Known through the ages as "melancholy," "shell shock" and "combat fatigue," post-traumatic stress disorder can strike a combat veteran at any time.

Known through the ages as "melancholy," "shell shock" and "combat fatigue," post-traumatic stress disorder can strike a combat veteran at any time.

Experts at the National Center for Posttraumatic Stress Disorder, part of the U.S. Department of Veterans Affairs, say symptoms can start soon after a traumatic event or months or years later.

They include aggressiveness, alcohol and drug abuse, emotional numbness, irritability, nightmares, problems with employment and relationships, sleeplessness and violence.

Events such as a door being slammed or the sound of someone shooting can spark a reaction associated with PTSD, experts say.

"It seems to be correlated with the amount of combat exposure a person has," says psychologist Francis Gilbert, associate chief of staff for mental health at the VA's Southern Oregon Rehabilitation Center and Clinics in White City. "The more combat exposure you have, the more likely you are to be symptomatic.

"But that doesn't mean if you have a small amount of combat exposure that you won't be symptomatic," he says.

Nor does a steady diet of combat necessarily mean a veteran will experience PTSD symptoms.

Some veterans don't show any signs of PTSD for decades after the event, Gilbert says.

"World War II veterans came back with expectations of coming back and going to work and taking care of their families," he says. "But once they retired and are in their late 70s and 80s, the irritability and dreams and numbness that oftentimes go along with PTSD begins."

An event such as losing a spouse can trigger the symptoms, he says.

Some Vietnam veterans are just now demonstrating PTSD symptoms because of media coverage of the Iraq and Afghanistan wars, says Keith Welsh, a former Army infantry captain who is the SORCC's program manager for returning Iraq and Afghanistan war veterans.

Since 2004, 725 Afghanistan and Iraq veterans have contacted SORCC for help, many with PTSD issues.

"Our referrals come in from family members or community members concerned about somebody who is drinking excessively or has personality changes — things like being very angry, detached from the family, disciplining young children in aggressive ways," says Billy Haden, a Navy veteran who is the outpatient case manager for severely injured veterans returning from Iraq or Afghanistan.

Both Welsh and Haden have master's degrees in social work.

Some people experiencing trauma can grow from the experience and use it for positive personal change, Gilbert says, referring to what experts call "post-traumatic growth."

"If there is growth, the traumatic experience is still there, still emotionally and psychologically powerful," Haden says. "But we are starting to see some growth from the guys who have been back for a period of time.

"You also see the ones who aren't having any tangible growth out of this trauma yet," he adds. "Whether it happens down the road is hard to say."

Many of the veterans not reporting PTSD symptoms are likely using their time in combat as a strengthening experience, Welsh believes.

But he cautions it would be inaccurate to generalize veterans.

"Two people in the same unit in the same combat experience can have such vastly different outcomes," he says. "It has to be on a case-by-case basis. What each one has gone through is unique to them."

Part of Welsh's job is to call returning veterans to let them know they have SORCC as a resource. "We can even meet people in their homes if they want," he says.

Welsh's number is 531-3274; Haden can be reached at 261-7843.

Veterans need not worry about being stigmatized if they seek help for PTSD issues, Gilbert stresses.

"We're not interested in documenting someone's disability," he says. "We're very much concerned with promoting their ability."

Reach reporter Paul Fattig at 776-4496 or e-mail him at pfattig@mailtribune.com.