In the months after checking out of Walter Reed Army Medical Center, he found himself easily frustrated and, his wife said, perpetually angry. Envisioning threats in grocery stores and shopping malls, he stopped leaving his house and started drinking heavily. His marriage was near collapse when, in a fit of alcohol-fueled despair, he drove his car into a brick wall, emerging so dazed that he thought he was back in Iraq.

“with a physical injury — three months, six months, whatever — your cuts will heal,” he said. but post-traumatic stress “is more difficult because people don’t see it.”

Like Mr. Pennington, many veterans injured in combat are finding that their invisible psychological and neurological wounds are proving more debilitating than their obvious physical ones.

About 1,700 American service members have lost limbs in Iraq and Afghanistan, most in roadside bombings that seared skin, shattered bones and damaged internal organs as well. Most of those troops also came home with traumatic brain injuries and post-traumatic stress disorder, which in many cases were not recognized for months.

While advances in prosthetics have made it possible for many lower-limb amputees to regain full mobility, the track record for overcoming brain injuries and chronic P.T.S.D. — both capable of altering personality and hampering mental functioning — is more spotty, experts acknowledge.

“I think the limiting factor for these people going back to their lives is not having lost a limb,” said Dr. Douglas Cooper, a neuropsychologist at Brooke Army Medical Center in San Antonio. “The P.T.S.D. symptoms and post-concussive symptoms are the ones that seem to get in the way.”

For Mr. Pennington, medications seemed to worsen his depression and therapy did not ease his anxiety. He seemed headed for divorce, isolation and perhaps alcoholism. And there his story might have ended, a case study on the intransigence of war’s psychological scars. but it did not end there.

In 2009, an unexpected opportunity landed in his e-mail inbox: a casting call, forwarded by a friend in Nashville, from an undergraduate filmmaker looking for someone to play a combat veteran who had lost a leg, had post-traumatic stress disorder and lived in Maine.

This is my life, Mr. Pennington thought.

So on a lark, Mr. Pennington — whose last appearance on stage was in middle school and who had become nervous in crowds and, indeed, avoided most human contact — decided that fixing his life depended on performing before a camera.

“I thought acting would be so out of the normal that it would force me to deal with things,” he recalled. “I wanted my life back.”

The struggle by wounded veterans like Mr. Pennington to reclaim their lives is the unfolding next chapter in America’s wars in Iraq and Afghanistan. Since 2001, 46,000 American service members have been injured in combat, perhaps a third or more seriously. Those veterans now face years of rehabilitation at a cost of billions of dollars annually.

In the coming weeks, The New York Times will profile a few of those veterans. Their cases say much about the critical importance of high-quality health care and loving families. but as with Mr. Pennington, they also underscore the individuality of recovery, where the most effective therapies are often discovered by the veterans themselves.

Mr. Pennington, 28, grew up in central Maine and Fort Worth, Tex., toggling across the continent between divorced parents. He was a talkative boy who loved the outdoors and was good in school, but bad at keeping the jobs that helped support him after he said he had problems with his alcoholic father. When he turned 17, he joined the Army.

He fell in love with the life immediately. His first deployment to Afghanistan in 2002 with the XVIII Airborne Corps was uneventful, so he volunteered to go to Iraq almost as soon as he returned home. He lost a dear friend during that tour, but it did little to sour him on the adventure of war. He raised his hand a third time.

On that third deployment, to Iraq in 2006, he was driving the lead Humvee in a convoy through the insurgent-friendly city of Samarra when a powerful bomb exploded beneath the engine. Through fire and thick smoke, he managed to maneuver the vehicle out of danger with a push from a truck behind.

But when he went to slam on the brakes, he realized his left foot was gone, taken off by shrapnel that had penetrated the bottom of the truck.

His rehabilitation at Walter Reed Army Medical Center in Washington went relatively smoothly, fueled by his hatred of wheelchairs. He was discharged from the Army and returned to Maine in just a year. And there his problems really began.

