Serving Together: How Trauma Affects Military Families

Understanding How Trauma Can Impact Military Members

Members of the armed forces often derive a sense of pride, meaning, and connection from their service. However, military members can experience trauma as part of their duty and in civilian life.

Natural disasters, car accidents, combat, and military sexual assault are potential traumatic incidents. Physical traumas such as losing the use of a leg or having a traumatic brain injury can impact a service member’s mental health.

While not all stressors result in a trauma disorder, chances increase depending on a variety of factors, including how severe the trauma was, how strong a person’s reaction was at the time of the event, whether someone close to them died, and if they were injured.

Chances further increase depending on the number of traumatic events a person experiences. Traumatic events are like weights on a scale. Repeated exposure places a person at higher risk as the weight accumulates. Protective factors, such as emotional support, balance the scale.

Military Service and Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is one of the most common health diagnoses U.S. service members receive. Research shows that 5-20% of service members deployed to Iraq and Afghanistan have developed the condition.

According to John Rodolico PhD, director of Military and Veteran Consultation at McLean, all deployed military members are affected by their experiences in some way.

“I think it would be fair to say that at least 50% of service members’ struggles are related to trauma,” Rodolico says. He added that while military members are in a heightened state while on deployment, this is not necessarily a sign of PTSD.

The risk of PTSD increases with a person’s level of combat exposure. However, combat isn’t the only cause of PTSD for military personnel. Traumatic events can occur in peacetime, on deployment, or in civilian life. PTSD can develop anytime service members—or anyone—experiences a traumatic or life-changing event.

For example, people who serve in the military can develop PTSD from witnessing someone die or learning about the death of someone they care about. They can also develop PTSD as a result of military sexual trauma (MST). According to the U.S. Department of Veterans Affairs, MST may be one reason PTSD is higher among women veterans using VA care.

Symptoms of PTSD can appear nearly instantaneously or decades after a traumatic event. Many people experience a delayed onset of symptoms once they have the opportunity to absorb what has happened.

It is normal for people who have experienced trauma to be upset on the anniversary of the event. Severe reactions, such as experiencing depression, having recurrent nightmares, or lashing out at others can be a sign of PTSD.

PTSD symptoms look different for each person and can last several years or up to a lifetime.

Someone with PTSD can experience the following symptoms. If you or someone you care about is experiencing any of these symptoms, it is important to seek treatment.

Unwanted and Intrusive Memories

People with PTSD may re-live traumatic events over and over, have flashbacks, or experience nightmares.

Sights, sounds, and smells related to the traumatic event can trigger physical and/or emotional distress.

Avoidance

A common reaction to trauma, avoidance can become problematic if it is a person’s primary way to cope. Avoidance can include resisting thoughts or conversations about the event, or avoiding people, places, or situations that remind someone of the event.

Changes in Physical and Emotional Reactions

People with PTSD can be easily startled, constantly vigilant, and unable to sleep. They often experience irritability, anger, as well as guilt and shame.

Negative Thoughts and Moods

It is common for people with PTSD to experience hopelessness or negative thoughts about themselves and the world. They may have difficulty maintaining close relationships and feel detached from family and friends.

People with PTSD can lose interest in things that once brought them joy and may experience an inability to experience positive emotions.

Memory Problems

People with PTSD can struggle with memory and may have difficulty recalling key details of their trauma.

What Leads to Trauma in Military Members?

Traumatic experiences can lead to feelings of shame and isolation. People who have experienced trauma can feel different from others, even their closest family and friends. They may believe that no one else can understand their experience. They may think they do not deserve compassion.

Feelings of being different may be especially true for service members, whose vocation sets them apart from civilians. Members of the military can experience trauma in specific ways.

Combat

When military members serve in a war zone, they live under a constant state of threat. They may have witnessed people being severely injured or killed. They may have been severely injured themselves in the line of duty.

Once service members return home, they may struggle with difficult memories from combat. At the same time, they may be recovering from serious physical injuries. It can also be hard to turn down the level of vigilance they maintained while serving.

Survivor’s Guilt

People in the military learn teamwork and develop a sense of responsibility for peers. This can lead to shame if members of the same unit are injured or perish.

Due to the strong bonds between military members, loss of a fellow service member can be especially painful.

Moral Injury

Moral injury is a reaction to trauma that military personnel may experience. This complex emotional wound can happen when someone behaves in a way that goes against their moral beliefs.

Moral injury often occurs when a person has few options under difficult circumstances.

For example, soldiers can experience moral injury if they unintentionally kill civilians as part of their mission. As a result, they can feel deeply ashamed and isolated within society.

Military Sexual Trauma

As defined by the U.S. Department of Veterans Affairs, military sexual trauma is sexual harassment or sexual assault that occurs during a person’s military service.

According to the U.S. Department of Defense, 8.4% of active duty women and 1.5% of active duty men reported unwanted sexual contact in 2020 alone.

Sexual trauma within the military can feel like a betrayal from a fellow service member. Shame can prevent survivors of such trauma from reporting abuse.

