Vietnam War Syndrome

After the end of military actions in Vietnam, for several years many people had such a mental disorder as Vietnam syndrome - this is a type of post-traumatic stress disorder, which is often diagnosed in those who were in war conditions. In fact, the same mental disorder is now called Afghan, Chechen syndrome - depending on what military actions influenced the appearance of the disorder.

Epidemiology

According to some data, at least 12% of former participants in local armed conflicts suffer from Vietnam syndrome to one degree or another (according to other data, from 25 to 80%). Such a stress disorder is diagnosed in 1% of the world's population, and 15% have some of its individual signs.

Over the past decades, this syndrome has been supplemented by Afghan, Karabakh, Transnistrian, Abkhazian, Chechen, and now Donbass syndromes – and the types of this pathology are becoming more complex each time.

Vietnam syndrome can last for a few weeks, but it can also persist for decades.

Unfortunately, there are no exact statistics on such cases. However, experts assume that the incidence rate is only increasing over the years.

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Causes Vietnamese syndrome

A form of post-traumatic stress disorder called Vietnam syndrome is considered a particularly complex psychopathic disorder, characterized by bouts of irritability and aggression, with a desire for destruction and even murder.

The causes of this syndrome may vary: these include past episodes of violence, witnessing physical injuries, one's own disability, and proximity to death. To qualify for Vietnam syndrome, one does not necessarily have to be a Vietnam War veteran: in most cases, this syndrome can be applied to people who participated in other military actions in other countries.

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Risk factors

• Participation in military operations, contemplation of violence, death, grief.
• Personal experiences and fears, often caused by the death of a friend or loved one.
• Forced risk of one's own life.
• Participation in accidents, disasters.
• Physical injuries, contusions, traumatic brain injuries.

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Pathogenesis

As a rule, Vietnam syndrome develops as a result of severe psychological trauma. As a rule, these are war-related events that are difficult to accept and comprehend. In most cases, the syndrome is provoked by cruelty, loss of life, violence and pain. Visual images are associated with a feeling of fear and horror, with a sense of inevitability and helplessness.

War has an extremely negative impact on a person's mental state. The constant feeling of fear and anxiety, the incessant nervous tension, the contemplation of murders and other people's grief make their negative contribution - this cannot pass without leaving a trace on the psyche.

Moreover, Vietnam syndrome can be found not only in direct participants in military operations, but also in members of their families, volunteers, journalists, doctors, rescuers, as well as in people living in the territory of a military conflict.

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Forms

Patients with Vietnam syndrome may experience several stages of increasing symptoms:

1. There is a loss of joy in life, insomnia, loss of appetite and sexual desire, and changes in self-esteem.
2. A desire for revenge appears, thoughts of suicide arise, which is often explained by the loss of the meaning of life.
3. The patient's conclusions become persistent, he does not make contact and does not give in to persuasion.
4. Delusional states develop, the patient blames himself for almost all troubles.

At a severe stage, the patient’s body becomes exhausted, cardiac disorders are observed, and blood pressure changes.

In addition, there are several phases of the human stress response:

• initial emotional response phase;
• the “denial” phase (emotional limitation, suppression of thoughts about traumatic events);
• an intermittent phase with the periodic appearance of “denials” and “intrusions” (thoughts and dreams that break through against one’s will);
• a phase of gradual processing of information, which usually ends with assimilation or adaptation of a person.

Vietnamese syndrome can have the following types of pathology:

• Acute syndrome (the first signs of the disease appear within six months after the injury and disappear within 5-6 months).
• Chronic syndrome (symptoms continue for more than six months).
• Delayed syndrome (symptoms appear after a certain latent period – six months or more after the traumatic situation, and continue for more than six months).

People who went through the war also have the following stages of Vietnam syndrome:

• primary impact stage;
• stage of denial (suppression) of events;
• decompensation stage;
• stage of recovery.

According to the general opinion of many experts, recovery may not occur in all patients, and much more slowly than it should.

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Complications and consequences

Of course, increased mental activity cannot go unnoticed by a person's health, manifesting itself in serious consequences later. Very often, unwanted memories and terrible visions visit the patient in a dream, which ultimately leads to insomnia. Often, a person is simply afraid to go to bed, and if he does fall asleep, then it is an intermittent and uneven sleep, often waking up in a cold sweat. Since such a dream cannot be called a full rest, the patient's psyche experiences additional colossal overloads, which only aggravates the situation.

The pathology makes itself known not only at night. During the day, hallucinations may occur - a person sees tragic pictures, and in real time, identifying them with reality. This can play a negative role and lead to isolation from society.

Another complication is the growing sense of guilt that people feel if they survive under certain circumstances while their friends or relatives die. Such people undergo a radical reassessment of values: they lose the ability to enjoy life and even just live in the modern world.

The most severe consequence of the Vietnam syndrome is the thought of suicide, which many manage to implement.

Among former military personnel who took part in combat operations in Vietnam, more soldiers committed suicide in the 20 years after the end of the war than died during the years of military conflict. Among those who survived, about 90% of families broke up - largely due to constant depression, the development of alcohol and drug addiction, etc.

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Diagnostics Vietnamese syndrome

A diagnosis such as “Vietnam syndrome” is made when the corresponding criteria for this disease are present:

1. The fact of being in a combat zone, the fact of a threat to life or health, stressful situations associated with war (anxiety, emotional concern for the lives of other people, moral trauma from contemplating the suffering of others).
2. Obsessive “replaying” of experienced moments, nightmares during sleep, vegetative reactions when mentioning the war (tachycardia, sweating, increased breathing, etc.).
3. The desire to “forget” about the war period, which is analyzed at the subconscious level.
4. The presence of signs of stress damage to the central nervous system (insomnia, bouts of irritability and irascibility, decreased attention, distorted reactions to external stimuli).
5. Long-term presence of signs of the syndrome (more than a month).
6. Change in attitude towards society (loss of interest in previously existing hobbies, in professional activities, isolation, alienation).