Perhaps it was leaving the secure cocoon of Walter Reed. perhaps it was living in a rural town, far from Army buddies. perhaps it was his battles with the Veterans Affairs bureaucracy over benefits. perhaps it was the long menu of medications his doctors prescribed: narcotics to ease his pain, antipsychotics to control his moods, sleep aids to tame his nightmares.

Whatever the cause, he grew more irritable, anxious and depressed, symptoms of post-traumatic stress disorder. After he crashed his car into the wall, he told his wife, Marjorie, “I can’t do it anymore.”

With the help of a nonprofit group, the couple moved to Houston in 2008, where he found the care at the veterans health center more to his liking. Doctors there got him off most of his medications, started treating him for traumatic brain injury for the first time and expanded his P.T.S.D. therapy. He felt he was getting better.

But in 2009, Ms. Pennington’s brother committed suicide and the couple returned to Maine to help care for her nephew. Mr. Pennington again fell into a deep funk. He imagined people everywhere judging him, for having killed Iraqis, for being a “crazy veteran.” He spent more of each day in front of the television, afraid to leave home.

Around that time, Nicholas Brennan was looking for actors for his senior project at New York University, a film about a wounded veteran struggling with the transition to civilian life. a casting call sent across a veterans’ e-mail network got about a dozen responses, mainly from soldiers who had lost legs or from out-of-work actors. but the last one, from Mr. Pennington, seemed the most poignant.

“I was injured in 2006,” Mr. Pennington wrote. “it resulted in a personality change for the far worse.”

Mr. Brennan, who was also from Maine, visited Mr. Pennington and was struck by the similarities between the real soldier and his lead character, a Marine named Connor. both had worked in boat repair shops, both loved to fish, both struggled with life in small-town Maine.

“it was pretty clear from the first few minutes I met him,” Mr. Brennan recalled, “that he would be a perfect partner on this project.”

At first, Mr. Pennington simply hoped that acting would force him out of his shell. but as he inhabited the role, he found himself not just identifying with Connor, but also realizing things about his P.T.S.D.

In the final scene of the 15-minute film, titled “a Marine’s Guide to Fishing,” Connor sits on a pier at sunset, his prosthetic by his side, decompressing after a violent flashback in front of his co-workers. His boss, a Vietnam veteran, counsels him to take his time, but leaves with a gentle warning: “You stay out here too long, you’ll never get back.”

“that rang right home to me,” Mr. Pennington said in his Texas twang. “I said, ‘well, dang, that’s what I’m doing.’ ”

After the film was finished last spring, Mr. Brennan and Mr. Pennington showed it publicly for the first time in Portland. Mr. Pennington says he was terrified about speaking before an audience, but afterward people came up looking for advice about relatives struggling with P.T.S.D. His ability to help them was deeply satisfying.

The two men decided to create a Web site to distribute the film and offer their services as speakers. they have done about a dozen such engagements, including one at the Veterans Affairs Health Care Center in Augusta, where Mr. Pennington receives his care and has, at times, clashed with bureaucrats and doctors.

For Mr. Pennington, the public engagements have been a form of exposure therapy, pushing him to articulate bad memories and buried feelings that he had avoided before. The experience has also motivated him to return to therapy himself, making him realize, he said, that “this P.T.S.D. is really getting the best of me.”

Experts say that public speaking alone is not a solution for the symptoms of P.T.S.D. but it can be therapeutic, helping people articulate their emotions and give meaning to their experiences.

“it gives people some authority over what happened to them,” said Dr. Matthew J. Friedman, director of the Veterans Affairs National Center for P.T.S.D. in New Hampshire.

Recently, the Penningtons, who live with their five dogs in a bungalow on a grassy knoll overlooking Dexter, renewed their wedding vows. He spends his days chain-smoking Marlboros, riding a mountain bike for exercise and studying books on acting. He is considering joining a local theater group and doing stints as a regular guest on a radio station owned by the author Stephen King.

