Post Traumatic Stress Disorder and
The Military Veteran Student
Roger P. Buck
Edgardo Padin-Rivera
Autonomy
• The organism possess a
certain degree of
freedom… It acts
according to its own
inherent nature, which
is based on intrinsic
forces, and is not under
the compulsion of
outside influences
Autonomy
• Characteristics:
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Self Governing
Self Determination
Self Understanding
Intrinsic Forces
“Self” is known
“The World” is
understood
– “Shattered
Assumptions”
Autonomy:
Assumptions about the “Self” and the World
Self
• Personal Empowerment
• Sense of Personal Efficacy
• Efficiently Manage Self and
Decisions
• Sense of Personal Power
and Self Control
• Capable of interacting
effectively with others
World
 The World is a Safe Place
 Some Personal Control
over the Environment
 Efficiently interacts with
the Environment & Others
 Empowered to Keep
Oneself & Loved Ones
Safe in the World
Autonomy: Once Assumptions are Shattered
Crisis with the SELF
• Failure to Maintain Sense of
Personal Power
• Question Ability to Self
Manage
• Question Efficiency and
Effectiveness of Choices
• Fear of Losing Control of
Self and Uncertainty about
the Future
World VIEW
 Question the Safety of the
World
 Question Self and ability
to control any Aspect of
Life in the World
 Questions Efficiency of
Being and Interacting in
the World
 Questions Personal Ability
to keep Loved Ones and
Self out of Harms Way
Why the Self and World View are
Changed
 The Crisis Event
Rendered the Person
“HELPLESS”
 Crisis events Cause a
Person to Question
Their SELF (Decision
Making)
 The Event is Incongruent
with Beliefs about Self
(Abilities and Strengths)
 The Event is Incongruent
with Belief about Safety
of the World
 An overpowering sense
of failure, personal
inadequacy,
abandonment and/or
Rejection Will Often Set
in Due to This
Incongruence
DANGER As A Profession
• Military Veterans
• Police Officers
• Emergency Medical
Technicians
• Fire Fighters
• Emergency Room
Personnel
• FBI, ATF, other
dangerous professions
Danger
Powerful vs. Powerless
Mild danger vs. extreme
Danger
• Impact of Traumatic
Events
– Self is Changed
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Beliefs
Self Esteem
Personality Shift
Biological
Fear
Spiritual Crisis
Danger
 Shatters one’s
perception about
themselves and their
place in the world.
 Shatters one’s sense of
safety & security
 Most Devastating effect:
Autonomous ability to
relax Ego Defenses –
(isolation, anger, guilt,
anxiety, depression)
Danger
 Other Ego Defenses
develop:
 Inability to Trust
 Inability to Establish or
Re-Establish Intimacy
 Emotional Numbing
 Hyper-Sensitivity
Toward Injustice
 Pervasive Sense of
Feeling Damaged
Symptoms: Physical, Cognitive, Emotional,
Behavioral, Spiritual (P.C.E.B.S.)
P.C.E.B.S.
Physical
 Agitation
 Fatigue
 Headaches
 Vision Problems
 Hyper-arousal
 Exhaustion
 Chest Pain
 Muscle Tremors
 Grinding of Teeth
Cognitive
 Intrusive Thoughts
 Memory/Concentration
 Confusion
 Preoccupation
 Uncertainty
 Feeling Overwhelmed
 Poor Problem Solving
 Poor Abstract thinking
 Intrusive Images
P.C.E.B.S. (Cont’d)
Emotional
 Anxiety
 Depression
 Hopelessness
 Despair
 Rapid Mood Swings
 Unpredictable Mood
 Denial
 Agitation
 Intense Anger
Behavioral
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Hyper-vigilance
Sleep Problems
Substance Abuse
Self Mutilation
Cry easily
Antisocial Acts
Defiance of Authority
Inability to Rest
Erratic Movements
Loss of Appetite
P.C.E.B.S. (Cont’d)
Spiritual
 Questioning Good and Evil
 Attempting to Make Sense
of Senselessness
 Searching for the Meaning
of the Experience
 Struggling with
Understanding Why
 Questioning God/Faith
Human Toll: Depth of Change
 Military Combat
 Violent Law
Enforcement Action
 First Responders and
Horrific Scenes
 Natural Disasters
 Virginia Tech Carnage
 Columbine
 9/11
 Oklahoma City Bombing
What the Soldier Brings Home:
Combat Stress, Trauma &
Readjustment
“No one comes
back unchanged”
COL (Dr.) Tom Burke,
Department of Defense,
Director of Mental Health Policy
Life on the Front
To understand what the soldier brings home, one needs to look at how the
environment of war gets inside the mind.
