Life After Combat: Coping with an Anxiety Disorder

In combat, you were under a lot of stress. You were in a strange place. You were away from your home and family. You lived with the constant threat of danger, violence, and personal harm. You may have been asked to do things that challenged you in unexpected ways. Military culture can be demanding, with long days, short nights, and little room for emotion. Being brave is standard practice. Anxiety is a healthy response to stress like this. But too much anxiety can be a problem. It may start kicking in at the wrong time. Or it may never go away. This causes physical and emotional discomfort. For some people anxiety can become so severe that it causes problems in daily life, at work or school, and in relationships. When anxiety becomes such a big part of your life, it’s an anxiety disorder.

How anxiety helps keep you safe

Anxiety is an extreme form of worry and stress. When you’re threatened, there’s rarely time to decide how to react. Instead, the body’s automatic defenses kick in. Your body is flooded with anxiety hormones. This causes physical and emotional responses. Your heart pumps harder. Your muscles tense. You tremble or sweat. Emotionally, you feel intense worry, fear, or dread. These sensations and emotions alert you to danger and help you react quickly. In response to a threat, anxiety prompts you to do what is needed to protect yourself.

When anxiety becomes a problem

In a war zone you’re on high alert. Even if there is no immediate threat, danger can present itself at any time. You may be worried for your own safety and the safety of others. It’s natural to experience anxiety in this situation. But the anxious feeling may continue after you leave the war zone. Even back at home, you may be on constant alert. Or extreme anxiety may pop up over minor issues. This unexplained anxiety makes it hard to live and enjoy your daily life. If this sounds like what’s happening to you, you may have an anxiety disorder. Someone with an anxiety disorder may:

• Have panic attacks. A panic attack is an abrupt, intense anxiety response. It includes extreme anxiety, severe physical symptoms (like a pounding heart or difficulty breathing), and a strong desire to escape. You may suddenly feel closed in or all alone, even if you’re in an open, public place. Most panic attacks start suddenly, for no clear reason. The attack can last around 5 to 20 minutes. During an attack, you may think that you’re having a heart attack, going crazy, or dying.

• Feel anxious all the time. You might worry about money, your family and friends, work, war, or the world in general. You might not even be sure what you’re anxious about. Whatever the cause of your worry, you have a strong fear that the worst will happen. This generalized anxiety affects your quality of life and makes it hard to function.

• Have intense anxiety in certain situations. For example, you may fear spending time in the dark or in enclosed spaces. These fears (sometimes called phobias) may relate to something that happened in combat. Or they may not. To escape the anxiety, you may try to avoid the situation that prompts it. Such avoidance can have a serious impact on your life.

• Feel a strong need to act on anxiety-provoking thoughts. Sometimes an anxiety disorder makes certain unwanted thoughts invade your mind. You know the thoughts are irrational. But you still feel a compulsive need to act on them, often in unhealthy ways. For example, you may constantly check your doors to make sure they’re locked. Or you might walk a perimeter around your house to make sure no one is watching. Doing so helps temporarily relieve the anxiety, but it can become very disruptive to daily life.

Symptoms of anxiety disorders

Anxiety makes you feel worried and fearful. It can also cause physical symptoms. In fact, many people with anxiety disorders first go to the doctor to get checked for a physical problem. Symptoms can include:

• A pounding or racing heartbeat

• Shortness of breath

• Chest pain

• Dizziness or lightheadedness

• Restlessness or problems sleeping

• Muscle tension, especially in the neck and shoulders

• Nausea or stomach problems

• Headaches

• Rapid speech

• Trembling

• Fear

• Feeling irritable or on edge all the time

• Trouble concentrating

Treatment will help you get your life back

You may think that asking for help is a sign of weakness. In fact, taking action to make your life better takes a lot of courage. With the right treatment, most people learn to manage anxiety. Your treatment may include counseling, a process during which you talk about your anxiety and related problems with a trained professional. Medications may also be prescribed. For many people with anxiety disorders, treatment includes both medication and counseling. Consider the following:

• Check with your doctor and rule out any physical problems that may be causing the anxiety symptoms.

• If an anxiety disorder is diagnosed, seek mental healthcare. This is an illness and it can respond to treatment. Most types of anxiety disorders will respond to "talk therapy" and medicine.

• Counseling involves working with a trained professional to better understand your anxiety and learn skills to manage it. Many types of counseling have been shown to be effective treatments for anxiety disorders. In counseling, you’ll likely learn new ways of responding to thoughts, feelings, and memories that make you anxious. This can improve your symptoms and help change how you react to situations that make you anxious. Counseling could be done one-on-one. Or you may have group therapy with other Vets who have been in combat.

• Medication may be prescribed. Some medications are used only for a short time, to treat immediate symptoms. Others are taken long-term, to help improve your mood over time. At first, medications and dosages may need to be adjusted. Tell your healthcare provider how a medication affects you. This way you can work together to find what works best for you. Be aware that a few weeks may pass before you see a medication’s full impact on your mood. If you don’t notice a change at first, you may simply need more time. But if you don’t notice results after the first few weeks, tell your doctor.

• Educate yourself about anxiety disorders. Keep track of helpful online resources and books you can use during stressful periods.

• Try stress management techniques such as meditation.

• Consider online or in person support groups.