Understanding PTSD in Military Veterans
Serving in the military is an honorable choice; not only do you impact your country and community, but your service can also lead to a fulfilling career and unique opportunities once your time in the armed forces has ended. However, military service doesn’t come without risks, especially when it comes to your mental health. You must be aware of the effects that your time in the service can have on your mental health — even more so if you were in combat, experienced trauma, or underwent any sort of traumatic or life-threatening experience while in the military.
Post-traumatic stress disorder is an area of particular concern for all military veterans. While about 7 or 8% of adults in the US will have PTSD at some time in their lives, this condition is significantly more prevalent among veterans. Though the number of veterans with PTSD varies greatly depending on their time of service, according to the National Center for PTSD, this group still experiences PTSD at higher rates than the general population:
- Operations Iraqi Freedom and Enduring Freedom: Anywhere from 11 to 20% of veterans in a given year;
- Gulf War: 12% of veterans in a given year
- Vietnam War: 15% of veterans were diagnosed at the time of the last study in the 1980s, and as many as 30% of veterans from this war have had PTSD at some point in their lives.
If you or a loved one is a veteran, you need to know what PTSD is, what causes it, and what you can do to treat this condition. Further, if you’re still on active duty, you may not even realize that you have this condition. If left untreated, PTSD can be debilitating or even deadly. As a member of the military, you are at a greater risk of developing PTSD at some point in your life, and in order to properly take care of your mental health, it’s vital for you to understand PTSD in military veterans and active service members.
What Is PTSD?
The National Institute of Mental Health defines post-traumatic stress disorder as “a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.” Anyone who has witnessed, been affected by, or personally experienced any kind of traumatic event can develop PTSD. Coping with a traumatic event can be hard, and it is perfectly natural to have difficulties dealing with it. Many people are able to recover naturally or on their own, though, after some time passes. If these difficulties and symptoms continue to occur months or years after the event, get worse as time goes on, or interfere with daily life, you may have developed PTSD.
Unfortunately, like many other mental health conditions, there is a stigma surrounding PTSD. Misinformation, myths, and false stereotypes are all contributing factors, and this stigma can have an incredibly negative effect on people who are dealing with PTSD. Because of this view, veterans even self-stigmatize their PTSD, which can exacerbate their symptoms, as well as those of any comorbid conditions.
Raising awareness of the issue of PTSD with accurate, factual information is a huge step in ending the stigma associated with this mental illness and allowing everyone to get the help they need. This cause is in need of as much support as possible, as it has the power to help save lives. In addition to actively raising awareness for this cause with custom coins and promotional materials, it’s important to provide people with the knowledge they need to understand this condition and encourage people (and especially service members and veterans) to reach out for help to truly put an end to the stigma surrounding PTSD.
Though PTSD is a unique experience for each individual who has it, there are several general types of this condition, each with different symptoms, causes, and treatments:
- Normal Stress Response: Many adults will experience some kind of trauma throughout the course of their lives, and if they undergo a single event in adulthood, it could result in the normal stress response. You may have bad memories, emotional numbness, physical symptoms or distress, and feel isolated or cut off from people you’re close to. Recovery often only takes a few weeks and symptoms may subside naturally, although group debriefing sessions to discuss the trauma may be helpful for treatment.
- Acute Stress Disorder: This is similar to the normal stress response, but it is more severe and typically the result of an enduring, lasting, or large-scale trauma. You may have panic attacks, dissociative episodes, insomnia, and may experience difficulty or inability to perform basic tasks in your daily life. Leaving the scene or area of the trauma, taking medication for anxiety and/or insomnia, and attending psychotherapy are all common treatments for acute stress disorder.
- Uncomplicated PTSD: Uncomplicated PTSD typically stems from a single traumatic event, rather than multiple events or long-term trauma. You may continually re-experience the trauma, avoid anything that reminds you of it, feel emotionally numb, and lose feelings of safety and comfort. As the name may indicate, this form of PTSD is the easiest to treat, often with cognitive or behavioral therapy, medication, group therapy, or some combination of the above approaches.
