Page 43 - Total War on PTSD

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 irritability and anger, causing him/her to want to flee the environment or lash out. Again and again in my office, I have witnessed the phenomenon of Veterans focusing on things that annoy them or make them angry to pull back from their anxiety or vulnerable feelings such as fear, helplessness or uncomfortable primary emotions. I have long surmised that this is an attempt to have some sense of empowerment and escape emotions that they feel are intolerable. Most Veterans will eventually present at my office due to either their overwhelming level of anxiety or anger issues that impact their families, jobs, or functioning in the community.
When fight or flight symptoms occur, they can feel overwhelming to the combat Veteran. Of course, different individuals can experience different levels of symptomatology. Common fight or flight symptoms may include:
• A full feeling in the head due to elevated blood pressure, which can lead to headaches
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