Signs of Post-Traumatic Stress Disorder (PTSD) in Military Service Members & Veterans
PTSD in veterans shows as hypervigilance, re-experiencing the trauma through smells, sounds or news reports, avoidance of people and places tied to deployment, and withdrawal from the people closest to them.
There are approximately 19 million veterans in the U.S. today, and over the past 13 years as many as 500,000 U.S. troops have received a PTSD diagnosis. 72% of U.S. adults rank veterans’ services as an essential priority, and post-traumatic stress disorder remains a national concern.
Healthy routes exist for addressing the anxiety and depression that follow trauma. The sections below cover recognizing and treating PTSD in military veterans who have served in combat, including the signs and symptoms, the causes, and the treatment options.
Veterans in crisis reach trained responders 24 hours a day through the Veterans Crisis Line. Dial 988 then press 1, text 838255, or chat at VeteransCrisisLine.net. TTY users call 1-800-799-4889. Call 911 for a medical emergency.
Why Are Veterans and Service Members at Higher Risk of PTSD?
Veterans and service members face repeated trauma exposure during service, including war zone deployment, training accidents and military sexual trauma, which raises their PTSD risk above the general population.
Service exposes veterans and military service members to many different types of trauma. Active duty, war zone deployment, training accidents, and military sexual trauma (MST) are a few of the traumas that produce PTSD and PTSD symptoms.
The link between combat deployment and raised risk of mental health conditions is the most documented, and military service outside combat produces mental health struggles as well. The military community experiences a range of conditions beyond PTSD, including depression. Reach out to a trusted medical professional where the world feels unsafe, or where you or someone close to you shows everyday fear.
What Are the Signs of PTSD in Veterans?
The four main signs of PTSD in veterans are hypervigilance carried home from deployment, re-experiencing the trauma, avoidance of reminders, and visible withdrawal from other people.
Veterans face specific challenges that shape how PTSD presents. The incidence of combat-related PTSD rises with the number of tours and the amount of combat a service member has experienced. Many of the responses a service member relied on during deployment resurface at home, where those responses no longer fit. The survival responses include hypervigilance, hyperawareness, and adrenaline-quick reflexes, all of which are symptoms of combat-related PTSD.
On reliving the event, service members re-experience traumas triggered by smells, news reports, or loud noises. Service members also avoid people or situations that bring up memories of their deployment, particularly to avoid talking about those experiences. Avoidance extends to crowds, films and television programs tied to a triggering event.
Service members who have returned from combat seem different than they were before deployment. A returning service member appears more withdrawn or more introverted. The signs matter, because they mark PTSD or another health condition.
There are 5 further symptoms veterans and service members develop besides the four main types above:
- depression and feelings of shame or hopelessness
- substance misuse or excessive substance use
- difficulty keeping employment or other important personal commitments
- trouble in relationships, increased irritability, or fighting with loved ones
- physical symptoms, including chronic pain
Substance misuse is a warning sign that you or someone close to you is struggling to cope with a traumatic event. Get help immediately where you notice changes in behavior, someone drinking more regularly, or growing reliance on pills or another substance. The changes are also signs of substance use disorder (SUD), which makes the feelings tied to a traumatic event harder to overcome and leads into addiction.
Begin Recovery
How Common Is PTSD Among Veterans?
PTSD reaches approximately 8 million American adults a year, and the military community carries a higher risk than the general population.
PTSD extends beyond the military. Military service members and veterans also face unique barriers to accessing adequate treatment for mental illnesses such as PTSD. That barrier raises the risk of substance misuse, because it pushes people toward substances as a way to manage mental health struggles on their own.
What Is PTSD?
PTSD is a mental health condition that develops after a shocking, scary or dangerous event, and its symptoms persist long after the danger has passed.
The National Institute of Mental Health records PTSD as developing in people who experience “shocking, scary or dangerous” events. Feeling frightened during and after a traumatic event is a natural fight-or-flight response, and PTSD symptoms last long beyond the event itself.
Fight-or-flight responses trigger split-second changes in the body that defend it against danger or avoid the danger altogether. In PTSD, those stressful and fearful responses continue after the threat has passed.
The National Center for PTSD classifies PTSD as a mental health condition that makes daily activities difficult, including going to work, attending school, and spending time with loved ones. PTSD symptoms start immediately or after time has passed, and they come and go. Where the symptoms carry on for longer than 4 weeks and the feelings from the traumatic event disrupt everyday life, investigate whether PTSD is present.
What Are the Pre-Trauma Risk Factors for PTSD in Veterans?
The three main contributing factors to PTSD are an intense or long-lasting traumatic event, an injury sustained during it, and exposure to particular types of trauma such as combat or sexual assault.
Anyone develops PTSD symptoms, at any age.
There are 3 main contributing factors:
- an intense or long-lasting traumatic event
- an injury
- exposure to particular types of trauma, such as combat or sexual assault
Risk factors matter, and what happens after the traumatic event matters more, along with how a person gets support.
A study by the RAND Center for Military Health Policy Research found that fewer than half of veterans who returned to civilian life and needed mental health treatment received any treatment at all. Of those receiving treatment for PTSD and major depression, fewer than one-third received evidence-based care. War-induced psychological trauma traces back as far as 490 B.C., and each war since has produced its own record of veterans living with mental health conditions.
What Do the PTSD Statistics by War Show?
