“I would have images of bullets going through my head or rage coming through the door,” says Anderson, who explains that six of his close friends were killed during the 33 months he served in combat. “There are times where I find myself more elevated than a person should be at normal, typical, daily stressors. That comes in the form of feeling like I’m being attacked,” he adds. It’s upsetting and shocking events like the deaths Anderson witnessed that can trigger PTSD. (2) And in Anderson’s case, a diagnosis of a traumatic brain injury (TBI) incurred after being exposed to detonating improvised explosive devices (IEDs) may have played a role in his diagnosis, as people who suffer from TBIs have an increased risk of developing PTSD. (3) But PTSD may occur as a result of trauma not only during combat, but also during training or even in times of peace. (4) For instance, military sexual trauma, or trauma as a result of sexual assault or sexual harassment during peacetime, training, or war, can cause men and women to develop PTSD. (5) According to data from the U.S. Department of Veterans Affairs (VA) national screening program, about 1 in 3 women and 1 in 50 men report that they have experienced sexual trauma in the military. (6) Indeed, post-traumatic stress can result after any event that is shocking, says Annette T. Hill, a licensed professional counselor at Warriors Heart, a treatment center for active military, veterans, and first responders in Bandera, Texas. Hill’s son suffered from PTSD and killed himself in 2009. A diagnosis of PTSD results when post-traumatic symptoms last for one month or more, she notes. (2) Operations Iraqi Freedom and Enduring Freedom Between 11 and 20 percent of veterans. Gulf War About 12 percent of veterans Vietnam War Studies suggest about 15 percent of veterans, yet it’s estimated that about 30 percent have had PTSD in their lifetime. Genetics may also make certain individuals more predisposed to developing PTSD than others. A study from 2017 reported a significant link between genetic variation and PTSD among American and European women. (However, researchers didn’t notice the same link in men.) They also found that those people who had other psychiatric diagnoses were at a higher risk for developing PTSD after exposure to trauma. (7) Research suggests that certain types of training, like stress inoculation therapy — which models exposure of the battlefield — can work like a buffer when individuals in the military do experience trauma, Moore says. Also, teaching people in the military how to reduce their stress levels and create healthy habits — like eating healthily, getting enough sleep, and finding ways to de-stress when they’re not on duty — can help. Other times, individuals suffering from PTSD in the military may fear being seen as feeble if they speak up and ask for help, says Stephen M. Stahl, MD, PhD, an internationally renowned psychiatrist and professor of psychiatry at the University of California, Riverside. “[The military] is a deeply entrenched culture of warrior mentality with idealizing the fighting warrior and basically denigrating the ‘coward,’” Dr. Stahl says. The concern comes down to a fear of being viewed as someone who can’t protect their peers on the battlefield. A meta-analysis found that among the study group of military personnel, 44 percent who experienced mental health concerns reported worrying that their supervisors would treat them differently if they revealed their struggle. Meanwhile, 42 percent reported being concerned they would be seen as weak if they made that admission. (9) Many people in the military also avoid speaking up about mental health problems because they think it may hurt their careers, which is a valid concern, Stahl says. Depending on the severity of their symptoms, as well as whether they’re deployed, in combat, or on reserve, they may be discharged if they admit they’re dealing with a mental health problem. Because of this risk, many people stay tight-lipped, Stahl says, explaining, “The closest thing they’ll complain about is insomnia and overstimulation.” At the very least, being diagnosed with PTSD may prevent a service member from being promoted, Stahl says. “Promotions are considered to be more stressful and more responsibility, and if you are ‘cracked’ and at a lower level, why would they advance you? It’s the kind of question that’s in the air, if unspoken,” Stahl says. But the way the military views PTSD is changing. Within the past 10 years, its leadership has made headway in trying to destigmatize PTSD, Stahl says. “I do think it has gotten the attention of the leadership, and there are some notable leaders that have even admitted to their own PTSD and others who are supportive of destigmatizing,” he explains. “Because in the military and first-responder communities there is such a strong directive — understandably — to override your emotions to deal with stress, you are at counter-purpose with dealing with that kind of stress after the moment is over,” Hill explains. People with PTSD often have co-occurring conditions such as depression, which also puts sufferers at risk of suicide. (11) Other factors that can increase the risk of suicide in the military PTSD population include substance use, other mental health conditions, and relationship problems — some of the most significant risk factors for suicide. (12) “Your guard is down; your heart is broken,” Hill explains. “You’re vulnerable, and you don’t have any weapon to deal with that.” Service members who have not been deployed are also at risk for suicide. In fact, a 2015 study found an increased risk of suicide in all of the following groups: those who separated from the military regardless of whether they were deployed, those who left the military after less than four years of service, and those who did not separate with an honorable discharge. (13) Although Anderson never had a suicide attempt, he often thought about it. “For the longest time, I felt like I was in a casket buried 6 feet under. I always questioned myself if I was even actually alive,” he says.
