Do you have a patient whose PTSD just doesn’t seem to get better? Have you treated someone who looks to relive combat experiences through combat-like activities or who engages in high risk activities which provide a rush? Is it possible that combat could be addictive?
Combat experiences vary greatly and impact service members in diverse ways. For many combat is much more than a series of negative or distressing events. It’s an extremely arousing experience that stimulates powerful and exciting memories of performing one’s duties with great competence while feeling somewhat omnipotent at the same time. While the combat environment may yield many traumatic episodes, it is often full of exhilarating encounters.
The combination of thrilling events and gruesome outcomes can sometimes leave one feeling guilty about their emotional reactions to combat. Some veterans have reported that combat is the ultimate rush; they feel bored or empty without that excitement. Because the combat rush feels so good, both psychologically and physically, many combat veterans want to re-experience that powerful feeling, similar to an addictive high. Re-experiencing those intense combat highs may be followed by experiencing depressing lows, just like the cycle of addiction. Many veterans have described the combat high as better than any drug they’ve experienced.
Is there evidence that supports the concept of combat addiction? In a nutshell, there is no empirical research base, but articles related to the topic began to appear in the literature after Vietnam. A recent pilot study termed the phenomenon combat attachment and indicated that combat veterans diagnosed with PTSD may spend more time re-experiencing exciting, positive combat-related events, accompanied by the ‘adrenaline rush,’ than they spend re-experiencing distressing, negative combat events. Furthermore, combat attachment behaviors appeared to demonstrate addictive features and were associated with impaired functioning.
Combat attachment behaviors can include playing combat-related videogames for hours, watching war movies, sharing combat stories with other combat veterans, going through one’s own combat photos and videos, or viewing combat-related Facebook posts and YouTube videos. Combat attachment even involves just thinking about, or daydreaming about combat, often when individuals are bored or involved in routine tasks, such as driving or working out.
So, what makes these behaviors different from “normal” military leisure behaviors? The answer lies in the amped up adrenaline rush the activity provides. Following deployment, these activities become more frequent, more intense, and last longer; also some become more compulsively serious with less social interaction and enjoyment.
Additional research is needed to help us better understand combat attachment behaviors and their potential relationship to combat PTSD and other post-deployment conditions.
The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Deployment Health Clinical Center or Department of Defense.