Indications of a Stress Reaction

A resource guide developed by DAV

After combat, service members demobilize and put away their weapons, turn in their ammunition and body armor and fold away their camouflage. In returning home, they also need to peel off layers of personal and collective behaviors that have protected them from danger and kept them functional and safe during deployments to theaters of military operation.  Developed by DAV (Disabled American Veterans), this resource guide was developed to ensure veterans and their families understand the normal reactions to combat and the need to work on reintegration and readjustment following deployment to a war zone. The stories and tips in this guide will help veterans identify how to reintegrate successfully into family, job and community; how to identify normal difficulties and how to spot the warning signs of illness. It will help you recognize when things are going wrong and identify when to ask for help from family, peers and combat buddies. To learn more about PTSD, click here to read the full guide.

You can identify early indications that you are having a stress reaction if you know what to look for and monitor yourself carefully. Self-monitoring includes seeking and being receptive to feedback from othersaround you.

Some symptoms may be clearly related to a traumatic event you experienced. They could include:

• Not being able to get memories of the traumatic event out of your mind
• Dreams about the event
• Becoming anxious, angry or depressed when you are exposed to cues that remind you of the event
• Feeling guilty about the event

The connection to the past traumatic experience, however, may not be obvious for most of the early behaviors. These symptoms may include actual attempts to NOT remember the traumatic event, such as:

• Avoiding thoughts about that time
• Avoiding people or conversations that may bring it up
• Detaching yourself from others emotionally

Some of the behaviors may be a continuation of ways you reacted that were adaptive at the time of the severe stress but are not adaptive in the present. They could include:

• Always looking for and expecting something bad to happen
• Overreacting to sounds, smells or the benign actions of others
• Having trouble falling or staying asleep

Many of the symptoms are more general in nature. Some are emotional reactions, such as:

• Moodiness
• Sadness
• Feeling tense
• Feeling bored all the time, as if nothing lives up to the excitement of the past
• Short temper
• Inability to feel and express emotions

Some may be changes in how you behave, such as:

• Driving too fast
• Drinking or smoking too much
• Gambling excessively
• Road rage

Some may be changes you notice in your body, such as:

• Weight changes
• Lowered sexual interest
• Rashes
• Headaches

Some may be changes in your thinking abilities, such as:

• Forgetting things
• Trouble concentrating
• Difficulty making decisions
• Lowered self-confidence

Self-monitoring may help you identify these early signs. Often, however, we do not easily recognize them. Those around us, including family, people at work and friends, may notice them first. Therefore, an important part of self-monitoring is to seek feedback from others and to listen, non-defensively, when others give you feedback on things that they notice which may indicate a stress reaction. This can be hard, but it is a potentially critical source of information.

If left unattended, the early signs of stress can grow and, for some, contribute to the development of a serious psychological condition known as post-traumatic stress disorder (PTSD). The symptoms of PTSD are not different in nature from many of the early signs of a stress reaction. They are, however, more persistent and severe. They significantly interfere with important life functions, such as family relationships, other social interactions, work and school.

Symptoms of PTSD include re-experiencing the traumatic event. This can occur in many ways, such as distressing memories, nightmares, flashbacks where you actually feel like you are back in the dangerous situation or feeling intense stress when you are reminded of the event by some external cue. A cue could be a sensory experience like a sound, a smell, humidity, heat, cold, or it could be something visual like a package lying on the side of the road or a helicopter flying overhead. Symptoms of PTSD also include avoiding anything that is associated with the traumatic event or which might remind you of it. This can result in isolating yourself, distancing yourself emotionally from people, avoiding being with people and diminished interest in activities you used to enjoy.

Symptoms of increased arousal are also present, such as feeling irritable all the time, intense anger, feeling on edge—constantly looking for some threat and sleep problems.

In PTSD these symptoms persist for at least one month and may continue for years. As with other stress reactions, the symptoms may occur immediately after the trauma or emerge as significant problems at any time later in life.