Psychotherapy
Evidence-based treatments for PTSD include prolonged exposure (PE) and cognitive processing therapy (CPT), which are two types of cognitive behavioral therapy (CBT). (14) Therapies that target the emotional brain instead of the logical brain — such as eye movement desensitization reprocessing (EMDR) and art therapy — can also be effective. Research suggests EMDR may be as effective as CBT. (15) Meanwhile, another study found CPT in conjunction with art therapy could also be an effective way to help improve trauma processing for veterans. (16) “Trauma is a whole-system experience. It’s not just a cognitive experience,” Hill says.
Medications
The VA lists four medications that are recommended to treat PTSD. The four drugs are used to treat depression, but can help reduce PTSD symptoms. Among antidepressant medications, they are considered the best for treating PTSD. They belong to a class of drugs known as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). (19) They include:
sertraline (Zoloft)paroxetine (Paxil)fluoxetine (Prozac)venlafaxine (Effexor)
Several other medications may be helpful but have less evidence to back them up. They include:
nefazodone (Serzone)imipramine (Tofranil)phenelzine (Nardil)
Although it’s not a long-term solution or cure for PTSD, medications can help improve sleep or other comorbid conditions, such as anxiety or depression. Talk to your doctor to discuss your options.
Complementary Therapies
Other treatments, such as mindfulness-based cognitive behavioral therapy; acceptance and commitment therapy (ACT), a form of mindfulness-based therapy; transcendental meditation; yoga; mixed martial arts; horticulture therapy; and equine therapy can help people with PTSD, Moore says. In fact, according to a small study from 2017, two-thirds of veterans who participated in horseback riding for three weeks had significantly lower symptoms of PTSD. (17)
Self-Care
A healthy diet, regular exercise, plenty of sleep, mindfulness, and other calming techniques can help people with PTSD learn how to manage the physiological symptoms of PTSD. For example, the Wounded Warrior Project and Give an Hour have PTSD treatment programs for the military and veterans. “You develop stronger relationships with people, you have a newfound sense of strength, maybe you develop a stronger spirituality or [deeper] connection,” Moore says. “You can actually become a better person for it and live a more rewarding, fulfilling life.” In 2013, briefly after joining the National Guard, Anderson was medically discharged as a result of his PTSD diagnosis. Although he had tried other types of treatments, he learned about accelerated resolution therapy (ART), and after just one session, his intrusive memories disappeared. “ART for me has been like brain fitness on steroids,” he says. According to a 2017 study, although early research suggests ART may be an effective therapy for PTSD, there has been only one randomized controlled trial to date, so more research is needed. (18) “It may very well be one of the top treatments in the next 10 years, but I think it’s too early to tell,” Moore says. Anderson, who opened a nonprofit to provide ART therapy for veterans, still struggles with memory, managing tasks, and being in public places with large crowds. Some days he can only write an email or make a phone call, but that isn’t always the case. “There are other days where you just can’t stop me and I can do everything,” he says. Every two weeks, he has talk therapy sessions that usually also include ART, and he makes time for self-care by doing integrative restoration, a type of meditation; yoga; and golf. He’s also able to spend more time with his family, like reading or playing with his son — activities he says he wasn’t able to do until recently. “There’s a lot of struggle that I still face, but I’m in a much better place than I’ve ever been since coming home from war,” he says.
