Post-traumatic stress disorder (PTSD) is a mental health disorder characterized by panic attacks, anxiety, flashbacks, and nightmares caused by traumatic events. PTSD is a type of anxiety disorder because it primarily involves anxious thoughts, worries, and fear that are difficult to control.
PTSD can also lead to other consequences like mental health issues, sleep problems, and possibly even physical health problems. What is the scope of PTSD among U.S. veterans, and how can trauma-related mental health be effectively addressed?
How Common Is PTSD Among Veterans?
PTSD is more common among veterans than it is in the general population. According to the U.S. Department of Veterans Affairs, 15% of Vietnam veterans were struggling with PTSD in the 1980s, and around 30% experienced PTSD at some point in their lifetimes. Around 12% of Gulf War veterans experience PTSD in any given year. From the two most recent conflicts, Operations Iraqi Freedom and Enduring Freedom, between 11% and 20% of veterans experience PTSD in a given year.
How Is PTSD Diagnosed?
PTSD is a trauma- and stress-related disorder with recurrent symptoms. It can have overlapping symptoms with other mental health disorders, especially other anxiety disorders. However, getting an accurate diagnosis is essential when it comes to getting the help you need. PTSD may have treatment approaches that are unique, so getting the right help for your needs is an important first step in getting effective treatment. Getting a diagnosis may start with a meeting with a doctor or therapist. When you’re seeking a mental health diagnosis, it’s often good to also get physical examinations and lab tests.
There is no medical exam that can identify PTSD, but it may help rule out other potential causes or contributing factors. For instance, certain vitamin deficiencies can contribute to psychological symptoms. You will also go through a psychological assessment, and your doctor or therapist will likely consult the Diagnostic and Statistical Manual of Mental Disorders (DSM) to help make an accurate diagnosis. PTSD is an officially diagnosed disorder in the fifth edition of the DSM (DSM-5).
According to the DSM-5, PTSD starts with a threat of “actual or threatened death, serious injury, or sexual violence.” Threats of violence don’t have to happen directly to you for you to experience PTSD. You may also experience trauma after witnessing a frightening event or hearing about a traumatic event that a loved one went through. Sometimes, PTSD is caused by repeated exposure to high-stress environments rather than a single traumatic event.
What Are the Symptoms of PTSD?
PTSD involves what is called intrusion symptoms, and you need to encounter one or more of these symptoms to be diagnosed with the disorder. Intrusion symptoms involve unwanted and difficult-to-control feelings, thoughts, and emotions. Symptoms include:
- Recurrent and intrusive memories of a traumatic event that happen involuntarily and cause distress, worry, or anxiety. The DSM also notes that children can show these symptoms through repetitive play with themes from the traumatic event.
- Dreams or nightmares that have to do with the traumatic events that are recurring. Children may also have frightening dreams that have content that is harder to connect to a traumatic event.
- Flashbacks that cause you to feel like you are re-experiencing the traumatic event that takes you out of the moment you are in. These are also called dissociative episodes, and the most extreme can cause you to feel completely absent from your current situation. Again, in children, flashbacks may be expressed through play.
- Anxiety or distress that’s caused by internal or external things that remind you of the traumatic event. For example, you may experience anxious thoughts when driving on a road where you were in a car accident.
- Significant psychological reactions when you’re reminded of a traumatic event. For instance, you may experience a panic attack when you think of a traumatic event.
Many anxiety disorders involve behavioral symptoms that are characterized by avoidance. You may start to avoid people, places, and situations that cause anxiety, panic, or flashbacks. This can significantly hinder your life, especially as more and more things trigger psychological PTSD symptoms. It may start to take a toll on your relationships and your ability to work or attend to other responsibilities. Avoidance symptoms can include:
- Avoiding or wanting to avoid memories, feelings, or thoughts that you associate with a traumatic event. These are internal reminders that are often hard to control.
- Avoiding or wanting to avoid external reminders like people, places, objects, activities, and situations that you associate with the traumatic event.
To qualify as PTSD, you will also have to experience two negative changes in your mood or thoughts that are caused by a traumatic event. At this point, the trauma you experience will start to leave lasting effects on your emotions, the way you think, and even your beliefs. These negative changes can include:
- Memory issues, especially memories about the traumatic event. This can be caused by something called dissociative amnesia, but memory issues caused by drugs or alcohol are not included in this symptom. Head injuries are also excluded.
- You may not be able to remember an important detail about an important event, like the time of day it occurred or who was involved.
- Negative beliefs about yourself, other people, or the world around you. You may feel you’re worthless or that the world is a dangerous place. You may also feel like your problems are permanent and that things won’t get better.
- You may also have distorted thoughts or beliefs about the event that causes you to blame yourself or someone else, even if it was out of anyone’s control.
- Persistent and lasting negative emotions. You may feel afraid, guilty, or ashamed for long periods.
- Spending less time participating in responsibilities or activities you once enjoyed.
- Feeling disconnected from other people or the community around you.
