In 2009 a regiment of Danish soldiers, the Guard Hussars, was deployed for a six-month tour in Afghanistan's arid Helmand province, a Taliban stronghold. They were stationed along with British soldiers—270 in all—at a forward operating base called Armadillo. Although none of the Guard Hussars were killed during the tour of duty, they nonetheless experienced many horrors of battle. A commander was seriously injured by a roadside bomb, and a night patrol ended in a firefight that killed and dismembered several Taliban combatants.

The Guard Hussars' war experience is graphically depicted in the award-winning documentary film Armadillo, which debuted in 2010. It follows the soldiers from their emotional farewells in Denmark through their months in combat and, finally, back to joyous homecomings and family reunions. The film is a study of the inner lives of young men as they experience the excitement and camaraderie, the tedium and—mostly—the terror and trauma of war.

Coincidentally, these same soldiers were also the subject of another, very different kind of study. At the same time that the film was being shot, the men were part of a larger group of Danish soldiers who were being scientifically observed and tested for emerging symptoms of post-traumatic stress disorder, or PTSD. A large team of Danish and American psychological scientists, led by Dorthe Berntsen of Aarhus University, wanted to do what had never been done before in this field of research: instead of studying soldiers who were already suffering from PTSD, they decided to assess young recruits before they were sent off to war, when they were still relatively unscathed, then to record them during the war experience, and finally to follow them back home and through several months of readjustment. In this way, the scientists hoped to see why some soldiers develop PTSD and others do not and how the symptoms of the disorder progress.

As in the film, the scientists first encountered the soldiers at home in Denmark, where they were readying for deployment to Afghanistan. Psychologists met with their 746 subjects five or six weeks before they were scheduled to be deployed and administered a battery of psychological tests. These included a PTSD inventory, a test for depression, and a questionnaire about traumatic life events, including childhood experiences of family violence, physical punishment and spousal abuse. Additional tests were administered during the soldiers' service, related to the direct experience of war: perceptions of war zone stress, actual life-threatening war experiences, battlefield wounds and the experience of killing an enemy combatant. The scientists continued to assess the soldiers when they were sent home, at a couple of weeks, at three months, and finally at least seven months after their return.

Cumulative Cause

The study revealed some surprising findings. The current and widely held view of PTSD is that its main cause is exposure to combat and other war atrocities—and that more trauma boosts the likelihood of experiencing the disorder. Moreover, experts believe that for those who develop PTSD, the typical pattern is for symptoms to emerge soon after a particularly traumatic experience and to persist over time. For unknown reasons, some soldiers appear resilient in the face of war trauma, never developing symptoms or else rapidly recovering.

These expectations did not match up with what the scientists found. Indeed, the consensus view of the disorder may be fundamentally wrong in at least two ways. As reported in a forthcoming issue of the journal Psychological Science, PTSD does not appear to be triggered by a traumatic battle experience, nor does there appear to be any typical trajectory for PTSD symptoms.

What Berntsen and her colleagues found instead is wide variation in both the causes and development of PTSD. The vast majority of Danish soldiers were resilient—recovering quickly from mild symptoms—or altogether impervious to psychological harm. The rest fell into distinct and unexpected patterns. The first group showed no symptoms before deployment or even during their tour of duty, but symptoms spiked after they returned home. For these soldiers, symptoms did not appear to follow any specific traumatic event, but by seven months after the men had returned, their stress symptoms had worsened to the point where they were diagnosed with PTSD. [For more on the potential cumulative causes of PTSD, see “Does Post-Traumatic Stress Disorder Require Trauma?” by Hal Arkowitz and Scott O. Lilienfeld; Scientific American Mind, May/June 2012.]

6 Comments

1. 1. rshoff 11:59 AM 11/21/12

   Sounds right to me. PTSD begins in childhood. I wonder though, is it an active process where the illness begins in childhood ripe for rupture when faced with further trauma in adulthood? Or is it a passive process due to the failure of acquiring coping skills in a violent or neglectful environment during childhood consequently leaving a deficit when faced with trauma in adulthood?

