Essay on "Veterans Diagnosed With Post Traumatic"

Essay 10 pages (3203 words) Sources: 15

[EXCERPT] . . . .

, 2007).

Transition to civilian family from combat military life

The difficulties experienced by returning soldiers naturally impact all facets of their life (Gabriel & Neal, 2002); thus, intimate relationships are also bound to suffer. Within this area of study, researchers have focused primarily on veterans suffering from PTSD, The unique feature of PTSD is the re-experiencing of the traumatic experience, followed by attempts to numb memories of the trauma and the feelings associated with the trauma. This re-experiencing and numbing cycle is repeated over and over, causing significant problems for the sufferer and those around him or her. PTSD severely impacts functioning across major life domains; among sufferers, unemployment can be increased by approximately 30% and marital instability by approximately 60% (Taft et al., 2007).

As indicated, PTSD often exerts a strong and pervasive negative influence on those around the sufferers (Gottman et al., 2011); thus, especially relevant are the PTSD symptoms that interfere with social relations. Given these effects of PTSD, it is not surprising that combat veterans diagnosed with this disorder appear to be at higher risk for significant relationship problems. Specifically, these individuals tend to be less satisfied with their intimate connections, and their relationships are less expressive, less cohesive, more violent and with more conflict.

Intimacy is a central focus in romantic relationships. A lack of intimacy with one's partner is likely to result in decreases in marital satisfaction as experienced by both partners. Veterans with PTSD appear to experience increased anxiety and discomfort around intimacy, and their partners also exhibit a greater fear of intimacy, perhaps as a result of the problems exhibited by the veteran's distress (Matsakis, 2007; Stecker et al., 2007). Additionally, sexual dysfunction and sexual disinterest among PTSD veterans can be common (Gabriel & Neal, 2002; Gottman et al., 2011).

Researchers have remarked that "injured veterans often struggle with believing that they are still attractive to their partner and that they have the capacity to sustain their relationship" (Westwood et al., 2005) Veterans may conscientiously push away significant others for fear that they may reveal the atrocities they have committed in combat and subsequently lose the love and respect of those they most value (Matsakis, 2007). Thus, it is not surprising that military couples characterized by a PTSD-diagnosed spouse experience more problems in their relationship as a result of difficulties with intimacy (Taft et al., 2007). In contrast, those veterans without PTSD do not tend to experience intimacy issues to the same extent as their counterparts.

Communication factors such as avoidance and emotional numbing have also been linked to lowered levels of relationship satisfaction among veterans and their spouses when PTSD is present (Cook et al., 2004; Shalev et al., 2001). Open communication is vital for success in all close relationships and integral to overall couple satisfaction; if it is lacking, other problems are likely to ensue (Gabriel & Neal, 2002; Gottman et al., 2011). Although the effects of emotional numbing once returned to civilian life are severe, during combat soldiers need to put aside their emotions in order to survive.

Acknowledging feelings would be both personally confusing and life-threatening, as connecting with powerful emotions would lessen the ability of most soldiers to give and take directions (Matsakis, 2007). Thus, although detrimental once removed from combat, emotional numbing serves a life-preserving function while in the military. Of course, when the veteran responds to current (non-combat) non-life-threatening situations by going numb, interpersonal problems are likely to ensue.

Although the veteran may not intend to shut out his or her partner through numbing, the partner usually experiences these behaviours as personal rejection (Matsakis, 2007). In fact, it has been found that emotional withdrawal, more than any other symptom, has influenced wives of PTSD veterans to seek divorce or separation (Gottman et al., 2011). This may be due to the fact that emotional numbing can contribute to relationship distress by impairing emotional engagement between spouses, a factor crucial for maintaining intimacy and resolving marital conflict (Cook et al., 2004; Kennedy et al., 2010).

Combat trauma also greatly reduces verbal involvement (Gabriel & Neal, 2002) and self-disclosure, "the process through which one person expresses his/her feelings, perceptions, fear, and doubts to another, allowing relatively private and personal information to surface" (Taft et al., 2007). According to Taft et al. (2007), PTSD veterans may want to maintain emotional distance from their partners because they may fear they will not be understood (and may even be rejected) if close others become aware of their experiences and their needs. While attempting to reintegrate into civilian life, veterans may feel that their partners have no concept of the change they have undergone, or the difficulties they have endured (Gawande, 2004).

