Veterans Day: How PTSD and Other Mental Health Conditions Impact Our Service Members

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According to the National Institute of Mental Health (NIMH), one out of five adults in the United States lives with a mental illness. When it comes to servicemembers, the National Alliance on Mental Illness (NAMI) notes that “nearly 1 in 4 active duty members showed signs of a mental health condition.”

Whether a mental illness or disorder is augmented by, or newly triggered by, their experiences in the armed services, veterans need more support when it comes to their mental health. The U.S. Department of Veteran Affairs (VA) reported that more than 1.7 million veterans received treatment in a VA mental health program in 2018. While it’s reassuring to hear that these vets have found the support and treatment they need, it’s also clear that many veterans and active duty members are not supported — nor are they even aware of the ways they can seek assistance.

To this end, the U.S. Government Accountability Office (GAO) found that veterans are 1.5 times more likely to die by suicide. In addition to suicidal ideation, veterans may also experience other mental illnesses or disorders, including post-traumatic stress disorder (PTSD), depression, traumatic brain injury (TBI) and substance use disorder (SUD).

Many of us honor our servicemembers on Veterans Day with words of gratitude, parades and ceremonies, but it should not end there — and should not be confined to a single day. All year long, you can find ways to support veterans with mental illnesses and disorders. The first step? Educating yourself. Here, we will take a deeper look at some of the most common mental health concerns vets navigate daily.

Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) develops after someone experiences a shocking, frightening and/or dangerous event. As you can imagine, PTSD is common among frontline vets and active duty soldiers who have seen combat. Triggers can include, but are not limited to, the following:

  • Witnessing the deaths of fellow military personnel or civilians
  • Life-threatening injuries
  • Lack of support from friends and family after retirement

During a traumatic event, our bodies react in a variety of ways to protect us from danger. Some people will struggle with anxiety immediately following their traumatic experience, but, over time, those feelings will lessen. However, people diagnosed with PTSD continue to be traumatized by the experience, and often feel stressed or frightened even when they are not in danger.

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Our bodies are incredibly well-equipped when it comes to keeping us safe; if we perceive danger, our fight-or-flight instincts kick in. When you experience a particularly traumatizing event, it can be challenging to convince yourself — and your body — that you’re no longer in danger. After all, anxiety does not listen to reason.

According to the American Psychiatric Association, common PTSD symptoms, which can often aid a doctor in formulating a diagnosis, can be grouped into the following four categories:

Intrusion

Alternatively known as re-experiencing symptoms, these intrusive thoughts are incredibly vivid and come in the form of “involuntary memories; distressing dreams; or flashbacks of the traumatic event.” No matter the type of intrusion, this symptom makes veterans feel like they are reliving the triggering traumatic experience all over again.

Avoidance

While some veterans might find sharing their combat stories cathartic, others do not enjoy recalling their time on the ground. These memories can cause unexpected emotions and reactions, which might lead a vet to avoid places, people and things that remind them of the inciting traumatic event; they may also withdraw from conversations surrounding the military or their service time. While some veterans may be conscious of their avoidance, others may not realize they’re doing so. No matter their level of awareness, veterans often have difficulty seeking support or treatment because they rather avoid a conversation — even a well-intentioned one — than relive a traumatic experience.

Alterations in Cognition and Mood

Undoubtedly, there’s a link between emotion and cognition. Emotional Intelligence (EI) is your ability to understand, use, perceive, and control their emotions, while cognition is your ability to gain knowledge, understand it, and react to it by making an appropriate decision. Some veterans may experience a cognitive bias — that is, they’ll put an excessive amount of their time, attention and energy into mitigating perceived threats.

For instance, during their time in the service, a vet may have seen a fellow soldier die as a result of someone’s decision-making. That said, this will stick with them, even if there isn’t a direct correlation between a decision and the traumatic outcome. Once home, vets might perceive everyday activities as dangerous and they’ll stay “on guard” to prevent a future traumatic event or threat, even if one doesn’t exist.

Alterations in Arousal and Reactivity

Also known as “hyper-vigilance,” this symptom is marked by enhanced awareness, which can turn into reckless behavior. Vets might be more easily agitated or have difficulty sleeping. Much like the feeling of being “on guard,” vets will often say alert because their bodies are anticipating danger. It’s like being unable to turn off your fight-or-flight instinct. Living with all that uncertainty can lead vets to engage in self-harming behaviors.

Depression (Major Depressive Disorder) 

Depression, or major depressive disorder, is marked by extreme sadness and feelings of hopelessness, which impact not only your mood, but your thoughts and actions as well. While most people experience sadness or depressive episodes, those who have been diagnosed with depression find these feelings of hopelessness and sadness interfering with, and inhibiting, their day-to-day lives.

