Life After Combat: Coping with an Anxiety Disorder

How anxiety helps keep you safe

Anxiety is a more intense 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. You feel intense worry, fear, or dread. These feelings alert you to danger. They are meant to help you react quickly. In response to a threat, anxiety prompts you to do what's needed to protect yourself.

When anxiety becomes a problem

In a war zone, you’re on high alert. Even if there is no urgent threat, danger can present itself at any time. You may worry for your own safety and the safety of others. It’s natural to have 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 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 a sudden, 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 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. But you have a strong fear that the worst will happen. This is called generalized anxiety. It 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, in new social settings, 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. This can have a serious impact on your life.

• Feel a strong need to act on anxiety-provoking thoughts. An anxiety disorder can make unwanted thoughts invade your mind. You know the thoughts don't make sense. But you still feel a strong need to act on them. 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 ease the anxiety for a short time. But it can disrupt daily life.

Symptoms of anxiety disorders

Anxiety makes you feel worried and fearful. It can also cause physical symptoms. Many people with anxiety disorders first go to the healthcare provider 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

• Very fast speech

• Trembling

• Fear

• Feeling irritable or on edge all the time

• Forgetfulness

• Trouble concentrating

• Unplanned weight gain or loss

Talk with your healthcare provider. They can rule out any physical problems that may cause the anxiety symptoms.

Treatment will help you get your life back

If an anxiety disorder is diagnosed, the next step is to get mental healthcare. It is an illness, and it can respond to treatment. Most types of anxiety disorders will get better with talk therapy and medicine.

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 talk therapy (counseling). This is a process in which you talk about your anxiety and related problems with a healthcare provider. You may be prescribed medicines. For many people with anxiety disorders, treatment includes both medicine and counseling.

Getting counseling

Counseling means you work with a healthcare provider to better understand your anxiety and learn skills to manage it. Many types of counseling have been shown to work well for anxiety disorders.

You’ll likely learn new ways of responding to thoughts, feelings, and memories that make you anxious. This can improve your symptoms. It helps 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.

Taking medicine

You may be prescribed medicine. Some medicines are used only for a short time. This is done to treat immediate symptoms. Others are taken long-term. This is to help improve your mood over time.

At first, medicines and doses may need to be adjusted. Tell your healthcare provider how a medicine affects you. This way, you can work together to find what works best for you. It may take a few weeks before you feel a medicine’s full impact on your mood. If you don’t notice a change at first, you may just need more time. But if you don’t feel results after the first few weeks, tell your healthcare provider.

Other steps to take

• Learn more about anxiety disorders. Keep track of helpful online resources and books you can use in stressful times.

• Try stress management methods such as meditation.

• Think about joining online or in-person support groups.

Moving forward

An anxiety disorder affects your emotions, health, and life. But treatment will help you get better. Taking the first step can be hard. But once you start treatment and see how much better life can be, you’ll be glad you did.

To learn more, talk with your healthcare provider or your Veterans Administration (VA) mental health coordinator.

You can also visit:

• U.S. Department of Veterans Affairs website at www.mentalhealth.va.gov/anxiety/

• Anxiety and Depression Association of America at adaa.org/