Signs of PTSD in Military Service Members

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after a person experiences or witnesses a traumatic event. For military service members and Veterans, combat exposure, injury, witnessing death, military sexual trauma (MST), and the cumulative stress of deployment are among the most common causes. Veterans struggling with PTSD and co-occurring substance use disorders may benefit from AAC’s specialized Veteran treatment program, which provides trauma-informed care designed to address the unique challenges of military service.

As of 2020, there were nearly 19.4 million U.S. Veterans. According to the U.S. Department of Veterans Affairs, PTSD rates vary by era of service, branch, and combat exposure. PTSD is not a sign of weakness. It is a medical condition that responds to treatment. Recognizing the signs is the first step toward getting help.

Signs of PTSD in Military Veterans

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) there are 4 main groups of symptoms involved with PTSD, though how you experience these symptoms may vary compared with others. Some of the symptoms can occur right after the event, but sometimes, they may not develop until years later—there is no set time frame—and in some cases, symptoms come and go.

Regardless of when they appear, symptoms that persist for longer than 4 weeks or create difficulties in everyday life can be a sign that you or your loved one has PTSD.

The main signs and symptoms of PTSD to look for include:¹

1. Reliving the event. Returning service members may re-experience the trauma in several ways. You may have nightmares of the event, flashbacks in which you feel like you are going through the trauma again, or you may have reactions to specific triggers, such as smells, news reports, or hearing loud noises that cause you to relive the trauma.
2. Avoiding situations that remind you of the event. You may avoid people, situations, or places that bring up memories of the event. You might want to avoid talking or thinking about the trauma, and you may avoid situations that feel unsafe, such as being in crowds, driving, or watching films or television shows that are related to the event. You may also try to stay as busy as possible, avoid seeking help, or deny that you have a problem.
3. Negative beliefs and feelings. Returning from combat means you may be different that your were before your deployment. You might seem more introverted and stay away from close relationships, and you may not appear to experience positive or loving feelings toward others. You may try to forget the trauma and avoid talking about it at all costs. You could also have increased feelings of fear about the world, feeling as though it is not a safe place, and you may feel unable to trust or rely on anyone.
4. In the context of PTSD, this means being unable to sit still, having difficulty concentrating, experiencing sleeplessness, or being easily startled (by loud noises such as sirens or a car backfiring, for example).

Effects of PTSD on Veterans

In addition to these 4 main types of symptoms, you could also experience several additional consequences that sometimes occur in conjunction with PTSD, such as:¹

• Feeling sad, hopeless, or ashamed
• Depression
• Alcohol and substance misuse
• Physical symptoms or chronic pain.
• Difficulties obtaining or maintaining employment, or other work-related issues.
• Relationship difficulties, such as increased fights or divorce.

Substance misuse, in particular, can be a warning sign that someone is struggling to cope with the trauma they experienced. If you notice you or your loved one regularly drinking excessively, misusing pain pills you may have been given for your injuries, or taking other drugs (e.g., marijuana, cocaine, heroin), consider these red flags.

Over time, this kind of regular misuse can develop into a substance use disorder (SUD), which not only compounds the problem of the trauma, but also necessitates appropriate treatment for the addiction as well.

PTSD Symptoms in Veterans: The Four Core Categories

The National Institute of Mental Health (NIMH) identifies four main categories of PTSD symptoms. These symptoms must last more than one month and be severe enough to interfere with daily life for a diagnosis to be made.

1. Reliving the Trauma (Intrusion Symptoms)

• Flashbacks: feeling like the traumatic event is happening again
• Nightmares related to the trauma
• Intrusive, distressing memories that come without warning
• Strong physical or emotional reactions to triggers (loud noises, certain smells, news reports, crowds)

2. Avoidance

• Avoiding people, places, or situations that remind you of the trauma
• Refusing to talk or think about the event
• Avoiding situations that feel unsafe (driving, crowds, enclosed spaces)
• Staying excessively busy to avoid processing the experience
• Avoiding seeking help or denying that there is a problem

