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Understanding Invisible Wounds: Post-Traumatic Stress

March 2, 2016 by James Kelly, MD
Combat stress is a common experience for military personnel in a war zone and can be seen as a healthy adaptation to the environment. But it may be problematic in a safe environment, such as one’s stateside home or in a restaurant.

This year, the Bush Institute is launching a new initiative to raise awareness about the invisible wounds of war: Traumatic Brain Injury (TBI) and Post Traumatic Stress (PTS).  The health and wellness of post-9/11 veterans is complex and often linked to their service experience. Physical and psychological injuries sustained during combat can affect multiple aspects of a veteran’s transition from the military to civilian life.  Our research indicates that invisible wounds of war pose a significant barrier to continued education, employment, and quality of life.

The Bush Institute will collaborate with experts in veteran health to develop comprehensive recommendations on improving the well-being of post-9/11 veterans.  A major focus of our work will examine how best to ensure veterans seek and receive effective treatment. We also will concentrate on strategies to eliminate barriers to care, including removing stigmas associated with these wounds.

Related

Dr. James Kelly examines traumatic brain injuries. Read more

What is Post-Traumatic Stress/Post-Traumatic Stress Disorder?

Well, there are different types of stress:

  • Traumatic stress is anxiety and other emotional responses to either sudden, intense or unexpected events (combat engagements, bombings, car crashes, rape). They also may come after long periods of experiencing stressful situations (war zone experience, hostage scenarios, domestic abuse).
  • Post-Traumatic Stress (PTS) describes a common human experience of anxiety and distress following life events.
  • Combat stress is a common experience for military personnel in a war zone and can be seen as a healthy adaptation to a potentially life-threatening environment.  For instance, being hyper-vigilant during a dangerous combat exposure is likely quite important and necessary. But it may be problematic in a safe environment, such as one’s stateside home or in a restaurant. 

What are the side-effects of Post-Traumatic Stress?

The common manifestations of PTS(D) are related to the traumatic event and may be in the form of:

  • flashbacks
  • re-experiencing the event
  • re-living the situation

PTS can interfere with normal day-to-day life.  A person may experience strong reactions to routine life events due to heightened levels of stress caused by crowds or a lot of commotion found in grocery stores or concerts.  Even being with family or friends can become difficult as a result of symptoms like exaggerated startle response or angry outbursts over trivial matters.  Sleep disturbance is also common in PTSD and can lead to vivid dreams and nightmares and sometimes lead to violent behavior. 

Some effects of PTS(D) are similar to those of mild Traumatic Brain Injury (TBI), such as difficulty with attention and concentration, moodiness, agitation and others.  However, it is important to identify those problems as a result of the traumatic event to target the underlying cause more effectively. 

There are effective treatment methods for PTS/PTS(D). Counseling can begin on operating bases in the military, or in various settings after a veteran has concluded their service.  Certain medication coupled with the application of “evidence based” PTSD treatment protocols have been shown to benefit as well.


Author

James Kelly, MD
James Kelly, MD

James Kelly, MA, MD, FAAN, a neurologist, is one of America’s top experts on treating concussions.  With 32 years of experience, Dr. Kelly has worked with countless patients with traumatic brain injuries and has researched concussions in athletes and military personnel.  In 2015, Dr. Kelly was named one of the Top Doctors in America in Neurology by Castle Connolly. Dr. Kelly is currently serving as a private consultant and Clinical Professor at The University of Colorado School of Medicine. The Military Service Initiative has engaged the services of Dr. Kelly as Senior Fellow for Wellness to help guide 2016 efforts in support of the Invictus Games and beyond.

Dr. Kelly served as the founder and director of National Intrepid Center of Excellence (NICoE), a Department of Defense institute that provides cutting-edge evaluation, treatment planning, research and education for service members and their families.  NICoE also treats complex interactions of mild and traumatic brain injuries and psychological health conditions, conducts research, and provides clinical patient care. 

His past positions also include assistant dean for graduate medical education at the University of Colorado School of Medicine, and the neurology residency program director at Northwestern University Feinberg School of Medicine.

Dr. Kelly has also served as director of the Brain Injury Program at the Rehabilitation Institute of Chicago.  He was the neurological consultant for the Chicago Bears of the National Football League and is consulted frequently by professional, elite amateur and youth athletes who have sustained concussions.  Kelly co-authored the sports concussion guidelines of the American Academy of Neurology and the Standardized Assessment of Concussion that is widely used in athletic and military settings worldwide.

Dr. Kelly completed a residency at the University of Colorado, internship in neurology at Michigan State University at Kalamazoo, and coursework at Northwestern University Feinberg School of Medicine, and earned a master's degree in psychology at Western Michigan University. He is also certified in neurology by the American Board of Psychiatry and Neurology and is a fellow of the American Academy of Neurology.

Full Bio