- You may experience the inability to have positive emotions. You may feel like you don’t feel happy, satisfied, or loved.
According to the DSM-5, PTSD also includes two or more changes to arousal or reactivity. These symptoms will begin or get worse after you experience trauma in your life. Increased sensitivity and irritability may start to put a strain on your relationships. Reactivity changes can include:
- Irritability, angry outbursts, and increased aggression with little or no causes. This can be expressed verbally or physically. Aggression may be toward people or objects.
- Self-destructive or reckless behavior.
- Hypervigilance or an increased state of alertness that may be inappropriate to the situation.
- Exaggerated response when startled.
- Concentration issues.
- Sleep problems that make it hard to fall asleep or stay asleep.
What Causes PTSD?
PTSD can be caused by a wide variety of stressful or traumatic events. The most easily identified causes are major threats to your life that result in injury or nearly result in injury or death. Many combat veterans develop PTSD after experiencing this kind of trauma in a combat scenario. However, PTSD can also be caused by other, less obvious traumatic events. Some people experience trauma after witnessing an event where someone is killed, or their life is threatened. In some cases, hearing about a dangerous or deadly experience that happened to a friend or family member can cause PTSD.
Why Many Veterans Don’t Seek Help for PTSD
Many veterans resist getting the help they need because they feel that being traumatized by an event makes them weak. However, PTSD affects all kinds of people, and there is no evidence that weakness plays a role. In fact, PTSD rates are higher among people who most would consider courageous including, military service members, police, firefighters, paramedics, and first responders. Many of the people in these positions are very good at what they do. PTSD is a risk of high-stress jobs and military roles, and researchers are looking into ways to safeguard against that risk.
Several variables go into the development of PTSD that may be out of your control. Researchers are still learning why people can experience the same traumatic event, and only one experiences PTSD while the other one doesn’t. Some research suggests that genetics may play a significant role as a risk factor for PTSD. A large 2018 study found that genetics may account for between 5% and 20% of your risk factor for PTSD. That means having a parent or grandparent who has experienced PTSD may increase your risk for the disorder.
Veterans experience PTSD at higher rates than the civilian population, and it’s especially common among service members who experience combat. Combat exposure is often associated with trauma and PTSD. But combat-related trauma can come in many forms. Here are some potential combat-related causes of PTSD:
- Attacks that threaten your life directly
- Witnessing an attack on someone else
- Being injured in an attack
- Witnessing a serious injury
- Witnessing death
- An accident that threatens or injures you
- Witnessing an accident that threatens or injures someone else
- Responding to the aftermath of a violent attack
- Handling human remains
- Killing or wounding others
- Long periods of high stress
One of the often-overlooked causes of PTSD is a drawn-out period of stress. Military members in combat situations or in hostile areas may be alert and on edge for long periods of time. These stressful periods may not allow you much time to rest, relax, and process.
Some people with PTSD may not remember one particular event that traumatized them, which can be frustrating when you’re looking for the cause of your symptoms. However, you may experience trauma over time with no single traumatic moment. It’s also possible to experience several life-threatening events with no trauma and then experience trauma after experiencing another one.
Military service members and civilians who don’t see combat may experience trauma that’s related to other causes. Any event that causes a high degree of stress or high stress for a long time can potentially lead to PTSD.
Here are some non-combat-related causes of trauma and PTSD:
- Automobile accidents
- Job-related accidents that threaten your life
- High-stress work environments
- Non-combat physical violence
- Non-combat injuries from accidents
- Witnessing an accident
- Serious illness or a frightening diagnosis
- Natural disaster
- Responding to a disaster or accident
- Military sexual trauma
Military sexual trauma (MST) is another overlooked but significant cause of stress and trauma in the military. MST involves sexual assault, repeated sexual harassment, and sexual harassment with threats. MST can occur in peacetime, war, and in training. It’s important to note that it can and has happened to both men and women in the military.
Several high-pressure jobs in the military can come with a higher-than-average risk of PTSD, even outside of combat. As with civilian populations, first responders like police and medics may experience more stress outside of combat situations. Other military jobs that may come with added stress include pilots, people who operate heavy machinery, doctors, nurses, and many others.
Associated Health Risks Among Veterans with PTSD
Post-traumatic stress disorder can have some serious consequences on your mental and physical health, especially when left unaddressed. PTSD can affect your long-term physical health, mental health, and cognitive functions. Here are some areas of your health that may be affected by untreated PTSD.
Substance Use Problems
PTSD often comes with co-occurring substance use problems among veterans. Around 46.4% of people with lifetime PTSD also experience a substance use disorder (SUD) at some point. Veterans often develop substance use disorders related to alcohol use because of something called self-medication. Self-medication is the use of a psychoactive substance to treat or mask uncomfortable symptoms without consulting a doctor.
Veterans may use alcohol to dull some of the symptoms of PTSD. However, developing a dependency and addiction to alcohol can only make problems worse. Alcoholism can lead to its own health consequences, including liver problems, heart disease, and cognitive issues. It also increases your risk of other issues like legal problems, relationship issues, and financial instability.