He still wakes each morning hating his carbon-fiber leg, which gives him cysts under the skin of his stump. but it is a part of him now. His relationship with P.T.S.D. is more complicated.

He is learning, he says, to talk about his darker memories of war, including the time he nearly killed an Iraqi family that had driven through a checkpoint. The family lived, he says, only because his gun jammed, and the event has haunted him since.

He is also learning how to talk about killing. it has not been easy, he says, because he still feels ashamed when acquaintances blithely ask how many Iraqis he killed. His solution has been to answer bluntly and without explanation: 18.

But the best thing, he says, is that he has become more confident about offering advice to other veterans.

During a recent trip to Augusta for a checkup, Mr. Pennington was approached by an older veteran, who pushed himself in a small cart. a former submariner with a bushy white beard, the man had diabetes, and doctors wanted to remove one of his legs. He nervously asked about what lay ahead.

Balancing gracefully on his good leg, Mr. Pennington removed his prosthetic and described the various annoyances the silicone sleeve could cause. then he put it back on and smiled.

“It’s not so bad,” he said. “if this was my only problem, I’d be doing great.”

NEW YORK, Nov. 30 (UPI) — Cadets whose stress hormone cortisol increased the most at waking were more likely to show stress symptoms later as police officers, U.S. researchers say.

Dr. Charles Marmar of the new York University’s Langone Medical Center, in collaboration with the San Francisco VA Medical Center and the University of California, San Francisco, assessed 296 police recruits during academy training for salivary cortisol at first awakening and after 30 minutes.

The difference between the two levels is known as cortisol awakening response. the study found the greater cortisol awakening response during academy training predicted greater peritraumatic dissociation and acute stress disorder symptoms over the first three years of police service.

Police academy recruits who showed the greatest rise in cortisol after waking up were more likely to show post-traumatic stress disorder in response to trauma years later as police officers, Marmar said.

“This study is significant as a potential indicator in determining when people may exhibit stress symptoms in the future,” Marmar said in a statement.

“Few studies have prospectively examined the relationships among pre-exposure hypothalamic-pituitary-adrenal activity, acute stress reactions and PTSD. the findings may lead us to new insights on how to identify those who are at a higher risk of PTSD.”

The study is to be published in Biological Psychiatry.

(PhysOrg.com) — when presented with images of faces depicting various emotional states, people who look briefly at fearful expressions are more vulnerable to Post Traumatic Stress Disorder (PTSD) than those who look at the images longer, a finding of particular concern for U.S. soldiers fighting in Iraq and Afghanistan, University of Texas at Austin researchers say.

Through a series of eye-tracking experiments Christopher Beevers, associate professor of psychology, and a team of researchers found soldiers who briefly looked at faces of fear are less psychologically resilient after stressful combat-zone experiences than those who gaze longer at the same images. the researchers also found soldiers who fixate on sad faces are more susceptible to depression if they also experienced higher levels of war zone stress.

Many researchers have studied the psychological effects of combat after the fact, but this is one of the first studies investigating whether cognitive processing, measured before soldiers were sent to a war zone, predicts PTSD symptoms.

As part of the study the researchers gave 139 soldiers in the U.S. Army with no history of combat experiences eye-tracking tests to gauge their propensity to avoid or fixate on emotional stimuli. For 30 seconds, they viewed images of faces in four emotional states: happy, sad, fearful and neutral. the respondents also completed a series of tests and interviews to determine any pre-existing mental health conditions.

While serving in Iraq, the participants filled out a Web-based combat experiences log every 30 days, reporting any stressful or traumatic experiences such as witnessing a roadside bomb or participating in a firefight. After indicating exposures, the respondents rated the severity of their stress reactions in an online questionnaire, allowing researchers to determine the severity of PTSD and depression symptoms.

