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PTSD And Veterans

What is PTSD in Veterans?

For very many veterans, returning from military service also means dealing with symptoms of post-traumatic stress disorder (PTSD). You may be having a hard time readjusting to life out of the military. Or you may constantly be feeling on edge, emotionally numb and disconnected, or close to panicking or exploding. But no matter how long the V.A. wait times, or how isolated or emotionally cut off from others you feel, it’s important to know that you’re not alone and there are plenty of things you can do to start feeling better. These steps can help you learn to deal with nightmares and flashbacks, cope with feelings of depression, anxiety or guilt, and regain your sense of control.

Post-traumatic stress disorder impacts 11-20 percent of Iraq and Afghanistan War veterans, approximately 12 percent of Gulf War veterans, and 15 percent of Vietnam veterans. In addition to the combat-related PTSD, roughly 1 in 4 women and 1 in 100 men utilizing the VA report instances of sexual assault, which can also result in prolonged traumatic stress.

What Causes PTSD in Veterans?

Post-traumatic stress disorder (PTSD), sometimes called “combat stress” or “shell shock,” happens after you experience severe trauma or a life-threatening event. It’s normal for your mind and body to be in shock after such an event, but this normal response becomes PTSD when your nervous system gets stuck between fight and flight syndrome. Post-traumatic stress disorder (PTSD) can occur after you have been through a trauma. A trauma is a shocking and dangerous event that you see or that happens to you. During this type of event, you think that your life or others’ lives are in danger.

Read more about PTSD

Your nervous system has two automatic or reflexive ways of responding to stressful events:

Mobilization, or fight-or-flight, occurs when you need to defend yourself or survive the danger of a combat situation. Your heart pounds faster, your blood pressure rises, and your muscles tighten, increasing your strength and reaction speed. Once the danger has passed, your nervous system calms your body, lowering your heart rate and blood pressure, and winding back down to its normal balance.

Immobilization occurs when you’ve experienced too much stress in a situation and even though the danger has passed, you find yourself “stuck.” Your nervous system is unable to return to its normal state of balance and you’re unable to move on from the event. Immobilization is PTSD.

Recovering from PTSD involves transitioning out of the mental and emotional war zone you’re still living in and helping your nervous system return to normal.

Going through trauma is not rare. About 6 of every 10 men (or 60%) and 5 of every 10 women (or 50%) experience at least one trauma in their lives. Women are more likely to experience sexual assault and child sexual abuse. Men are more likely to experience accidents, physical assault, combat, disaster, or to witness death or injury.

PTSD can happen to anyone. It is not a sign of weakness. A number of factors can increase the chance that someone will develop PTSD, many of which are not under that person’s control. For example, if you were directly exposed to the trauma or injured, you are more likely to develop PTSD.

PTSD And The Military:

When you are in the military, you may see combat. You may have been on missions that exposed you to horrible and life-threatening experiences. These types of events can lead to PTSD.

The number of Veterans with PTSD varies by service era:

  • Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF): About 11-20 out of every 100 Veterans (or between 11-20%) who served in OIF or OEF have PTSD in a given year.
  • Gulf War (Desert Storm): About 12 out of every 100 Gulf War Veterans (or 12%) have PTSD in a given year.
  • Vietnam War: About 15 out of every 100 Vietnam Veterans (or 15%) were currently diagnosed with PTSD at the time of the most recent study in the late 1980s, the National Vietnam Veterans Readjustment Study (NVVRS). It is estimated that about 30 out of every 100 (or 30%) of Vietnam Veterans have had PTSD in their lifetime.

Other factors in a combat situation can add more stress to an already stressful situation. This may contribute to PTSD and other mental health problems. These factors include what you do in the war, the politics around the war, where the war is fought, and the type of enemy you face.

Another cause of PTSD in the military can be military sexual trauma (MST). This is any sexual harassment or sexual assault that occurs while you are in the military. MST can happen to both men and women and can occur during peacetime, training, or war.

Among Veterans who use VA healthcare, about:

  • 23 out of 100 women (or 23%) reported sexual assault when in the military.
  • 55 out of 100 women (or 55%) and 38 out of 100 men (or 38%) have experienced sexual harassment when in the military.

