Mental illness

What mental health issues can arise after serving abroad

Soldiers' mental health is particularly affected by traumatic experiences during overseas deployments. Post-traumatic stress disorder (PTSD) is probably the best-known mental illness that can occur as a result of overseas deployment. Other mental illnesses are now also being diagnosed in connection with foreign deployments. Within the British Armed Forces, these illnesses are recognised as mental disorders resulting from deployment, on a par with post-traumatic stress disorder. Some soldiers develop several such deployment-related disorders. All of these are serious illnesses and require professional treatment.

The German Armed Forces statistics show a total of 290 new cases of mental illness related to military service in 2019. These include 183 PTSD patients and 107 patients with other mental illnesses.

Below, we briefly explain the most common mental illnesses that can occur after a posting abroad.

Here you will find:

Post-traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) describes a range of psychological symptoms that can occur in response to a potentially traumatic event. PTSD comprises four main symptom groups:
  • Memories and flashbacks: The traumatic event is repeatedly relived in the form of uncontrollable thoughts, images (known as flashbacks) and nightmares.
  • Avoidance: Thoughts, activities, places or people that may trigger memories of the trauma are avoided.
  • Negative perception and mood: Feelings are almost exclusively limited to joylessness, fear, shame and guilt, a constant feeling of numbness and emotional dullness, indifference towards other people, apathy towards one's surroundings.
  • Constant inner restlessness: Difficulty falling and staying asleep, excessive jumpiness, extreme alertness, difficulty concentrating, pronounced irritability.

Other psychological disorders resulting from deployment

1. Addiction disorders

Stressful events are the main contributing factor to the development of addiction. A distinction is made between substance-related and non-substance-related addictions.

Substance-related addictions: Substances are consumed to such an extent that they cause damage to the body, the psyche and the social environment.

These substances include

  • legal substances such as nicotine or alcohol;
  • illegal substances such as crystal meth or cocaine.

Such an addiction usually begins with a kind of self-treatment attempt. Those affected initially try to relax, reduce anxiety or forget what has happened by taking the substances – even if only temporarily.

As time goes on, this can lead to a loss of control. The substance must be taken more and more frequently and in larger quantities in order to continue to achieve a positive effect. A single instance of substance abuse can quickly develop into addiction. This can go so far that other interests are put aside in favour of consuming the substance and almost all thoughts revolve around taking the substance. If an attempt is made to stop taking the substance, withdrawal symptoms appear.

Regular consumption of legal and illegal substances is not only harmful to the body and mind, but also to the social environment. Those affected spend a lot of time obtaining and consuming the substance in question. They often have to recover from the after-effects, which severely restricts their social life. Despite the harmful physical consequences, those affected are unable to stop using the substance.

Non-substance-related addictions describe the dependence on certain behaviours that can no longer be controlled. These include, for example, gambling behaviour, computer or internet use, shopping, work, sports or sexual behaviour.

Further information

2. Anxiety disorders

People react to dangerous or threatening situations with symptoms of anxiety. An anxiety disorder is present when a relatively harmless situation triggers an unreasonably strong feeling of anxiety, leading to significant limitations in everyday life. Those affected increasingly avoid putting themselves in situations that cause them anxiety.

There are five main types of anxiety disorders:

Agoraphobia

Fear of being in large spaces and crowds. Those affected fear experiencing embarrassing situations from which they cannot escape or in which they are unable to get help in time.

Typical situations:
Shopping in the supermarket; visiting public places such as restaurants or cinemas; using public transport.

Social phobia

Fear of social situations. Those affected are afraid of being the centre of attention and of being observed and (supposedly negatively) judged by other people. The fear can be so pronounced that social contact is avoided altogether.

Typical situations:
Discussions with superiors or authorities; giving a presentation; approaching someone.

Specific phobia

Fear of a specific situation or object.

Typische Beispiele:
Fear of enclosed spaces, heights, injections, blood, animals (e.g. spiders, insects, mice).

