FamilyOfaVet - Real world info about PTSD, TBI, & life after combat
FamilyOfaVet - Real World info about PTSD, TBI, & life after combat.

Understanding Combat PTSD from the Inside, Out

Combat-Related Post Traumatic Stress Disorder (or Combat PTSD) is not just something
that happens to a soldier when they have to kill someone (though that can play a part).  It’s
about what happens, physically and psychologically, inside of a soldier’s brain when they
are faced with weeks, months, and years of constant fear, death, adrenaline, and danger.  
This enormous, prolonged stress literally changes the way their brain looks and functions.   

Physical Changes

HIPPOCAMPUS - The hippocampus is a section of our brain that plays an important part in
short-term memory and the regulation of our emotions.  Researchers, using Magnetic
Resonance Imaging (MRI’s), have been able to determine that the hippocampus of
veterans with PTSD has actually suffered damage.  They believe this damage may be
under stress.

PREFRONTAL CORTEX – Our Prefrontal Cortex helps us decide how we experience and
react to an emotion and resolve conflicts.  It also tells our brain when a threat has passed.  
People with PTSD have altered blood flow to this area of their brain (the more change in
flow, the more severe the
symptoms of PTSD).  This decrease in function causes their
brain to sort of be stuck in a permanent fear mode, because it doesn’t relay the “all clear”

ADRENALINE RESPONSE – When we’re in danger, our brain flips into “fight or flight”
mode, a place where it is primed to decide whether or not we should run or engage a
threat.  Our bodies make two handy hormones that cause this response: noradrenaline
that handles fight, and adrenaline which is responsible flight.  In “normal” brains, these
hormones are released by a current threat (i.e., when someone is standing face to face
with a bear).  But, in a brain affected by
PTSD, these hormones are triggered not by actual
threats but by reminders of threats that occurred months or years before.

GRAY MATTER – The gray matter section of our brain is responsible for processing
information from our body (sensory neurons) and sending information to our body (motor
neurons).  Veterans have 5% - 10% less gray matter after developing PTSD.  This means
their neurons (their communication signals) have been damaged.

Psychological / Mental Changes

HOSTILITY / AGGRESSION – Veterans with PTSD exhibit significantly higher levels of
hostility and aggression than the general public, or even than other soldiers who have
experienced combat.  Since they have lived for a long period of time where they needed to
aggressively react at a moment’s notice in order to stay alive, this way of acting has
become an ingrained habit.  Spouses often joke that it is not safe to wake a sleeping
veteran from anywhere close by.  This is because, when startled awake, the vet can react
with an unbelievably strong amount of aggression because he believes he is responding to
an unknown threat.  On a wider scale, it is very common for individuals with PTSD to get
into fights, drive aggressively, become angry at insignificant things, and drastically
overreact to any sort of challenge.

GUILT – The guilt associated with post traumatic stress disorder is often called survivor’s
guilt.  The veteran feels a great deal of guilt because he survived an attack when a
comrade did not.  He feels guilty  because a friend lost his legs in an explosion while he
remained mostly untouched.  He feels guilty that he is at home in safe surrounding while
others he fought with are in harm’s way.

post traumatic stress disorder are seven times
more likely to be depressed than someone in the general population.  It is one of the most
complaints associated with PTSD.  And, unfortunately, this depression goes hand in hand
with high rates of suicide among our nation’s returning heroes.  As of April, 2010 (the last
time data was published), eighteen of our nation’s heroes were committing suicide each

PARANOIA – In Iraq, a paranoid soldier is a soldier who stays alive.  Every item in his
environment, from a pothole to a child carrying a backpack, must be regarded as a
potential threat.  When that same soldier, whose mind has been changed by PTSD, returns
home, he is often unable to shut off his vigilant behavior.  Veterans will often almost
constantly “patrol” their homes to check for intruders, insist that they sit with their backs to
a wall and facing the door so that they can analyze every person who enters a room, or
even drive off the road in order to avoid discarded trash (because this often indicated an
Improvised Explosive Device or IED in combat).

LACK OF TRUST – This change in a veteran with
PTSD is also caused by his time in
combat.  While in Iraq or Afghanistan he had to assume that everyone he met, even those
who were called allies, were possible enemies.  The only people he knew he could rely on
in order to stay alive were himself and those in his immediate group - people who had
proven themselves to each other in combat.  After that same Veteran returns home, he
feels alone and without the protection of his battle-tested counterparts.  He doesn’t trust
anyone else (even people he’s known for his entire life) to be able to watch out for him.  He
feels that he, alone, is the only one he can count on or trust.     

POOR COPING SKILLS - Due to the physical and mental changes Veteran with PTSD has,
they are often unable to cope in what most people would consider “normal” circumstances.  
They are easily overwhelmed by too much noise, too many people, too many changes, or
too much stimuli of any sort.  Dealing with post traumatic stress disorder and all of its
symptoms takes most of their energy and concentration.  Anything else, especially
something that is unexpected, can cause a violent reaction or simply cause the Veteran to
shut down.

Understanding these changes helps many people understand for the first time just how
“real” post traumatic stress disorder is.  Unfortunately, hidden wounds (like PTSD), are
often hard for people to grasp and empathize with.  Hopefully, after learning more about
the “mechanics” behind
PTSD, you will be better able to talk about PTSD and the real
impact it can have on the life of a Veteran and on those who love and care for him or her.

This article was written by Brannan Vines, the proud wife of an OIF Veteran with TBI and
PTSD and founder of, an organization devoted to helping heroes and
their loved ones survive and thrive after combat by providing real world education and
resources about PTSD, TBI, and other post-combat issues.  You can contact Brannan by e-
mail at brannan -at- or through Facebook at

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