There are many more male Veterans than there are female Veterans. So, even though military sexual trauma is more common in women Veterans, over half of all Veterans with military sexual trauma are men.

What Are Some Of The PTSD Symptoms of Veterans?

While you can develop symptoms of PTSD in the hours or days following a traumatic event, sometimes symptoms don’t surface for months or even years after you return from deployment. While PTSD develops differently from veteran to veteran, there are four symptom clusters:

Being on guard all the time, jumpy, and emotionally reactive, as indicated by irritability, anger, reckless behavior, difficulty sleeping, trouble concentrating, and hypervigilance.

Recurrent, intrusive reminders of the traumatic event, including distressing thoughts, nightmares, and flashbacks where you feel like the event is happening again. Experiencing extreme emotional and physical reactions to reminders of the trauma such as panic attacks, uncontrollable shaking, and heart palpitations.

Extreme avoidance of things that remind you of the traumatic event, including people, places, thoughts, or situations you associate with the bad memories. Withdrawing from friends and family and losing interest in everyday activities.

Negative changes in your thoughts and mood, such as exaggerated negative beliefs about yourself or the world and persistent feelings of fear, guilt, or shame. Diminished ability to experience positive emotions.

Suicide Prevention For Veterans With PTSD

It’s common for veterans with PTSD to experience suicidal thoughts. Feeling suicidal is not a character defect, and it doesn’t mean that you are crazy, weak, or flawed, it simply means that you are overwhelmed and need some help. If you are feeling suicidal, please seek help immediately. If you don’t feel you can talk to your friends and loved ones, there are a great number of suicide hotlines available that offer free, non-judgemental, confidential counseling. Here are some of the following suicide help lines. You are not alone, no matter how you feel. Things can get better. Please call:

In the US:

In Canada:

  • CALL TOLL FREE 1.833.456.4566 Available 24/7.
  • CHAT available 5pm-1am ET 
  • Text 45645 Available 5pm-1am E

In the UK and ROI:

  • Hotline: +44 (0) 8457 90 90 90 (UK – local rate)
  • Hotline: +44 (0) 8457 90 91 92 (UK minicom)
  • Hotline: 1850 60 90 90 (ROI – local rate)
  • Hotline: 1850 60 90 91 (ROI minicom)
  • Website: samaritans.org
  • E-mail Helpline: jo@samaritans.org

In Australia, call:

Wordwide:

Learning To Live With And Heal From PTSD In Veterans:

Step One: Regulate Your Nervous System

PTSD can leave you feeling completely vulnerable and totally helpless. However, you have more control over your nervous system than you may know. When you feel agitated, anxious, or out of control, these tips can help you change your arousal system and calm yourself.

Sensory input: We know that loud noises, certain smells, or the feel of sand in your clothes can instantly transport you back to the combat zone. Sensory input quickly calm you. Everyone responds a bit differently, so experiment to find what works best. Think of your time on deployment: what brought you comfort at the end of the day? Perhaps it was looking at photos of your family? Or listening to a favorite song, or smelling a certain brand of soap? Or maybe petting an animal quickly makes you feel calm?

Mindful breathing: To quickly calm yourself, begin by taking 60 breaths, focusing your attention on each breath. Breathe in, hold for a couple of seconds, breathe out. In with the good air, out with the bad. Count them – it helps your mind to focus on something other than your anxiety.

Reconnect emotionally: If you can react to uncomfortable emotions without becoming overwhelmed, you can make a huge difference in your ability to manage stress, balance your moods, and take back control of your life

Step Two: Move Your Thing

Making time for regular exercise has always been one of the keys to cope for veterans with PTSD. Not only does physical activity help to burn off adrenaline, exercise can release endorphins and improve your mood. And by really focusing on your body and how it feels as you exercise, you can even help your nervous system become “unstuck” and move out of the immobilization stress response.

Exercise that is rhythmic and engages both your arms and legs—such as running, swimming, basketball, or even dancing—works well if you stop feeling your feelings and focus your thoughts upon how your body feels.