According to the findings, soldiers who briefly viewed fear stimuli in the pre-deployment eye-tracking experiments required nine war zone stressors to reach the cut-off score for probable diagnosis for PTSD. And those who lingered longer on fearful faces required 17 war zone stressors to reach the clinical threshold.

The researchers theorize that soldiers at risk for PTSD avoid images of threat, partly as a way to regulate their emotional response to them. this tendency to avoid threat-related information may interfere with natural processing of traumatic events when they occur in the soldier’s life, setting the stage for vulnerability to anxiety, Beevers said.

“Prevention programs that help soldiers better cope with their war-zone experiences, and the emotions that result from them, might be particularly beneficial for those who are susceptible to anxiety disorders or depression,” Beevers said.

More information: the study is published online in the April issue of the American Journal of Psychiatry. ajp.psychia … 1.10091309v1

Provided by News from the University of Texas at Austin

By Christopher Shea

A Time reporter interviews Scott Lilienfeld, a professor of psychology at Emory University, about “critical incident stress debriefing.”

Once held up as a way to fend of post-traumatic stress disorder, debriefing has fallen out of favor, for reasons that Lilienfeld explains:

It usually involves putting people in groups very shortly after the traumatic event and strongly encouraging them to “get their feelings out” and “Talk about it” and so on. in classic debriefing, they almost prescribe symptoms, saying things like “Don’t be surprised if you start feeling X, Y or Z” or “There’s a good chance you’ll have nightmares or flashbacks.” There’s some speculation that that [in itself] might bring some of the symptoms on …

In helping people work through anxiety, he adds,

you have to allow anxiety to peak first and then pass, and give people enough opportunity to fully process it. [Debriefing] may bring up some anxiety and increase it, maybe even bring up new anxieties and not really resolve them or make them worse.

Lilienfeld does note that the research is not clear-cut on these questions, and that some recent papers have suggested that the downside of post-trauma counseling has been overstated.

One approach taken by charities that assist children is to attempt to establish semi-normal routines, even in crisis zones. rather than have the children talk about what they’re feeling, such groups will create playgrounds near refugee camps, for example.

The Time writer suggests that “psychology seems to have a bias against distraction,” and suggests that “you could go for a run or even just watch TV,” to fend off traumatic memories. maybe so, but even Lilienthal, who plays up the resilience of people who have faced trauma, observes that as many as 30% of survivors may experience some post-traumatic symptoms.

Understandably, therefore, research is underway to see if there are ways to prevent traumatic memories from lodging in the brain in a way that will cause future psychological harm. it sounds bizarre, but one avenue that has shown promise is to have the survivors play games that involve the mental manipulation of objects in space. (The study I’m thinking of made use of the video game Tetris.) such exercises are partly a distraction, but, more importantly, they may also interfere with the cognitive creation of the kinds of memories that cause night sweats.

TUCSON – the survivors’ physical wounds are healing.

But the path to recovery for Tucson residents is far from over.

For those who were there, knew someone who was there or even have in the past suffered from prolonged anxiety or depression, a gunman’s Jan. 8 attack outside a Safeway near here may play like a movie reel over and over again in their minds.

For most, the pain and sadness will wane with time, a tribute to the gift of human resilience.

For others, particularly those with a close connection to the event, it may persist, causing flashbacks, anxiety, insomnia, irritability, isolation and fear.

Three weeks after the tragedy, it’s too early to tell whether those symptoms will evolve into a more serious condition, such as post-traumatic stress disorder.

PTSD is a psychological condition that affects those who have experienced a traumatizing or life-threatening event such as combat, natural disasters, serious accidents or violent personal assaults.

If symptoms persist for more than 30 days, the possibility of the disorder becoming chronic or disabling does exist.

“To expect someone to act normally after an abnormal event is not reasonable,” said David Jacobson, manager of social work at University Medical Center, the hospital that treated and released 11 of the victims, including U.S. Rep. Gabrielle Giffords, after the shooting. Giffords is recovering at a Texas rehabilitation center.

