Dr. James Bender, DCoE clinical psychologist on December 13, 2012
Dr. James Bender is a former Army psychologist who deployed to Iraq as the brigade psychologist for the 1st Cavalry Division 4th Brigade Combat Team out of Fort Hood, Texas. During his deployment he traveled through Southern Iraq, from Basra to Baghdad. He writes a monthly post for the DCoE Blog on psychological health concerns related to deployment and being in the military.
For most of us, the holidays are parties and food, and a happy time when we reconnect with faith, family and friends. For some, it’s a time of heightened stress. Feeling some stress during the holiday season is normal — keeping track of everyone’s wish lists is one example. However, for combat veterans who recently returned from theater or those diagnosed with posttraumatic stress disorder (PTSD), the holidays can bring special challenges for both them and their family.
PTSD symptoms including nightmares, avoiding situations that remind you of the traumatic event, feeling numb and keyed up at times can make the holidays difficult to manage. While you may be feeling happy and celebratory, your veteran may be feeling detached, lonely and frustrated with the bright lights, loud noises and large crowds. If your loved one has PTSD or recently got back from deployment, here are a few issues you should be aware of that may be troubling for them.
Crowds and Crowded Spaces
Anyone who has ever put off Christmas shopping until the last minute knows about crowds. Lots of people don’t like crowds, but for combat veterans, this has special significance. Service members who go on patrols while deployed are taught that crowded areas make it harder to maintain situational awareness and easier for insurgents to hide. As a result, service members learn to be especially alert when facing crowds. It can be difficult to “unlearn” this response when the service member returns from theater. Extreme anxiety around crowds is a symptom that can improve with treatment, but it takes time. Try to understand if your loved one isn’t thrilled about going shopping with you during this busy time or doesn’t seem happy at the holiday party.
There’s nothing wrong with moderate drinking, but people with PTSD are at-risk for alcohol abuse and dependence. For some, alcohol alleviates PTSD symptoms in the short-term. This makes them more likely to drink again as they seek relief from their symptoms. But alcohol interacts with a common class of PTSD medication called SSRIs, which can lead to impaired coordination, reaction time and judgment (more so than alcohol use alone).
This doesn’t mean everyone with PTSD will be an alcoholic or can’t drink responsibly. If your loved one isn’t drinking to take part in the festivities but is drinking to alleviate symptoms, consider seeking professional help.
Avoidance is a prominent symptom of PTSD. People avoid situations that remind them of their traumatic experience. It can also mean they avoid social interactions in general. While social interactions can be stressful for anyone, they’re especially so for people with PTSD. I’ve had patients describe family gatherings the way I would describe combat missions, complete with descriptions of danger and physical discomfort. Social withdrawal symptoms can be managed with relaxation techniques to reduce anxiety and by having your loved one take a 5-10 minute “time out” during a party — they can walk around the block or step outside for a breath of fresh air. Also, don’t be surprised if your loved one finds social gatherings to be both physically exhausting and stressful.
After reading this you may get the impression that your loved one is incapable of functioning in the world or that you have to go to great lengths to protect them. Don’t feel that way. All it takes to avoid these common problems is some understanding and planning.
For more on this topic, join me for a live Twitter chat from 11:30 a.m. to 12:30 p.m. (EST) Dec. 18, 2012. Follow DCoE or #DocBender to get involved in the discussion. For a closer look at PTSD treatment options, read this blog post.
To all veterans and their loved ones, thank you for your service and kindness. Happy Holidays!