One of the clearest consequences of PTSD that can affect your health involves sleep disruption. Sleep is an important part of maintaining both physical and mental health. Insomnia and nightmares are commonly associated with PTSD. Not getting enough restful sleep can cause various common health issues. It can increase your blood pressure, cause weight gain, increase your risk for diabetes, increase your risk for heart disease, and weaken your immune system. It can also worsen your balance and increase your risk of an accident.
Sleep problems can also cause you to experience issues related to cognitive functions. You may have memory problems, difficulty concentrating, and impaired problem-solving skills. Sleeplessness is also associated with mood issues. Mood swings and irritability are common among people who don’t get enough sleep. Long-term sleep issues may cause issues like depression and generalized anxiety.
Long-Term Health Effects
Stress can cause physical symptoms, even in the short term. For instance, periods of high stress can cause headaches, muscle tensions, body aches, chest pains, gastrointestinal problems, fatigue, and sexual dysfunction. But long periods of stress and anxiety associated with PTSD may cause significant long-term health consequences. Severe stress can affect your heart health, which can lead to heart disease, heart attacks, and other cardiovascular issues.
Research that looked into the results of an electrocardiogram (EKG) tests among Vietnam War veterans with and without PTSD found that the group with PTSD had more instances of abnormalities, atrioventricular conduction defects, and infarctions. However, researchers are still unclear about how PTSD specifically affects one’s physical health. Still, the disorder could affect your physical health in direct or indirect ways.
Mental Health and Suicide Risk
PTSD is a mental health disorder, so it can significantly affect your overall mental health and quality of life. The disorder can lead to other mental health issues like depression and generalized anxiety disorder. It can also get in the way of you living your life.
As it affects your relationships and jobs, you may start to feel overwhelmed, which can lead to issues like depression. If you experience panic attacks or frequent flashbacks, you may start to experience generalized anxiety between episodes. Some people also experience social anxiety for fear that they will have a PTSD-related episode in public or around friends or family. This can lead to isolation, which can worsen mental health.
PTSD may also cause suicidal thoughts and ideation. PTSD is a significant risk factor in suicides, especially among women. Around 0.6% of suicides in men are linked to PTSD; the disorder was also a factor in 3.0% of suicides in women, according to the study.
How to Prevent PTSD?
Traumatic experiences are a part of the job for military services members, just as they are for many first responders. However, that doesn’t necessarily mean that PTSD has to be inevitable for some people. There are several ways that military service members can prepare for and respond to traumatic events that may help prevent PTSD. With more awareness about the risks of PTSD, people with high-risk jobs have more options to help safeguard against this disorder.
Many first responders who experience PTSD feel like they were unprepared for the traumatic event that caused it. Feeling overwhelmed during a traumatic event may make you more susceptible to PTSD. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), some researchers suggest an emphasis on preparedness and better assessment for first responders to determine if they are prepared for what they will have to do on the job.
In the military, it’s impossible to prepare for every possibility, but there is an emphasis on being well prepared. When going into specific jobs and tasks, it’s important to be well prepared and to know what to expect if possible. If you’re going into a combat or disaster response situation, mental preparedness can also help you avoid or manage trauma.
When it comes to disaster response, higher risks of PTSD are associated with workers who spend more time closer to the epicenter of the disaster. The same principle may be applied to other roles that require you to spend time near the aftermath of an attack or a disaster. In military services, the circumstances of your mission or task may require you to spend time near danger. However, limiting an individual’s exposure to danger or witnessing violence can help limit their risk for PTSD.
Another way to prevent PTSD is to debrief after a potentially tragic event. In a psychological sense, debriefing means talking to someone after an incident about your experience. Working through the potential trauma right after it happened can help prevent it from becoming PTSD. You may speak to a therapist or chaplain to unpack your experience. However, SAMHSA noted that many first responders find talking to peers who can empathize with them more effective. That may be similar for military members.
Can PTSD Be Cured?
There is no known cure for post-traumatic stress disorder. Like other mental health disorders, PTSD is a complex problem with several potential causes and consequences that makes each case unique. There is no physical exam or test that can diagnose PTSD, and getting a diagnosis and treatment plan requires a complex assessment process. While PTSD is a chronic disease with no cure, it can be treated effectively. However, treatment must begin with an accurate diagnosis. Through the treatment process, you may receive various therapies that are appropriate for your needs. These may include cognitive behavioral therapy and eye movement desensitization and reprocessing (EMDR). SSRI medications, which are antidepressants, can also treat anxious thoughts or depression.
Many veterans struggle with PTSD and trauma-related issues. Thankfully, they have several resources to help them address these issues. The first step in treating PTSD is to speak to someone about what you’re going through. A doctor, therapist, or clinician may be able to point you to the treatment you need.
The U.S. Department of Veterans Affairs has also compiled several resources to address PTSD specifically. It also provides a PTSD Treatment Decision Aid to help you navigate your next steps in seeking treatment for mental health issues related to trauma.