According to Beth L. Murphy, MD, PhD, medical director of the LEADER (Law Enforcement, Active Duty, Emergency Responder) Mood, Anxiety, Stress, and Trauma Clinic at McLean, “For men in particular, there is a great deal of shame that they were not powerful enough to have prevented the assault.”

Impact of Military Rank and Specialty

Military rank and specialty can influence the experience of trauma. The higher in rank a military member is, the less they are exposed to imminent danger. Non-officers and supply personnel may have a higher chance of PTSD, likely due to their increased combat exposure. However, all military professionals are at risk for trauma.

Length of deployment may also be a contributing factor. Data shows that people who spent over a year on deployment in the last three years were at a greater risk of experiencing mental health issues. PTSD was more likely when there was a difference between the expected and actual length of deployment.

A person’s specialty is another factor. Medical personnel may experience a trauma response from treating fellow soldiers that is different from the trauma response of the wounded person. Communications personnel can be impacted by what they witness, even if they are not participating in combat.

How Military Trauma Can Impact Families

Military trauma can impact all members of the household, as well as close friends and extended family.

Often, service members are unsure if, or how, to open up to their spouses about their experiences. Spouses can struggle to know how to offer support, and children may not know how to express their worry about a parent.

These concerns are compounded by aspects of the military lifestyle, such as deployments and relocations.

When a Service Member Comes Home

The re-integration process for military members and their families can create strain. According to Rodolico, “You’re told before going into a wartime deployment that you will come back a different person. Most people don’t believe that.”

Military members can feel estranged from others.

People who have not served can struggle to understand combat experiences. Service members are used to being in a heightened state of potential danger and may react to situations differently once they are home.

Signs of trauma reactions can vary. Factors to look out for include:

• Increased withdrawal from family members or activities
• Difficulties with sleep
• Being on edge
• Feelings of anger or guilt following deployment

Service members may have trouble sharing with their families about their experiences. At times, they may want to protect their loved ones from the traumatic events that occurred.

It can take time for returning service members to readjust to their home environments. Strategies that kept them safe while deployed, such as being vigilant or relying on an extremely structured routine, can interfere in civilian or family life.

Some returning service members may feel uneasy or on edge when engaging with family or in social gatherings. Responses look different for each individual. Families need to stay mindful that change could be difficult for their loved ones.

Each type of relationship in a family poses different challenges. Family members at home develop new routines in the household while their loved one is deployed.

Most spouses get accustomed to a double workload at this time. This new role can create added fatigue, yet it can be difficult to let go of the independence of taking care of everything.

What About Children in Military Families?

Children can be resistant to their deployed parent’s transition home. They might continue looking to their other parent as a sole caregiver. When this happens, the service member might feel like they are no longer needed in the family.

According to the National Child Traumatic Stress Network, children in military families face unique stresses. Factors that increase a child’s risk for trauma reactions include:

• Preexisting health and mental health conditions
• Parents who are reserve personnel
• Parents with multiple deployments
• Living far from military communities
• Living in single-parent families with one parent deployed

If the service member is experiencing trauma-related symptoms, the adjustment can be more difficult. Trauma responses of irritability and withdrawal can complicate the adjustment. Children in the household may be affected by the mood and actions of the service member.

Age plays a role in responses you may see from a child dealing with challenging transitions. Children between the ages of one and three years old experience an interruption in their time bonding with a parent when that parent is on deployment.

Young kids may show anxiety through temper tantrums. They may not want to go to school for fear the parent could leave on another deployment while they are in class.

Older kids may show anger when a service member returns home. They may reject the returning member’s authority as a parent.

If a parent returns home with a serious injury, children can sometimes be given too much responsibility in the family. As “hidden helpers,” these children may take on caregiving responsibilities along with a veteran’s spouse.

Such children can also be tasked with household responsibilities and caring for younger siblings, sometimes at a higher level of responsibility than the older child may be prepared for.

It is important that these families receive mental health support and connect with resources to cope with stress.

How Family Members Can Help

Veterans and current service members often experience stigma for mental health challenges.

Although this issue is improving, many members find it difficult to ask for help. According to Rodolico, “Family members are the first line of defense against mental health issues and preventing suicide.”

In considering how to support your loved one who is serving in the military, encourage them to seek counseling. It is important that family members know where to get help.

Watch out for things like isolation and alcohol use. Try to recognize signs of trauma-related problems and offer to help with areas that are challenging.

According to Murphy, “We may not have control over whether traumatic events happen. But military members can focus on boosting resiliency factors.” She adds, “These include attending to physical illnesses, eating healthfully, and exercising.”

Recognizing Trauma and Offering Support

Following a spiritual practice may help provide a sense of meaning or purpose, and a strong support system with family and friends can aid in coping. Murphy recommends being proactive in seeking resources when struggling with trauma-related symptoms, such as depression.

