Post-traumatic stress disorder or PTSD occurs as a result of witnessing or experiencing a traumatic event or prolonged exposure to high-stress and volatile environments. Examples of such include war zones, accidents, natural disasters, and abuse.
As a result of these experiences, feelings of intense panic and fear shock the body and over time, the body learns to adapt in maladaptive ways. These events can change the biomechanical processes within our automatic nervous system and evoke extreme responses and reactions. Consequently, the body and mind succumb to this chronic cycle of triggers when experiencing any type of stress, even after the exposure to trauma or the traumatic event has passed.
It is important to understand and recognize how PTSD can wreak havoc on a person’s sense of self. Combat PTSD has the ability to lead to dissociative episodes and increase the prevalence of suicidal thoughts as a result of dissociation (Able & Benedek, 2019).
The reason dissociation is risky is because of the disconnection between thoughts, feelings, and actions. This de-personalized sense of self can cause veterans to behave in unusual ways and lose their identity, leading to poor quality of life.
To expand, combat veterans who do not have meaning in life tend to have a higher prevalence of suicidal ideation and attempts (Sinclair, Bryan, & Bryan, 2016).
Maladaptive Coping Mechanisms are Common
Others find maladaptive coping mechanisms such as alcohol abuse. According to Possemato (2017), alcohol dependence and PTSD commonly co-occur. Veterans with severe PTSD and without meaningful treatment have a higher instance of alcohol dependence, which further distances these veterans form their true sense of self.
Those with PTSD have a higher prevalence of clinical depression and anxiety disorders as comorbidities, creating a dire need for grounding techniques when experiencing a flashback, depressive episode or panic attack.
Specifically, older adults with PTSD have a higher correlation with lower quality of life (Chopra et al., 2014). As a veteran ages, the ability to reconnect with their true identities becomes more challenging because of various other cognitive barriers that may not allow them to really work on healing those unseen wounds.
Furthermore, combat veterans exposed to new stressors later in life are more sensitive to triggers. Extreme reactions to these new life stressors are common among combat veterans and as a result, they become more vulnerable to exacerbating symptoms of PTSD (Sachs-Ericsson, Joiner, Cougle, Stanley, & Sheffler, 2016).
At the end of life, these symptoms of PTSD tend to get mixed into the myriad of other symptoms with terminal-disease-specific symptoms. Pain, cognitive impairments, social isolation, and emotional disturbances are a few ways PTSD can manifest in a veteran at the end of life and therefore it is important for providers to understand PTSD and accurately assess the etiology of a symptom.
Symptoms of PTSD Can Be Mistaken
Because of limitations of many veterans at the end of life, proper identification of a symptom of PTSD can be mistaken for a symptom of a terminal disease. Veterans can spend a great deal of time being treated with only minimal positive outcomes because of underlying untreated PTSD (Glick, Cook, & Moye, 2018).
To better help our veterans at end-of-life, it is important for providers to recognize all the ways in which PTSD can be masked and manifested in day-to-day symptoms. Working one-on-one with veterans and their families and obtaining a history of dissociation is important in helping veterans stay grounded in the context of current time and place.
Given the prevalence of suicide, especially among combat veterans, identifying life stressors and assigning these stressors to a high-risk scale for re-emergence of PTSD symptoms will help providers differentiate terminal-disease symptoms from psychosomatic symptoms of PTSD.
Providers can further intervene at this time by discussing the triggers and creating trauma-sensitive plans of care. Additionally, working with these veterans and discussing their life achievements and areas in which they hold pride and gratitude can help them repurpose negative thoughts into positive growth.
This process validates their meaning for life and purpose which can curtail episodes of suicidal ideation and minimize the use of drugs and alcohol as a coping mechanism. Most importantly, providers must always screen and re-screen this highly vulnerable population to ensure that the proper evidence-based interventions are in place to address PTSD complications at the end of life because PTSD can manifest differently from veteran to veteran.
Able, M.L., & Benedek, D.M. (2019). Severity and Symptom Trajectory in Combat-Related PTSD: a Review of the Literature. Current Psychiatry Reports, 21, 1535-1645.
Chopra, M.P., Zhang, H., Kaiser, A.P., Moye, J.A., Llorente, M.D., Oslin, D.W., & Spiro, A. (2014). PTSD Is a Chronic, Fluctuating Disorder Affecting the Mental Quality of Life in Older Adults.
The American Journal of Geriatric Psychiatry, 22, 1, 86-97.
Glick, D. M., Cook, J. M., Moye, J., & Kaiser, A. P. (2018). Assessment and Treatment Considerations for Post Traumatic Stress Disorder at End of Life. The American journal of hospice & palliative care, 35, 8, 1133–1139.
Possemato, K., Maisto, S. A., Wade, M., Barrie, K., Johnson, E. M., & Ouimette, P. C. (2017). Natural Course of Co‐Occurring PTSD and Alcohol Use Disorder Among Recent Combat Veterans. Journal of Traumatic Stress, 30, 279-287.
Sachs-Ericsson, N., Joiner, T.E., Cougle, J.R., Stanley, I.H., & Sheffler, J.L. (2016). Combat Exposure in Early Adulthood Interacts with Recent Stressors to Predict PTSD in Aging Male Veterans. The Gerontologist, 56, 1, 82–91.
Sinclair, S., Bryan, C.J., & Bryan, A.B. (2016). Meaning in Life as a Protective Factor for the Emergence of Suicide Ideation That Leads to Suicide Attempts Among Military Personnel and Veterans With Elevated PTSD and Depression. International Journal of Cognitive Therapy, 9, 1, 87-98.