Taft et al. (2007), note that misunderstandings are further exacerbated by the lack of communication. Even nonverbal communication may be reduced, through the avoidance of eye contact, physical touch, and by keeping physical distance from close others. As a result of these negative communication patterns, the veteran's partner may feel rejected, and may resort to decreasing his or her positive interactions with the spouse. The marital communication system thus further becomes characterized by defensive rather than supportive behaviours (Taft et al., 2007).

The effects of intimacy, avoidance, emotional numbing, and self-disclosure may appear to be pervasive over time, with one study finding that these negative behaviours were related to problems in veterans' intimate relationships even 50 years after their involvement in war (Cook et al., 2004). In addition to the distancing behaviours described above, veterans experiencing combat-related PTSD are significantly more likely to display anger and hostility (Howard, 2007; Matsakis, 2007; Westwood et al., 2005).

It appears that veterans with PTSD respond to potential threats in the environment with a heightened anger response (Taft et al., 2007). Specifically, they have "frequent arousal to-anger states, a wide range of anger-eliciting situations, a more hostile attitude towards others, and a tendency to hold anger in and brood" (Campbell et al., 2009). This anger, coupled with other negative patterns, may push both partners to exhibit verbal and nonverbal behaviours that are threatening or punishing to the other, including judgmental responses, attempts to control the other, and expressions of indifference or superiority (Campbell et al., 2009).

The constricted intimacy, lack of self-disclosure expressiveness and limited expression of emotion, add to the marital discord that may be already present. The result is an escalating and recurring pattern of detachment, isolation, conflict, and withdrawal (Gawande, 2004). Anger may be the emotion of choice due to the fact that, while grieving makes one feel weak and helpless, anger makes one feel powerful and full of energy (Matsakis, 2007). Additionally, in the war zone, anger is one of the few emotions that is permitted expression (Westwood et al., 2005). Thus, it Anger problems that are highly correlated with PTSD tend to pose a particular risk for physical abuse similar were observations made by (Taft et al., 2007).

Veterans experiencing increased anger may be particularly likely to enter "survival mode" across multiple situations, resulting in an increased likelihood for engaging in abusive relationship behaviour (Taft et al., 2007). As a result of military training, many veterans are used to reacting violently to any perceived threat. While this quick-action response is essential on the battlefield, it is no longer useful -- and can be very harmful -- upon return to civilian life. Intimate partner violence (IPV) is thus a serious problem in veteran couples (Gottman et al., 2011; Kennedy et al., 2010; Taft et al., 2007; Van de Pitte, 2007) with negative consequences for both perpetrators and victims.

Prevalence rates range widely from 13.5% to 58%, with PTSD contributing to the higher end of this range, and available representative studies have demonstrated that rates of IPV perpetration among military veteran couples are up to three times higher than those found among civilian couples (Westwood et al., 2005). Perceived IPV has been shown to be inversely associated with relationship quality, with those couples perceiving poor marital and relationship adjustment experiencing more IPV (Gawande, 2004; Howard, 2007). It appears that it is the presence of PTSD that is more greatly associated with elevated levels of hostility and physical violence (Howard, 2007), although combat exposure also appears to be influential (Clark et al., 2009).

References

Campbell, T.A., Nelson, L.A., Lumpkin, R., Yoash-Gantz, R.E., Pickett, T.C., & McCormick, C.L. (2009). Neuropsychological measures of processing speed and executive functioning in combat veterans with PTSD, TBI, and comorbid TBI/PTSD. Psychiatric Annals, 39(8), 796-803.

Clark, M.E., Scholten, J.D., Walker, R.L., & Gironda, R.J. (2009). Assessment and treatment of pain associated with combat-related polytrauma. Pain Medicine, 10(3), 456-469.

Cook, J.M., Riggs, D.S., Thompson, R., Coyne, J.C., & Sheikh, J.I. (2004). Posttraumatic Stress disorder and current relationship functioning among World War II exprisoners of war. . Journal of Family Psychology, 18(36-45).

Cozza, S.J. (2005). Combat exposure and PTSD. PTSD Research Quarterly, 16(1), 1-7.

Gabriel, R., & Neal, L.A. (2002). Lesson Of The… READ MORE

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