Working with Patients Coping With PTSD

In hospice care, it’s not uncommon to work with combat veterans and those who have served in the U.S. Armed Forces, so it’s important to understand that some may be coping with the effects of Posttraumatic Stress Disorder (PTSD). The better you understand PTSD, the better prepared you will be to treat these patients.

Combat veterans have lived through events that most people can’t understand. They and their friends were in danger. Life in the war zone was very different from life at home. Their daily routine could be interrupted by intensely stressful and chaotic events. In fact, they’ve likely been in or seen life-threatening situations. And they had to hide their feelings and reactions to stress. Now they’re home. Even though they’re safe, something’s not right. They may have nightmares. Or unwanted memories of combat are popping into their head unexpectedly, sometimes triggered by a sound or smell. They may feel anxious, angry, scared, guilty, or isolated. And the feelings won’t go away. These are signs of PTSD.

What is PTSD?

PTSD is a state of heightened fear and anxiety. It develops after a traumatic, life-threatening event. It’s normal to react to danger with fear and anxiety. But these feelings should fade after the danger has passed. With PTSD, someone’s body and mind have trouble recovering from the trauma. The feeling that you’re in danger can remain for months or even years. Military combat is a common cause of PTSD.

How does PTSD feel?

Symptoms of PTSD last more than a month. They may include:

• Unwanted or intense memories of a trauma
• Nightmares
• Vivid memories (flashbacks) that make you feel like you’re reliving the event
• Feeling worried, fearful, anxious, or suspicious
• Strong reactions when you’re reminded of the trauma (or sometimes for no obvious reason at all)
• Intrusive thoughts about combat, death, or killing
• Feeling disconnected or isolated, as if you’re “not yourself”
• Loss of interest in things you once enjoyed
• Feeling agitated, tense, on edge, or easily startled
• Bursts of anger or irritation
• Problems concentrating
• Trouble falling or staying asleep

What are triggers?

With PTSD, things that remind you of the traumatic event can make you feel as if you’re in danger again. These reminders are called triggers. They bring back memories, emotions, and physical reactions related to the trauma. In some cases, a trigger is obvious. The sound of thunder may recall gunfire. Or you may see debris on the side of the road and suddenly flash to a roadside bomb. Other times, the link is less clear. For example, a trigger could be the taste or smell of food that was common where you were deployed. Or hearing a voice that sounds like someone you served with can trigger memories. Triggers can even appear in your dreams, causing you to react while you’re asleep.

PTSD can interfere with life

Though they’re safe now, PTSD can make someone feel as if they’re in danger. When your brain senses danger, your body acts before you have time to think. When they encounter a trigger, they may suddenly become angry or afraid. Their body is flooded with anxiety and adrenaline. They may react extremely quickly. They may not even remember the trigger. This can lead to outbursts and behaviors that seem to have come “out of the blue.” When you have PTSD, you may:

• Stay away from triggers such as people, places, and things that remind you of the trauma.
• React strongly to reminders of the trauma (such as TV news reports about war or conversations with others in the military).
• Constantly scan your surroundings for signs of danger.
• Put yourself at risk with sudden reactions to a perceived threat (such as veering to avoid an overpass while driving).
• Abuse alcohol or drugs so you don't think about the trauma (self-medicating).
• Change your routine to stay away from triggers.

Treatment will help you get your life back

They may think that asking for help is a sign of weakness. In fact, taking action to make their life better takes a lot of courage. Talking about a trauma can be hard, but it can make a big difference. The main treatment for PTSD is counseling. They can work with a trained professional (therapist) to learn new ways to cope with their experiences. Medicine may also be prescribed to help with anxiety, depression, or sleep. Most people with PTSD benefit from a combination of counseling and medicine.

What lies ahead

In combat, some Veterans have been through significant, life-changing events. These will likely affect them to some degree for the rest of their life. Even so, getting help is a big step in the right direction. Though many people can’t relate to their time in combat, they don’t have to face PTSD alone – and the better you understand where the patient is coming from, the more effective you may be in treating them. Encourage the patient to accept help and support from family, friends, and other health care providers. Encourage them to stay connected with friends from the military. There are likely more people who can understand what they’ve been through than they think.

To learn more and offer resources to Veterans:

For more information and resources, contact the Veterans Crisis Line at 800-273-8255 or online at www.veteranscrisisline.net. You can also text 838255 for support. You don't have be enrolled in VA benefits or health care to connect to this support.

If you’re thinking about hurting yourself

Ask for help now. There are many ways to ease your pain and manage the problems in your life. Talk to your health care provider, your Veterans Administration (VA) suicide prevention coordinator, or a friend or family member right away. Don't wait.

If you have a plan or are thinking of harming yourself, call 800-273-8255 and press 1 to connect to the Veterans Crisis Line. Or text 838255 from your mobile phone. You will be connected to trained crisis counselors who will help you. An online chat option is also available at www.veteranscrisisline.net. The Veterans Crisis Line is free and available 24/7. You can also call or text 988 to be connected to crisis counselors at the National Suicide Prevention Lifeline.