The management of post traumatic stress reactions in the military.

Corresponding Author: Surg Lt Cdr J Harrison Department of Community Mental Health Portsmouth, HMNB Portsmouth, Hants. PO1 3LS What is a Post Traumatic Stress Reaction? Given the substantial scientific and media interest in traumatic events, whether civilian or military, natural or man-made it is perhaps understandable that such events are often regarded as being likely to leave a legacy of psychological symptoms. To a degree this is true. There are a variety of psychiatric conditions which can follow traumatic experiences and these have collectively been labelled as Post Traumatic Stress Reactions (PTSR). Whilst Post Traumatic Stress Disorder (PTSD) is undoubtedly a significant component of PTSR it does not constitute the majority of diagnoses subsumed under this heading. Other common PTSR include mood disorders (including clinical depression), anxiety disorders (including phobic and panic disorders), somatoform and sleep disorders in the longer term [1] and acute stress disorders in the immediate aftermath [2]. One common misconception is that a large number of those exposed to traumatic events will initially exhibit normal symptoms of distress and then almost inevitably develop a psychological illness. This is not necessarily the case. Following a traumatic event classical symptoms of avoidance, re-experiencing and hyperarousal commonly occur. Despite this, there is significant evidence to suggest that after the initial distress, approximately 50% of individuals will adapt, that is return to their normal state of functioning, over a period of 3 to 6 months without any formal therapeutic input [3]. Understanding the “normal” responses to abnormal events leads to several relevant points: firstly, not everyone who might be diagnosed as suffering from an Acute Stress Reaction (ASR) [4] or Acute Stress Disorder (ASD) [5] following a trauma will develop PTSD in the long term, although Bryant suggests that up to 75% will do [3]. Secondly, it is not possible to reliably predict those who will go on to long term PTSD from the pattern of symptoms experienced in the acute stages of resolution from the trauma [3]. Finally, there is an ongoing debate about what form of treatment, if any, should be provided to those who are experiencing normal reactions to traumatic events [6].