3. Negative Changes in Beliefs and Feelings

• Persistent negative thoughts about yourself or the world (‘I am broken,’ ‘No one can be trusted’)
• Feeling detached or estranged from family and friends
• Loss of interest in activities you once enjoyed
• Difficulty experiencing positive emotions (numbness)
• Guilt, shame, or self-blame related to the traumatic event

4. Hyperarousal (Feeling on Edge)

• Being easily startled or frightened
• Difficulty sleeping or staying asleep
• Irritability, angry outbursts, or aggressive behavior
• Difficulty concentrating
• Hypervigilance (constantly scanning the environment for threats)
• Reckless or self-destructive behavior

War Veteran PTSD Statistics

As of 2020, there were nearly 19.4 million U.S. Veterans, with 7.7 million of them having served in the Gulf War era from 1990 to the present (the largest percentage of Veterans in the country).²

The number of service members who develop PTSD varies by era of service, but the U.S. Department of Veterans Affairs reports that approximately 15% of Veterans who served in a Gulf War develop PTSD in any given year.⁴

Pre-Trauma Risk Factors for Veteran PTSD

There is nothing that can predict with 100% certainty who will and who will not develop PTSD as a result of combat. However, there are certain pre-trauma risk factors that can predispose someone to develop the disorder when placed in war-time situations. These include:^5,6

• Being female. The overall number of females serving in the military has increased, and reports indicate that they tend to experience more injuries and have less military preparedness, less unit cohesion, and higher rates of depression, all of which can impact the development of PTSD.
• Being non-white. It is not entirely clear why minorities experience higher rates of PTSD, but this may be because minorities are more often assigned to high combat roles or have more pre-existing trauma risk factors.
• Having a low level of education. Service members with higher educational levels may have developed better coping mechanisms than their less-educated counterparts.
• Being non-officers. These service members are more likely to be exposed to combat.
• Branch of service. Studies indicate that people who serve in the Marines, Air Force, Navy, or Coast Guard have a lower risk of PTSD than those who serve in the Army.
• Experiencing more deployments or having a longer cumulative length of deployment. These factors place service members at a higher risk of attack, combat, and exposure to trauma.
• Experiencing adverse life events. Early childhood traumas, such as sexual abuse, appear to increase the risk of PTSD, but only small studies have examined this correlation to date.

During & Post-Trauma Risk Factors for Veteran PTSD

Specific risk factors that happen during and after combat can also affect a person’s chances of developing PTSD. These include:^5,7

• Exposure to combat. People who are deployed and experience combat have a higher rate of PTSD than those who were deployed but did not experience combat.
• Worry about family. People who were away from their families for longer times have a higher risk of developing PTSD.
• Discharging a weapon. Discharging a weapon can create traumatic memories that increase the risk of PTSD.
• Witnessing an injury or death during deployment. Viewing injury or death can create feelings of intense fear, which is a strong risk factor for PTSD.
• Being attacked, fired upon, or handling human remains. Research shows that people who have been exposed to any of these traumatic experiences are more likely to develop PTSD.
• Lack of post-deployment support. A positive and supportive environment after exposure to trauma is necessary for recovery. Social support is correlated with a lower risk of PTSD.
• Subsequent life stress. People who experience life stressors, such as unemployment or a lack of resources, may have a higher risk of PTSD.
• Comorbid psychological problems. Research has been mixed regarding the effect of co-occurring psychological problems on PTSD, but some studies have shown that people with depression have a higher chance of developing PTSD.

The Connection Between PTSD and Substance Use Disorders in Veterans

PTSD and addiction frequently go hand in hand. Many Veterans turn to alcohol, prescription painkillers, or other drugs to manage the distressing symptoms of PTSD. 

While substances may provide temporary relief, they worsen both the trauma response and overall health over time, creating a cycle that becomes increasingly difficult to break without professional help.

Key data on the PTSD and substance use overlap:

• More than 2 in 10 Veterans with PTSD also have a substance use disorder
• Nearly 1 in 3 Veterans seeking SUD treatment also have PTSD
• 61% of Veterans with PTSD have a co-occurring substance use disorder, with opioids being the most common
• 85% of Veterans with PTSD also report depression
• Combat Veterans with PTSD and alcohol problems tend to binge drink at dangerous levels
• Veterans with PTSD are significantly more likely to smoke (60%) compared to Veterans without PTSD (30%)

Self-medication is one of the primary pathways from PTSD to addiction. A Veteran experiencing flashbacks, insomnia, and hypervigilance may use alcohol to fall asleep, opioids to numb emotional pain, or marijuana to reduce anxiety. Over time, tolerance builds, and what started as coping becomes dependence.

