Psychology

This is a term used to refer to psychological consequences of exposure to or confrontation with quite stressful encounters (Militaryspot.com. 2009). This disorder can occur after life threatening encounters like military combat, natural disasters, incidents of terrorism, dangerous accidents or even violent personal assault like rape. People who survive trauma usually return to normal life after sometimes, though some people develop stress reactions which do not disappear on their own and sometimes may worsen with time.  Such individuals develop post traumatic stress disorder (Swan, 2009). People with this disorder usually experience nightmares, flashbacks, have insomnia, hyper arousal avoid reminders and feel emotionally detached. These signs are detrimental to the victims daily life. The disorder was initially called shell shock, combat fatigue, and even post Vietnam syndrome. It was officially recognized in 1980 that it is a mental disorder (Elias, 2008).
Post traumatic stress disorder has physical and psychological signs which include depression, drug abuse, memory loss, and cognition. Other physical and mental health problems are also experienced. The disorder can also be linked to difficulties in social or even family life like work insecurity, marital issues, family disagreement, and financial problems. Military personnel are likely to suffer from post traumatic stress disorder since the nature of their job exposes them to such threatening conditions like combat, missions which are horrible and have life threatening experiences, being shot at, or even seeing someone dying (U.S. Army War College Library, 2008). Other factors in combat situation can increase the level of stress to an already stressed military officer and this is likely to culminate into PTSD and other related mental ill health (Grinage, 2003). The aggravating factors include what you do in the war, politics surrounding the war, where the war is and the type of enemy you are facing (Overman, 2008).
PTSD in the military is also associated with sexual trauma. This is any sexual harassment or even sexual assault while in the military. It can affect both men and women and most likely at the time of training, peacekeeping, or even at war (U.S. Army War College Library, 2008). Though sexual assault is common in women soldiers, it is reported that more than a half of the veterans with military sexual harassment are men (Science News, 2008).
Background of the disorder in the military
    The psychological impacts of trauma in the military have been described as a long as the military has existed. It was referred to as Da Costa syndrome or even soldier heart which was associated with signs like cardiac signs, hyper reaction and provocation. These symptoms were described in the war veterans of the American civil war. During the World War 1, it was suggested that the syndrome was due to brain damage caused by exploding shells. Later at the time of World War 2, new terms like combat necrosis and operational fatigue were used to describe the symptoms of PTSD. The current knowledge on PTSD was influenced by Vietnam War. The method of diagnosing PTDS was established in 1980, though method of diagnosis proposed was later upgraded (Grinage, 2003).
Military doctors have been wondering why some war fighters exposed to bombing and bloodsheds develop stress while some exposed to the same conditions are never affected. Studies which were conducted on war veterans and civilians provided some insight into this problem. Individuals who experienced childhood abuse have history of mental illness and degrees of trauma have been observed to have increased chances of developing (Swan, 2009). Protection from this disorder can be found by having friends whom you can share with the experience one went through and also developing some coping strategy (Militaryspot.com. 2009).
Technology is currently being employed in detecting early signs of the disorder. Military officers are supposed to undergo a series of physical and mental test before being sent to the field. The tests done also include genetic testing, brain imaging and stress examinations. These tests are carried again in the war fields and also after return from the war zones. There is dire need to detect the early signs of the disorder (Science News, 2008).
PTSD is an incapacitating tension disorder that may cause a lot of suffering and increased use of health resources though the condition most of the time goes unnoticed. The emotional and physical signs occur in three categories which include re- experiencing the pain, serious avoidance of normal activities, and increased signs of hyper reaction (Overman, 2008). Diagnosis of the disorder can only be made after the signs have been observed for more than one month and the effects on the normal activities are noticeable. Majority of the patients with PTSD have experienced some psychological disorder (Elias, 2008). The most common psychological disorder which such people experience includes depression, substance abuse and other nervous disorders. Management of the condition depends on the multifaceted strategy which must constitute supportive patient education, cognitive behavior treatment, and psychopharmacology. Pharmacological therapy involves discriminatory serotonin reuptake inhibitors (Grinage, 2003).