- Comorbid PTSD: This type of PTSD presents itself in conjunction with other major psychiatric disorders, such as depression, substance use disorder, panic disorder, or anxiety disorders. All of your conditions should be treated simultaneously, rather than one at a time. Many of the treatment options for comorbid PTSD are the same as uncomplicated PTSD, in addition to whatever treatment is appropriate for any other condition.
- Complex PTSD: Also called complicated PTSD, this is the result of prolonged or multiple traumas, particularly in childhood, although all of the traumatic events can have happened in adulthood as well. On top of the symptoms of uncomplicated PTSD, you may experience destructive or impulsive behavioral tendencies, extreme emotions, or amnesia. Treatment for complex PTSD is also similar to uncomplicated PTSD, but often takes longer and patients typically have slower recoveries.
There is no single cause of PTSD. Witnessing, being affected by, or personally experiencing any kind of traumatic event can cause you to develop PTSD. Traumatic events typically include situations involving death, violence, serious injury or illness, or sexual violations. Some common traumas that lead to PTSD include:
- Serious accidents;
- Natural disasters;
- Terrorist attacks;
- Physical assault;
- Sexual assault or rape;
- Abuse of all kinds, including childhood and domestic abuse;
- Combat and warfare;
- Serious health issues, such as extreme illness or injury;
- Loss of a loved one;
This is by no means an exhaustive list of traumas that can cause PTSD, and not everyone experiences and copes with trauma in the same way. You can experience the same traumatic event as another individual, and you may develop PTSD, but they may not. It isn’t always clear why some people develop PTSD but others do not, as genetic and personality factors may also play a role.
There are many different symptoms associated with PTSD, and they can vary depending on the type of PTSD you have. Symptoms generally fall into four different categories: re-experiencing, avoidance, arousal and reactivity, and cognition and mood.
- Flashbacks in which you relive the traumatic event;
- Bad dreams or nightmares;
- Terrifying or scary thoughts related to the experience;
- Unwanted or upsetting memories of the event;
- Feelings of distress or tension when reminded of the event;
- Accompanying physical symptoms when thinking about or reliving the event, such as increased heart rate or sweating.
- Avoiding all thoughts, feelings, and memories related to the event;
- Staying away from people, places, situations, and experiences that remind you of the event;
- Refusing to discuss the trauma with other people;
- Keeping yourself busy and distracted to avoid thinking about the traumatic event.
Arousal and Reactivity Symptoms:
- Having trouble sleeping or experiencing insomnia;
- Feeling anxious, tense, or edgy;
- Having angry outbursts or feeling irritable;
- Feeling hypersensitive or anxious about potential dangers or risks;
- Being jumpy or easily startled;
- Being unable to focus or concentrate.
Cognition and Mood Symptoms:
- Being unable to remember key aspects of the traumatic event;
- Losing interest in activities and hobbies you previously enjoyed;
- Feeling disconnected, cut off, or distant from other people, even if you’re close to them;
- Feeling emotionally numb or an inability to feel happy or positive;
- Blaming yourself or feeling guilty or responsible for the event.
You may not experience any symptoms until weeks, months, or even years after the traumatic event, though many people are affected shortly after it. To be diagnosed with PTSD, you generally must have at least one or two symptoms from each category for at least a month, and they must be severe enough to interfere with your relationships, work, or life. For some people, symptoms last only a few months, but for others, PTSD can become a chronic or lifelong condition. You may not experience any symptoms until weeks, months, or even years after the traumatic event.
People react to PTSD and respond to its associated symptoms in different ways. How you respond depends heavily on the type of trauma you experienced, what type of PTSD you’ve developed, and other personal and behavioral factors. Common reactions to PTSD include:
- Having issues with work, school, or other obligations;
- Behaving recklessly or impulsively;
- Smoking or using alcohol and drugs more frequently;
- Experiencing intense and sudden mood swings;
- Feeling nervous, fearful, and anxious, but unable to feel positivity, love, or joy;
- Experiencing physical symptoms, such as headaches or stomach aches, particularly when thinking of the trauma;
- Becoming withdrawn or isolated from friends and family.