Panic disorder

Recurring, pronounced anxiety attacks that occur several times within a month. A panic disorder occurs suddenly, is not limited to specific situations and is therefore unpredictable.

Common symptoms:
Heart palpitations, chest pain, shortness of breath, dizziness.

Generalised anxiety disorder

Fear of everything possible. Those affected constantly have serious worries and fears about everyday situations and real potential dangers. For example, they worry about their health, their relationship, their job or their finances. They overestimate the likelihood of the feared events occurring and the possible consequences thereof.

Some typical fears: Something bad might happen to a relative; there won't be enough money; the children might get ill.

3. Adjustment disorder

A stressful life event can trigger problems in the process of adapting to the new life situation. The affected person may then exhibit negative changes in their state of mind and social behaviour. Depression, sleep disorders, impaired performance or increased irritability are further symptoms that often lead to problems at work and/or in private life.

4. Depression

Patients with depression suffer from a depressed, negative mood, joylessness and reduced motivation without any direct trigger. Those affected talk about their inability to experience joy. They report circular, brooding thoughts and an inner emptiness, even total numbness. It is torture for them to make decisions and cope with everyday situations. Often, they are no longer able to cope with even the smallest of tasks.

Eine Depression führt zu psychischen und körperlichen Symptomen. Die wichtigsten Symptome einer Depression sind:

Psychological symptoms

  • Depressive mood
  • Loss of interest, joylessness
  • Loss of self-confidence
  • Self-reproach and pronounced feelings of guilt
  • recurring thoughts of death or suicide
  • Brooding or ruminating without finding a solution that brings relief
  • Difficulty in making decisions
  • Impaired thinking and concentration

Physical symptoms

  • Reduced drive, increased fatigue
  • Sleep disturbances with early morning awakening, sometimes increased need for sleep
  • morning low mood with evening brightening
  • Loss of appetite and weight, sometimes increased appetite
  • Decrease in sexual interest
  • Persistent symptoms that do not respond to treatment, such as headaches, digestive problems, general weakness, dizziness, chronic pain

A distinction is made between different forms of depressive disorders:

Depressive phases (major depression):

Such phases can occur once or repeatedly. They are usually the result of severe stress and display several of the symptoms mentioned above. If left untreated, these phases can last four to six months.

Persistent depressive disorder (dysthymia):

This is a longer-lasting form of major depression, but the symptoms are less severe. Those affected often experience additional depressive episodes.

Manic-depressive disorder (bipolar affective disorder):

Those affected experience both depressive and manic phases.

Manic phases are characterised by

  • an elevated and agitated mood
  • increased activity
  • urge to speak;
    reduced need for sleep
  • reckless behaviour, for example through ill-considered spending of money
  • psychotic symptoms such as overconfidence or delusions of grandeur

In addition to foreign assignments, the following factors can contribute to the development of depression:

  • previous depressive episodes
  • depressive and manic-depressive illnesses or suicide attempts in the family
  • Alcohol, tablet or drug addiction
  • stressful events in one's personal life, such as the death of a relative, separation, loss, relationship crisis, pressure to perform, excessive demands
  • Isolation and lack of social support

Depression is one of the most common and serious mental illnesses. People with depression experience profound changes in their feelings, thoughts and behaviour, and even changes in their physical functions. People suffering from depression have a significantly increased risk of suicide.

5. Dissociative disorders

In dissociative disorder caused by trauma, part of the conscious perception, memory or sensation splits off. For example, a person affected by this may no longer be able to remember what they have experienced, may suffer from paralysis of the extremities or even complete immobility, or may develop emotional numbness. These symptoms usually subside on their own after a few months.

6. Eating disorders

People who suffer from eating disorders become obsessively preoccupied with food and weight. Refusal to eat, binge eating or deliberately induced vomiting are characteristic symptoms. Eating disorders can quickly lead to serious health consequences.

7. Moral injuries

During foreign deployments, soldiers may find themselves in situations that require them to behave in ways that are incompatible with their own values. Troops operating outside their camps are particularly at risk of suffering serious moral violations.