“People are like sponges,” Jacobson said. “Once they’ve soaked up too much water, at some point they can’t soak it up anymore. Everyone reaches a breaking point.”

Six people were killed in the rampage. Jared Loughner, 22, of Tucson, is in custody and facing charges.

In the days after the shooting, several therapists in Tucson offered free counseling for those who were traumatized.

That effort will continue in the coming weeks, said Susan Warren, a licensed professional counselor in Tucson.

She and about 50 other professionals will team up to offer free therapy to the public. Dates and locations have not been finalized.

“It’s really important for people to know what to do and what not to do,” Warren said. “Many people want to focus on the issue, watch it on TV over and over again, and they are really just retraumatizing themselves.”

The victims

The blood, the loss of lives and the feeling of helplessness that arose as a gunman fired, first at Giffords and then at a line of her constituents, sparks flashbacks for some and causes heightened anxiety for others.

University Medical Center provided immediate attention to those whose wounds needed treatment.

Some said the hospital’s safe environment served as a safety blanket, a cocoon. Each individual’s mental health was assessed, and therapists were available at all hours.

As they were discharged, victims took with them the unsettling images of the day and a plan for long-term therapy.

Ron Barber, Giffords’ district director, was shot twice: once in the face and once through the leg, the latter of which nicked an artery.

Around him, friends and co-workers were wounded and killed.

In his retelling of the day’s events, he mentions the occasional flashback.

“(There was) a big pool of blood gathering underneath me, and right in the middle of it was a shell casing, a bullet shell casing,” he said. “I looked at my hands, and they were covered in blood.”

Barber said he will turn to a longtime friend and former colleague from the state Department of Economic Security to act as his therapist.

He also has a strong support system at home.

Even so, he acknowledges the day will likely continue to haunt him.

“Even though I feel I’m a pretty strong person in a lot of ways, I know that something like this could really have an effect on you that might not even be apparent right away,” Barber said. “So, I’m . . . not being shy about asking for help.”

Others who are struggling with similarly strong emotions say they also probably will take advantage of counseling.

Bill Hileman, husband of shooting victim Susan Hileman, told the media of his wife’s physical and mental afflictions a few days after the shooting.

Susan was clasping the hand of 9-year-old Christina-Taylor Green, whom she had taken to the event, when the bloodshed took place.

Although Susan attempted to shield the girl from the bullets, Christina-Taylor was fatally wounded.

After Susan’s breathing tube was removed, the first thing she asked Bill was whether the girl had survived.

Hileman recently recounted the tragic day on her blog.

“I know that it is possible to watch the light go out of another person’s eyes. I do not know if it is possible to live with that knowledge. I do know that I will try.”

The witnesses

Those who were spared physical wounds also are haunted by the shooting.

Shayne Spude, a bagger at the Safeway just north of Tucson, was speaking with another employee outside the store when the gunman opened fire. her fellow employee prevented her from being hit by throwing her to the ground, she said.

“I’m taking one step at a time, and I’m starting to feel better,” Spude said on Jan. 15, the day the store reopened.

Counselors have been on-site at the Safeway at Ina and Oracle roads since then to provide support for store employees, said Cathy Kloos, a company spokeswoman.

Safeway also provided counseling for employees from Jan. 9 to 14, while the store was closed.

“I am so angry,” said Laura Parker, a courtesy clerk, who was at Beyond Bread, about 75 yards from the storefront, when the shooting began.

Also affected were the first responders – firefighters, paramedics and emergency medical technicians. Capt. Adam Goldberg, spokesman for the district, arrived at Ina and Oracle roads to face the most demanding scene in his 22 years as a firefighter.

As the father of 8-year-old twin boys and a 5-year-old girl, he found the death of Christina-Taylor Green the most difficult to digest.

“It was a graphic and tragic scene that many of the firefighters will play over and over again in our heads,” Goldberg said. “We deal with children a lot, but it doesn’t make it any easier.”

