Soldiers Face Stresses of War

There is compelling evidence that a combat stress injury can actually be a physical one; that the damage to these areas of the brain causes a disruption in both the natural balance that these areas provide one another and a resultant disruption in the neurotransmitters released. The manifestations include many of the symptoms of a combat stress injuries or PTSD, including aggression, anger, irritability, depressed mood, anxiety, paranoia, sleep disregulation, and exaggerated startle response.

Most researchers believe that these physical injuries are capable of healing over time and with treatment. However, the very nature of PTSD includes the fact that a traumatic memory is involved. No matter how much chemical and/or cognitive/behavioral therapy is used to help the patient manage his symptoms and reclaim his life, the memory will always be with him. Symptoms can be triggered throughout life by a variety of stimuli. Current, evidence-based treatments for PTSD include a discussion about triggers and relapse of symptoms based on triggers.

With good treatment in a safe environment, veterans with combat stress injuries should recover to the point that they do not experience daily disability and/or dysfunction. But since the underlying cause of the condition will be life-long, they need to develop insight into their own experience of the memories, and in how to re-engage in the recovery process throughout the rest of their lives.

Susan,

The research studies I have read indicate that prolonged exposure to severe, traumatic/threatening situations produces changes in brain functioning in the areas of the Prefrontal Cortex (PFC) and the Hippocampal (HC) region. The PFC is involved in regulating responses to fear and inhibiting emotional response. The HC region is involved in long term memory storage, new learning, and, to a lesser extent, memory and emotional processing. When a human is exposed to a life threatening situation, the Fight or Flight response takes over. If it didn't, we wouldn't last as a species. This means the PFC takes a back seat. Typically, after the threat is over, the brain and body return to normal. The brain remembers the threat and the effective response, and then goes about its business. However, after prolonged exposure to threatening situations (like combat) the brain continues to operate in a fight or flight mode. This decreases blood flow to the PFC and impacts the brain's ability to process the trauma to long term memory (the role of HC). This leaves the brain in a "hair trigger" mode of operation, all of the time. The brain operates as if always under threat (even when it is not). The decrease flow of blood and nutrients to the PFC and HC results in a decrease in functioning, and, in the case of HC, studies indicate that it shrinks in volume. The soldier may feel always on edge, angry and hyper-aroused. Sleep is poor, so exhaustion adds to the brain's struggle to maintain a logical and focused grip (also a function of the PFC and frontal lobe).

I have seen no studies that indicate the impact to brain function is permanent. To the contrary, the brain can be retrained/recalibrated to deal with traumatic memories without defaulting to a fight or flight mode. That is what we do in therapy. I have seen no studies that indicate the brain is permanently damaged. The brain can reverse a considerable amount of damage by compensating and generating new brain tissues. Like any body insult, the more severe the damage, the longer and more difficult the rehab. However, the vast majority of soldiers can and have returned as functioning members of society.