Psychology of Trauma

Combat trauma and PTSD: The impact, risks and protective factors

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Combat related post-traumatic stress disorder (PTSD) is a complex and continuing disorder caused by exposure to a traumatic event (Xue et al., 2014). Treatment of combat related PTSD is a major public health concern (Wangelin & Tuerk, 2014), with an estimated 5 – 17% of serving members returning from operations in Iraq and Afghanistan at risk of developing the disorder (Peterson, Luethcke, Borah, E., Borah, A., & Young-McCaughan, 2011). This recent increased need for services for returning military personnel is in addition to those Vietnam era veterans who continue to be affected (Wangelin & Tuerk, 2014).

Throughout history trauma-related nervous disorders caused by war have had many names and explanations. During WWI, the term ‘shell concussion’ was used to describe soldiers who had been physically injured by exploding shells and developed psychological symptoms, whereas the term ‘shell shock’ was reserved for soldiers who had not experienced a physical concussion, but had the same symptoms. Essentially, they were thought to be weak and not suited to war (Chamberlin, 2012). This stigma surrounding PTSD is still relevant today, with many serving personnel reluctant to seek professional help due in part to a military culture that is inconsistent with showing weakness, as well as career-related concerns and their suitability for future deployments (Creamer, Wade, Fletcher & Forbes, 2011).  

By WWII the term ‘combat fatigue’ had replaced ‘shell shock’ and ‘shell concussion’. Another change was the US militaries introduction of a screening process for all new enlistees. Due to the high economic costs of psychiatric casualties during WWI, the aim of this was to create an army of only brave and strong men who could make it through the war (Chamberlin, 2012). However, despite the screening process, some soldiers still succumbed to the disorder within a short amount of time, whilst others could engage in multiple deployments with seemingly no debilitating symptoms (Dupont-Morales, 2011). What this outcome showed was that in the face of war, all men were vulnerable (Chamberlin, 2012).

In 1980 PTSD was officially recognised as a diagnosable disorder. This was in part driven by Vietnam veterans and their families, who wanted the mental health effects that they had suffered to be documented (Dupont-Morales, 2011). One of the first major studies of combat related PTSD also focused on Vietnam veterans. However, given this study was conducted many years after the war, it wasn’t until the recent conflict in Iraq and Afghanistan that there was an opportunity for the effects of PTSD to be studied immediately after return from deployment, and in the weeks following (Creamer et al., 2011).