Interconnections of Trauma and Military Related PTSD 1

Interconnection Between Childhood Trauma and Military Service-Related PTSD.

James D Robinson

CAPS04101 Health Science Capstone

Logan University

04/01/2021
Interconnections of Trauma and Military Related PTSD 2

Introduction

The purpose of this research paper is to cover the intersections between childhood trauma

to include sexual assault, military trauma to include sexual assault, and minority status as they

relate to the development of PTSD in military veterans. This paper will focus primarily on the

subset of veterans who served post 9/11 during Operation Iraqi Freedom and Operation Enduring

Freedom. PTSD (Post Traumatic Stress Disorder) is defined using the work of Dr. Hoge M.D.

who directed the U.S. military’s research program on mental health and neurological conditions

due to the wars in Afghanistan and Iraq from 2002 to 2009 from the Walter Reed Medical

Center. Dr. Hoge defines PTSD as the evolution of combat stress which he defines as “A combat

stress reaction can manifest as virtually any physical symptom (e.g., fatigue, chest pain,

shortness of breath, muscle shaking, headaches, neurological symptoms) or behavioral reaction

(e.g., rage, agitation, fear, panic, restlessness, bizarre behavior, inability to think clearly.).

“(Hoge, 2010, p.1) The symptoms of a combat stress reaction are very similar to the U.S.

Department of Veteran Affairs and American Psychology Association’s definition which state

that PTSD is “PTSD (posttraumatic stress disorder) is a mental health problem that some people

develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster,

a car accident, or sexual assault.” (PTSD, 2021)

To experience trauma is to experience an abnormal situation, a situation deviating from

what is culturally or nationally understood to be common. The word normalcy is avoided due to

it being a fallacy for the understanding of trauma as normally sets out to define what is normal

for situations that are not normal or common. The interconnections between the experience of
Interconnections of Trauma and Military Related PTSD 3

adverse situations that go beyond an individual’s ability to cope with, or handle being stored as

not a long-term memory but a short-term memory thus replaying in the form of flashbacks is a

symptom of PTSD. In the context of combat veterans this can be more than simply auditory or

visual hallucinations but of a more tactile sense thus inducing a state where the individual feels

as though they are being watched (paranoia), feels on edge (ready for combat), and is easily

startled due to this hyper-focused state. The connections between childhood trauma and the

development of PTSD as an adult can be seen in the same feelings that are inspired by both

forms of trauma. Childhood trauma can be physical, emotional, or sexual in nature and inspire

feelings of hopelessness, powerlessness, guilt, and fear. Experiencing the loss of a comrade,

experiencing sexual harassment, molestation, or penetrative rape also instills the same feelings in

an adult.

To understand anything, one must first understand its meaning, thus, to understand

trauma in its various forms one must first understand the word trauma. “Trauma is an emotional

response to a terrible event like an accident, rape, or natural disaster. Immediately after the event,

shock and denial are typical. Longer-term reactions include unpredictable emotions, flashbacks,

strained relationships, and even physical symptoms like headaches or nausea. “(APA, 2021)

Thus, trauma is the response to an event that is so fundamentally different from the daily

experience of an individual that it radically changes or harms the individual. Some individuals

have experienced childhood trauma such as natural disasters, murder, and sexual assault who do

not develop any symptoms of PTSD thus it is not the only reason for an individual developing

PTSD but a major contributing factor.

The Toll of War on Veterans

Interconnections of Trauma and Military Related PTSD 4

As the United States has been a nation at war for the majority of the time it has been a

sovereign nation there has been a need to understand the minds of first men only and later men

and women as it relates to the unique natures of not only war but of unit cohesion, mission-

focused mindset, and the modeling of individuals into a functioning group. The taking of

individuals from diverse backgrounds be it socioeconomic, gender, religious, national origin,

ethnicity, sexual orientation, and sexual identity breeds differences in how methods of training

and combat-related experiences affect each individual. PTSD has been known in the Western

World in some form or another since the beginning of humanity's desire to fight each other but

truly became known during the Second World War as shell shock.

