Combat-Related PTSD

Combat-related post-traumatic stress disorder (PTSD) is a mental health condition that occurs in service members who have experienced or witnessed trauma during their military service.

Although combat-related PTSD is not a clinically recognized term, it is known and understood that combat members have a higher risk of developing PTSD compared to the general population.

PTSD and its Relationship With Veterans

In 1952, the American Psychiatric Association (APA) invented the Diagnostic and Statistical Manual of Mental Disorders (DSM), which was adopted after many World War II soldiers experienced severe levels of psychological distress due to their time in combat. The APA initially coined this “gross stress reaction.” Other common names for PTSD include “shell shock” and “combat fatigue.”

The official diagnosis of PTSD was not formally included in the DSM until 1980 after a large amount of research highlighted the debilitating psychological symptoms found among Vietnam veterans.

Anyone who has experienced a life-threatening traumatic event and experiences symptoms of negative mood and cognition, hyperarousal, intrusive thoughts, and avoidance may receive a PTSD diagnosis. However, PTSD is more commonly diagnosed in veterans compared to the general population.

Those who’ve served in active war zones experience PTSD percentages as high as 80%, and a breakdown of veterans with combat-related PTSD from different conflicts is as follows:

The prevalence of PTSD in Vietnam veterans ranges from 18%-31%.
The prevalence of PTSD in Iraq and Afghanistan War veterans ranges from 11%-20%.
The prevalence of PTSD in Gulf War veterans is 12%.

Common PTSD Symptoms in Veterans

While not every veteran will present with the same symptoms, common combat-related PTSD symptoms include:

Re-experiencing Symptoms

Re-living the traumatic events in either flashbacks, nightmares, recurrent memories, or distressing thoughts is a common occurrence. Loud sounds such as fireworks, gunshots, flashing lights, or certain smells can trigger traumatic memories and can cause physical symptoms such as racing heart, chest pain, gastrointestinal issues, and headaches.

Avoidance Symptoms

Staying away from places, people, and objects that are reminders of traumatic events and avoiding thoughts and feelings related to these events is common among those with combat-related PTSD. Examples include avoiding crowded or loud places and overstimulating environments, as well as refraining from discussing war, combat, and military service. Some veterans may not even mention their service as a way to avoid their history altogether.

Arousal and Reactivity Symptoms

Feeling easily startled or always on alert or “on edge” can present as a combat-related PTSD symptom. This also includes difficulty sleeping, problems with focusing and concentrating, and an irritable mood. Veterans may “stand watch” at night, sitting in front of their entryway or always finding seats close to a door in a public place to watch for signs of danger. They may also act recklessly and have intense mood swings.

Cognition and Mood Symptoms

Cognition and mood symptoms of combat-related PTSD include social isolation and loneliness, emotional numbness, loss of interest in activities, depression, anxiety, and difficulty remembering things associated with the trauma.

PTSD and Homelessness in Veterans

Veterans are at a higher risk of PTSD compared to the general population, and PTSD is linked to homelessness. Homelessness is a risk factor for PTSD, as homeless individuals have a higher rate of sexual assault, violent attacks, and other traumas that can lead to PTSD.

Veterans with PTSD have a significantly higher risk of becoming homeless, especially those who served in high-stress war zones. These individuals have a difficult time re-integrating into civilian life because of their PTSD symptoms and face hardships when trying to form new relationships, secure employment, and find stable housing. They may struggle with strained family relationships due to the psychological burden of their PTSD symptoms, and all of these can lead to social isolation, increasing the risk of homelessness.

Other factors that can increase the risk of PTSD in service members include:

Longer deployment times or multiple deployments
Being in an active combat or war zone
Lower rank
Prior trauma exposure
Female gender
Less education
Severe physical injury during combat
Traumatic brain injury
Lack of social support from the unit
Poor support system back home
Sexually assault (military sexual trauma [MST] is any sexual harassment or sexual assault that occurs while a service member is in the military. Studies have shown that 44.6% of all females and 2.9% of all male soldiers report experiencing MST.)

