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Note: This story has been updated and corrected.

WASHINGTON — When her post-traumatic stress disorder surfaces, Roxann Abrams sees the gun pointed at her face again.

She sees the man threatening her life. She hears him yelling something, but can’t quite make out the words. She starts to hyperventilate, both in the past and in the present.

What her waking nightmare doesn’t include are the deserts of Iraq or the mountains of Afghanistan. That’s because Abrams never served in the military. Her PTSD stems from a robbery in Southern California 10 years ago.

“I’ll never know what it’s like to be on a battlefield,” she said. “I’ll never know what these guys have had to face out there.

“But I do know what it’s like to have night terrors, to lose control of your emotions. I know to some degree what they’re going through.”

PTSD is a signature wounds of the Iraq and Afghanistan wars, a debilitating disability that ruined the lives of countless Vietnam veterans. It’s viewed as automatic side effect of seeing dead bodies and flying bullets, the inevitable lingering stress unique to the battlefield.

Only, it’s not.

It’s actually a common physiological reaction to any sudden tragedy, including car accidents, sexual assaults and childhood abuse. Medical experts report thousands of cases following public horrors like the Sept. 11 attacks and the recent tornado in Oklahoma. Teams of counselors were immediately mobilized after the Boston marathon bombing.

The National Center for PTSD reports that about 8 percent of all Americans will suffer from the disorder at some point. Less than 1 percent ever saw the wars in Iraq or Afghanistan. But it’s the military that has dominated the headlines and research surrounding the illness over the last decade.

Abrams son, Army Sgt. 1st Class Randy Abrams, killed himself in 2009 in what investigators believe was a panic attack connected to his undiagnosed post-traumatic stress. His story fits the well-worn narrative of PTSD as a war disease, the one that veterans groups grumble stigmatizes all returning troops.

Friends said Abrams hid his combat flashbacks from his family, along with his struggles to adapt to post-military life. He withdrew.

Abrams separated from the Marine Corps and then later decided to enlist in the Army. On the day he was scheduled to report to a new Army assignment, he shot himself in his Georgia apartment. It took family and military officials a month to discover his death.

His mother said she was devastated by the news, not only because of the loss but also because of her own knowledge and struggles with post-traumatic stress. She boils when she talks about military and Veterans Affairs efforts to tackle mental health issues, blasting officials for slow-moving and poorly targeted programs.

She’s convinced that if her son had understood the illness better, or if she had known about his symptoms, his life wouldn’t have ended so soon.

“I’m a pissed-off mother who lost her son when I shouldn’t have,” she said.

Not just a 'military problem'

Pentagon and Veterans Affairs officials have been working against those stigma issues for years, part of a larger effort encourage treatment and find ways to stem the growing suicide rate among troops and veterans.

As many as 500,000 recent war veterans may be struggling with the disorder, according to military health experts.

But federal researchers note that as many as 3 million children also suffer from PTSD, due to abuse, neglect or other traumatic experiences. Veterans groups worry that calling it a “military problem” instead of a national mental health challenge adds to troops fears that they’ll be marked and ostracized for admitting problems.

Abrams said she can empathize with that. It took her years to receive the help she needed to cope with her flashbacks and emotional paralysis, largely because most civilian doctors she saw didn’t really understand what PTSD was.

Her trauma stems from a robbery at a cellular phone store she owned back in 2003. While she was running the shop alone one day, a man shoved a handgun in her face and demanded all of her money, threatened her life, then locked her in a backroom closet as he escaped.

“I remember the police afterwards asking me if I needed counseling for what I had been through, and I asked them, ‘What for?’” she said. “They told me, ‘We don’t know, we’re just supposed to ask that.’”

Her friends and family noticed changes in her mood, her temper, her paranoia. She wrote it off as the normal after-effects of the robbery, but knew there was a more serious problem when the symptoms persisted for months.

Most physicians she saw referred her to psychiatrists, who relied mainly on a battery of medications and trauma re-experience therapies. It wasn’t until a counselor more than seven years later taught her meditative and relaxation techniques that she felt control over the illness.

“I wouldn’t say I’m cured, but it’s something I can control now,” she said. “I have a set of tools in my toolbox now, to help me get through it when things get bad.”

Those include yoga and massage treatments, deep breathing exercises and an almost Pavlovian associative technique where she rubs her fingers together to calm her nerves.

It took her years to refine the approaches — knowledge that tragically came too late for her son.

Fighting the stigma, treating the disorder

Abrams said the family never knew her son was struggling with PTSD until after his death, when friends told her about his flashbacks and nightmares.

In 2012, Abrams founded Operation IV, a non-profit offering a broad spectrum of PTSD treatments for combat veterans. She envisions one day shepherding hundreds of veterans at a time through the same types of treatments she learned and numerous others, including hyperbaric chamber sessions and animal therapies.

But the first challenge, she said, is combatting that PTSD stigma, and convincing troops that seeking help isn’t a death sentence for their reputation.

“Most of these guys worry that they’re psychopaths because they’re dealing with this (disorder),” she said. “And I tell them, psychopaths don’t have to worry about PTSD. They don’t feel any guilt or trauma. The fact that you do means you’re normal.”

Research shows that nearly one in five troops returning from Iraq and Afghanistan suffer some form of post-traumatic stress. That’s a much higher rate than the civilian mark, but combat zones are also a more traumatic experience than average civilian life.

Still, Abrams thinks most civilians with little military familiarity see veterans struggling with PTSD as scary, distant threats.

“People outside the military seem to think that boot camp takes the emotion out of you. It teaches you how to shoot a gun, not how to get rid of your feelings,” she said.

“These guys were raised in the same neighborhoods as you, and they’re no more emotionally prepared for war than you are.”

Abrams says her son’s death gives her instant credibility with struggling servicemembers. But she said her personal battles with the disorder give them a feeling that they’re not facing a weird, distant problem on their own.

“We as regular American citizens are never going to understand what it feels like to be on a battlefield,” Abrams said. “But PTSD is a physiological response. We can understand that. And we can treat that.”

Correction: The original version of this story published on this web site on June 5, 2013, contained inaccurate information. Randy Abrams separated from the Marine Corps, then later decided to enlist in the Army. He took his own life the day he was scheduled to report to a new Army assignment, not the day he enlisted. This story was updated and the correction added on June 18, 2013. Twitter: @LeoShane


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