To better train, assist, and reduce the number of individuals suffering from PTSD

understanding its possible connection to childhood trauma is important. War is an unnatural

situation as it is the practice of two groups placing individuals in opposition with the goal being

either the destruction of the other force or subjugation via one side’s surrender. Placing groups

into life-or-death situations, and individuals that may not be ready when these attacks happen

increases their abnormal experiences. A group is a collection of people and as it relates to the

military it is a diverse collection of individuals who were assigned by the Department of the U.S.

Army to a division, brigade (group), battalion, company, platoon, section, squad, and team.

When deployed into a non-conventional war such as the war in Iraq and the ongoing war

in Afghanistan where the enemy is not a standing army that is being faced from one side but a

guerilla operation that is attacking from all sides and in an increasingly wide range the

individuals involved in the war naturally expands, this includes individual who is not part of the

direct combat job classes and are support by job description and training. These individuals are

forced to use basic army training that may be years behind them or a few months behind them,
Interconnections of Trauma and Military Related PTSD 5

this can cause an increase in the individual feeling unprepared and not feeling ready for the

situation of war at hand. Feeling unprepared, helpless, and witnessing death is a life-threatening

and life-changing experience that many are not prepared for.

The Toll on Individual Veterans

Individuals who enlist in the armed forces come from a variety of backgrounds due to the

integration of the military during the Vietnam war and the integration of women into combat

roles during the Obama administration. As the military is a volunteer service and a diverse

service many factors are contributing to individuals suffering from disorders or conditions before

enlistment without prior knowledge. This does not only affect individuals from lower

socioeconomic statuses “American teens from upper-middle-class families are more likely to

have higher rates of depression, anxiety, and substance abuse than any other socioeconomic

group of young people.” (Luther, 2014) Individuals from lower socioeconomic levels are

exposed to higher levels of stress and are more likely to have experienced childhood trauma.

(Assari, 2020, p.1) Both of these statements can be true, individuals who are already suffering

from other conditions can still develop PTSD as mental illnesses can be comorbid thus existing

in parallel. One person can suffer from PTSD which is an anxiety-based disorder while also

suffering from panic disorder and generalized anxiety disorder which are also anxiety disorders

but distinct in their scope, function, and symptoms from PTSD. The toll that these conditions

take on individual veterans can range from problems of nightmares and flashbacks to an

individual experiencing a flashback that is encompassing their senses to the point that they feel

the gravel beneath their feet, the smell of smoke in their nose, and the sounds of bombs, gunfire,

or screams. The intensity of symptoms as well as their frequency vary from veteran to veteran

and can have triggers (reminders) or no triggers, an induvial can also have multiple sources of
Interconnections of Trauma and Military Related PTSD 6

trauma as it relates to their PTSD as they can have experienced military sexual trauma in the

form of assault or harassment, bombs, gunfire, and even the feeling of being out of control can

serve as a trigger as being in a situation of sexual assault, war, witnessing death and destruction,

all can incur strong feelings of helplessness and guilt.

Placing these traumatic experiences in early adulthood on top of traumatic or adverse

experiences in childhood can meld the two experiences together thus giving the individual a

sense of earning it or ‘having it coming’ these feelings are natural protection methods to explain

a situation that is so overwhelming that the individual can not deal with it. The problem that

arises from such thinking and from experiencing both adverse childhood events and such events

in adulthood is that as a child there is an expectation of having someone that is supposed to

protect them such as a parent or guardian whereas in adulthood the ability to protect oneself in a

combat zone falls to the individual as well as the squad or team that individual is a part of. In the

case of military sexual assault or trauma, an individual has already experienced that a member of

their team can not be trusted and thus loses a potential resource for support. Sexual minorities

during the federal policy of DADT (Do not Ask Do not Tell) had the added problem of not being

able to be open about their sexuality and not being able to talk about how they were being

mistreated by their fellow warriors nor the ability to confide in a superior about being harmed

due to the act of revealing a sexuality other than heterosexual was a discharge. “The deleterious

impacts of sexual assault on service members have been documented (Godfrey et al., 2015; Katz,

