Page 314 - Total War on PTSD Final

The avoidance symptoms of PTSD are likewise extremely conducive to loneliness. Trying to refrain from any reminder of the trauma gradually minimizes Veterans’ social interactions. Among such avoidances one can enumerate avoiding conversations about the trauma, avoiding crowded places, and avoiding social interactions. Often, Veterans’ withdrawal from social life may be attributed to their attempts to avoid reminders or triggers that may reactivate their PTSD. As they engage in avoidance and concealment of their strife, their loneliness’ reign strengthens.
Since loneliness is predominantly interweaved with cognitive and affective phenomena (J. T. Cacioppo & Hawkley, 2009), the alterations in cognitions and mood are central to this experience. Indeed, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA, 2013), “Feelings of detachment or estrangement from others” are examples of this symptom cluster (p. 272). Trauma undermines and disrupts global schemas, such as our view of the world as a safe place, of people being mostly benevolent and ourselves being generally competent, lovable and good (Janoff-Bulman, 1992). Trauma survivors, Veterans included, may lose trust in people and generate a negative view of themselves as part of the meaning-making process that ensues participation in war and the emergence of PTSD. This may exacerbate in cases of moral injury (Litz et al., 2009). Moral injury may be defined as follows:
Disruption in an individual’s confidence and expectations about one’s own or others’ motivation or capacity to behave in a just and ethical manner. This injury is brought about by bearing witness to perceived immoral acts, failure to stop such actions, or perpetration of immoral acts, in particular actions that are inhumane, cruel, depraved, or violent, bringing about pain, suffering, or death of others. (Drescher et al., 2011, p. 9)
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