Page 56 - Total War on PTSD

they view as “soft targets.” They will often leave environments when triggering occurs and their anxiety peaks. Some Veterans rarely leave their home at all and become isolated from the world they perceive as unpredictable and dangerous. Even in their homes, they will can have new combat related behaviors and routines, such as always keeping the blinds closed to avoid being seen or targeted, needing everything in their homes in a designated spot (to maintain predictability), “Clearing the house” and repeatedly checking the doors, windows and perimeter for intruders. These, along with many other combat related behaviors, start to affect the Veteran’s quality of life and that of their family members. The family can often start to take on the behaviors of the combat Veteran to accommodate the Veteran’s PTSD, and can lead the family into isolation.
Triggers and Re-experiencing Symptoms:
When combat Veterans are in public places, their anxiety is frequently triggered by stimuli that remind them of their combat experience, either on a conscious or unconscious level, which creates a significant fight/flight physical reaction in them and/or anxiety response. At times the triggers in the environment are clear, such as loud noises, crowds, and people being aggressive towards one another. At other times, however, the triggers are very subtle to the point the combat Veteran is not even aware they are being triggered. For Veterans who have been deployed related to Operation Enduring Freedom (Afghanistan) or Operation Iraqi Freedom (OIF), common triggers can include heat, sewer smells, debris, driving, animal carcasses, and even Middle Eastern individuals. Environments that are unplanned, over-stimulating, or ambiguous are also commonly stressful for Veterans. To give an example of triggering, a combat Veteran who was involved in an IED/bombing was eating Sunchips at the time of the incident. When he returned home from his deployment, he would become highly anxious whenever he went to Subway to get a sandwich, as the smell of Sunchips would instantly trigger his anxiety.
When he came into treatment, he did not understand that that this seemingly benign sensory trigger in his environment was creating a fight/flight response in him related to what had occurred while he was in danger overseas. Like most Veterans who are exposed to triggers, he would become instantly anxious and almost automatically his anxiety would be channeled into
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