Evidence-Based Treatments for PTSD in Military Veterans

The VA and DoD Clinical Practice Guidelines recommend several evidence-based psychotherapies and medications for treating PTSD in Veterans. These treatments have strong research support and are available through the VA, community care providers, and private treatment centers like AAC.

Recommended Psychotherapies

• Prolonged Exposure (PE) Therapy. You work with a therapist to gradually confront trauma-related memories, feelings, and situations you have been avoiding. PE typically involves 8 to 15 sessions and has the strongest evidence base for PTSD treatment in Veterans.
• Cognitive Processing Therapy (CPT). You learn to identify and challenge negative thoughts and beliefs that have developed because of the trauma (‘It was my fault,’ ‘The world is completely unsafe’). CPT usually involves 12 one-hour sessions.
• Eye Movement Desensitization and Reprocessing (EMDR). A therapist guides you through recalling the trauma while making specific sensory movements (eye movements, hand tapping). EMDR helps the brain process traumatic memories so they become less distressing.
• Cognitive Behavioral Therapy (CBT). A broader therapeutic approach that helps Veterans identify negative thinking patterns and develop healthier responses to triggers and stressors.

Medications for PTSD

The VA recommends the following medications as first-line treatments for PTSD:

• Sertraline (Zoloft). An SSRI antidepressant approved by the FDA for PTSD treatment.
• Paroxetine (Paxil). Another SSRI approved by the FDA for PTSD. Both sertraline and paroxetine have been shown to reduce PTSD symptoms in clinical trials.
• Prazosin. May be prescribed for trauma-related nightmares, though evidence is mixed.

Medication is often most effective when combined with psychotherapy. Your treatment team will work with you to determine the best combination based on your individual needs.

Which PTSD Treatments Work Best?

There are several treatments and programs to help Veterans with PTSD that are supported by research. These evidence-based approaches include:

Trauma-informed care.

Focusing on how trauma can affect all aspects of a person’s life, trauma-informed care is an umbrella term used to describe the person-centered approach that aims to improve wellness and functioning instead of simply focusing on treating symptoms. People may undergo a wide range of therapies that can include trauma-based psychotherapy (talk therapy on an individual or group basis), prolonged exposure therapy (PE), cognitive processing therapy (CPT), or EMDR (eye movement desensitization and reprocessing).

Prolonged Exposure Therapy

This form of treatment has the most scientific evidence to support its usefulness. You receive between 10 and 12 sessions that last 90 minutes each and participate in psychoeducation, breath retraining, imaginal exposure, and in vivo exposure. People are educated about PTSD and its symptoms, learn breathing techniques to promote relaxation, and undergo specific imaginary exposure exercises to become habituated to the memory of the trauma. You may repeatedly tell your story or be asked to confront your fears associated with the trauma in different ways.⁷

Cognitive-Behavioral Therapy (CBT)

CBT helps you understand why you think and react to things in the way that you do and helps you identify your triggers.⁸ CBT has been demonstrated to be effective at treating PTSD in service members through a variety of techniques in which you learn to identify and replace unhealthy thoughts and behaviors with healthier ones.

Cognitive Processing Therapy (CPT)

CPT also has significant scientific evidence to support its benefits and includes elements of CBT. You receive psychoeducation about PTSD, participate in cognitive restructuring (identifying and changing inaccurate or negative associations and thoughts about the trauma), and undergo exposure exercises. You usually receive 12 one-hour-long sessions.⁷

Eye Movement Desensitization and Reprocessing

While this approach is widely used for PTSD, research has shown mixed results, although a number of studies have demonstrated some promising benefits, such as reduced symptoms. In this form of treatment, a therapist assists you with recalling the trauma while making specific sensory movements, such as eye movements or hand tapping.⁹