PTSD has not been exhaustively studied in basic health care, though the terrorist attack of September 11, 2001 increased knowledge of the disorder. Now many cases of  can be handled in family practice patients since patients are more than willing to share the information with their doctors and also are aware of the diagnosis (Tull, 2009). Quick diagnosis and proper treatment of these patients can be of great benefit to the patients themselves and the family.
 Epidemiology
It is estimated that the overall prevalence rate of PTSD in the US is a bout 9 and the condition is more common in women as compared to men. Majority of the people show signs which do not qualify to be diagnosed and these signs are commonly observed in groups who are highly predisposed to the condition (Militaryspot.com. 2009). The contributing factors to the disease are directly associated to the traumatic situations. The probability of developing varies with the factors like severity of the trauma experienced, for how long it was experienced, and the nearness of the trauma experienced (Swan, 2009). It is also reported that there is a likelihood of 30 of people who have been exposed to traumatic conditions developing signs of PTSD, though how someone responds to trauma is dependent on severity and personal encounter linked with the trauma.  PTSD in women are always associated with rape and sexual assault while in men it is linked to seeing someone being injured seriously or killing (Elias, 2008).
People who had fallen victims previously are very prone to victimization in future. An individual who has a history of childhood abuse stands a greater chance of developing PTSD in adulthood. There exist a link between mental problems and victimization by assault therefore patients diagnosed with mental ill health have high probability of suffering from PTSD (Science News, 2008). Substance abusers are more likely to be exposed to traumatic situations hence they stand higher chances of developing PTSD. An individual who suffered any behavioral problem before attaining the age of 15 like in patients with antisocial personality problem have high chances of developing PTSD. PTSD is one of the least researched on nervous problem there is some proof that genetic factors may increase the chances of developing PTSD if such a person is exposed to adequate traumatic event.
 Causes
The real cause of PTSD is not known well, most researchers suggest that a subjective inclination is required for the signs to develop after a traumatic encounter. The people who are likely to develop PTSD usually have prior misery or anxiety problem or may even originate from a family with anxiety and neuroticism (Militaryspot.com, 2009). Taking it from the biological point of view, failure of the body to adjust to its original state before the trauma occurred differentiates PTSD from a simple fear. When one is scared, the immediate sympathetic discharge prepares one for either fight or flight reaction (Overman, 2008).
PTSD does not have specific age at which it can develop. The time period at which the signs will be observed is varied and it is affected by nearness, and the degree of the trauma as well as existent of other psychiatric problems (Elias, 2008). The victims personal understanding of the trauma affects the signs observed. For victims who have gone for treatment, the signs may last for about 36 months while those who have not gone for treatment may last for about 64 months. 75 of patients who have PTSD do not heal fully. The conditions prognosis is dependent on how fast one seeks medical attention, early and continuous social support, preventing re-traumatization, and absence of other psychological disorders or drug abuse (Grinage, 2003).

Diagnosis
   
There should be a prior traumatic experience though this is not enough in making diagnosis (Tull, 2009).  The method of diagnosis should specify the factors related to the patients view of the trauma together with the time the effects of associated signs, memory of the traumatic incident and disruption of the usual activities and signs of increased irritability (Swan, 2009). Before diagnosis of PTSD can be made, the signs should have lasted for more than one month and must have resulted in some degree of disruption in the normal activities of the patient. Victims of a traumatic incident who have showed signs of anxiety which lasted for less than a month are said to suffer from a condition known as acute stress disorder. Acute stress disorder requires at least 3 dissociative signs plus constant signs associated with PTSD (Swan, 2009). 
    At times diagnosis of PTSD may prove a bit complicated in the events where the victim cannot relate the connection between the signs and the traumatic incident experienced (U.S. Army War College Library, 2008). Other conditions which may make diagnosis a bit difficult include unwillingness of the patient to reveal the incident, or even the signs observed may be blocked by depression, substance abuse and other factors. History taking should be direct, empathic, and the physician should not attempt to judge the patient. Connecting patients current signs with the trauma which occurred when the victim was still young is not easy (Elias, 2008).