The stress

The number of people who could suffer from post-traumatic stress disorder is unknown.

Symptoms of acute stress must persist for at least four weeks before a diagnosis can be made.

In the aftermath of the Sept. 11, 2001, attacks, many New Yorkers, Pentagon workers and other Americans experienced anxiety, depression, insomnia, flashbacks and irritability.

As the weeks passed, the percentage of those displaying acute symptoms waned, said Dr. John Markowitz, a research psychiatrist at New York State Psychiatrist Institute and a professor of clinical psychiatry at Columbia University.

“Who has the resilience to shake this off and who will fall into PTSD is a really interesting question that we don’t have a foolproof answer to,” Markowitz said.

In a five-year trial funded by the National Institute of Mental Health, Markowitz has studied the effectiveness of different kinds of psychotherapy for post-traumatic stress.

Having patients record their voice while they retell the traumatic event is among the most successful methods, Markowitz said.

After the session, the patient listens to the recording several times and returns the next week to retell the event. the process lasts 10 weeks in the trial, he said. “It clearly works, but it can be painful,” Markowitz said.

Reach the reporter at .

However, a problem can arise when nervousness occurs and there may not be an associated primary trigger. Some people can feel nervous for no reason at all. These people, unfortunately, can experience episodes where they feel extremely nervous — and this can occur without any particular reason. These symptoms fall under a condition called anxiety.

The person who feels anxious will find that their heart pounds faster than normal, their chest feels tight, they breathe rapidly, they feel that they cannot get a deep enough breath, their hands will tremble, they do not think properly, they worry continuously and these thoughts cause them to be pre-occupied to the point that it may even interfere with their daily life. when this occurs, it becomes a true anxiety disorder.

Anxiety disorders are very common. it has been estimated that more than 25 million Americans suffer from anxiety disorder. the main kind of anxiety disorders include panic disorder, phobias (fears), social anxiety, post-traumatic stress disorder and obsessive compulsive disorder.

These anxiety disorders can start in a person because of the lack of the body’s own defense to prevent anxiety. the body produces chemicals that prevent anxiety. Some people can inherit a lack of these chemicals. thus, it can be said that some anxiety disorders come from genetic causes. Also, environmental situations can cause anxiety. Stress, hard work and lack of sleep can lead to anxiety.

If a person believes he or she could be suffering from an anxiety disorder, talk it over with a doctor. there are many treatments available that help with this condition.

The first thing people should examine when they feel excessively nervous or anxious is what they are doing. If they are working long hours without rest periods, they should try to curtail that. If they are drinking a lot of caffeine containing drinks, they should try to reduce that. If they are not getting a good night’s sleep, they should try to correct that. If they are doing everything right and they still have these episodes of anxiety, then it is time to see a doctor.

Dr. Gordon J. Rafool is a specialist in family practice and geriatrics at Gessler Clinic in Winter Haven.

armytimes.com/news/2011/01/gannett-army-formerly-awol-campbell-soldier-deploys-011011/ By Jake Lowary – the (Clarksville, Tenn.) Leaf-Chronicle Posted : Monday Jan 10, 2011 13:26:34 EST

A Fort Campbell soldier who was considered AWOL in November and turned himself in said he would follow orders and deploy back to Afghanistan.

Jeff Hanks, 30, said Saturday that he would follow orders to deploy on Sunday even though he claims he still has post-traumatic stress disorder and has not received proper treatment from the Army. His attorney has also filed a formal complaint with the military claiming he was “wronged.”

“of course I’m going to do my job, but there’s parts of me that know something’s wrong,” he said Saturday night.

Hanks went home to North Carolina in October when he was on mid-tour leave and went to the Army to get help but said his commanders failed to help. the day he was to go back to Afghanistan to finish his tour, his anxiety and depression reached its limit when someone behind him clapped loudly in an airport restaurant.