Possible situations that can cause moral harm to soldiers include:

  • Combat operations involving injury or killing of other people may conflict with one's own religious beliefs.
  • Suffering, misery or acts of violence among the civilian population often lead to feelings of helplessness and self-reproach, as one is unable to help.
  • The behaviour of superiors can be judged morally and lead to internal reactions.

Those affected often report that such experiences lead to significant changes in their personal values. These include, for example, a greater appreciation of family, friends and positive character traits, while material goods become less important. Those affected often perceive such changes with pride and satisfaction. However, psychological stress can arise if their changed values are met with incomprehension or rejection in their social environment.

8. Sleep disorders

Sleep disorders occur particularly frequently in connection with PTSD and other mental illnesses (resulting from trauma). However, sleep is very important for humans so that the body and mind can recover. Traumatised individuals often try to avoid sleep for as long as possible. For them, sleep is associated with unpleasant feelings.

These fears prevent traumatised people from sleeping.

  • Fear of nightmares
  • Fear of potentially dangerous situations to which one cannot react while asleep
  • Fear of memories of the traumatic event, especially if it occurred at night

Sleep disorders can have many causes. The most important ones are:

Depression: People with depression often wake up earlier than planned or find it difficult to get out of bed.

Medicines: Certain medicines can disrupt sleep.

These include

  • Medicines for asthma
  • Various freely available nasal drops/decongestants
  • Allergy and cold medicines
  • various steroids
  • Beta blockers (medication for heart problems)
  • Medications for ADHD
  • various antidepressants

Anyone taking such medication and experiencing sleep problems should consult their doctor for advice.

Sleeping pills: They alter your natural sleep cycle. With regular use, most preparations require a constantly increasing dose in order to induce sleep. Long-term use of sleeping pills can lead to psychological dependence. The effects of sleeping pills often last into the day after taking them, leaving you feeling sleepy or lethargic throughout the day.

Sleep apnoea: This condition causes breathing interruptions during sleep, which are caused by a narrowing of the airways (nose or throat) while sleeping. As a result, not enough oxygen-rich air reaches the lungs, causing the body to react by waking up frequently. Those affected are usually unaware of the condition. Symptoms such as loud snoring, snorting or gasping for air are usually noticed by the partner.

These symptoms could indicate sleep apnoea:

  • Morning tiredness and sleepiness during the day
  • morning headaches that quickly disappear after getting up
  • Waking up with a dry mouth

Worries: Mulling over problems, planning future events or even the fear of not being able to fall asleep keeps you awake.

Further information

  • Regular nightmares – a symptom of PTSD – prevent restful sleep. Anyone suffering from this should seek psychotherapeutic treatment immediately. There are very effective methods that can help stop nightmares.
  • For soldiers, many nightmares revolve around dangerous combat missions. Some people mentally replay the content of their nightmares after waking up. They want to find out why they had the nightmare and what it might mean. Some experts believe that this, along with avoiding sleep, increases the likelihood of future nightmares.

You can find helpful tips for restful sleep in our advice section.

These measures help to stop the cycle of worry:
  • Consciously postpone your musings and planning until the next day and set a fixed time for this.
  • Be aware that it is not a big deal if you do not sleep well once in a while.
  • If you can't switch off at all, it's better to get up and distract yourself with something else – listening to music, for example. Once your head is clear, you can go back to bed and sleep.

9. Somatoform disorders

Somatoform disorders describe physical complaints that persist over a long period of time but for which no organic medical causes can be found. Uncertainty about their own state of health often leads to pronounced fears of illness in those affected.

The most common complaints include:

  • Pain symptoms, for example back pain, joint pain, stomach ache and headache
  • Gastrointestinal complaints, such as nausea, bloating and diarrhoea
  • Complaints affecting the respiratory and cardiovascular systems

To alleviate their suffering, most sufferers develop protective and avoidance behaviours with regard to their symptoms. They take medication without a doctor's prescription, use medical services more frequently than usual or often change doctors, a practice known as doctor shopping.

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