These are just a few common reactions that people may have when developing or coping with PTSD, but everyone responds to these situations differently. Be aware of what constitutes normal behavior and feelings for you, and take note if you see any sudden shifts after experiencing a traumatic event.
Researchers have found that roughly 80% of individuals who are diagnosed with PTSD have comorbid mental health conditions. In some cases, it’s not always clear if these conditions were present before the PTSD or occurring because of it, which can complicate treatment plans. In fact, you may not even be aware you’re dealing with two conditions, but if you have been diagnosed with PTSD, it’s important to understand what other conditions could be affecting you. Some related conditions that are frequently comorbid with PTSD include:
- Adjustment Disorder: Also called “Stress Response Syndrome,” this is a short-term condition that you may experience when having difficulties dealing with a major source of stress. Common events that can cause this response are the end of a relationship, losing a job, losing a loved one, or undergoing a major life event. Some symptoms of this disorder overlap with that of PTSD. Treatment typically involves talk therapy, but medication may also be helpful in some cases.
- Anxiety Disorders: There are a number of anxiety disorders — such as generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, and social anxiety disorder — that can occur at the same time as PTSD. One study actually found that 40% of veterans who were diagnosed with PTSD were also diagnosed with a generalized anxiety disorder. Stress management techniques, talk therapy, and medication are all common treatments for anxiety disorders.
- Borderline Personality Disorder: This mental disorder is characterized by a pattern of shifts in behavior, mood, and emotional functioning. You may be prone to impulsivity, intense shows of anger or sadness, and anxiety. Though BPD and PTSD are two distinct disorders, the symptoms of one can exacerbate symptoms of the other, which can present additional treatment challenges. Luckily, getting treatment for one disorder can also be helpful in treating the other.
- Major Depressive Disorder: Clinical depression is a mood disorder that seriously affects your ability to function in your daily life, often involving feelings of sadness or hopelessness, insomnia, anxiety, and even thoughts of death or suicide. It’s one of the most common mental health conditions and occurs frequently with PTSD; research indicates that about half of people who have been diagnosed with PTSD have also been diagnosed with depression. Because the symptoms of these conditions frequently overlap, depression and PTSD can be treated simultaneously in many cases.
- Neurocognitive Disorders: This umbrella term refers to any condition that affects your cognitive function — such as traumatic brain injury (TBI) and neurocognitive disorder (NCD) — and many of these conditions can exist comorbidly with PTSD. Together, these issues can have a huge impact on your memory and mood, and can cause physical symptoms like headaches, dizziness, or vision problems. In this case, it’s important to discuss treatment options with both your primary care physician and a mental health professional.
- Substance Use Disorders: Whether it’s prescription drugs or alcohol, substance abuse occurs when your drug use or alcohol consumption causes a decrease in functionality or disrupts your daily life. Substance use disorders are often comorbid with PTSD, as substance use is a risk factor for developing PTSD and vice versa. Because they are so closely linked, treating both conditions at the same time can be highly effective. Treatment often involves therapy, but may also include medication or a sobriety support group.
How Can Service Members Find Help?
As an active duty service member, PTSD can be hard to identify on your own and you may not realize that you have it, even if you’ve experienced a traumatic event. If you’re experiencing any symptoms associated with PTSD or you notice sudden or large shifts in your mood and behavior, you should seek help from a medical or mental health professional. PTSD can be difficult, if not impossible, to manage without help, but with a treatment plan, you can overcome this condition.
Being diagnosed with PTSD does not mean that your time in the military is over, but letting your mental health issues go untreated can have an extremely negative impact on your career. The National Alliance on Mental Illness (NAMI) notes that “97% of personnel who sought mental health treatment did not experience any negative career impact.” Even though you are not required to disclose any of your mental health issues, including PTSD, to your chain of command, it may be advantageous to both you and your fellow service members to do so. Not only can you get the help you need, a formal diagnosis may help you obtain benefits during and after your time in the service.