The 1st Brigade Combat Team soldier said he developed PTSD following a 2008 deployment to Iraq. Since, he says he struggles with headaches and anxiety in large crowds, has nightmares and trouble sleeping and has been unnecessarily mean to his daughters.

Hanks, with supporters from the anti-war groups Iraq Veterans Against the War and Operation Recovery, held a press conference on Veterans Day to call attention to his situation and advocate for better mental health services for soldiers with PTSD.

“It’s sad that I had to resort to that, but I did what I thought was right,” he said then of his flight from the Army.

Since turning himself in, Hanks said he’s been going regularly to appointments both on and off post. the appointments and treatment on post with military behavioral health specialists have “never really got anywhere,” he said.

According to the IVAW website, four civilian doctors have diagnosed Hanks with PTSD.

The military recommended Hanks for a 12-week group therapy course, but his commanders and provider both “balked” because the course would take too long and said he would still have to deploy, he said.

“‘He didn’t really need it anyway, we’re just tying up loose ends,’ ” Hanks said of what he was told by the Army.

He sought a second opinion and that provider, also in the military, acknowledged symptoms of depression, anxiety, stress and sleep problems, he said.

“He cleared me [to deploy],” Hanks added.

Hanks’ attorney on Saturday filed an Article 138 with his commanders at Fort Campbell. the article allows any member of the military to officially claim that they were “wronged” by a commanding officer. Under the article, grounds for the claim can include “violation of law or regulation; beyond the legitimate authority of that commander; arbitrary, capricious, or an abuse of discretion; or clearly unfair.”

Hanks said he is not sure what the result of the filing will be, but that he plans to deploy anyway.

“I’m going to follow orders and go,” he said.

WEDNESDAY, Dec. 1 (HealthDay News) — Crohn's disease may cause post-traumatic stress disorder (PTSD), a new study contends.

The study included nearly 600 Swiss adults with Crohn's disease, an incurable inflammatory bowel disorder that causes severe pain and diarrhea.

The study participants underwent PTSD assessment at the start of the study and 19 percent of them were found to have the disorder. all the participants were monitored for 18 months. The researchers found that Crohn's patients with PTSD were more than 13 times likelier to experience worsening symptoms than those without PTSD.

The study appears Dec. 2 in the online edition of Frontline Gastroenterology.

Crohn's can't be cured but PTSD can, and doctors treating Crohn's patients need to be alert for PTSD and refer patients for appropriate therapy, said the researchers, led by Roland von Kaenel, a professor with Bern University Hospital, in Switzerland.

PTSD is typically triggered by violence, natural disasters and emergency situations. but a growing body of research shows that serious illness, along with diagnostic and treatment procedures, may trigger the psychological condition.

Over a long period of time, PTSD can permanently change the body's hormonal and immune responses, making a person more prone to serious health problems, the researchers said.

"in most cases, patients avoid talking about cures which remind them of having the disease," the researchers wrote in a news release from the journal's publisher. "Such behavior may unwillingly be encouraged by the usual shortness of consultation time and unfamiliarity of [gut specialists] in dealing with the psychological needs of their patients."

More information

The Crohn's and Colitis Foundation of America has more about Crohn's disease.

There are totally different kinds of anxiety disorders that folks can get.

Panic disorders are episodes of anxiety that hit frequently and generally without a warning. among the symptoms are shortness of breath, dizziness, chest pain, heart palpitations, fear of dying and stomach distress. One other type of anxiety disorder is post traumatic stress disorder. this disorder gives you symptoms that occur after an upsetting event just like natural disasters, crashes, assault, child abuse, warfare, feelings, nightmares depression, anger, and flashbacks to point out a few. Obsessive compulsive disorder are compulsive behaviors that you cannot control and have trouble stopping.