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2. 2. sjn 01:00 PM 11/21/12

   It's not clear how many people were actually deployed - there is reference to 270 (Brits or Danes?) and 746 In either case, over 6 months the only reported casualty is one injury by a roadside bomb?!
   This doesn't seem like a comparable exposure to more engaged US troops. Can you really say anything more than that previous high stress outweighed the actual combat stress in contributions to PTSD? Wouldn't you need a more rigorous study where combat levels of stress were more significant? The fact that no one without previous very high stress situations developed PTSD is claimed to be proof that combat stress didn't cause PTSD - how can we rule out that the stress levels experienced by this regiment were not sufficient to lead to significant PTSD?

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3. 3. EBark 08:43 PM 11/21/12

   This article is so fascinating as it relates to my hypothesis about cortisol reactivity and baby brains and attachment disorders with child abuse. I have been researching this since last year and it is all related. The mind is connected to the body and the emotions and the touch we receive as children whether they are touched with negative reinforcement or positive. It is all we can do to prevent child abuse now. It is a perpetuating cycle. I think it also leads to bipolar disorders in adults.

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4. 4. Army veteran 07:53 PM 11/22/12

   The study has flaws as it is only on one group of soldiers from a single country. The Danes may be subject to more childhood violence than some other countries and as such this has a major impact on the study. The other point I like to raise is how long were these members in combat? Were they subject to the same long periods of combat as experienced in Vietnam? Civilians in Vietnam were born into a war and many experienced 30 or more years of traumatic events. I can verify that very little child abuse happened and many suffer from PTSD. I am a veteran married to a Vietnamese wife and both have witnessed war and tragic events and both of us come from a well adjusted family without any child abuse. Finally this type of study is dangerous as it depicts people wrongly and it has not been done over a wide sector of the community, it was only compared to a group of Danish soldiers and is too small to make any substantial accurate statements on PTSD.

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5. 5. ChrisSciAm in reply to Army veteran 01:37 PM 11/23/12

   I completely agree. Further, 13 percent of subjects had significant anxiety and nightmares before deploying. That is, that had psychology issues prior to combat. So what does this have to do with PTSD? If you want to say that childhood traumas can manifest themselves as psychological problems resembling PTSD when individuals undergo stressful situations, that makes sense. I don't see how this proves a relation between the two. This is just bad science.

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6. 6. bongobimbo 07:53 PM 11/23/12

   Yeah, yeah. And baloney. I'm a 12-year Navy noncombatant woman veteran who resigned because of the horrors of Vietnam and what it was doing to so many combat-destroyed friends, and I'm an active member of 3 peace veteran groups and a peace grandmothers' group. I know many, too many, vets, even elders of WWII and Korea, who still suffer badly from PTSD. This sounds to me like some clunkhead in the Danish VA who's trying -- yet again, endlessly! -- to blame the VICTIM. For God's sake, PTSD sufferers need help, not dredging up what may be an exaggerated "troubled" childhood! My dad came from the most disfunctional family I ever heard of--and he grew up to be one of the mildest, kindest, most non-neurotic adults who ever had a crowded funeral service in Iowa that drew hundreds of old friends from New England, Virginia, Florida and California. But that MAY have been because WWI ended a few weeks after he got to boot camp at Great Lakes, so he never got aboard a ship that was torpedoed by a submarine of the Kaiser, never at the age of 19 had to tread water and watch his friends burn to death or drown! People who write articles like this, or smug psychologists who conclude that combat traumas have little to do with PTSD, should be sent to Afghanistan for about 6 months. Maybe they'd learn a little humility. I AM ANGRY AND SORROWFUL THAT MY FRIENDS AND COMRADES IN ARMS COULD BE SO MALIGNED!

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