Try to notice the sensation of your feet hitting the ground, for example, or the rhythm of your breathing, or the feeling of wind on your skin. Many veterans with PTSD find that sports such as rock climbing, boxing, weight training, and martial arts make it easier to focus on your body movements – obviously, if you don’t, you could get injured. Whatever exercise you choose, try to work out for 30 minutes or more each day—or if it’s easier, three 10-minute spurts of exercise are fine.

One of the great parts of being outside is that pursuing outdoor activities in nature like hiking, camping, mountain biking, rock climbing, whitewater rafting, and skiing can help challenge your sense of vulnerability and help you transition back into civilian life.

Seek out local organizations that offer outdoor recreation or team building opportunities, or, in the U.S., check out Sierra Club Military Outdoors, which provides service members, veterans, and their families with opportunities to get out into nature and get moving.

Step Three: Take Care of Yourself

The symptoms of PTSD in veterans, such as insomnia, anger, concentration problems, and jumpiness, can be hard on your body and eventually take a toll on your overall health. That’s why it’s so important to take care of yourself.

You may be drawn to activities and behaviors that pump up adrenaline, whether it’s caffeine, drugs, violent video games, driving recklessly, or daredevil sports. After being in a combat zone, that’s what feels normal. But if you recognize these urges for what they are, you can make better choices that will calm and care for your body—and your mind.

Relax: Relaxation techniques such as massage, meditation, or yoga can reduce stress, ease the symptoms of anxiety and depression, help you sleep better, and increase feelings of peace and well-being.

Find safe ways to blow off steam: Pound on a punching bag, pummel a pillow, go for a hard run, sing along to loud music, or find a secluded place to scream at the top of your lungs.

Support your body with a healthy diet: Omega-3s play a vital role in emotional health so incorporate foods such as fatty fish, flaxseed, and walnuts into your diet. Limit processed and fried food, sugars, and refined carbs which can exacerbate mood swings and energy fluctuations.

Get plenty of sleep: Sleep deprivation exacerbates anger, irritability, and moodiness. Aim for 7 to 9 hours of quality sleep each night. Develop a relaxing bedtime ritual (listen to calming music, take a hot shower, or read something light and entertaining), turn off screens at least one hour before bedtime, and make your bedroom as dark and quiet as possible.

Avoid alcohol and drugs: It can be tempting to turn to drugs and alcohol to numb painful memories and get to sleep. But substance abuse can make the symptoms of PTSD worse. The same goes for cigarettes. If possible, stop smoking and seek help for drinking and drug problems.

Step Four: Connect With Others

Connecting face-to-face doesn’t have to mean a lot of talking. But for any veteran with PTSD, it’s important to find someone who will listen without judging when you want to talk, or just hang out with you when you don’t. That person may be your significant other, a family member, one of your buddies from the service, or a civilian friend.

Volunteer your time or reach out to someone in need. This is a great way to both connect to others, feel good about yourself, while reclaiming your sense of power.

Join a PTSD support group. Connecting with other veterans facing similar problems can help you feel less isolated and provide useful tips on how to cope with symptoms and work towards recovery.

Connecting with Civilians

You may feel like civilians in your life can’t understand you since they haven’t been in the service or seen the things you have. But people don’t have to have gone through the exact same experiences to relate to painful emotions and be able to offer support. What matters is that the person you’re turning to cares about you, is a good listener, and a source of comfort.

You don’t have to talk about your combat experiences. If you’re not ready to open up about the details of what happened, that’s okay. You can talk about how you feel without going into a blow-by-blow account of events.

Tell the other person what you need or what they can do to help. That could be just sitting with you, listening, or doing something practical. Comfort comes from someone else understanding your emotional experience.

People who care about you want to help. Listening is not a burden for them but a welcome opportunity to help.

If Connecting Is Too Difficult

No matter how close you are to someone, PTSD can mean that you still don’t feel any better after talking. If that describes you, there are ways to help the process along.

Exercise or move. Before chatting with a friend, either exercise or move around. Jump up and down, swing your arms and legs, or just flail around. Your head will feel clearer and you’ll find it easier to connect.

Vocal toning. As strange as it sounds, vocal toning is a great way to open up to social engagement. Find a quiet place before you meet a friend. Sit straight and simply make “mmmm” sounds. Change the pitch and volume until you experience a pleasant vibration in your face.