Further, if you do choose to disclose your diagnosis with your chain of command and fellow service members, you will have even more support and treatment resources open to you. Whether you’re exploring what treatment options are available or looking to get a formal diagnosis, here are a few ways you can get help with PTSD as an active duty service member:
Talking to a Counselor
Counselors, therapists, and other licensed mental health professionals are a great starting point for getting help with PTSD, especially if you’re not sure what type of help you need. They are also able to help with any comorbid conditions you may have. Confidential counselors are readily available for active duty service members through Military One Source by calling 1-800-342-9647.
Talking to a Primary Care Provider
Primary care providers are another good choice if you aren’t sure what type of treatment you need or what type of condition you’re experiencing. In addition, they can diagnose and treat other health issues, such as a traumatic brain injury or cognitive disorder, that often accompany PTSD. There are several different ways to find care while on active duty, depending on where you’re stationed and what healthcare facilities are available in your area.
Talking to Behavioral Health Care Providers
Finally, you can always reach out to a behavioral health care provider, such as a psychiatrist or psychologist, for help with PTSD. They frequently work at primary care clinics on military bases, so you can easily seek out a specialist’s advice and insight. Some bases may even have Embedded Behavioral Health teams that are distinct from the main medical facilities.
How Can Veterans Find Help?
There are a number of ways that you can find help for PTSD and other mental health conditions once you’re out of the service. You may find it more difficult as a veteran, since you’re no longer in the middle of daily military life and may feel survivor’s guilt. Further, a stigma still surrounds mental health and PTSD in the civilian world, especially among vets who are transitioning out of military life. A study recently found that combat veterans put off or avoid treatment entirely so they aren’t labeled as “mentally ill.” The same study also found that other veterans best understood each others’ experiences. You should never delay PTSD treatment out of fear or due to the stigma, but it can be incredibly difficult to do so without proper support and community.
As you begin to disclose your PTSD to your loved ones, look into treatment options, and find support groups, be sure to turn to your fellow veterans for help. Whether or not you personally knew each other in the service, your time in the military can help create a sort of automatic kinship between veterans. You can use the tradition of military challenge coins, by doing a coin check or simply sharing your story, to start a conversation about PTSD or getting treatment with other veterans. Using your challenge coin, in particular, automatically highlights what you have in common with other veterans and provides the perfect opportunity to ask about their experience with PTSD and how you can get help.
Your fellow veterans play an important role in deciding to get help, as well as throughout the entire treatment process. Ultimately, It’s up to you to make the decision to do so, and to take an active approach to recovery. Simply deciding to find help is a vital step, and once you do, you’ll find that there’s a world of assistance waiting for you.
Talking to Family and Friends
Receiving adequate social support is hugely important for decreasing your risk of developing PTSD, treating it effectively, and coping with any comorbid conditions. Discussing your diagnosis with your loved ones and asking for the support you need can be difficult, but it will be much-needed for your treatment and recovery. You don’t need to tell everyone you know about your PTSD, and of the people you do choose to tell, you don’t have to share all the details of your trauma or recovery. Only share what you feel comfortable with, and emphasize the importance of receiving love and support from your friends and family members as you undergo treatment.
Accessing VA Programs
As a veteran, you are free to access any available Veterans Affairs (VA) programs. All VA medical centers provide PTSD treatment, even if there isn’t a specialized program, though you can search to find one that specifically offers this service. Through VA PTSD programs, you can access mental health assessments, receive any needed medications, go to therapy, and attend group therapy sessions. If you have a disability, you can even find rides to VA medical centers via the Veterans Transportation Program.
Going to Support Groups
Support groups are another way to get social support as you deal with PTSD. These groups are made up of other people who have also gone through trauma and provide a safe environment for everyone to discuss their experiences. Though support groups are not known to alleviate PTSD symptoms, they do allow you to connect with other people who understand what you’re going through, learn their coping tips, and help you understand that you don’t have to deal with PTSD alone. Some groups may even use customized challenge coins or other meaningful symbols to bring everyone together and remind you that you always have support, even when you aren’t physically together. Support groups aren’t a replacement for PTSD treatment, but they are a great addition to your recovery regimen. You can find support groups that are either in-person or online.