Over time, the patient may develop various types of addictions (including alcohol or drug addiction), which must also be taken into account when making a diagnosis.

Instrumental and laboratory diagnostics do not provide results to confirm Vietnam syndrome.

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Differential diagnosis

When diagnosing Vietnam syndrome, one must be careful, as the disease can easily be confused with other pathologies that develop in response to psychological trauma. It is very important to be able to identify diseases of a somatic or neurological nature that respond well to treatment if it is started in a timely manner.

For example, the use of certain medications, withdrawal symptoms, and head trauma can also lead to the development of “delayed” symptoms that are detected only after several weeks. In order to detect and recognize somatic and neurological disorders, it is necessary to collect as detailed anamnesis as possible, and also to examine the patient not only physically, but also using neuropsychological techniques.

During Vietnam syndrome, no disturbances in the patient's consciousness or orientation are observed. If such signs are detected, additional diagnostics are required to rule out organic pathology of the brain.

The clinical picture of Vietnamese syndrome often coincides with that of panic disorders or generalized anxiety disorder. In this case, anxiety and autonomic hyperreaction may become common symptoms.

For correct diagnosis, it is important to establish a time connection between the appearance of the first signs and the time when the psychotraumatic events occurred. In addition, with Vietnam syndrome, the patient constantly "replays" traumatic episodes in his head, and at the same time tries to protect himself from any reminders of them - such behavior is not considered typical for panic and generalized anxiety disorders.

Medical professionals often have to distinguish Vietnam syndrome from major depressive disorder, borderline personality disorder, dissociative disorder, and also from deliberate imitation of psychoneurological pathology.

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Treatment Vietnamese syndrome

Drug treatment for Vietnam syndrome is prescribed in the following cases:

• if the patient is in a state of constant nervous tension;
• if a person has hypertrophied response reactions;
• with frequent paroxysmal obsessive thoughts, accompanied by autonomic disorders;
• with periodically recurring illusions and hallucinations.

Medication treatment is prescribed in combination with methods such as psychotherapy and psychocorrection – and this is mandatory.

If the clinical picture of Vietnamese syndrome in a patient is not very pronounced, then sedatives based on valerian root, motherwort, peony, and hop cones can be used.

If the symptoms are quite severe, then the use of sedatives alone will not bring a therapeutic effect. In difficult cases, it will be necessary to take antidepressants from the series of selective serotonin reuptake inhibitors - for example, Prozac (Fluoxetine), Fevarin (Fluvoxamine), Zoloft (Sertraline).

The listed drugs improve the quality of life, eliminate anxiety, normalize the state of the autonomic nervous system, eliminate obsessive thoughts, reduce aggression and irritability, and reduce cravings for various types of addictions.

When taking antidepressants, anxiety symptoms may worsen at the initial stage of treatment. To smooth out this effect, treatment begins with minimal amounts of the drug, gradually increasing the dosage. If the patient complains of constant nervous tension, then Seduxen or Phenazepam are prescribed as auxiliary drugs during the first 20 days of therapy.

Among the main drugs that are often used for Vietnam syndrome, there are also β-blockers, which help to improve the functioning of the autonomic nervous system. These are drugs such as Anaprilin, Atenolol, etc.

If the patient suffers from drug addiction against the background of attacks of aggression, drugs based on lithium salts, as well as Carbamazepine, will be needed.

If the patient experiences illusory-hallucinogenic attacks in combination with persistent anxiety, then a good effect can be achieved by taking the neuroleptics Thioridazine, Chlorprothixene, and Levomenromazine in small quantities.

In complicated cases, with nocturnal hallucinations and insomnia, benzodiazepine drugs, as well as Halcion or Dormicum, are often prescribed.

Nootropic drugs (Piracetam) have a general stimulating effect on the nervous system - they are used to treat the asthenic variant of the syndrome. Such drugs are taken in the first half of the day.

Psychotherapy should be an obligatory component of complex therapy for Vietnam syndrome. In most cases, psychotherapeutic sessions on behavioral psychocorrection are practiced – such sessions can be both individual and group.

The following additional methods can be successfully used:

• hypnosis;
• auto-training;
• relaxation techniques;
• artistic treatment (transmission of emotions and fears in images).

Prevention

The emergence of Vietnam syndrome cannot be prevented, just as cruelty and loss of life during military operations and conflicts cannot be prevented.

However, timely psychological support often helps early self-healing of the disorder. That is why it is very important to provide such assistance to all people without exception involved in a psychotraumatic situation – in this case, military actions.

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Forecast

Vietnam syndrome cannot be cured overnight: treatment is usually long-term, and its outcome depends on many circumstances, for example:

• from the timeliness of seeking help from specialists;
• from the presence of support from family and loved ones;
• from the patient's attitude towards a successful outcome;
• from the absence of further psychological trauma.

For example, if a patient turns to specialists at the stage of preliminary exacerbation of the syndrome, then the duration of treatment and recovery of the body can be from six months to a year. The chronic version of the syndrome is treated for one or two years. The delayed syndrome has a more protracted course - its treatment continues for at least two years.

If Vietnam syndrome is complicated by any pathological disorders, then there is often a need for lifelong rehabilitation and psychotherapeutic treatment.