PTSD prevalence among veterans runs from about 12% after the Gulf War to about 30% lifetime among Vietnam veterans, with roughly 13.5% of Iraq and Afghanistan veterans screening positive.
There are 4 recorded PTSD figures by conflict:
- 700,000 Vietnam veterans, almost 25%, received a diagnosis requiring some form of psychological care for delayed effects of combat exposure.
- 60,000 veterans of Iraq and Afghanistan, Operations Iraqi Freedom and Enduring Freedom, screened positive for PTSD, which is 13.5%.
- Approximately 12 out of every 100 Gulf War (Desert Storm) veterans have PTSD.
- Approximately 15 out of every 100 Vietnam veterans had PTSD at the time of the most recent study, and approximately 30 out of every 100 have had PTSD in their lifetime.
Is It Combat Stress or PTSD Symptoms?
Combat Stress Reaction is a short-lived natural response to the strain of combat, and its symptoms overlap with PTSD while resolving within weeks to months of returning home.
Combat Stress Reaction (CSR), known as shell shock or battle fatigue, is a response to the mental and emotional strain service members and combat veterans experience after returning home from combat.
Military OneSource records that strain as resulting from dangerous and traumatic experiences, and as a natural reaction to the wear and tear on body and mind after extended and demanding operations.
The symptoms resemble PTSD. There are 7 key combat stress symptoms:
- headaches and fatigue
- loss of appetite
- excessive fear or worry
- irritability and outbursts of anger
- depression or feelings of apathy
- personality changes
- difficulty sleeping
How Does Combat Stress Differ From PTSD?
Combat stress resolves within weeks to months and falls inside the range of a natural reaction, while PTSD persists beyond 4 weeks, presents more severely, and interferes with daily responsibilities.
Combat stress occurs for brief periods and falls within the range of a natural reaction to traumatic events such as combat, disaster or assault.
Combat stress in a service member or veteran resolves within a few months of returning home, and sometimes within weeks.
PTSD is more severe and includes symptoms that last longer than 4 weeks. PTSD symptoms are more aggressive than those of CSR, interfere with daily responsibilities, and require professional assistance to process the emotions involved.
How Is PTSD Treated?
The Department of Veterans Affairs identifies two PTSD treatments: trauma-focused psychotherapy and medication for PTSD symptoms.
Managing the symptoms of PTSD is possible, and PTSD is not a condition to face alone or live with unaddressed. Veterans and service members across the army, marine corps, navy, air force and coast guard have received treatment for PTSD and found relief from their symptoms through research advances in the field.
The U.S. Department of Veterans Affairs (VA) identifies 2 types of treatment:
- trauma-focused psychotherapy
- medications for treating PTSD symptoms
Trauma-Focused Psychotherapy
Trauma-focused psychotherapy is the most recommended PTSD treatment, and it covers 5 approaches: cognitive processing therapy, cognitive behavioral therapy, prolonged exposure, art therapy and EMDR.
The VA defines trauma-focused as treatment that focuses on the memory of a traumatic event or its meaning.
There are 5 forms of trauma-focused psychotherapy:
Cognitive Processing Therapy (CPT). CPT is a type of cognitive behavioral therapy (CBT) focused specifically on trauma. CPT builds the skills to address how the traumatic event changed a person’s thoughts and feelings, which changes how they think about the trauma and how they feel.
Cognitive Behavioral Therapy (CBT). CBT teaches the reasons behind your thinking and actions, and identifies the triggers connected to them. Research records CBT as a successful PTSD treatment for service members, through methods that identify destructive thought patterns and behaviors and exchange them for healthier ones.
Prolonged Exposure (PE). PE approaches trauma-related memories gradually, repeating the memory on purpose until the memory no longer upsets the person.
Art Therapy. A study of mask-making in an art therapy program for service members with PTSD recorded therapeutic effects. Creating masks let participants express their difficulties visually, which supported their recovery.
Eye Movement Desensitization and Reprocessing (EMDR). EMDR is a structured therapy that focuses on the trauma memory alongside bilateral stimulation, such as eye or hand movements, while the person talks about the trauma. The method works the brain through traumatic and distressing memories.
Which Medications Treat PTSD?
SSRIs and SNRIs are the medications most recommended for PTSD symptoms, and the four named examples are fluoxetine, paroxetine, sertraline and venlafaxine.
The medications most recommended for treating PTSD symptoms are antidepressants, specifically SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors). The inhibitors treat depression and anxiety, and they work for PTSD.
There are 4 examples:
- fluoxetine
- paroxetine
- sertraline
- venlafaxine
Alternative approaches include outdoor activities such as camping, hiking and rock climbing, which challenge a sense of vulnerability and support the transition back into civilian life. Organizations and facilities offer social support, outdoor recreation and time in nature.
Where Can Veterans Get Help for PTSD and Substance Use Disorder?
Riverside Recovery of Tampa treats substance use disorder with co-occurring PTSD through dual diagnosis programming, addressing both conditions from the first day of care.
Coping with the symptoms of PTSD is overwhelming for veterans and service members, and steps exist that improve things now. Blaming yourself or a family member for PTSD symptoms or combat stress serves nobody. The step that matters is getting help.
Reach out to our admissions team to learn more about dual diagnosis treatment for veterans living with substance use disorder alongside PTSD.
Veterans in crisis reach trained responders 24 hours a day through the Veterans Crisis Line. Dial 988 then press 1, text 838255, or chat at VeteransCrisisLine.net. TTY users call 1-800-799-4889.
- 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.