Using Digital Resources and Hotlines
If it’s difficult or impossible for you to get help in-person, you can also find help for PTSD online. There are myriad resources, mobile apps, and hotlines that you can use to find additional information or reach out. Always reach out as soon as you think you might need help. You don’t have to hit rock bottom or feel horrible to get treatment; use what resources you have to feel better now.
What Are the Treatment Options for PTSD?
Today, there are a number of different PTSD treatment options available to you. Which form of treatment is best for your needs will depend on what type of PTSD you’ve been diagnosed with, what symptoms you’re experiencing, and if you have any comorbid conditions that need treatment.
Generally, psychotherapy — and more specifically, Cognitive Behavioral Therapy — is the primary method used to treat PTSD. In some cases, a psychiatrist or primary care physician may prescribe medication to help relieve some of your symptoms. For instance, if you’ve been having panic attacks, you may be prescribed an anti-anxiety medication to help you keep calm while you work through the cause of the attacks in therapy. It simply depends on what you need and what your physician or psychiatrist thinks will work best for you. Other PTSD treatments include:
Cognitive Processing Therapy (CPT)
Cognitive Processing Therapy (CPT) is a form of CBT that is used to modify unhealthy beliefs related to a traumatic event, which works to reduce PTSD symptoms and develop a new understanding of the event itself. Taking place over 12 sessions, CPT begins with you writing down a detailed account of how the trauma occurred, how you currently view it, and how it impacts your beliefs. Your therapist will then use Socratic questioning to challenge your views and unhelpful thoughts related to the event. Your therapist then helps you develop coping strategies that you can use outside of treatment to improve your daily functioning.
Prolonged Exposure (PE)
Prolonged exposure therapy (PE) addresses the trauma through “imaginal” exposure, allowing you to gradually approach the memory and your feelings about it in a safe environment. You also deal with the trauma through “in vivo” or real-life exposure to the situations and activities you have avoided due to the trauma. PE is supposed to teach you that avoidance isn’t an effective coping mechanisms, as it only serves to reinforce your fear of the event. With PE, you can stop avoiding the trauma and improve your overall quality and enjoyment of your life.
Eye Movement Desensitization and Reprocessing (EMDR)
Eye movement desensitization and reprocessing therapy (EMDR) is a new, nontraditional form of psychotherapy that is often used as a treatment for PTSD. Rather than focusing on the traumatic memory itself, you’ll talk about the negative thoughts, feelings, and symptoms you’ve experienced because of the event. Your therapist then uses a back-and-forth hand motion, similar to a swinging pendulum, to stimulate your eye movement while you speak. This helps to desensitize the memory so you can process it and think about it without experiencing any negative emotions or reduced quality of life.
Medication can be a highly effective way to treat and manage PTSD, especially for veterans or individuals who have seen combat. As with treating other mental health conditions, medication is almost always used in conjunction with therapy, and is not necessarily an effective PTSD treatment in and of itself. There are only two FDA-approved drugs that can be used to treat PTSD: selective serotonin reuptake inhibitors (SSRIs), Zoloft and Paxil. SSRIs work to restore the balance of serotonin in your brain. Serotonin plays an important role in regulating mood, appetite, sleep, and anxiety, and is often linked to happiness and wellbeing. In certain cases, atypical antipsychotic agents such as Seroquel or Risperdal have also been helpful for reducing psychotic symptoms in individuals with PTSD, but they are not used as frequently as SSRIs.
What Are Some Tips for Living with PTSD?
If you have PTSD, you will need the help of a physician or mental health professional for treatment, but that’s not the only way you can overcome this condition. In fact, taking strides in your daily life to take care of your mental health is a positive, proactive, and healthy way to cope with your PTSD.
Do your best to maintain a regular and consistent daily routine. It may be tempting to avoid the outside world, close yourself off from others, and avoid things that remind you of your trauma, but it’s often better to face situations that may evoke negative or distressing feelings. You can then take your reactions and thoughts to your therapist and talk through them. You can’t avoid your PTSD forever, and going about your normal activities will make bad days that much easier to deal with.
