Page 310 - Total War on PTSD

and trepidation all come gushing in as if one is actually there. As Veterans return to the battle, they dissociate from the engagements of the here-and-now, and become engulfed in a world of their own. Not only does this set them away from social interactions, but it is itself beyond description. Whether triggered by the coincidental shatter of a glass in a restaurant or otherwise waking up in the middle of the night, screaming and howling, covered with sweat from the nightmares that haunt their sleep, these are very lonely experiences.
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
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