Step Five: Flashbacks, Nightmares, and Intrusive Thoughts

For veterans with PTSD, flashbacks usually involve visual and auditory memories of combat. It feels as if it’s happening all over again so it’s vital to reassure yourself that the experience is not occurring in the present. Trauma specialists call this “dual awareness.”

Dual awareness is the recognition that there is a difference between your “experiencing self” and your “observing self.” On the one hand, there is your internal emotional reality: you feel as if the trauma is currently happening. On the other hand, you can look to your external environment and recognize that you’re safe. You’re aware that despite what you’re experiencing, the trauma happened in the past. It is not happening now.

State to yourself (out loud or in your head) the reality that while you feel as if the trauma is currently happening, you can look around and recognize that you’re safe.

Use a simple script when you awaken from a nightmare or start to experience a flashback: “I feel [panicked, overwhelmed, etc.] because I’m remembering [traumatic event], but as I look around I can see that the event isn’t happening right now and I’m not in danger.”

Describe what you see when look around (name the place where you are, the current date, and three things you see when you look around).

Try tapping your arms to bring you back to the present.

Tips For Grounding Yourself During A Flashback:

If you’re starting to disassociate or experience a flashback, try using your senses to bring you back to the present and “ground” yourself. Experiment to find what works best for you.

  • Sight – Blink rapidly and firmly; look around and take inventory of what you see
  • Movement – Move around vigorously (run in place, jump up and down, etc.); rub your hands together; shake your head
  • Sound – Turn on loud music; clap your hands or stomp your feet; talk to yourself (tell yourself you’re safe, you’ll be okay)
  • Taste – Suck on a strong mint or chew a piece of gum; bite into something tart or spicy; drink a glass of cold water or juice
  • Touch – Splash cold water on your face; grip a piece of ice; touch or grab on to a safe object; pinch yourself; play with worry beads or a stress ball
  • Smell – Smell something that links you to the present (coffee, mouthwash, your wife’s perfume) or a scent that has good memories

Step Six: Work through survivor’s guilt

Feelings of guilt are very common among veterans with PTSD. You may have seen people injured or killed, often your friends and comrades. In the heat of the moment, you don’t have time to fully process these things as they happen. But later—often when you’ve returned home—these experiences come back to haunt you. You may ask yourself questions such as:

  • Why didn’t I get hurt?
  • Why did I survive when others didn’t?
  • Could I have done something differently to save them?

You may end up blaming yourself for what happened and believing that your actions (or inability to act) led to someone else’s death. You may feel like others deserved to live more than you—that you’re the one who should have died.

This is survivor’s guilt.

Healing from survivor’s guilt:

It’s important to remember that healing doesn’t mean that you’ll forget what happened or those who died. And it doesn’t mean you’ll have no regrets. What it does mean is that you’ll look at your role more realistically.

  • Is the amount of responsibility you’re assuming reasonable?
  • Could you really have prevented or stopped what happened?
  • Are you judging your decisions based on full information about the event, or just your emotions?
  • Did you do your best at the time, under challenging circumstances?
  • Do you truly believe that if you had died, someone else would have survived?

Honestly assessing your responsibility and role can free you to move on and grieve your losses. Even if you continue to feel some guilt, instead of punishing yourself, you can redirect your energy into honoring those you lost and finding ways to keep their memory alive. For example, you could volunteer for a cause that’s connected in some way to one of the friends you lost. The goal is to put your guilt to positive use and thus transform tragedy, even in a small way, into something worthwhile.

Step Seven: Seek professional treatment

Professional treatment for PTSD can help you confront what happened to you and learn to accept it as a part of your past. Working with an experienced therapist or doctor, treatment may involve:

Cognitive-behavioral therapy (CBT) or counseling. This involves gradually “exposing” yourself to thoughts and feelings that remind you of the event. Therapy also involves identifying distorted and irrational thoughts about the event—and replacing them with more balanced picture.

Medication, such as antidepressants. While medication may help you feel less sad, worried, or on edge, it doesn’t treat the causes of PTSD.

EMDR (Eye Movement Desensitization and Reprocessing). This incorporates elements of CBT with eye movements or other rhythmic, left-right stimulation such as hand taps or sounds. These can help your nervous system become “unstuck” and move on from the traumatic event.

