Family Members Also Suffer from PTSD
Coping with symptoms of post-traumatic stress is a fact of life for many who return from combat tours, and helping troops become mentally and physically healthy has become an increasingly consuming task for military and civilian physicians in Jacksonville.
But the effects of traumatic events overseas do not end with those closest to the incident.
A Jacksonville Marine wife, a "veteran" of more than 10 of her husband's deployments, told a seminar audience that she would change her routine drastically while he was away, spending her days by the telephone, watching CNN 12 hours a day.
Another woman whose son, a Camp Lejeune Marine, completed three combat deployments and returned home with traumatic brain injuries from a humvee explosion, PTSD and self-medicating substance abuse, said anxiety over her son's condition would make her physically ill.
"When my son was going through a lot of issues, and the phone would ring, and I would look down and see it was him, I would literally get nauseous," she said. "I've had to redefine the way I interact with him."
While data on the effects of combat stress response on military families is hard to come by, it's something that military officials are asking about.
In May, Defense Department officials sent online surveys to 100,000 military spouses and 40,000 married active-duty service members asking them about the effects of coping with multiple deployments and other facts of military life in the interest of improving services available to spouses and families.
Camp Lejeune Naval Hospital's director of Mental Health, Cmdr. Robert O'Byrne, said stories such as those of the wife and mother above -- who asked to not be identified -- are "regretfully common."
"If you've got a family system, any part of the system that is disrupted disrupts another part of the family system," he said. "That's guaranteed to play itself out in the family dynamic. The more symptomatic that individual is, the more disruptive it is on the family system."
Such disruption can be measured on a color-coded stress continuum, O'Byrne said, a system used throughout the Navy and the Marine Corps to identify levels of reactivity and symptoms of mental injury or illness when a stressor presents. The model, developed to identify PTSD or combat trauma in troops, is equally applicable to family members affected by the altered behavior of a loved one, he said.
In the four-color continuum, green represents "ready," functioning with normal focus and control.
Yellow is "reacting," with transient symptoms including sleep disruption, irritability, and anxiety.
Orange is "injured," with severe and persistent, scarring symptoms including recurrent nightmares, panic or rage.
And red, or "ill," represents trauma reactivity becoming a clinical disorder or full-fledged PTSD.
Who in the family system is most affected and how much depends on a number of factors, O'Byrne said.
"The 19-year-old who is a freshly minted newlywed with a 19-year-old spouse may not be as resilient as someone who is 27 or 28," he said. "Young kids are remarkably resilient, but they are also remarkably responsive to stress in the family dynamic."
Lt. Cmdr Erin Simmons, Ph.D., staff psychologist and program director for the Intensive Outpatient PTSD program at the Naval Hospital, noted in a recent seminar that one of the symptoms indicating diagnosable PTSD is when stress indicators and reactions cause problems in daily activities and relationships.
Warning briefs emphasizing caution in these relationships are standard procedure when troops return from deployment, Simmons said.
"We jokingly call them the 'do-not-kill-your-wife' speeches," she said.
Troops in the yellow, orange or red stages can alienate loved ones in self-defense.
"You avoid talking with family because you're terrified that they're going to ask you questions that you don't want to answer," she said. "It's damaging, because it's hard to have a relationship with someone like that. That's one of the reasons the divorce rate is getting so high in the military."
And, she said, the secondary effects of combat stress reactions can be physical, as well as emotional.
"We have guys who have to sleep with a body pillow between them (and their spouse) so there's less danger of inadvertent violence," she said.
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