Below is a list of information currently available from the National Center for PTSD on war. For more information, click on the related links and/or search the PILOTS database for a more complete listing of articles available on this topic.

The Iraq War Clinician Guide, 2nd Edition

The Iraq War Clinician Guide was developed by members of the National Center for PTSD and the Department of Defense. It was developed specifically for clinicians and addresses the unique needs of veterans of the Iraq war. For the complete PDF click Iraq War Clinician Guide, 2^nd Edition. You can also download individual chapters by clicking on the chapters below.

Information for the Public

On Line Resources

Personal Emergency Preparedness Brochure from the Department of Veterans Affairs

The Family Deployment Guide by Department of the Army, Headquarters, 88th Regional Support Command, 506 Roeder Circle, Fort Snelling, MN 55111-4009

Fact Sheets

A brief guide to recognizing the symptoms of stress and managing traumatic stress

10 common reactions to trauma are descibed by Edna B. Foa, Elizabeth A. Hembree, David Riggs, Sheila Rauch, and Martin Franklin

Describes how trauma and PTSD can have significant effects on relationships with others

Information about the impact of PTSD on alcohol use and dependence, which commonly occur in tandem with PTSD

Military Medicine

Military Medicine Special Supplement on the Mental Health Response to the Pentagon Attack on 9/11 Vol 167 Supplement 4

AMSUS has established this site on the World Wide Web as an easily accessible resource for our members and any others with an interest in Federal Healthcare.

Advice/Information about Self and Family Care

Answers to some questions about PTSD and service-connected disability that are frequently asked by veterans and their families

Provides information for PTSD survivors about positive techniques for dealing with PTSD

Gives information about the effects of PTSD on family members and how to cope with the effects

A checklist to help one discuss traumatic stress disorder symptoms with primary care physicians

An overview of recent research that confirms that trauma and PTSD affect physical health

Describes the links between trauma and anger and provides treatment strategies for anger management.

Information for Professionals

On Line Resources

Reviews of the literature on war-related PTSD

Schnurr, Paula P; Aldwin, Carolyn M. Encyclopedia of adult development, Oryx Press, 1993, pg 351-356

Curran, Erika. National Center for PTSD Clinical Quarterly, 997, vol 7, iss 2, pg 30-33

Schnurr, Paula P; Friedman, Matthew J; Bernardy, Nancy C. Psychotherapy in Practice, 2002, vol 58, iss 8, pg 877 - 889

Clinical Information and Advice on Early Intervention

Identifies the core issues in early intervention that need to be addressed in resolving the debate over psychological debriefing (PD). It critiques the available evidence for PD and the early provision of cognitive behavorial therapy.

Describes the issues commonly encountered in individuals with Acute Stress Disorder or early traumatic stress, which must be carefully addressed in considering treatment options for these individuals.

Recommendations for health care professionals written by Holly Prigerson, PhD and Selby C. Jacobs, MD, PhD that appeared in the Journal of the American Medical Association.

Following a traumatic event or disaster, it is frequently necessary to notify family members of the casualty or death of a loved one. This fact sheet is a cirriculum on compassion casualty/death notification for professional counselors and victim advocates

Friedman, Matthew J; Schnurr, Paula P; McDonagh-Coyle, Annmarie. Psychiatric Clinics of North America, 1994, vol17, iss 2, pg 265 -277

PTSD in Primary Care

Schnurr, Paula P; Jankowski, M. Kay. Seminars in Clinical Neuropsychiatry, 1999, vol 4, iss 4, pg 295-304

Web link to on-line Continuing Education course for physcians, nurses, and other health care professionals.

Caulfield, Marie B; Prins, Annabel. National Center for PTSD Clinical Quarterly, 1999, vol 8, iss 2, pg 31

Outreach to Veterans

McFall, Miles E; Malte, Carol; Fontana, Alan; Rosenhack, Robert A. Psychiatric Services, 2000, vol 51, iss3, pg 369-374

Website links

Website links related to children

How Terroristic Acts May Affect Veterans

A National Center for PTSD Fact Sheet

By Candice Monson, Ph.D.

What might veterans experience as a result of terroristic acts?

Veterans, like other individuals, respond to traumatic situations in a variety of ways. They feel concern, anger, fear, and helplessness, which are all normal responses to an abnormal event. However, research indicates that people who have previously survived traumatic events may be particularly sensitive to the effects of later traumatic events such as terroristic acts and war. In general these events can cause a range of symptoms from general distress to an increase in PTSD symptoms, irritability, anger, alcohol and substance use, sensitivity to military stimuli, sleep disturbance, and avoidant/phobic reactions. Some individuals might anticipate and prepare for the worst possible future circumstances so they are not retraumatized by a subsequent shock. Studies of a recent American terroristic situation and of a recent military situation have provided information about some of the effects such events have on veterans.