Prevention of PTSD for Active-Duty Service Members

Although it is not entirely clear whether PTSD can be prevented, early treatment and support services have shown to be the most successful avenue for minimizing symptoms.

Seeking mental health therapy and joining support groups while in the military, especially after experiencing a traumatic event, is advisable. Keeping in close communication with family and loved ones back home, finding support within your military unit, talking about any stressors, and trying to stay mentally and physically healthy are essential ways to prevent PTSD. When trauma does occur, it is crucial to immediately debrief and adopt quick interventions to address the traumatic event.

It is also important to avoid unhealthy coping mechanisms, such as substance abuse, as these can numb emotions and cover up the trauma, resulting in worsening avoidance symptoms. Active-duty service members and veterans are at a higher risk for substance abuse compared to the general population because they often use drugs and alcohol to numb their emotions and memories associated with war trauma, which can lead to or worsen PTSD symptoms.

Unfortunately, there is a considerable stigma associated with mental health disorders in the veteran community, which impedes a lot of soldiers from seeking immediate professional help.

There is also a lack of education and awareness about PTSD and the importance of seeking help after a trauma, even before symptoms of PTSD appear. Mental health providers who do not treat veterans consistently may misdiagnose PTSD or may not be best suited for treating PTSD in veterans. Therefore, veterans need to seek treatment from mental health professionals who have a background in working with veterans, trauma, and PTSD.

Therapy for PTSD in veterans consists of the following approaches:

Cognitive Processing Therapy (CPT) helps Identify how traumas shape their thinking patterns and works to evaluate these thoughts, adopting coping skills to change them into healthier thoughts and beliefs about themselves, others, and society as a whole.
Prolonged Exposure (PE) slowly exposes the person to their trauma in a safe and controlled setting until the trauma no longer triggers the person. By confronting the veteran with their trauma and triggers, over time, symptoms of PTSD can decrease.
Eye Movement Desensitization and Reprocessing (EMDR) brings up trauma events and triggers while using back-and-forth eye movements to help process and make sense of the trauma.

Medications for PTSD are not first-line treatments but are often used to help treat symptoms of depression and anxiety, which are commonly seen as cognition and mood symptoms in PTSD. Depression and anxiety can commonly co-occur with PTSD.

Medications that are approved for PTSD treatment and have shown symptom reductions include antidepressants, specifically SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors). These medications work to re-balance the neurotransmitters that are affected by PTSD. Medications do not work as well as trauma-focused psychotherapy, but they have shown to be effective, especially when used in conjunction with therapy. The following are SSRIs/SNRIs that are used to help manage PTSD:

Sertraline (Zoloft)
Paroxetine (Paxil)
Venlafaxine (Effexor)

The diagnosis and treatment of PTSD in veterans and active service members is the same as in the general population. Still, veterans and active-duty service members have more resources available to them. The VA, veterans support groups, and crisis lines are resources that can greatly help veterans who are living with PTSD.

Emotional support dogs: Support dogs for veterans can help recognize signs of distress, interrupt nightmares, act as a catalyst for social interactions in public, and provide assistance and companionship, which can help veterans feel less isolated and more secure and independent. The VA can cover the cost of training for a service dog, and many organizations provide service dogs to veterans at no cost. Some organizations include the following:

Support Groups for Veterans: Peer support groups for veterans with PTSD allow people to talk about their past trauma, experiences, symptoms, and daily life with peers who are also experiencing similar stories and can relate. They can offer a sense of connection and community, which is essential for many veterans who struggle with loneliness and isolation. Support groups can be virtual or in-person and are easily accessible through the Veterans Health Library.

Crisis Hotlines:

Crisis Text Line: Text CONNECT to 741741
Veterans Crisis Line: 1-800-273-TALK (8255)
National Veterans Foundation Hotline: 1-888-777-4443
Gulf War Veterans Hotline: 1-800-796-9699

If you or a loved one is struggling with PTSD symptoms related to time served in the military, help is available. Talk to your primary care physician or a mental health professional about your symptoms. They can help conduct an assessment and provide you with therapy and treatment options to get you started on your healing journey.

Last Updated: May 28, 2025

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