PTSD is the most severe form of stress reaction following exposure to a traumatic event, but it is not unusual. It is estimated that about one out of every 15 people will have PTSD at some time during their life. It is, of course, most common in groups of people who are likely to be exposed to severe trauma, such as those who served in a war zone or were exposed to situations with a high probability of sexual abuse or experienced a catastrophic disaster such as a hurricane, earthquake or other life-threatening event. As many as one in five people in these high-risk situations may develop PTSD.

Stories from Veterans

Jessica just accepted a rare assignment as part of an Air Force Security Force. She returned two months ago from a deployment where she was protecting supply convoys from the airbase to frontline units. Early in the deployment, an improvised explosive device (IED) blew up a vehicle in her convoy. Every trip after that was stressful. Her body and mind reacted normally; she was on constant alert. Since coming home, she is unusually irritable, has trouble sleeping, has frequent headaches and is drinking more than ever. She doesn't enjoy things that she used to, and her relationships with family and her best friends are strained. She recognizes that she just hasn't been able to get her foot off the adrenalin-accelerator pedal.

Jeremy served as an infantryman in Operation Desert Storm. His unit saw combat near oil fields in Iraq, and he spent weeks camped downwind from the burning wells. He finished his tour of duty, returned home, studied to become a draftsman and has been working for a major manufacturing company for the past 15 years. During a deep recession, his company suddenly shifted operations overseas. He has been unable to find a comparable position and recently took a part-time job at a large retailer. His daughter is graduating from high school and looking into colleges, but they have spent their family savings. Last week an exhaust pipe on his car fell off. As he drove in heavy traffic, smelling exhaust fumes, he was trying to figure how he'd get money for the car repair. He felt increasingly agitated, and when he got home he turned on the nightly TV news in the middle of a graphic report of a combat scene in Afghanistan. Since then, he's felt overwhelmed.

John was a Navy corpsman in Vietnam. The Marine company he served with took heavy casualties in repeated firefights. John was wounded but returned to his unit. When he came home he and his older brother opened a small pizza shop and restaurant and soon expanded into five sites. They both worked long hours, but John loved growing the business. Whenever his wife complained that he worked too hard, he had a standard response: we'll retire with enough money to travel around the world. Two years ago his brother, who was not only his business partner but also his closest friend, died suddenly of a heart attack. John threw himself even more into the business. Three months ago his wife was diagnosed with cancer. She begged him to retire so they could travel when her treatments were over. He had to agree, he owed it to her. He has started having dreams about his time in Vietnam—vivid, realistic scenes that wake him in the middle of the night. When he can't get back to sleep, he goes for long walks, but the night sounds, even just the quiet, pull his mind back to memories of Marines who died in his arms. He can't believe how accurately he remembers their faces, their voices.

Tom was an 18-year-old Marine when he shipped out to Korea. During that bitter cold winter he saw and experienced things that people in the States never could have imagined. When he came home, no one wanted to talk about the "police action" that had gone sour, and neither did he. Now Tom sits in his room at the assisted living center waiting for his granddaughter to arrive. She's dead set on chronicling the family history. Tom enjoys being interviewed; she's so interested, so organized. He'd skipped over his experiences in Korea, enthralling her with some tales about boot camp and then telling the funny story of how he met her grandmother at a USO Halloween dance the week before he was discharged. But she had done her prep work. Before she left she kissed him and said that next week she wanted to hear about his war experiences. It was ridiculous; Tom had spent the week arguing with himself, unable to make a decision about what to tell her. He could feel his heart thumping, maybe because he had tripled up on his coffee all week. He usually jokes about how bad his memory has gotten, but now here he was, tears running down his cheeks, all over something he could remember but wanted to forget.

DAV is dedicated to empowering veterans to lead high-quality lives with respect and dignity, through providing free, professional assistance to veterans and their families in obtaining benefits and services, providing outreach to disabled veterans and their families, representing the interests of disabled veterans and their families, and providing structure through which disabled veterans can express their compassion for their fellow veterans through a variety of volunteer programs. For more on DAV and its services, visit DAV.org.