Signs of PTSD in Military Service Members
This article will address several key factors to identifying and treating PTSD in veterans returning from combat, including:
- Common risk factors.
- Signs and symptoms to look for.
- Which treatments work best.
Signs of PTSD in 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 timeframe—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
- 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.
- 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.
- Negative beliefs and feelings. People who have just returned from combat can seem different than they were before their 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.
- In the context of PTSD, this means being unable to sit still, having difficulty concentrating, experiencing sleeplessness, or being easily startled (for example, by loud noises such as sirens or a car backfiring).
In addition to these four 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.
- Substance abuse.
- Physical symptoms or chronic pain.
- Difficulties obtaining or maintaining employment, or other work-related issues.
- Relationship difficulties, such as increased fights or divorce.
Substance abuse, in particular, can be a warning sign that someone is struggling to cope with the trauma they experienced. If you notice your loved one regularly drinking excessively, abusing pain pills they may have been given for their injuries, or taking other drugs (e.g., marijuana, cocaine, heroin), consider these red flags.
Over time, this kind of regular abuse 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.
War Veteran PTSD Statistics
As of 2016, there were nearly 20.4 million US veterans, with 7.1 million of them having served in the Gulf War era from 1990 to the present (which makes up the largest percentage of veterans in the country).2
Up to 20% of veterans from the Gulf War develop PTSD in any given year.
In 2011, the US Government Accountability Office reported that around 2.6 million military service members had been deployed during the Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), which began in 2001 and continues to present day.3
The number of service members who develop PTSD varies by era of service, but the U.S. Department of Veterans Affairs reports that 11–20 out of every 100 veterans who served in a Gulf War develop PTSD in any given year.4
Another study showed that as of 2014, the percentage of veterans with PTSD averaged around 13.5% in a representative sample of OEF/OIF-era veterans.3
Pre-Trauma Risk Factors
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. Those 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.
Risk Factors During and After Trauma
Specific risk factors that happen during and after combat can also affect a person’s chances of developing PTSD. Those 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 at, 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.
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:
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
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
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 benefitted their recovery.3
Resources for Service Members
In addition to these forms of therapy, the following resources can be useful for service members and their families who want to receive more information about different types of PTSD treatment.
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.
- 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 Defense and Veterans Brain Injury Center maintains a long list of resources on trauma, PTSD, and other concerns that affect service members with traumatic brain injury (TBI) and their families.
- 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 abuse treatment providers throughout the U.S.
- 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 U.S.
- U.S. Department of Veterans Affairs. (2017). PTSD Basics.
- Bialik, K. (2017). The changing face of America’s veteran population.
- Walker, M. S., Kaimal, G., Gonzaga, A. M. L., Myers-Coffman, K. A., & DeGraba, T. J. (2017). Active-duty military service members’ visual representations of PTSD and TBI in masks. International Journal of Qualitative Studies on Health and Well-Being, 12(1), 1267317.
- U.S. Department of Veterans Affairs. (2016). How Common Is PTSD in Veterans?
- Xue, C., Ge, Y., Tang, B., Liu, Y.,… Zhang, L. (2015). A Meta-Analysis of Risk Factors for Combat-Related PTSD among Military Personnel and Veterans. PLOS One.
- Adams, R. S., Nikitin, R. V., Wooten, N. R., Williams, T. V., & Larson, M. J. (2016). The Association of Combat Exposure with Postdeployment Behavioral Health Problems Among U.S. Army Enlisted Women Returning From Afghanistan or Iraq. Journal of Traumatic Stress, 29(4), 356–364.
- Peterson, A., Luethcke, C., Borah, E., Borah, A., & Young-McCaughan, S. (2011). Assessment and Treatment of Combat-Related PTSD in Returning War Veterans. Journal of Clinical Psychology in Medical Settings, 18(2), 164–175.
- Cook. J. (2010). Cognitive Behavioral Therapy for Combat-Related PTSD: A Manual for Service Members.
- Lake, J. (2015). The integrative management of PTSD: A review of conventional and CAM approaches used to prevent and treat PTSD with emphasis on military personnel. Advances in Integrative Medicine, 2, 13–23.