Following the Oklahoma City bombing, some veterans of World War II, the Korean War, and some of those in the war during the Vietnam era reacted by experiencing the following more than they had before the bombing:

o More frequent military and homecoming memories

o Depressed mood

o General distress

o Posttraumatic stress disorder symptoms

Veterans with posttraumatic stress disorder may be particularly susceptible to reactivation or a worsening of their PTSD symptoms if reexposed to military situations.

During the Gulf War:

o Vietnam veterans followed media coverage of the Gulf War closely and reported that the coverage brought back thoughts and feelings of Vietnam.

o The reactivation or worsening of PTSD symptoms experienced by some veterans may have been related to similarities in the traumatic experiences (e.g., planes were a major part of both events). Situations that have high emotional or symbolic value, such as veteran gatherings or American symbols, also can reactivate or worsen PTSD symptoms.

How can veterans take care of themselves when current events cause distress?

Below is a list of potentially helpful strategies that veterans with or without PTSD can use to help them cope during periods of disaster.

For Yourself

· Consider limiting your exposure to television coverage. While watching television coverage of terroristic or military action may be compelling, increased viewing can raise stress levels. Monitor yourself for signs of anger, rage, depression, anxiety, etc., and take a time-out from the coverage to allow yourself to recover from these feelings.

· As much as possible, keep up with daily schedules and routines. Try to incorporate positive activities into your day, even for brief periods of time.

· Keep up with your physical needs relating to exercise, food, and sleep.

· Feel what you feel. It is normal to feel a range of emotions. Having these feelings is to be expected; how you deal with them is most important.

· Slow down and give yourself time and space to deal with what has happened.

· Remember that people have their own pace for dealing with traumatic incidents, and it is important to listen to and honor your own pace.

· Count on feeling angry, but temper your actions with wisdom. Try to stay calm and avoid reacting with impulsive anger toward any group or persons. Consider the long-term consequences of these actions for the overall benefit of the country.

· Talk with someone close to you who might understand what you are going through.

· Studies suggest that if you do not feel like talking, writing in a journal may be helpful for dealing with intense feelings.

· While it may feel more natural to avoid other veterans as a way to avoid reminders of military involvement, studies show that seeking support along with other veterans can be very helpful when stress is increasing. This can be done through the VA, Vet Centers, and veteran's service organizations.

· Seek assistance from your medical doctor or a mental-health professional who is skilled in working with survivors of trauma if:

o You are experiencing any symptoms that are causing significant distress, causing significant changes in relationships, or impairing functioning at work

o You are self-medicating with alcohol or drugs

o You are unable to find relief using the strategies listed above

For further information and online sources of support, see fact sheets for Veterans, Seeking Help for PTSD, or Self-Care following disasters.

For Children in Your Life

· Honestly and openly answer any questions that children in your life may have. Safety is of primary concern for them. Reassure them that adults are working hard to make society safe.

· During this traumatic time, kids will be looking to adults to help them understand and cope with their feelings. Be a positive role model for them by showing them how you are able to handle this national crisis.

For further information and online sources of support, see fact sheets on Relationships, Family, and Terrorist Attacks and Children.

For Your Community

· Support your neighbors, friends, family members, and fellow veterans.

· Talk to others whom you trust. Talking can help you process painful feelings.

· Expect that you may have fantasies of revenge. Try to transform these feelings by contributing to support efforts in a positive way (e.g., donate blood, give money to the Red Cross, volunteer, donate to a food bank). Encourage others to do the same.

· Avoid blaming people whom you may associate with a particular religious or ethnic group. Rather than decreasing distress, depression, and other PTSD symptoms, increasing anger toward and blame of others has been shown to increase veterans' debilitating symptoms.

· Try to join together, demonstrate patience, and help other Americans in times of hardship.

All information contained on these pages is in the public domain unless explicit notice is given to the contrary, and may be copied and distributed without restriction.

For more information call the PTSD Information Line at (802) 296-6300 or send email to ncptsd@ncptsd.org. This page was last updated on Thu Dec 18 16:17:22 2003.

A National Center for PTSD Fact Sheet

Why is anger a common response to trauma?

Anger is usually a central feature of a survivor's response to trauma because it is a core component of the survival response in humans. Anger helps people cope with life's adversities by providing us with increased energy to persist in the face of obstacles. However, uncontrolled anger can lead to a continued sense of being out of control of oneself and can create multiple problems in the personal lives of those who suffer from PTSD.

One theory of anger and trauma suggests that high levels of anger are related to a natural survival instinct. When initially confronted with extreme threat, anger is a normal response to terror, events that seem unfair, and feeling out of control or victimized. It can help a person survive by mobilizing all of his or her attention, thought, brain energy, and action toward survival. Recent research has shown that these responses to extreme threat can become "stuck" in persons with PTSD. This may lead to a survival mode response where the individual is more likely to react to situations with "full activation," as if the circumstances were life threatening, or self-threatening. This automatic response of irritability and anger in individuals with PTSD can create serious problems in the workplace and in family life. It can also affect the individuals' feelings about themselves and their roles in society.