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Veterans with PTSD are likely to experience depression as a comorbidity — a concurrent condition. Veterans and other people with depression might experience the following symptoms:

  • Feeling sad or depressed for a sustained length of time
  • Loss of interest in activities you once enjoyed
  • Changes in appetite
  • Changes in weight
  • Trouble falling or staying asleep
  • Sleeping too much
  • Loss of energy or fatigue
  • Inability sit still
  • Feelings of worthlessness or guilt
  • Difficulty concentrating or making decisions
  • Suicidal thoughts or ideation

Sometimes these symptoms go undiagnosed or, due to the diagnostic requirements, a veteran may be living with depression for months or years before they receive a proper diagnosis and treatment. If the disorder remains underlying, veterans and other people with depression may experience worsening symptoms, including increased suicidal thoughts. The VA approximates that between 18–22 veterans a day die by suicide. Regardless of the symptoms a veteran is experiencing as a result of major depressive disorder, finding support is essential to learning how to better manage their day-to-day lives.

Traumatic Brain Injury (TBI)

While a traumatic brain injury (TBI) is often caused by a physical, outside force, it affects how your brain functions, which can lead to accompanying mental illness or disorders. “The Defense and Veterans Brain Injury Center (DVBIC) reported nearly 414,000 TBIs among U.S. service members worldwide between 2000 and late 2019,” the VA notes. “More than 185,000 Veterans who use VA for their health care have been diagnosed with at least one TBI.”

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As mentioned, TBIs result from a significant blow to the head or body. According to the U.S. Department of Defense, 1% of vets suffered from severe cases, while 9.1% suffered from moderate cases of the condition. The remaining 82.4% suffered from mild cases.

While TBI and PTSD share several symptoms, the two conditions are not the same. TBI stems from a combat-related incident, which means the diagnosis is generally concurrent. Veterans with a TBI may experience the following:

  • Difficulty maintaining intimate relationships
  • Personality changes, such as varying mood swings
  • Depression
  • Motor impairment

Substance Use Disorder (SUD)

Substance use disorder (SUD), which is sometimes referred to as addiction, can impact a person’s physical and mental wellbeing. For many, the way a substance changes their brain and behavior leads to an inability to control their substance use. The VA reports that of the vets returning from tours in Iraq and Afghanistan, 10% have a substance abuse disorder involving either drugs or alcohol.

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While it’s not always the case, veterans with substance abuse disorder may also experience depression or PTSD. According to the VA, one third of vets seeking treatment for SUD also have PTSD. Veterans and other people with substance abuse disorder may experience the following symptoms:

  • An intense urge to use the substance/drug regularly — daily or several times a day — that blocks out other thoughts
  • Needing to take larger amounts of the substance to achieve the desired effect
  • Unsustainably spending money on the substance
  • Inability to deliver on obligations and work tasks
  • Retreating from social activities
  • Using the substance even if you know it’s causing you harm
  • Experiencing withdrawal symptoms when you stop taking the substance
  • The substance — needing to get it, take it, use it, recover from it — interferes with your ability to function or perform other daily activities
  • Inability to stop using the substance
  • Periods of binge drinking
  • Impaired judgement
  • Mood swings
  • Depression
  • Negatively impacting those around you or an inability to maintain relationships

Knowing how to offer support to a loved one with a substance use disorder can be challenging. For many people, not just vets, drugs and alcohol can provide a means of temporary “escape” from depressive episodes, intrusive thoughts, anxiety or trauma. As a form of self harm, it often provides in-the-moment relief, which makes it difficult for the person with a substance use disorder to stop using the substance.

This can be complicated by comorbidities, such as PTSD and depression: SUD, like all other mental illnesses, has a stigma attached to it; often, people blame the person with the substance use disorder. When these stigmas — and the accompanying feelings of guilt and shame — compound, seeking support and treatment becomes that much harder.

How Can You Support Veterans with Mental Illnesses and Disorders?

Although some service members may seek treatment from a nonmilitary healthcare provider, the VA, or U.S. Department of Veterans Affair, is a federal department charged with providing life-long healthcare services to veterans. With roughly 1,700 VA medical centers and clinics throughout the country, the department ensures vets receive the support and treatment they need for both their physical and mental health.

Despite the VA’s best efforts, however, our healthcare system is still lacking. According to the National Council for Mental Wellbeing, “less than 50% of returning veterans in need receive any mental health treatment.” While more people are speaking out about their mental health and mental illnesses, there’s still a stigma — and that stigma often prevents vets (and all of us) from seeking treatment or support. In fact, this stigma can also lead to a lack of education; often, people don’t know what they’re experiencing when symptoms of a mental illness or disorder begin.

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So, how can we start to change this harmful status quo? The first step might just be educating veterans — and all people — on the importance of mental health. Just as you’d seek treatment for a physical injury or illness, you should feel comfortable seeking treatment for a mental illness, too. You can also help advocate for better standards of care for our vets as well as an increased number of trained mental healthcare providers who are both accessible and well-versed in the specific needs vets may have when seeking support.

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