Treatment
    Therapy for patients suffering from PTSD is based on multifaceted strategy. The treatments given include patient education, social support, and nervous management by counseling and psychopharmacology (Science News, 2008). It is very necessary to start with patient education and social support so as to lessen the effect of the traumatic incident. Local and national support groups may be necessary to destigmatize the mental ill health diagnosis and confirm that signs of PTSD entail several reactions to stress and need therapy. Family and friends support encourages appreciation and reception that may eliminate the guilt felt by the victim. The main treatment of PTSD is psychopharmacologic and psychotherapeutic (Overman, 2008).
    Studies have showed that cognitive behavior therapy is successful in eliminating the signs seen in PTSD (Militaryspot.com, 2009). There are various types of cognitive behavior therapy which include cognition therapy, exposure therapy and stress immunization training. The therapies are mainly concerned with ways for patients to approach fear and develop worry management apparatus. The various types of cognitive treatments are uniformly effective when used alone or in combination. Other treatments like group therapy, movement desensitization, and reprocessing action may show some role in the management of PTSD. Though their effectiveness has not been established, cognitive behavior therapy remains the basic method of treating PTSD (Grinage, 2003).
    It is also estimated that about 14 of patients suffering from PTSD do not complete their treatment in psychotherapy. Highest drop out is recorded in exposure therapy and this shows that most of the patients have problems with re-experiencing the trauma (Science News, 2008).  The physician attending to the victim should provide a concrete therapeutic approach with good listening skills and empathic support. If the elimination of the signs of PTSD fails with the initial support and medication, then the victim can be referred to a therapist (Tull, 2009). Since the disorder may result in suffering for the patient as well as the family members, then family and other group treatments may be recommended as a supportive therapy to individual management of the patient suffering from PTSD (Elias, 2008).
    As at now, paroxetine and sertraline are the only drugs that have been recommended by the US food and drug administration for the management of PTSD. These drugs have been found to be successful in the acute management of signs of PTSD. Sertraline has been found to be successful in preventing the return of signs of PTSD. Use of neuroleptics in the management of PTSD is left for research. Patients who show signs of the disorder that are more serious and disturbing are managed using neuroleptic medications. It is noted that these drugs reduce flashbacks and nightmares especially risperidone. Clozapine was also reported to be effective in the management of patients with related psychosis. The use of tricyclic antidepressants and monoamine oxidase inhibitors was found to be moderately effective as compared to placebo. The problem with these medications is serious side effects and this makes them to be considered as the third option when choosing medication for PTSD (Elias, 2008).
Prevention
    Catastrophes like Indian Ocean tsunami may have caused PTSD in the victims and the rescue workers. Currently rescue workers from organizations like Red Cross and Salvation Army have included counseling for the victims of a major catastrophe so as to prevent the development of post traumatic stress disorder (Overman, 2008). In the United States, there is a provision for compensation of victims of PTSD. Most of the war veterans of Iraq and Afghanistan are returning home with serious physical, emotional and relational disturbances and because of this, the United States Marine Corps has established a program that would enable cope with these problems. Also Walter Reed Army Institute of Research established the Battlemind program with the aim of helping service members to avoid or eliminate PTSD and associated disorders (Militaryspot.com, 2009). In the United Kingdom, there has been an outcry that National Health Service is directing veterans on service charities such as combat stress. Veteran affairs Canada provides a new program to the veterans like psychoanalysis, financial payback, deployment, health advantage program, disability awards and family support (Elias, 2008).
    Prevention of PTSD is also possible through early admission to cognitive behavioral treatment in addition to some medication like propranolol though their efficacy is modest. Critical incident stress management has been employed with the aim of reducing the impact of potential traumatic incident and to try to avoid occurrence of PTSD. Studies carried to determine the effectiveness of critical incident stress management proved that it has no tangible efficacy while some indicated that it is aggravating the situation (Grinage, 2003).

    Although the overall incidences of  in the military is relatively low, a substantial increase in the number post traumatic stress disorder if the number of combat troops in war torn regions such as Afghanistan is increased.  Therefore, determining the number of military personnel with symptoms of this disorder may result in reduced burden in the future. Additionally, further research efforts should be aimed at gaining a clear understanding of the vulnerability to PTSD signs among military personnel.