Some veterans called in sick in the days afterward, while one, an alcoholic struggling to stay sober, resumed drinking. Others had flashbacks of the gore of war, with one so consumed by television coverage of the Marathon blasts and the ensuing manhunt that she had to be hospitalized. Another veteran, after learning of all the severed limbs on Boylston Street, ruminated about a fellow soldier who had been torn apart in battle.
In the days after the bombings, which brought home a horror that many of them faced abroad, some veterans began to experience again the trauma they had spent years struggling to overcome.
A study released Friday of Boston-area military veterans previously diagnosed with post-traumatic stress disorder found that 38 percent of those surveyed said they experienced emotional distress as a result of the bombings and the lockdown during the search for the suspects. Of those, a majority told researchers that they experienced unwanted memories of their own trauma.
“These veterans are among the unrecognized victims of the terrorist attacks, those whose injuries are hidden,” said Mark Miller, associate professor of psychiatry at the Boston University School of Medicine and the lead author of the study, which will appear in the December issue of the Journal of Traumatic Stress.
He said it is the first study to be published about the mental health effects of the bombings on Boston-area residents. While a relatively small number of veterans were surveyed, Miller said, his paper is among only a few to document the effect of traumatic events on people with preexisting PTSD.
“This study shows that people who experienced similar horror in the past are especially vulnerable to the terror,” Miller said. “For combat veterans, the similarity between the Marathon bombing explosives and their own combat experiences triggered a reoccurrence of their own traumatic memories and an exacerbation of their symptoms.”
The study surveyed 71 local veterans who had been taking part in a long-term study of those who have suffered heightened anxiety, increased irritability, sleeplessness, and other symptoms of PTSD as a result of their combat experience. Each was contacted by phone within a week of the capture of Dzhokhar Tsarnaev, who has been accused of joining his brother, Tamerlan, in planting the two bombs that killed three people and injured more than 260 others on April 15.
More than 40 percent of the veterans, mostly older men who served in Vietnam, told researchers that they were personally affected by the bombings, either by being close to the attacks, having a relative nearby, or by suffering emotionally.
The authors of the study declined to identify the veterans, but they provided some of the comments the former service members made to the researchers.
One veteran who was in the grandstands during the attack, across the street from the first bomb, told the researchers that he “felt very drained and kind of fearful” after helping the victims.
“Reality hits after the fact, and that’s when the feelings and the physical symptoms come in,” he said. “I drank after – I’m [an] alcoholic – had been dry for a couple weeks before.”
Another veteran said: “When the people lost their legs, it reminded me, and I flashed back to my friend getting cut in half. It made me angry.”
Paula Schnurr, deputy executive director of the US Department of Veterans Affairs National Center for PTSD, pointed out that the study was limited in time and reflected that the majority of those surveyed did not experience a recurrence of their emotional trauma as a result of the bombings.
But she called the research “an important reminder” of how quickly and unexpectedly PTSD symptoms can be triggered.
Miller, who is also affiliated with the National Center for PTSD, said his team plans to follow up with the veterans over coming months and years to see how long-lasting their symptoms are. He said more research needs to be done to understand why the bombing induced nightmares and flashbacks in some veterans with a history of PTSD, while leaving others unaffected.
David Dockstader, co-coordinator of the Boston Area Trauma Recovery Network, which has provided counseling to first responders and others affected by the bombing, said those still experiencing heightened anxiety and other symptoms should seek help.
“Each time there’s a trigger of the PTSD, the likelihood of being triggered increases,” he said. “Treatment can ameliorate the old experience and the new experience.”
Matthew McKenna took some time to be comfortable driving or walking in crowds and has had more of a temper after returning from Afghanistan, where he served in the infantry as an Army sergeant. He was in a car about a block away when the bombs exploded near the Marathon finish line. He said he could feel the blasts and saw the crowds running away.
But he describes himself as lucky because he did not experience distress afterward. He knows fellow veterans and friends who are suffering as a result of the attacks.
“It certainly triggered some memories for me, but it didn’t trigger an emotional response,” said McKenna, who serves as communications director for the state Department of Veterans’ Services.
He and others said the hardest part has been trying to understand the idea that attacks like those he became accustomed to in Afghanistan could happen in Boston.
“We expected it there,” he said. “When it happens here, it just stirs some different emotions. It really angers a lot of veterans.”
Retired Army Brigadier General Jack Hammond said the bombings had a deep impact on some of his friends who are veterans, as well as on their families.
“For me, it triggered enough memories that I had sleepless nights, reliving all the things that I had been through,” said Hammond, executive director of the Red Sox Foundation and the Massachusetts General Hospital Home Base Program , which provides clinical care to recent veterans who have post-traumatic stress and traumatic brain injuries. “You end up having a lot of thoughts flashing through your mind about all the experiences you had.”
Hammond, who served in Iraq and Afghanistan, said he worries most for the veterans who had recently overcome their feeling of having to be on alert constantly.
“We try to teach folks that you’re in a safe place at home, that there’s no need to look for cars parked funny or dogs blowing up,” he said. “My concern is that the rug has been pulled out from under them and that this validated their hypervigilance.”