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Warzone-Related Stress Reactions: What Families Need to Know

By: the National Center for PTSD

Military personnel in war zones frequently have serious reactions to their traumatic war
experiences. Sometimes the reactions continue after they return home. Ongoing reactions to war zone fear, horror, or helplessness connected with posttraumatic stress and can include:

• Nightmares or difficulty sleeping
• Unwanted distressing memories or thoughts
• Anxiety and panic
• Irritability and anger
• Emotional numbing or loss of interest in activities or people
• Problem alcohol or drug use to cope with stress reactions

How Traumatic Stress Reactions Can Affect Families

Stress reactions in a returning war veteran may interfere with the ability to trust and be emotionally close to others. As a result, families may feel emotionally cut off from the service member. The veteran may feel irritable and have difficulty with communication, making him/her hard to get along with. He or she may experience a loss of interest in family social activities. The veteran may lose interest in sex and feel distant from his or her spouse. Traumatized war veterans often feel that something terrible may happen “out of the blue” and can become preoccupied with trying to keep themselves and family members safe. Just as war veterans are often afraid to address what happened to them, family members also may avoid talking about the trauma or related problems. They may avoid talking because they want to spare the veteran further pain, or because they are afraid of his or her reaction. Family members may feel hurt, alienated, or discouraged because the veteran has not overcome the effects of the trauma and may become angry or feel distant from the veteran.

The Important Role of Families in Recovery

The primary source of support for the returning soldier is likely to be his or her family. Families can help the veteran avoid withdrawal from others. Families can provide companionship and a sense of belonging, which can help counter feelings of separateness and difference from other people. They can provide practical and emotional support for coping with life stressors. If the veteran agrees, it is important for family members to participate in treatment. It is also important to talk about how the post-trauma stress is affecting the family and what the family can do about it. Adult family members should also let their loved ones know that they are willing to listen if the service member would like to talk about war experiences. Family members should talk
with treatment providers about how they can help in the recovery effort.

What Happens in Treatment for PTSD

Treatment for PTSD focuses upon helping the veteran reduce fear and anxiety, gain control over traumatic stress reactions, make sense of traumatic experiences, and function better at work and in the family. A standard course of treatment may include:

• Assessment and development of an individual treatment plan.
• Education of veterans and their families about posttraumatic stress and its effects.
• Training in relaxation methods, to help reduce physical arousal/tension.
• Practical instruction in skills for coping with anger, stress, and ongoing problems.
• Discussion of feelings of anger or guilt, which are common among survivors of war trauma.
• Detailed discussion to help change distressing beliefs about self and others (e.g., self-blame).
• If appropriate, careful, repeated discussions of the trauma (exposure therapy) to help the service member reduce the fear associated with trauma memories.
• Medication to reduce anxiety, depression, or insomnia.
• Group support from other veterans, often felt to be the most valued treatment experience.

Mental health professionals in VA Medical Centers and community clinics and Readjustment Counseling Service Vet Centers have a long tradition of working with family members of veterans with PTSD. Educational classes for families and couples counseling may be available. Family members can encourage the veteran to seek education and counseling, but should not try to force their loved one to get help. Family members should consider getting help for themselves, whether or not their loved one is getting treatment.

Self-Care Suggestions for Families

• Become educated about PTSD.
• Take time to listen to all family members and show them that you care.
• Spend time with other people. Coping is easier with support from caring others, including extended family, friends, church, or other community groups.
• Join or develop a support group.
• Take care of yourself. Family members frequently devote themselves totally to those they care for, and in the process, neglect their own needs. Watch your diet, exercise, and get plenty of rest. Take time to do things that feel good to you.
• Try to maintain family routines, such as dinner together, church, or sports outings.

Additional Resources

For more information about PTSD and treatment, visit the National Center for PTSD website at