely the physician fails to inquire. The patient's symptoms are attributed to stress or a rough patch that should hopefully improve with time.

To ensure that a proper diagnosis of PTSD is not missed, better education for both veterans and primary care physicians needs to become the new standard protocol.

For the veteran

1. Recognize you might have PTSD. If you spent time overseas and experienced war, violence, bloodshed and death, PTSD is a real possibility. Don't be afraid to admit you might have PTSD because of the stigma and misinformation about the condition.

2. Educate yourself on the symptoms of PTSD, and ask for input from your loved ones about their observations of your symptoms and behaviors. Learn about the condition before you go to the doctor.

3. Take a list of your symptoms (including those suggested by your loved ones) in writing to your physician. This allows for more efficient use of your time with the doctor.

4. Be open to suggestions your doctor might have for treatment of your condition. Don't be fearful of asking appropriate questions about suggested further evaluations, treatments or referrals. Remember the treatment of PTSD is not something the doctor does to you, but rather a process that you and your doctor (or therapist) engage in as a team.

5. In general, treatment for PTSD can include both talk therapy (psychotherapy) as well as medication. Your doctor may want to refer you to a therapist or psychiatrist (VA or civilian) for more specialized care.

Finally, know that doing nothing, or hoping that time will heal PTSD, are generally ineffective ways of dealing with it. Treatment will only work if recommendations are appropriate and are followed and the veteran becomes an active and willing partner in the treatment process.

For primary care physicians

1. Primary care physicians need to realize that millions of Americans served in Iraq, Afghanistan and other parts of the world. The chance a patient is a veteran is very likely, and asking "Are you a veteran?" needs to become standard practice.

2. Primary care physicians need to attend more continuing medical educations programs that teach the right questions to ask veterans, along with the signs and symptoms to look for that could point to PTSD.

3. Offer the veteran reassurance that you are not there to judge him or her, but your role is to serve as an ally in his treatment and recovery. Always be optimistic with the veteran because PTSD can be controlled.

Combat-related PTSD is the "silent killer" of the military because it's often misdiagnosed, and without the right help it can be extremely debilitating and is linked to an increased risk of suicide. The good news is that veterans can take control of PTSD with the right help, and go on to be extremely valuable and productive assets to our communities and workforce. The sooner treatment begins the better, and that starts with increased education about PTSD for both veterans and physicians.

For more by Harry Croft, M.D., click here.

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