Prepare Yourself to Cope with Setbacks
Speaking of bad days, it’s important to understand that you likely will have them as you go through PTSD treatment. Recovery is not linear; it’s a gradual process that takes time, energy, and effort. You can’t expect to recover immediately or right after you begin treatment. Take it easy on yourself and give yourself the time you need to heal completely.
Remember What You’ve Learned
As you begin therapy and other forms of treatment, you’ll have myriad coping strategies to use when you need them. However, try to remember what you’ve learned and keep it present in your mind. Writing them down, taking an audio recording of them, or giving yourself a briefing at the beginning and end of your day are all great ways to keep track of everything you’ve learned during your recovery. Similar to a coin or chip from a sobriety support group, keeping a challenge coin on your person, whether it’s one from your service or one that honors your recovery, is a simple way to carry a physical symbol of your progress with you wherever you go.
Spend Time in Nature
Make an active effort to go outside and spend time in nature. It doesn’t matter whether you bike, hike, or simply relax and admire your surroundings; the simple act of being outdoors in a natural environment is thought to have a positive effect on PTSD. One study reported a 29% decrease in PTSD symptoms after a week-long river-rafting trip, and another study has found that nature-based therapy may be another effective treatment option for veterans with PTSD.
Connect with Other Veterans
Whether you’re still enlisted or a veteran, it helps to talk to other veterans about what you’ve gone through. You can create a supportive network of individuals who are linked through your shared experiences and service to this country. Be proud of your contributions and build up a community of veterans and service members who you can rely on. You can do activities together, attend peer sessions, or even create a commemorative challenge coin to honor your recovery and build up a sense of camaraderie. This is a simple, but highly effective, way to connect with others, as challenge coins are of special importance to veterans and service members.
PTSD is a difficult condition to develop and overcome, but it isn’t impossible to do so. As someone who is either currently or used to be in the military, you need to be aware of the risks that face you and what you can do to cope with them. PTSD doesn’t define you, and you don’t ever have to go through it alone.
For additional information, further reading, and more help with PTSD, see the following resources and organizations:
- 23rd Veteran: This nonprofit organization provides informational seminars and reconditioning programs to help veterans with trauma live happier, healthier lives.
- DAV: This charity organization assists veterans and their family members by offering transportation, helping with employment, and assisting them with benefit claims.
- Family of a Vet: This nonprofit group works to inform and educate veterans and their family members about the risks of PTSD and TBIs so they can thrive after seeing combat.
- Government Benefits for Vets with PTSD: This webpage provides a brief guide to the government benefits available to veterans with PTSD.
- Lifeline for Vets: This hotline connects active duty service members who are struggling with their mental health with veterans who are there to help and offer support over the phone.
- Make The Connection: This online resource website was created to help veterans, their friends, and their family members find the information they need to live healthy lives after their time in the service.
- National Suicide Prevention Lifeline: This hotline is open 24 hours per day, seven days per week, to offer confidential support to anyone who is experiencing a crisis.
- Objective Zero: This nonprofit organization and its mobile app work to combat the issue of suicide among veterans and active duty service members by connecting them to peer support and mental health resources.
- PTSD Foundation of America: This organization is working to help veterans who have personally seen or experienced combat to overcome the affects of PTSD and heal “the invisible wounds of war.”
- SAMHSA’s National Helpline: This free, 24/7 hotline is available to help anyone who is coping with mental health problems or substance abuse issues.
- Veteran Restore Program: This program helps people dealing with PTSD reclaim their lives with CPT, resilient yoga, dialectical behavioral therapy (DBT), and resilience training.
- Veteran’s Crisis Line: This hotline connects veterans or their concerned loved ones with qualified responders from the Department of Veterans Affairs.
- Veteran’s Stress Project: This website offers low-cost online therapy sessions to veterans who are dealing with PTSD.
- We Honor Veterans: This organization provides educational tools and resources to better serve veterans and increase their access to supportive services.
- XSports4Vets: This organization helps veterans overcome their physical and mental war wounds by creating a community that does extreme or intense sports together.