The sad fact is that the very people who should most enjoy an explosive celebration of our nation's birth often do not. According to the U.S. Department of Veteran Affairs, military veterans who suffer from posttraumatic stress disorder (PTSD) may find that Fourth of July fireworks do not inspire happy thoughts but trigger severe anxiety and panic attacks instead. This is very much an issue, then, for 30 percent of the 800,000 veterans of Afghanistan and Iraq — the current figure for recent veterans diagnosed with PTSD.

An individual reaction to fireworks can range from a heart-pounding startle to a "full-blown anxiety attack and flashback of combat. It's something they try to avoid," said Dr. Jeffrey Fine, director of the PTSD program at VA New York Harbor Healthcare System. Worse, it's not the big 'booms!' from public and planned displays that are the most difficult for veterans, but the smaller unexpected blasts resulting from a cherry bomb lit and thrown in a backyard. With fireworks so easily accessible, kids (and grown kids) may be setting off minor explosions at any time and doing so throughout the entire weekend.

PTSD 101

Posttraumatic stress disorder can plague anyone after a traumatic event, which may include combat exposure, a single or repeated instances of sexual or physical abuse as a child, a terrorist attack, sexual or physical assault, or any type of serious accident like a car wreck.

In the most simple terms, the body's response to a traumatic event is a flood of stress hormones ("fight or flight"); this flood incapacitates areas and functions of the brain (including parts of the cerebral cortex, which creates logical thought). Because of this disabled function, the event is neither processed nor stored in the usual ways, remaining outside the borders of long-term memory; in the future, then, the event is not remembered so much as re-lived.

During a traumatic event, people often feel afraid, out of control, and may even believe that they or others will die. Nothing is more common than to have some stress-related reactions afterward, though a problem arises when the symptoms don't go away over time and continue to disrupt ordinary life. That's a sign of an unordinary response to a trauma or PTSD.

The primary four symptoms of PTSD are:

  • Reliving the event (also called re-experiencing symptoms): This may take the form of memories or nightmares or, in many cases, a person feels as if they are going through the event again (a flashback).
  • Avoiding situations that are reminders of the event: PTSD sufferers may try to avoid situations or people that trigger memories of the traumatic event. They may even avoid talking or thinking about the event.
  • Negative changes in beliefs and feelings: The way people think about themselves and others may change because of the trauma. People may feel fear, guilt, or shame. They may lose interest in activities formerly enjoyed.
  • Hyperarousal: Trauma survivors may feel jittery, always alert, and on the lookout for danger, or they may have trouble concentrating or sleeping.

Although many trauma victims experience some or all of the above symptoms soon after the event, delayed-onset PTSD accounts for nearly one-quarter of all instances of the disorder. Thankfully, in most cases of PTSD, treatment can alleviate these symptoms.


Dr. Matthew Friedman, executive director of Veteran Administration's National Center for PTSD, believes that simply knowing there are treatments that work would lead people who suffer with PTSD to seek the care they need. "Many barriers keep people with PTSD from seeking the help they need," said Friedman. "Greater public awareness of PTSD can help reduce the stigma of this mental health problem and overcome negative stereotypes that may keep many people from pursuing treatment."

Posttraumatic stress disorder treatment commonly includes both medication and psychotherapy. In some cases, sufferers are prescribed a short course of antipsychotics to relieve severe anxiety and related problems, such as difficulty sleeping or emotional outbursts. Antidepressants and anti-anxiety medications may help with symptoms of anxiety as well, while also improving sleep problems and concentration. If symptoms include insomnia or recurrent nightmares, a drug called prazosin may help, as it blocks the brain's response to an adrenaline-like brain chemical called norepinephrine.

Psychotherapy approaches include cognitive therapy, where discussion helps trauma survivors to recognize their ways of thinking (cognitive patterns) that remain 'stuck' — negative or inaccurate ways of perceiving normal situations. Cognitive therapy is often used along with a behavioral therapy called exposure therapy. This technique is all about a survivor facing what caused the trauma. Virtual reality programs may even allow a person to re-enter the setting as would be the case with a "Virtual Iraq" program. Another recent therapy, eye movement desensitization and reprocessing, combines exposure therapy with a series of guided eye movements that help process traumatic memories.

For many sufferers, families and friends also greatly ease the anxiety.

Traumatic Brain Injury

For many veterans, the buffer of family and friends may be the only support required throughout an explosive Fourth of July weekend. Other veterans more practically keep noise-canceling headphones on hand. In many cases, PTSD will fade over the years as a veteran understands his or her particular 'triggers' while also learning how to minimize reactions to fireworks or sudden or loud noises.

Despite the fact that many veterans eventually gain enough knowledge of their condition to once again move smoothly through the world, their difficulties should not be underestimated. In fact, researchers have only recently begun to understand the many complexities of PTSD. A recent Australian study, for instance, highlighted the trajectories of PTSD symptoms over time and its link to mild traumatic brain injury (MTBI).

To study how PTSD is affected by brain injury, researchers selected patients from recent admissions to four major trauma hospitals across Australia. A total of 1,084 traumatically injured patients were assessed during hospital admission from April 1, 2004, through February 28, 2006, and 785 (72.4 percent) were followed up at three, 12, and 24 months after injury. Of those who met PTSD criteria at 24 months, 44.1 percent had reported no PTSD at three months while the remaining 55.9 percent had reported either insignificant symptoms or full PTSD at that same time.

In those who displayed no PTSD at three months, the severity of their disorder at 24 months could be predicted by MTBI and the number of stressful events experienced between three and 24 months, among other factors. The study, then, "points to the roles of ongoing stress and MTBI in delayed cases of PTSD and suggests the potential of ongoing stress to compound initial stress reactions and lead to a delayed increase in PTSD symptom severity," the authors wrote. "This study also provides initial evidence that MTBI increases the risk of delayed PTSD symptoms, particularly in those with no acute symptoms."

As brain science progresses, the possibility of developing a comprehensive treatment for this painful disorder will in all likelihood increase, and soon those who suffer will no longer need to hide on the one day that most celebrates their sacrifice.

Source: Bryant RA, O'Donnell ML, Creamer M, McFarlane AC, Silove D. A Multisite Analysis of the Fluctuating Course of Posttraumatic Stress Disorder. JAMA Psychiatry. 2013.