Life on the Front:
How Combat Shapes Minds, Emotions, & Behaviors
 86% received artillery fire.
 93% were shot at with small arms.
 77% fired at the enemy.
 95% saw dead bodies or remains.
 89% were attacked or ambushed.
 86% know a troop injured or killed.
 65% saw dead or injured American.
 69% saw injured women/children
and were unable to help.
-- These numbers correspond in part to a study in the New England Journal of Medicine and pertain to service members in Iraq.
Life on the Front:
How Combat Shapes Minds, Emotions, & Behaviors
No true ‘safe zone’ or ‘rear’, in Iraq & Afghanistan,
there is a sense of danger in all occupations
and areas all the time.
The stresses and demands
on cognitive and emotional
capacities are many and
almost constant.
Being on constant alert, or
“hyper-aroused” becomes
a way of life.
Life on the Front:
How Combat Shapes Minds, Emotions, & Behaviors
Prolonged exposure to combat stress
• Most soldiers exposed to multiple terrorism or life
threatening events.
• Some may have
participated in atrocities.
• Often develop a mindset
of “act immediately,
debate later”.
Life on the Front:
How Combat Shapes Minds, Emotions, & Behaviors
Exhaustion is constant. The soldier does not have energy or
time to process events until after leaving the battlefield.
The violence is scary, but also
exhilarating and immediately rewarding.
Many returning soldiers say combat was
the most exciting and important
thing they have ever done. Many
are bored when they come home.
Life on the Front:
How Combat Shapes Minds, Emotions, & Behaviors
Many face loss of comrades that can be emotionally
devastating. Nothing is more
important to a soldier than his war
brothers.
For many service members,
a comrade’s death is
an overwhelming
experience, often leading
to prolonged unresolved
mourning and anger.
What the Soldier Brings Home
Post-Combat Battlemind
• Heightened sensory awareness of sights, sounds & smells.
• Action oriented ways of coping with new experiences.
• Identification and closeness with their military unit and
comrades who have shared similar experiences.
• Regimentation into highly structured and efficient routines.
• Confused about ideals, values & identity shaped by war.
• Habituation to intensity and extreme emotions of combat life.
What the Soldier Brings Home
The PTS Syndrome
• Intrusive
thoughts/memories
• Nightmares
• Avoidance/isolation
• Anger/angry outbursts
• Hyper-startle response
• Flashbacks
• Hyper vigilance
• Feelings of grief, guilt, &
loss…
What the Soldier Brings Home
•
It’s not just about PTSD
Disillusionment with “civilian life”
& activities.
– Challenging of one’s previous identity
& core beliefs.
– Irritability & anger toward non-military.
– Profound feeling of alienation.
– Social isolation.
Memories of events that can be
difficult to “square” with civilian reality.
• Self-blame or guilt for acts of war.
• Despair or hopelessness about future.
• Physical health problems
• Alcohol and drug abuse
•
Coming Home: Life, Work, Learning
What They Say Are Problems (from Focus Groups)
● Wanting to be left alone - Social avoidance/isolation
● Sensitivity to loud noises and jumpiness – hyper-arousal
● Anger, lack of patience - irritability
● Chronic joint pain, generally ankle, knee and back pain
● Memory problems or "lapses“ - trouble concentrating
● Drinking or smoking too much
● Personality changes, emotionally distressed
● Body image issues: scars, weight changes, etc.
