With her collar-length blond bob, dark blazer and big diamond ring, this new patient looked like she could be heading to Nordstrom.
Meeting her, Tampa psychologist Michael Sunich thought she looked "put together."
Within minutes, he saw she was anything but.
She wrung her hands and cried easily, recalling nightmares and panic attacks. Six months before, her soldier-husband had returned from a 16-month deployment to Iraq. He was unhurt and untroubled.
But she was a wreck.
Every morning, she told Sunich, she awoke in fear.
Listening to his footsteps upstairs as he got ready to go to work at MacDill Air Force Base filled her with dread. She couldn't push away thoughts that something terrible would happen, that she would never see him again.
She couldn't sleep or concentrate and didn't want to eat. She avoided television, lest she be reminded of the war. When the Middle East came up during lunch with friends, she left.
Sunich was struck. It was uncannily similar to what he heard from veterans of Vietnam and Iraq.
She had never gone to battle.
Yet she had some symptoms similar to post-traumatic stress disorder.
"A lightbulb went off in my head," said Sunich (pronounced SUN-itch), an assistant professor on the counseling and psychology faculty at Troy University in Tampa.
Now he wants to know: Are there more military spouses like her?
• • •
Post-traumatic stress disorder, or PTSD, describes a set of reactions many people have after seeing or surviving something involving death or the threat of death or serious injury.
Traumas that can lead to the disorder include going to war, being violently attacked, sexually assaulted, kidnapped, held hostage or tortured or living through a disaster.
Symptoms include having nightmares, insomnia, or flashbacks, avoiding reminders of the trauma, and feeling excessively angry, vigilant or jumpy.
To count as PTSD, the symptoms must last more than a month and must hurt the patient's ability to function at work or in relationships.
A key factor in the diagnosis is being directly exposed to a traumatic event, something not present for Sunich's patient.
Still, "there's a lot of research to show that partners and spouses and kids suffer from secondary PTSD," said Tom Berger, a senior analyst for veterans benefits and mental health issues for the Vietnam Vets of America.
A 2005 study of the families of Dutch peacekeepers, for example, found that partners of soldiers with PTSD symptoms reported more trouble sleeping and marital problems than partners of soldiers with no symptoms.
"If somebody is with you and they're constantly hypervigilant . . . you can sometimes take on that kind of anxiety," said Dr. Carri-Ann Gibson, director of the PTSD and trauma recovery program at James A. Haley VA Medical Center in Tampa.
Unresolved traumas in the past, such as car accidents, can trigger PTSD symptoms in spouses facing anxiety related to their loved ones' deployments.
Also, a lot of exposure to war news can drive a more general anxiety for someone living in constant fear for their spouse, she said.
Still another scenario is possible: The warrior has PTSD but doesn't acknowledge it to protect his or her career in the military.
This year, the New England Journal of Medicine reported that less than half the troops returning from the Middle East who met the criteria for a mental disorder actually seek treatment. Nearly two-thirds said they didn't want it because "I would be seen as weak."
• • •
MacDill Air Force Base chaplain Capt. John D. VanderKaay tells stressed-out spouses he knows something about secondary PTSD.
VanderKaay, a Protestant chaplain ordained through the Assemblies of God, was deployed to Iraq in late 2003 and early 2004.
At a base near Balad, north of Baghdad, he endured the mortar attacks like everyone else. And he counseled countless soldiers, Marines and others who had seen and done things human beings were not meant to see or do.
Returning home, VanderKaay was diagnosed with PTSD, largely from helping colleagues unburden themselves of so much.
Struggling with stress is not a sign of weakness, he tells the people he counsels. For those who live through war — and those who love them and fear for their safety — it's a sign they are human.
It's not common to run into a case like Sunich's patient, he said.
But neither is it surprising.
Some family members do reach out to VanderKaay for help. The services of a military chaplain are strictly confidential, so talking to him won't affect anyone's career.
More often, however, VanderKaay finds himself talking to someone at a dinner or other event, hears what's going on at home and sees they're overwhelmed.
When he does, there are a variety of resources at MacDill he can remind families about.
The base's mental health services are for active duty service members, though the Tricare health program for military members and their families provides referrals for spouses to mental health professionals like Sunich.
Also, before, during and after deployments, MacDill's Airman and Family Readiness Center works to let family members know they are not alone, employing e-mails and events such as dinners, marriage retreats and reunion cruises.
And in recent months, the base has begun a military and family life consultant program, which offers short-term, situational counseling services to military families.
In treating veterans for PTSD, Gibson said she encourages spouses to get treatment, too. And Haley has developed relationships with several local private agencies to help not only veterans but spouses and older children, too.
Though the military has gotten better at recognizing and responding to PTSD in military families, VanderKaay says more could be done.
The nation as a whole, he said, has not had to sacrifice in this war. So the hardships fall squarely on those who volunteered to serve and their loved ones.
"The cost of the war," he said, "has been put on the back of the military family."
• • •
Sunich worked with his first patient for about nine months, and she responded well.
Then he had a second patient with similar symptoms, though not as bad. She asked him, how common is PTSD in spouses and families of soldiers in combat?
To find out, Sunich put together a survey.
At first, he offered it to military spouses he knew. Then he contacted a support group whose members filled out the questionnaire online and passed it to friends.
When Gloria Anderson took the survey, she found herself thinking, "This is stuff I have seen or dealt with myself."
Anderson, 30, is a mental health counselor who met Sunich while studying at Troy University in Tampa.
She also has firsthand experience with the stress of a loved one's deployment. Her husband, C.J., served tours in Kosovo and Baghdad before leaving the Army as a sergeant.
While he was gone, Anderson talked to friends about their fears and how they avoided television news and other things that reminded them of the war.
But the anxiety didn't go away after C.J. came home or even when he left the Army. He went to work for a construction company. He started traveling, and Gloria felt the old fear all over again.
"It was like a shock; all those emotions started pouring back," she said. "He's safe in New York City, but there's the same feelings of dread and anxiety."
So far, more than 40 spouses, almost all of them wives, and about two-thirds of them Army wives, have taken the survey.
That's a small sample, and there are reasons to approach the numbers very cautiously, Sunich said. There is no control group, and the sample is not random but self-selected; that is, the spouses heard what the survey was about and decided to take it.
Still, he said, the responses are intriguing.
More than half described having nightmares about their husband being hurt in combat. About four of 10 reported their heart racing or feeling shaky when something reminded them of their spouses' deployment. Roughly the same number said they often felt like something horrible was going to happen to their loved one when they were apart.
Sunich has been invited to speak to a lunch group on Jan. 20 at MacDill, and is scheduled to discuss his research at a meeting of the American Counseling Association in March.
But what he really hopes for is that more people take his survey.
"This is either nothing, or it's huge," he says. "But it's not going to be anything in the middle."
Richard Danielson can be reached at firstname.lastname@example.org or (813) 269-5311.