SEAVIEW — He had a fear of leaving the house. He didn’t like group settings or crowds. His agoraphobia had become so severe that he didn’t even like going to the grocery store.

    He didn’t pay much attention to hygiene.

    Clothing choices were too much of an effort. He resorted to wearing two layers of thermals at all hours, and his wardrobe consisted of hunting or military camouflage.

    He was depressed. And suicidal.

    This man — a former military serviceman suffering from post-traumatic stress disorder — was the illustration given by Candis Sollars, LCSW, at a public discussion hosted by the Pacific County chapter of the National Alliance on Mental Illness at the Peninsula Church Center last month. Vince Morrison, MSW, was also a presenter at the event that focused on how traumatic brain injuries can impact communication, and the biology and neurology of the anxiety known as post-traumatic stress disorder, or PTSD.

    A daughter and wife of Army war veterans, Sollars’ private practice serves veterans from Tillamook, Ore., to Aberdeen and east to Clatskanie.

    A Vietnam veteran, the man she spoke about was a patient who saw Sollars weekly for three years for anxiety triggered by a pipe bomb explosion at his workplace.

    Morrison and Sollars explained that being witness to or being involved in a vehicle crash, natural disaster, combat or other tragedies can trigger the onset PTSD. Though the anxiety disorder has been a common topic in the media recently, Morrison noted that PTSD is not a new side effect of war, as it has also been called shell shock, combat neurosis, battle fatigue and acute stress disorder.

    According to Sollars, Vietnam-era veterans have “tremendous levels of untreated PTSD,” but there is much more help available for Iraq and Afghanistan vets.

    

The paths to PTSD

    Morrison explained that PTSD occurs when an individual attempts to respond to varying levels of stress in his or her life, either voluntarily or involuntarily, possibly to the point of being “taken out of control.”

    In the case of military personnel, Morrison said that often struggles develop when a soldier returns home and attempts to find meaning and value in the civilian world. But what interferes with their return to civilian life is hypervigilance to perceived threats. Stimuli that remind a person of their former stressors, such as loud noises or certain smells, are called “triggers.”

    There are types of triggers that are unavoidable and can’t be deactivated — the time of day, seasons or atmospheric conditions, work, waking up and going to sleep, eating and drinking — and triggers and are avoidable and may be deactivated, such as where the person lives, the clothing they wear, who they socialize with, sensory choices, the vehicle they drive, the house they live in, and their name.

    How a person deals with triggers can be attributed to the brain’s limbic system, which is responsible for how a person emotionally responds to their memories.

    He referred to the April 2012 issue of Scientific American, where Yale School of Medicine’s Amy Arnsten, Carolyn Mazure and Rajita Sinha explained that the prefrontal cortex — the area of the brain behind the forehead that acts as an emotion and impulse control center — can be sensitive to even the most common anxiety and worry.

    The part of the brain responsible for controlling concentration, planning, decision-making insight, judgment and memory retrieval, new research shows that the prefrontal cortex will sometimes surrender control to other parts of the brain. In response to stress, the amygdala can elevate levels of norepinephrine and dopamine, which weakens the prefrontal cortex’s ability to regulate emotional responses; hunger, sex and aggression habits; and inappropriate thoughts and actions.

    According to Morrison, norepinephrine is adrenaline “crucial to thinking at a pace that an organism can survive.”

    “…In the presence of norepinephrine and cortisol, the amygdala alerts the rest of the nervous system to prepare for danger and also strengthens memories that are related to fear and other emotions,” wrote Arnsten, Mazure and Sinha. They also found that estrogen hormone may amplify a woman’s sensitivity to stress.

    According to the article, this change can result in “paralyzing anxiety” or impulses where one might indulge in excess food, spend money, consume alcohol or abuse drugs.

    

Avoiding perceived threats

    Morrison said impulse control changes often result in the person being impatient, temperamental, distractible, or being assertive or withdrawn from perceived threats. Often a person will try to create balance by seeking out things (or environments) that aren’t triggers.

    In the case of servicemen and women, Morrison and Sollars gave examples of how one suffering from PTSD might act, either consciously — like a Coast Guard swimmer who avoided the ocean — or unconsciously, such as a veteran’s habit of backing his or her vehicle into a parking space, anticipating the moment when they may need to quickly flee from danger.

