The military often involves extremely high exposure to stress and traumatic events. A 2020 study of the men and women who have spent time in a war zone as military, contracted civilians, reporters, or aid workers, revealed that around 83% go on to experience some degree of PTSD (Statista, 2024).
Stress disorders are complex somatic, cognitive, affective, and behavioral consequences of psychological trauma. Stress disorders are caused by experiencing, witnessing, or being confronted with an event involving significant injury, death, or threat to the physical integrity of that person or someone close to them. These events are accompanied by a response involving helplessness, intense fear, or horror.
Intrusive thoughts and feelings characterize PTSD, and there are often nightmares and flashbacks of past traumatic events, desires to avoid reminders of the trauma, and the presence of hypervigilance and sleep disturbances. All of these can lead to considerable occupational, social, and interpersonal dysfunction.
It has been shown in assorted studies that a direct relationship can be observed between the severity of a traumatic event and the risk of developing a stress disorder. Prior exposure to repeated traumatic events and such factors as the event's duration, severity, and proximity may also contribute to the degree of stress the individual experiences.
Table 6. Events Often Associated with PTSD Onset- Military combat.
- Terrorist attacks.
- Violent physical assault.
- Severe physical injury.
- Life-threatening illness.
- Severe motor vehicle accidents.
- Negative media saturation.
| - Natural Disasters.
- Serious accidents.
- Sexual assault.
- Incest.
- Childhood sexual abuse.
- Observing or learning about a traumatic event.
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The initiating events associated with PTSD are the same as in acute stress disorder. PTSD may be considered an extension of acute stress disorder and has acute, chronic, or delayed subtypes.
Acute PTSD typically lasts three months or less, while chronic PTSD symptoms last longer than three months. In delayed-onset PTSD, the symptoms that characterize the condition tend to be unnoticed for at least the first six months following the traumatic event, creating a time-lapse that may make linking the symptoms with an initiating event tricky to isolate.
Table 7. Definition Time“Complex” PTSD or CPTSD is a newer term used interchangeably for both delayed-onset PTSD (symptoms taking longer than six months to manifest) and the all-to-common ‘hard to diagnose’ disorders that spew a spread of symptomatology across the spectrum of emotional/behavioral/cognitive functioning.
Be aware that CPTSD is not in the DSM-5 but is listed in the World Health Organization’s (WHO) International Classification of Diseases, 11th Revision (ICD-11). The term was developed in the 1990s during research for “Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM-IV Field Trial for Post-traumatic Stress Disorder.” Whether CPTSD arrived too late to make the DSM-5 revision or failed to gain enough support during the cavalcade of expert-led committees delegated to determine version five contents is unknown. What is important is that the undefined term of CPTSD is commonly used, so be aware of it.
Disorders of Extreme Stress Not Otherwise Specified (DESNOS) is another term commonly used.
CPTSD or DESNOS can be argued as being used incorrectly, or at least unnecessarily, for both of its primary uses (delayed and complicated forms of PTSD). - PTSD, with an onset more than six months from the trigger incident(s), is known in the DSM-5 as Delayed Onset PTSD.
- PTSD with complicating factors may be referred to as DESNOS.
One last word about DESNOS (and the term CPTSD when/if it is used for complex cases): DESNOS all too frequently is birthed from severe, protracted abuse, most notably childhood sexual abuse, victims of torture, or living in a war zone. |
| (Gore, 2024a; Morales-Brown, 2023) |
Research into identifying and treating stress disorders has led to recent changes in diagnostic criteria. In the recently released DSM-5, greater focus is placed on the behaviors that accompany PTSD. Four distinct clusters or groupings of behaviors are proposed as significant indications for diagnosis.
This can be demonstrated by reckless, aggressive, self-destructive behaviors. Sleep disorders, hypervigilance, and the formation of protective habits such as always sitting with a back to the wall, sleeping facing a locked door, etc., are all examples of arousal. Please note that current diagnostics emphasize an element of avoidance or flight from traumatic reminders. A strong flight response or reaction is also typical of the arousal behaviors of stress disorders.
In addition to the presence of key behaviors are three conditions or criteria that aid in diagnosing PTSD. These three criteria are:
- The duration of symptoms for the person has been longer than one month.
- The disturbance causes significant distress or impairment in that individual's functioning.
- The disturbance is not attributable to the effects of a substance or other medical conditions.
While no physical diagnostic tests can readily catch a stress disorder's presence, there are physical signs to notice. The presence of poor hygiene or poor personal appearance, in general, can be a tip-off to poorly functioning cognitive processes. The presence of unexplained bruises or injuries, such as bruised or lacerated knuckles from punching inanimate objects, and indications of fatigue from poor sleep may indicate difficulties. Heightened startled responses to sudden noises or shadows may be clues as well.
Mental status checks can also be helpful, as an orientation to person and place can be affected by stress disorders. Not knowing the current time or date may reveal where an individual’s internal attention is focused. The area most affected by stress disorders such as PTSD is memory. Reports of forgetfulness, particularly in details associated with a specific traumatic event, are frequently reported. Poor concentration with pressured or abnormally slowed speech may also be an indicator. Mood changes are common with stress disorders, as are feelings of generalized nervousness, fear, anxiety, guilt, and depression.
Please be alert for suicidal thoughts or feelings when PTSD is suspected. Changes in mood and struggles with core beliefs brought about by an intense trauma can be difficult for an individual (table 8). A small percentage of stress disorder clients may also become homicidal during the difficulties of dealing with delusional feelings, new phobias, hallucinations, and reliving experiences during flashbacks.
Table 8. Core BeliefsCore beliefs are the foundational bedrock of our minds. They are the fundamental beliefs about our world, ourselves, and everything around us by which we measure all experiences.
Core beliefs form the rules by which we perceive and interpret what is happening all around us.
Core beliefs typically bypass conscious thought and operate outside an individual’s perceptions. |
| (Schaffner, 2024) |