Pharmacological Treatment

Medication for Veterans with PTSD could help alleviate or control some of your symptoms. The U.S. Department of Veterans Affairs and Department of Defense recommend the use of specific medications to treat PTSD, namely paroxetine and sertraline, which are antidepressants known as SSRIs, or selective serotonin reuptake inhibitors.⁷

Post-Deployment “Battle Briefing”

This approach was developed by the Army to help reduce PTSD symptoms in newly returned soldiers. During this time, you learn effective coping skills to help address anger management, stress, insomnia, and other symptoms, while also working on issues like social isolation.⁹

Complementary and Alternative Practices (CAM)

CAM approaches that have demonstrated some clinical benefits for returning service members with PTSD include meditation; mind-body practices like yoga; and biofeedback, a form of treatment that involves learning to monitor and control bodily functions like heart rate and blood pressure through the help of electrical sensors. One form of biofeedback that may be useful for PTSD is cardiac coherence training (a specific treatment that involves using biofeedback to control your heart rate to induce relaxation).⁹

Art Therapy

One study showed the benefits of mask-making in an art therapy context for service members with PTSD. Making masks helped participants represent their challenges, struggles, and experiences in a visual manner, which benefited their recovery.³

Find Veteran PTSD & Addiction Treatment

Learn about our specialized Veteran track at American Addiction Centers.

AAC’s Veterans Program: Treating PTSD and Addiction Together

American Addiction Centers offers the Salute to Recovery Veterans program at facilities nationwide. This program is designed specifically for Veterans and first responders who are dealing with both substance use disorders and co-occurring mental health conditions, including PTSD.

The Salute to Recovery program includes:

• Trauma-informed care and PTSD-specific therapies (PE, CPT, EMDR)
• Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT)
• Dual diagnosis treatment for co-occurring PTSD and substance use
• Peer support groups with fellow Veterans
• Therapists who are Veterans themselves or have deep experience with military populations
• Pain management and emotional regulation training
• Family therapy and reintegration support
• Aftercare planning and relapse prevention from day one

AAC is a VA Community Care Network provider. Eligible Veterans can use VA benefits to cover treatment through the MISSION Act. AAC also accepts TRICARE and most major private insurance plans.

Resources for Veterans and Families

If you or someone you care about is struggling with PTSD, the following resources can help:

• Veterans Crisis Line: Call 988 (press 1), text 838255, or chat online. Available 24/7, free and confidential.
• VA National Center for PTSD: Comprehensive information about PTSD symptoms, treatment options, and self-help tools for Veterans and families.
• VA Substance Abuse Screening: Free, private online screening tools for PTSD, depression, and substance abuse.
• SAMHSA National Helpline (1-800-662-4357): Free, confidential, 24/7 treatment referral and information.
• Strong Star Research: Clinical trials for PTSD treatment for Veterans, primarily in Texas but expanding.
• Sidran Institute: Nonprofit providing trauma-related resources and therapist referrals.

Contact your family doctor. The U.S. Department of Veterans Affairs advises Veterans to consult their family doctor as one way of finding an experienced trauma-care provider. Additionally, these resources may help:

• Strong Star, a south Texas–based research organization, offers clinical trials to Veterans suffering from PTSD. Though the organization primarily recruits people in Texas cities for participation in their studies, a growing number of areas outside of Texas may also be available.
• The Sidran Institute is a nonprofit organization dedicated to helping people with trauma find and locate trauma-related resources by providing referrals to therapists, treatment centers, and organizations throughout the country.
• The Military Crisis Line is a free, confidential service for all members of the military who require support. You can call the hotline or visit the website to chat with a qualified VA responder online.
• The U.S. Department of Veterans Affairs PTSD Treatment Locator allows you to search for a specialized PTSD treatment program by state.
• The EMDR International Association’s website has a searchable database of qualified practitioners around the country who offer this specialized treatment.
• The Substance Abuse and Mental Health Services Administration offers a searchable database of mental health and substance use treatment providers throughout the United States.
• The International Institute for Traumatic Stress Studies also has a searchable database of qualified clinicians who specialize in treating PTSD and trauma.
• The Association for Behavioral and Cognitive Therapies website offers listings of qualified practitioners who offer cognitive-behavioral therapy in the United States.