    In an effort to “treat” their fears, a person may turn to maladaptive behaviors — substance abuse, anger, withdrawing and avoiding, addictions, or obsessions/compulsions. Morrison says these actions may make a person feel as if they are “in control,” but it actually leads to them using bigger and bigger doses — such as more substance abuse or more fixation on obsessions.

    The speakers stated that there is still a stigma attached to PTSD. Sollars said soldiers don’t want to appear as if they can’t pull their own weight or feel as if they’re letting their unit down by accepting PTSD diagnosis and treatment. Some are even fearful that they will be discharged.

    Morrison added that when military personnel return home, the last thing they want to do is spend more time on base than they have to, so they don’t ask for counseling or other anxiety assistance.

    Sollars reported that her patient was able to slowly recover once she was able to figure out what things could get him excited about living life again — and after he realized that he was not expected to live as a soldier anymore. Though she was able to help that particular patient recover, Sollars noted that there is no one treatment that works for every PTSD case, “It’s a very fine line finding those things that work.”

    

Murray weighs in on issue

    In February, U.S. Sen. Patty Murray (D-WA), chairman of the Senate Veterans’ Affairs Committee and a senior member of the Defense Appropriations Subcommittee, ques- tioned Army Surgeon General Lieutenant General Patricia Horoho on recent shortcomings in the Army’s efforts to properly diagnose and treat the invisible wounds of war. Specifically, the senator discussed the forensic psychiatry unit at Madigan Army Medical Center on Joint Base Lewis-McChord that is under investigation for taking the cost of PTSD into consideration when making diagnosing decisions.

    According to Murray’s office, the Army is currently reevaluating over 300 service members and veterans who have had their PTSD diagnoses changed by that unit since 2007.

    Referring to a recent Seattle Times article about the investigation, Murray told Army Secretary John McHugh, “What it shows is that since that unit was stood up in 2007 over 40 percent of those service members who walked in the door with a PTSD diagnosis had their diagnosis changed to something else or overturned entirely.

    “What it says is that over    4 in 10 of our service members — many who were already being treated for PTSD — and were due the benefits and care that comes with that diagnoses — had it taken away by this unit. And that they were then sent back into the force or the local community.

    “Now, in light of all the tragedies we have seen that stem from the untreated, invisible wounds of war – I’m sure that you would agree that this is very concerning.”

    All of this has surfaced in the wake of a civilian massacre allegedly committed by U.S. Army Staff Sgt. Robert Bales in Afghanistan on March 11. Bales, from Joint Base Lewis-McChord, who was armed with a 9mm pistol and an       M-4 rifle at the time of the rampage. He has been charged with 17 counts of premeditated murder and six counts of attempted murder.

    Murray continued, “Not only is it damaging for these soldiers, but it also furthers the stigma for others that are deciding whether to seek help for behavioral health problems.”

    Recently, the Department of Veterans Affairs Inspector General released a report about how long it takes the VA to  complete mental health care appointment for veterans (www.va.gov/oig/pubs/VAOIG-12-00900-168.pdf). Murray plans to hold a hearing on April 25 to seek answers to the problem.

    “This report confirms what we have long been hearing, that our veterans are waiting far too long to get the mental health care they so desperately need,” Murray said in a statement released Monday. “It is deeply disturbing and demands action from the VA. This report shows the huge gulf between the time VA says it takes to get veterans mental health care and the reality of how long it actually takes veterans to get seen at facilities across the country.

    “Getting our veterans timely mental health care can quite frankly often be the difference between life and death. It’s the critical period, not unlike the ‘golden hour’ immediately after a traumatic physical injury. Yet, this report clearly shows that the VA is failing to meet their own mandates for timeliness. Clearly the VA scheduling system needs a major overhaul.  The VA also needs to get serious about hiring new mental health professionals in every corner of the country.”

    NAMI Pacific County has resources and support groups to help anyone who may be suffering from PTSD and other forms of mental illness. For more information, call Rosi at 665-5372 or Kat at 665-6305.

    

    

    

    

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