Afghanistan and Iraq

Post Traumatic Stress Disorder (PTSD) was initially considered as a separate category for the Diagnostic and Statistical Manual of Mental Disorders (DSM) after the Vietnam War. The social, emotional, and psychological problems of the returning war veterans were noticeably similar. The compilation of their information and further research into their symptoms concluded that exposure to life threatening stressors resulted in PTSD. In fact, at the 50th anniversary of Pearl Harbor in Hawaii, questionnaires were completed by veterans of WWII and produced astounding results: those veterans still suffered the symptoms and problems of PTSD. In the days following the return to the United States of WWII veterans, the description of the troubled and traumatized veterans was "shell shocked". The changes in the pre-war soldier were obvious and evident; "shell shocked".

The soldiers fighting in Iraq and Afghanistan face some critical aspects of war that the earlier fighting men and women did not and the WWII veterans faced some critical aspects of war that the Vietnam and Iraqi war veterans do not face. That being said, modern warfare in the Middle East has some unique stressors that impinge upon the psyche and emotional stability of the modern soldier.

Upon returning to the United States the soldier who suffers from PTSD might first contact his or her primary care physician with physical complaints resulting from their war trauma and PTSD is not an easily recognizable diagnosis outside the mental health providers or the Veterans Administration Hospital facilities. A study conducted by Magruder et al(1) showed that out of 746 veteran patients 40 patients out of 86, who met the DSM-IV criteria for a PTSD were diagnosed with PTSD.

Stressors of Modern Warfare

The American soldiers stationed in the Middle East are exposed to many stressors that are unique to modern warfare. The following stressors may or may not contribute to PTSD depending upon the individual and his or her distinct experiences:

• combat exposure: firing weapons and being fired upon; danger of death or severe injury; exposure to the death of fellow soldiers and/or other individuals; exposure to the destruction of communities and those who live there

• anxiety and fear associated with sustained exposure to life threatening situations

• fear of exposure to chemical, biological, and radiological and the long-term health problems associated with that exposure

• continued exposure to difficult working conditions, a foreign culture, extreme weather conditions, unfamiliar and strange foods, and poor living arrangements

• sexual harassment

• terrorist tactics which make it difficult if not impossible to identify suicide bombers from civilians

• potential abuse or execution if captured

1. Magruder KM, Frueh BC, KnappRG, Davis L, Hamner MB, Martin RH, et al. Prevalence of posttraumatic stress disorder in Veterans Affairs primary care clinics. Gen Hosp Psychiatry 2005;27:169-179.