Effects of PTSD On Relationships:

PTSD can affect how couples get along with each other. It can also affect the mental health of partners. In general, PTSD can have a negative effect on the whole family.

Male Veterans with PTSD are more likely to report the following problems than Veterans without PTSD:

  • Marriage or relationship problems
  • Parenting problems
  • Poor family functioning

Most of the research on PTSD in families has been done with female partners of male Veterans. The same problems can occur, though, when the person with PTSD is female.

Effects on marriage

Compared to Veterans without PTSD, Veterans with PTSD have more marital troubles. They share less of their thoughts and feelings with their partners. They and their spouses also report more worry around intimacy issues. Sexual problems tend to be higher in combat Veterans with PTSD. Lower sexual interest may lead to lower satisfaction within the relationship.

The National Vietnam Veterans Readjustment Study (NVVRS) compared Veterans with PTSD to those without PTSD.

The findings showed that Vietnam Veterans with PTSD:

  • Got divorced twice as much
  • Were three times more likely to divorce two or more times
  • Tended to have shorter relationships
Family violence

Families of Veterans with PTSD experience more physical and verbal aggression. Such families also have more instances of family violence. Violence is committed not just by the males in the family. One research study looked at male Vietnam Veterans and their female partners. The study compared partners of Veterans with PTSD to partners of those without PTSD. Female partners of Veterans with PTSD:

  • Committed more family violence than the other female partners
  • Committed more family violence than their male Veteran partners with PTSD
Mental health of partners

PTSD can affect the mental health and life satisfaction of a Veteran’s partner. The same research studies on Vietnam Veterans compared partners of Veterans with and without PTSD. The partners of the Vietnam Veterans with PTSD reported:

  • Lower levels of happiness
  • Less satisfaction in their lives
  • More demoralization (discouragement)
  • About half have felt “on the verge of a nervous breakdown”

These effects were not limited to females. Male partners of female Veterans with PTSD reported lower well-being and more social isolation.

Partners often say they have a hard time coping with their partner’s PTSD symptoms. Partners feel stress because their own needs are not being met. They also go through physical and emotional violence. One explanation of partners’ problems is secondary traumatization. This refers to the indirect impact of trauma on those close to the survivor. Another explanation is that the partner has gone through trauma just from living with a Veteran who has PTSD. For example, the risk of violence is higher in such families.

Caregiver burden

Partners have a number of challenges when living with a Veteran who has PTSD. Wives of PTSD-diagnosed Veterans tend to take on a bigger share of household tasks such as paying bills or housework. They also do more taking care of children and the extended family. Partners feel that they must take care of the Veteran and attend closely to the Veteran’s problems. Partners are keenly aware of what can trigger symptoms of PTSD. They try hard to lessen the effects of those triggers.

Caregiver burden is one idea used to describe how hard it is caring for someone with an illness such as PTSD. Caregiver burden includes practical problems such as strain on the family finances. Caregiver burden also includes the emotional strain of caring for someone who is ill. In general, the worse the Veteran’s PTSD symptoms, the more severe is the caregiver burden.

Why are these problems so common?

The exact connection between PTSD symptoms and relationship problems is not clearly known. Some symptoms, like anger and negative changes in beliefs and feelings, may lead directly to problems in a marriage. For example, a Veteran who cannot feel love or happiness may have trouble acting in a loving way towards a spouse. Expression of emotions is part of being close to someone else. Not being able to feel your emotions can lead to problems making and keeping close relationships. Numbing can get in the way of intimacy.

Help for partners of Veterans with PTSD

The first step for partners of Veterans with PTSD is to gather information. This helps give you a better understanding of PTSD and its impact on families. Resources on the National Center for PTSD website may be useful.

Some effective strategies for treatment include:

  • Education for the whole family about the effects of trauma on survivors and their families
  • Support groups for both partners and Veterans
  • Individual therapy for both partners and Veterans
  • Couples or family counseling

VA has taken note of the research showing the negative impact of PTSD on families. PTSD programs and Vet Centers have begun to offer group, couples, and individual counseling for family members of Veterans.