Coming Home: Life, Work, Learning
Obstacles to Restoring Previous Ties
• Homecoming feelings of joy and euphoria are short lived
(Eventually not reinforcing).
• Attempts to restart old ways of interacting, old roles fail.
• Difficulties arise in trying to generate a “new normal”
(rigidity, fears, isolative struggles get in the way).
• Civilian life at home may not have the edge and adrenaline and
“life or death” purpose associated with wartime duty.
• Problems of internal chaos impinge on relationships.
Coming Home: Life, Work, Learning
Greatest need after traumatic
experiences is for active
engagement, affiliation, and
comfort available through
supportive relationships.
Biggest (unrealized) fear
of most returning soldiers
is engagement, affiliation,
and intimacy.
Coming Home: Life, Work, Learning
Problems Reconnecting with Friends & Community
• Difficult for soldier to feel “at ease”
with “civilians” who do not
understand military or combat
life (will gravitate toward veterans).
• Soldier may find self unable
to share experiences with
non-combat friends:
“they wouldn’t understand”,
“they would react with horror
or shock”).
Coming Home: Life, Work, Learning
Difficulties with Public Interactions
• Tension about the “politics” of war; public has mixed views of the
war.
• Awkwardness on both sides: Public may not always know what to
do or say.
• Veteran too often becomes a community media event.
• Veteran unsure who he/she can talk to.
Questions can arise about:
What will they want me to talk about?
What can I talk about?
How will they react to a story or event?
Coming Home: Life, Work, Learning
Workplace Problems
• Veteran ability and employer expectations may conflict.
– Veteran may be unable to do same work
– Same exact job may not be available.
• Post-war images and memories may intrude on ability to
concentrate.
• Co-workers may behave differently toward him/her.
• Veteran may feel others expect things he/she may not be
able to do or meet.
Coming Home: Life, Work, Learning
Learning Environment Problems
Veteran learning capacity vs instructor expectations.
– May not be able to focus on single subject for long periods of time.
– Has difficulty with “vague” subject matter or mixed conclusions.
Need for concrete outcomes.
– mTBI issues may create short term memory deficits
(difficulty with details, memorization, etc)
Coming Home: Life, Work, Learning
Learning Environment Problems
• Internal chaos (intrusive images and memories) may intrude on ability
to concentrate, pay attention.
• Hyper-arousal (on guard), in crowds, among new persons, changing
environments (new classroom each course), may create tension,
irritability, anxiety.
• Tendency toward social isolation leads to difficulty seeking help for
studies, working with other students.
– May feel others expect things he/she may not be able to do.
– Other students may behave differently toward him/her.
• Subject Matter or presentation may arouse anger, irritation, isolating
response (politics, history, social sciences are especially red flags).
Coming Home: Life, Work, Learning
The perception of positive community support
whether or not it is used is one of the best known antidotes to
chronic mental health problems after a traumatic event. So…
Fifteen Environmental Cues That May Trigger
Increased Symptoms
 Cues that May Cause Agitation, Anxiety, Panic,
Intense Anger, Apprehension, Sadness:
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Inefficient Support Services
Non-Compassionate Attitude of Staff Members
Waiting in Long Lines for Services
Getting the “run-around” about Administrative
Paperwork
 Immoral and Unethical Practices by Staff, Faculty or
Students
 Lack of Clear “Chain of Command” to resolve problems or
concerns
Environmental Cues (Cont’d)
 Lack of Respect for & Acknowledgment of Veteran and Their Service
 Lack of Respect by Faculty or Staff for Sacrifice of Veteran’s Friends
Killed and Injured in War
 Childish Behavior by “Traditional Teenage Students” (Loud Music after lights out
– Dorm life)
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Roll Call
Overall Lack of effective and efficient leadership at the college
Timeliness of GI Bill Processing and Other Financial Supports
Large, Loud and Crowded Classrooms
Classrooms Where Veteran Cannot Sit With Back to the Wall
Chaotic Classroom – Instructor Not in Charge
Sensory Triggers to Consider
• Visual:
– Use of Laser Pointer
– Emergency Light Flashing
– Middle Eastern
Student/Clothing
– Human Suffering
– Dry/Arid Environment
Sensory Triggers to Consider
 Other Senses
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Loud Noises
Helicopter Blades
Smells (Raw Sewage)
Smells (Sweat)
Oppressive Heat
Taste/Smell of Middle Eastern
Foods
 Sitting in uncomfortable chairs
with back pain, knee injuries
other chronic medical concerns
Twelve Administrative Action Items
 1. Ask the Vets
 2. Special Supports During Registration for Rapid Enrollment
 3. Veteran Task Force
 4. Encourage and Develop Peer Support Organization (Student Veterans of
America)
 www.studentveterans.org
 5. Host Veteran Recognition and Welcoming Activities
 6. Specific College Policy and Procedures addressing action if student deployed
 7. Institution Admin consistency: GI Bill, Course Credit for Military Schooling,
Financial Aid etc.