Cojucar, Beheshti, Nakamura, & Murray, 2012; Mondragon et al., 2015; Schry et al., 2015;

Wilson, 2016), but those studies did not address the sexual orientation or gender identity of

participants. Estimates show47% of lesbian, gay, and bisexual service members in the military

have experienced some form of violence, including military sexual trauma (MST), because of
Interconnections of Trauma and Military Related PTSD 7

their sexual orientation (Burks, 2011). MST for LGBTQ service members is unique because of

the history of the military’s stigma and discrimination toward LGBTQ service members (Burks,

2011). Past military policies such as “Don’t Ask, Don’t Tell” (DADT)and the ban on transgender

service made it difficult for LGBTQ members to openly embrace their identity and serve in the

military without obtrusiveness. “(Senter,2020)

The Toll on Veterans and Their Families

The toll on veterans and their families is the problem that one is faced with upon

returning from active-duty service and being faced with having to integrate with the civilian

populace of their communities as well as immediate family. This, adjustment is needed to

integrate successfully into now a familiar environment but changed not only psychologically but

physiologically. “Although PTSD is considered a mental disorder, it is a physical condition that

affects the entire body and is best understood through the emerging science of stress physiology,

which describes how the body normally responds to extreme stress.” (Hogs,2010) These stresses

of being different from the majority and suffering conditions that the majority has not or does not

recognize can create further friction. One of the major contributions to this problem currently is

military sexual trauma (MST) both men and women can experience MST at the hands of either

opposite gender or same gender though rates at which sexual minorities experience it is shown to

be 47% vs “1 in 4 female veterans and 1 in 100 male veterans in the VA healthcare system report

experiencing MST. It is important to note that by percentages women are at a greater risk of

MST, but nearly “40% of veterans who disclose MST to the VA are men.” (DAV, 2021) The toll

that this places not on veterans in general but on veterans that are also sexual minorities is higher

due to the perceived and institutional barriers to care. Throughout the United States, there is no
Interconnections of Trauma and Military Related PTSD 8

federal-level law that requires sexual minorities to be treated as equals. As the majority of

individuals receiving VA care are veterans or servicemembers the culture of the military can be

seen inside the VA healthcare system. “In Military culture that emphasizes heteronormative roles

and male-dominated structure, it is probable to assume the estimation of 47% of LGB service

members in the military have experienced some form of victimization or discrimination, at least

once, because of their sexual orientation is accurate, if not underestimated (Northcut & Kienow,

2014). These individuals are also likely to be at a greater risk of being victims of sexual

violence.” (Senter, 2020)

How all of this affects not only the veteran, but their family is that the family not having

experienced the same situations or having the same condition and or conditions as the veteran

may experience trouble understanding the scope of the disorder. The veteran may have enjoyed

hunting, fishing, fireworks, and loud concerts before experiencing their traumatic experience but

now those activities may have little interest for them, or they may serve as triggers. A veteran

that experienced rocket attacks may feel uncomfortable with fireworks and loud concerts and a

veteran that had to kill may feel differently about hunting and fishing may give them too much

time alone with their thoughts. These differences may make it hard to connect with friends from

before their service and it also may hinder their ability to function in one or more areas of their

life such as school, employment, or interpersonal interactions.

How these changes can have an effect on the community at large is that as these

individuals have served their country and look to make use of the services and benefits earned,

they are going to need individuals trained to assist and understand them. A military veteran

starting their undergraduate education at twenty-two or later when their peers started at eighteen

can make for an uncomfortable experience due to the vast differences in experiences that the
Interconnections of Trauma and Military Related PTSD 9

individual has. If the veteran lives in a religiously devote community, attending religious

services may also prove to be another point of contention due to it being a gathering of people in

a space that is not designed for the individual to look behind them or always at the exit. As

places of worship are orientated so that the focus is forward be it towards a religious leader,

statue, or structure.