Overall, the message for partners is that problems are common when living with a Veteran who has been through trauma. The treatment options listed above may be useful to partners as they search for better family relationships and mental health

How PTSD Can Affect The Family:

When a loved one returns from military service with PTSD, it can take a heavy toll on your relationship and family life. You may have to take on a bigger share of household tasks, deal with the frustration of a loved one who won’t open up, or even deal with anger or other disturbing behavior.

Family members may feel hurt, alienated, or discouraged because your loved one has not been able to overcome the effects of the trauma. Family members frequently devote themselves totally to those they care for and, in the process, neglect their own needs.

Sympathy: You may feel sorry for your loved one’s suffering. This may help your loved one know that you sympathize with him or her. However, be careful that you are not treating him or her like a permanently disabled person. With help, he or she can feel better.

Negative feelings PTSD can make someone seem like a different person. If you believe your family member no longer has the traits you loved, it may be hard to feel good about them. The best way to avoid negative feelings is to educate yourself about PTSD. Even if your loved one refuses treatment, you will probably benefit from some support.

Avoidance: Avoidance is one of the symptoms of PTSD. Those with PTSD avoid situations and reminders of their trauma. As a family member, you may be avoiding the same things as your loved one. Or, you may be afraid of his or her reaction to certain cues. One possible solution is to do some social activities, but let your family member stay home if he or she wishes. However, he or she might be so afraid for your safety that you also can’t go out. If so, seek professional help.

Depression This is common among family members when the person with PTSD causes feelings of pain or loss. When PTSD lasts for a long time, you may begin to lose hope that your family will ever “get back to normal.”

Anger and guilt: If you feel responsible for your family member’s happiness, you might feel guilty when you can’t make a difference. You could also be angry if he or she can’t keep a job or drinks too much, or because he or she is angry or irritable. You and your loved one must get past this anger and guilt by understanding that the feelings are no one’s fault.

Health problems: Everyone’s bad habits, such as drinking, smoking, and not exercising, can get worse when trying to cope with their family member’s PTSD symptoms. You may also develop other health problems when you’re constantly worried, angry, or depressed.

Helping a Veteran With PTSD

Social support is extremely important for preventing and helping with PTSD. It is important for family members to take care of themselves; both for their own good and to help the person dealing with PTSD.

Family members may feel hurt, alienated, or discouraged because your loved one has not been able to overcome the effects of the trauma. Family members frequently devote themselves totally to those they care for and, in the process, neglect their own needs.

Social support is extremely important for preventing and helping with PTSD. It is important for family members to take care of themselves; both for their own good and to help the person dealing with PTSD.

Don’t take the symptoms of PTSD personally. If your loved one seems distant, irritable, angry, or closed off, remember that this may not have anything to do with you or your relationship.

Don’t pressure your loved one into talking. Many veterans with PTSD find it difficult to talk about their experiences. Never try to force your loved one to open up but let them know that you’re there if they want to talk. It’s your understanding that provides comfort, not anything you say.

Be patient and understanding. Getting better takes time so be patient with the pace of recovery. Offer support but don’t try to direct your loved one.

Try to anticipate and prepare for PTSD triggers such as certain sounds, sights, or smells. If you are aware of what causes an upsetting reaction, you’ll be in a better position to help your loved one calm down.

Take care of yourself. Letting your loved one’s PTSD dominate your life while ignoring your own needs is a surefire recipe for burnout. Make time for yourself and learn to manage stress. The more calm, relaxed, and focused you are, the better you’ll be able to help your loved one.

Additional PTSD and Veterans Resources:

Real Warriors: A website to support the promotion of psychological health, reduce stigma of psychological health concerns and encourage help seeking behavior for service members, veterans and their families.

VA Caregiver Support website: Support for caregivers and loved ones of veterans who have PTSD.

Call the VA Caregiver Support Line: 1-855-260-3274

Sierra Outdoors Club: Military Outdoors organizes outdoor trips for veterans, other service members and their families, because we know that time spent in nature provides a unique experience to foster mental and physical health, emotional resiliency, and leadership development. For many veterans, spending time in the outdoors can also help ease the transition to civilian life.

VA Peer Support Groups: Peer support groups are led by someone like you who has been through a trauma. Groups often meet in person, but many groups also provide online (Internet) support.

Page last audited 8/2018

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