Phobias are another kind of anxiety. there are 2 types of phobias, social phobia and specific phobia. Individuals who have social phobia have fear of embarrassment, humiliation, scrutiny, causing them to stay away from social situations and miss out on other significant activities in their own life. Specific phobia is where you experience a fear of things that pose no danger to you. this will cause an individual to avoid particular objects and conditions. this may restrict peoples lives in many ways. another type of anxiety disorder is generalized anxiety disorder. this is when you have persistent thoughts of fear and stress about your day by day routines, life events and other activities. Even though there is no reason to anticipate it, you almost will always think the most horrible. The bodily symptoms are exhaustion, tension, queasiness, headache, and trembling.

There are specific methods that will be able to treat anxiety disorders. An anxiety checklistcan come in handy.

Treatments for anxiety problems are medications, and psychotherapy. These things may be combined together to help people with their anxiety. there are more drugs than there has ever been before to help treat anxiety disorders. some of these drugs are referred to as antidepressants. If one drug isn’t effective when it’s tried than others could be, try to see if they are going to be effective. new medicines are currently under development to help treat anxiety.

2 effective types of psychotherapy utilized in treating anxiety disorders are behavioral therapy and cognitive behavioral therapy. Behavioral therapy focuses on changing specific actions and makes use of some methods to stop undesirable behaviors from happening. Besides the behavioral therapy techniques, cognitive behavioral therapy will educate patients how to understand and change their thinking so that they could act in a different way to the conditions that bring about anxiety to them. Panic Awayis an online program to cure panic attacks. For some individuals this may be a good alternative.

Stop Panic Attacks the easy way.

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Posted on: Thursday, 2 December 2010, 15:22 CST

Post-traumatic stress in Crohn’s disease and its association with disease activity

The inflammatory bowel disorder Crohn’s disease produces its own variant of post traumatic stress (PTSD), indicates research published online in Frontline Gastroenterology.

PTSD creates a vicious circle by worsening the Crohn’s symptoms, indicates the study.

Crohn’s disease is incurable and can potentially affect the entire digestive tract, producing severe pain and diarrhoea. It is particularly common in Northern Europe, including the UK, and North America.

Its precise cause is not known, but its unpredictability makes it difficult to treat, and treatment is itself expensive, exhausting, and onerous, and carries its own risk of complications, say the authors.

The researchers tracked the health and psychological wellbeing of almost 600 adults over a period of 18 months. All of them had been diagnosed with Crohn’s disease and lived in various different locations in Switzerland.

At the start of the study, each patient’s mental health was assessed using a 17-item validated PTSD scale, which scores the degree of fear, suffering and impaired quality of life associated with PTSD from 0 to 51.

A score of 15 or more points is suggestive of post traumatic stress disorder, and almost one in five (19%) of the patients achieved this score.

The worsening of symptoms was then monitored during the subsequent 18 months to see if there was any link with the scores and a diagnosis of PSTD.

The results showed that those individuals with PSTD were more than four times as likely to experience worsening symptoms as those who scored below this threshold, and more than 13 times as likely to do so as those scoring zero.

Post traumatic stress occurs in response to traumatic experiences, and is typically manifest in recurring dreams/thoughts, avoidance tactics, irritability and sleeping difficulties.

It is normally associated with violence, emergency situations and natural disasters, but increasingly, research indicates that particular illnesses, such as cancer and HIV infection, plus the diagnostic and treatment procedures that accompany them, also take a hefty emotional toll, say the authors.

They add that over the long term, post traumatic stress permanently changes the body’s hormonal and immune responses, so making the sufferer potentially more prone to serious ill health.

"in most cases patients avoid talking about cures which remind them of having the disease…such behaviour may unwillingly be encouraged by the usual shortness of consultation time and unfamiliarity of [gut specialists] in dealing with the psychological needs of their patients," warn the authors.

Crohn’s disease can’t be cured, but PTSD can, and doctors should be alert to the psychological fall-out and refer patients for appropriate therapy, they suggest.

• BMJ-British Medical Journal
• Frontline Gastroenterology

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