Posttraumatic Stress Disorder Needs to Be Recognized in Primary Care

All across the country, military health centers are facing a growing wave of veterans returning from Iraq and Afghanistan who are struggling to readjust to life at home. While the changes wrought by the physical injuries of war are obvious, many veterans' lives have been changed in more subtle ways by the psychological aftereffects. Bomb blasts, gunfire, and the constant threat of danger have left an estimated 15% of veterans with chronic posttraumatic stress disorder (PTSD), a disorder that many people still stigmatize as a sign of weakness or something that veterans should just ignore or get over. However, an anonymous survey of veterans returning from active duty in Iraq or Afganistan noted PTSD as the biggest mental health problem that they were facing (1).

Ignoring PTSD can be disastrous. The disorder manifests as intrusive and unexpected re-experiencing of the initial trauma; avoidance of people, places, activities, or thoughts that trigger traumatic memories; emotional numbing; feelings of being on guard or irritable; and difficulty concentrating. Left untreated, these symptoms can put people at increased risk for suicide, car accidents, job loss, divorce, social isolation, and illness. People with PTSD often develop substance abuse and mental health comorbidities, including heavy smoking, alcohol and drug use, depression, panic disorder, anxiety, and insomnia. They are also more likely to have hypertension, asthma, and chronic pain and frequently experience unexplained symptoms, such as shortness of breath, tremor, palpitations, and nausea.

Studies of Vietnam veterans demonstrated the common co-occurrence of the symptoms of PTSD, which helped to establish it as a syndrome; the diagnosis was first officially recognized in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, in 1980. After the terrorist attacks on 11 September 2001, the diagnosis came to the forefront of civilian mental health. “September 11^th brought …