Another line of research is revealing that anger can also be a normal response to betrayal or to losing basic trust in others, particularly in situations of interpersonal exploitation or violence.

Finally, in situations of early childhood abuse, the trauma and shock of the abuse has been shown to interfere with an individual's ability to regulate emotions, which leads to frequent episodes of extreme or out of control emotions, including anger and rage.

How can posttraumatic anger become a problem?

Researchers have described three components of posttraumatic anger that can become maladaptive or interfere with one's ability to adapt to current situations that do not involve extreme threat:

* Arousal: Anger is marked by the increased activation of the cardiovascular, glandular, and brain systems associated with emotion and survival. It is also marked by increased muscle tension. Sometimes with individuals who have PTSD, this increased internal activation can become reset as the normal level of arousal and can intensify the actual emotional and physical experience of anger. This can cause a person to feel frequently on-edge, keyed-up, or irritable and can cause a person to be more easily provoked. It is common for traumatized individuals to actually seek out situations that require them to stay alert and ward off potential danger. Conversely, they may use alcohol and drugs to reduce overall internal tension.

* Behavior: Often, the most effective way of dealing with extreme threat is to act aggressively, in a self-protective way. Additionally, many people who were traumatized at a relatively young age do not learn different ways of handling threat and tend to become stuck in their ways of reacting when they feel threatened. This is especially true of people who tend to be impulsive (who act before they think). Again, as stated above, while these strategies for dealing with threat can be adaptive in certain circumstances, individuals with PTSD can become stuck in using only one strategy when others would be more constructive. Behavioral aggression may take many forms, including aggression toward others, passive-aggressive behavior (e.g., complaining, "backstabbing," deliberately being late or doing a poor job), or self-aggression (self-destructive activities, self-blame, being chronically hard on oneself, self-injury).

* Thoughts and Beliefs: The thoughts or beliefs that people have to help them understand and make sense of their environment can often overexaggerate threat. Often the individual is not fully aware of these thoughts and beliefs, but they cause the person to perceive more hostility, danger, or threat than others might feel is necessary. For example, a combat veteran may become angry when others around him (wife, children, coworkers) don't "follow the rules." The strength of his belief is actually related to how important it was for him to follow rules during the war in order to prevent deaths. Often, traumatized persons are not aware of the way their beliefs are related to past trauma. For instance, by acting inflexibly toward others because of their need to control their environment, they can provoke others into becoming hostile, which creates a self-fulfilling prophecy. Common thoughts people with PTSD have include: "You can't trust anyone," "If I got out of control, it would be horrible/life-threatening/intolerable," "After all I've been through, I deserve to be treated better than this," and "Others are out to get me, or won't protect me, in some way."

How can individuals with posttraumatic anger get help?

In anger management treatment, arousal, behavior, and thoughts/beliefs are all addressed in different ways. Cognitive-behavioral treatment, a commonly utilized therapy that shows positive results when used to address anger, applies many techniques to manage these three anger components:

* For increased arousal, the goal of treatment is to help the person learn skills that will reduce overall arousal. Such skills include relaxation, self-hypnosis, and physical exercises that discharge tension.

* For behavior, the goal of treatment is to review a person's most frequent ways of behaving under perceived threat or stress and help him or her to expand the possible responses. More adaptive responses include taking a time out; writing thoughts down when angry; communicating in more verbal, assertive ways; and changing the pattern "act first, think later" to "think first, act later."

The Iraq War Clinician Guide, 2nd Edition

Information for the Public

On Line Resources

Personal Emergency Preparedness Brochure from the Department of Veterans Affairs

Fact Sheets

Military Medicine

Advice/Information about Self and Family Care

Information for Professionals

On Line Resources

Reviews of the literature on war-related PTSD

Clinical Information and Advice on Early Intervention

PTSD in Primary Care

Outreach to Veterans

Website links

Website links related to children

Homecoming After Deployment: Dealing with Changes and Expectations

Expectations for Soldiers:

Expectations for Spouses:

What Children May Feel:

Homecoming After Deployment: Tips For Reunion

Tips for Soldiers for Reunion:

Tips for Spouses for Reunion:

Tips for Reunion with Children:

How Terroristic Acts May Affect Veterans

A National Center for PTSD Fact Sheet

By Candice Monson, Ph.D.

What might veterans experience as a result of terroristic acts?

How can veterans take care of themselves when current events cause distress?

A National Center for PTSD Fact Sheet

Why is anger a common response to trauma?

How can posttraumatic anger become a problem?

How can individuals with posttraumatic anger get help?