Administrative Action (Cont’d)
8. Present “Veteran Awareness and Sensitivity” training for all
Staff & Faculty
9. Create a Veteran Resource Center & Devote Office Space
10.Register as Service Member Opportunity College (SOC)
11.Develop a Veteran Foundation Account to Assist Student
Veterans with Tuition, Books, Fees and Household Emergencies
12.Presidential and Senior Leadership Support
Fifteen Faculty and Staff Actions To
Consider
 1. Recognize you “Will” Have Higher Numbers of Both Male
and Female Veterans With Traumatic Stress History
 2. Recognize the Cultural Diversity That Exists Between
Traditional Students and Military Veterans
 3. Military Veterans are Permanently Changed Due to
Experiences and are Often in a Period of Intense Adjustment
and Transition
 4. Military Veterans with Combat Experience will Have
Normal and Predictable PCEBS
Faculty and Staff Action
 5. Recognize there are Potential Cues in the College
Environment That Will Trigger PCEBS Symptoms
 6. Recognize Some Veterans will meet ADA Criteria for
Support Due to Injury (TBI)
 7. Understand there are Major Financial Stresses Due to GI
Bill Delays, Federal Red Tape, VA Medical Appointments
etc.
 8. Readjustment after Extreme Experiences Cause Family
Strain As Well as College Stressors
Faculty and Staff Action
9. Recognize the Veteran is Reintegrating Into More Than
One Environment.
10.Some Veterans will Admit Their Veteran Status While
Others May Keep it Quiet (Women Veterans)
11.Honor and Respect Differing Viewpoints and Strong
Emotional Commitment to a Position or Belief
12.Be Flexible with Attendance and Classroom Assignments
Faculty and Staff Action
 13. Recognize and Support
Military Dependents
 14.Learn the Various Trauma
Symptoms That Occur with all
Trauma Victims
 15. Know all Veteran Support
Services on Your Campus and in
the Community
Institutional Services to Provide
• Local College Military Veteran Task Force
Determines Specific Services - To Include the
Following as a Minimum
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Orientation Program specific to veterans
One stop Center of Excellence
Veterans Advisory Council
Prevention Program
Veteran Volunteer Program
Develop “on-line” and Print Educational Information
Resource Listing
• National Center for Post Traumatic Stress
Disorder (NCPTSD) (www.ncptsd.va.gov)
• National Child Traumatic Stress Network
(NCTSN) (www.nctsn.org)
• National Center for Trauma Informed Care
(NCTIC)
(www.mentalhealth.samhsa.gov/nctic/ )
• Student Veterans of America
(www.studentveterans.org)
If you see a returning service member this month,
just say thank you.
Contact Information
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Roger P. Buck, Ph.D.
Director, Counseling Services
3301 Hocking Parkway
Hocking College
Nelsonville, OH 45764
Phone: 740 753-6133
Buck_r@hocking.edu
Contact Information
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Edgardo Padin-Rivera, Ph.D.
Louis Stokes Cleveland DVA Medical Center
10,000 Brecksville Road, Brecksville, OH 44141
Phone: (440)- 526-3030 xt. 6900
Email: edgardo.padin@va.gov