Access to Care

At the institutional level, there is a problem for the organizations tasked with not only

taking care of individuals who have suffered MST, PTSD, and other mental illnesses but it is

written into how the VA is perceived as a disability. One of the primary questions regarding

disability compensation in the context of the VBA (Veterans Benefits Administration) is that a

person’s condition was caused or worsened by their military service. Though there is a

connection between childhood trauma, and childhood sexual assault and further development of

PTSD be it combat-related, or MST related there is no proof that it is the sole reason for the

development of it as the majority of individuals have not experienced either but the rate of PTSD

for post 9/11 veterans who develop PTSD is 11-20% per year. (USDVA, 2021, p.1)

The contribution of an adverse childhood on the development of PTSD “after adjustment,

those who reported adverse childhood experiences in more than one category were significantly

more likely to be diagnosed with post-deployment PTSD. Specifically, childhood physical

neglect was most strongly associated with post-deployment PTSD.” (LeardMann, Smith, Ryan,

2010) How this relates to access to care is through providers needing to be understanding of the

complex interactions between childhood and the development of PTSD as well as how an

individual can have PTSD that is not from one experience but the combination of experiences.

An individual who was sexually harassed or assaulted in the military, while also experiencing
Interconnections of Trauma and Military Related PTSD 10

neglect as a child, followed by knowing of someone who was killed during a conflict or witness

death or simply was overwhelmed by the sounds of rockets, bombs, and gunfire can have a

complex problem as it relates to their mental health so that they have comorbid conditions which

can include major depressive disorder, generalized anxiety, panic disorder, and other physical

conditions relating to the traumatic or life-threatening event. At the institutional level, there need

to be adjustments to ensure that all veterans have access to the care that they earned through their

service and accommodations made for their disability.

The Department of Veteran Affairs is a unique organization due to “The Department of

Veterans Affairs (VA) workforce of more than 300,000 – including more than 90,000 who are

Veterans.” (VA, 2010) The expansion of protected sexual minorities from discrimination in

regard to employment came via the Obama administration in the form of an executive order

signed in 2014. The protection of veterans receiving care from discrimination based on their

sexual orientation or gender identity was in place in 2013 due to changes brought about by the

VA itself to ensure more equal and fair access across its facilities. The VA healthcare system is a

federal system thus state limits on protection for individuals' sexual and gender minorities do not

apply on federal property thus providing protection that was not previously there. The Supreme

Court via its ruling on the Civil Rights Act of 1964, now makes it illegal for employers to

discriminate based on a person’s sexual orientation or transgender status. Though court

decisions have made individuals that are sexual and gender minorities more equal as it pertains

to marriage, child benefits, and spousal benefits there are still barriers in place at the local level

due to the nature of local social and political environments.

Impact Statement
Interconnections of Trauma and Military Related PTSD 11

All of the previously listed information and research mean very little if there is no

purpose for them. The purpose is to highlight the interconnections between an adverse

childhood, military sexual trauma, and PTSD and how these interconnections influence the lives

of not only the individual veterans that suffer from them but the communities, organizations, and

families that they live in. At the individual level, there is the condition and how it is maladaptive

to the individual’s life. At the interpersonal level, it is how it influences those around the

individual veterans. At the institutional level, there is how it affects and requires the

organizations that treat veterans to be prepared and aware of these conditions. At the community

level, it serves as an insight into how an individual can change and thus should be understood

and supported. At the public policy level, it shows the gaps in public policy that are covering

individual veterans and are not covering individual veterans.

Being aware or informed does not require an individual to change who they are but it

does help the individual better understand and be more knowledgeable. To be ignorant is to lack

information on a subject or thing, thus, to give knowledge is to give the individual, group,

community, or organization the information needed to treat all individual veterans and veteran

groups with equal respect and deference under the law. By having this information these

organizations, communities, families, and individuals can ensure the equitable and fair treatment

of their fellow veteran citizens and their families.

Interconnections of Trauma and Military Related PTSD 12

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