According to Rodolico, the military has strengthened its recognition of family members and their needs. This is true for families of military members who have deployed and for those who have not. Family support groups, family centers in active-duty places, and a variety of groups all work towards supporting family systems.

Various studies reports that even though parental deployment can be the most challenging event in a child’s life, most military children are resilient. Family support services help mitigate the effects of deployment and other factors of military life, such as frequent relocation.

Murphy stated the importance of family members educating themselves on common symptoms of trauma that they and their loved one might experience. “Speak with others in similar circumstances,” she says.

Fostering Resilience and Seeking Resources

Murphy points out it is important to find a balance in expectations. “Believe the affected person is doing their best while maintaining an expectation that they will engage in the family and in treatments.” Family members can seek counseling and stay mindful of maintaining their own resiliency factors.

Trauma for military members and their families can pose many challenges. A military member’s experiences may not be understood, but their family can still offer support.

Rodolico encourages family members to listen. “Every veteran has a story,” he says. “Some readily tell you their story, but that’s a minority. But be patient—don’t try to pull it out of them.”

Families and their loved ones can seek outside help and work with each other to heal and learn to manage the strains and adjustments they face.

Treatment for Service Members and Veterans Facing Trauma

Everyone’s experience of trauma and recovery is unique. Treatments that work for some people may not work as well for others. Various treatments are effective for military-related trauma symptoms or problems.

Evidence-Based Therapies for PTSD

Trauma-focused psychotherapy (talk therapy) is a first-line treatment for military members with PTSD. Cognitive behavior therapy (CBT) has the most evidence for treating the symptoms of the condition.

Cognitive processing therapy (CPT) and prolonged exposure therapy (PE) are two of the most researched types of cognitive behavioral therapy for military members. Both types of therapy typically take three months of weekly treatment.

In cognitive processing therapy, therapists help patients identify negative thoughts related to the trauma and replace them with more balanced, less extreme thoughts.

In prolonged exposure therapy, therapists help patients revisit trauma in a safe, clinical setting. Through the process, patients can change how they react to traumatic memories, and learn how to face stressful events going forward.

Another form of therapy, eye movement desensitization and reprocessing (EMDR) can also be highly effective in treating PTSD in service members. In EMDR, therapists guide patients to follow visual stimuli or feel tapping movements. While focusing on stimuli while recalling traumatic memories, patients can reprocess traumatic memories.

Although research has shown that trauma-focused psychotherapy is often the best treatment for PTSD in service members, antidepressant medications are also effective in addressing mood-related symptoms.

Approximately 60% of patients experienced a reduction in symptoms after taking selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant medication. Patients may prefer medication to psychotherapy, or may take medication in combination with psychotherapy.

Complementary and Integrative Approaches

Whether or not military members have a diagnosis of PTSD, those who are exposed to trauma can benefit from trauma-focused psychotherapy, medication, as well as complementary and integrative therapies such as yoga, meditation, bodywork, and expressive arts therapy.

According to a 2020 report that surveyed 119 veterans, respondents reported that yoga practice was related to a decrease in perceived stress, meditation was linked to improved physical functioning, and tai chi was linked with reduction in anxiety, as well as overall improvements to mental and physical health.

The VA and other organizations that support military members now offer complementary and integrative treatments. Awareness of how these treatments benefit service members is growing among mental health professionals and the public. Such treatments offer hope to veterans, whose conditions can be long-lasting and who may wish to play a more active role in their healing process.

Barriers to Treatment

Societal attitudes around mental health can be a barrier to treatment for people in the armed forces. Members of military culture have feared that having mental health issues can be a sign of weakness.

Fortunately, this attitude is shifting. While more still needs to be done about the issue, service members are becoming more comfortable talking about their mental health, supporting their peers, and seeking treatment.

Part of this shift is due to changes in policy. Until 2014, rules within the armed forces discouraged members from seeking help for mental health issues. Service members could be discharged for receiving a diagnosis or treatment.

According to the National Alliance on Mental Illness (NAMI), the armed forces now recognize how important it is for service members to receive help for mental health concerns. The military understands that service members’ mental health is just as important as their physical health when carrying out a mission.

Service members are no longer required to report mental health concerns to their chain of command. If you seek treatment, your career and your security clearance will not be affected.

Where To Find Help

NAMI recommends service members seek help from primary care providers, behavioral health counselors available on military bases, or confidential counselors available through Military One Source.

When health care providers work with service members, they are obligated to follow the Health Insurance Portability and Accountability Act (HIPAA). They will only break confidentiality in certain situations, such as when someone poses a threat to themselves, others, or their military mission.

The United States Department of Veterans Affairs (VA) offers mental health services to veterans regardless of discharge status, service history, or eligibility for VA health care.

According to the VA, veterans are often unaware of their VA benefits. Because of this, they face practical barriers, such as inability to pay for treatment and inadequate health insurance. They often struggle with logistical issues, such as lack of transportation and trouble fitting health care appointments into their schedules.

Veterans can call or walk in to any VA Medical Center. They can also call their nearest VA medical center to schedule an appointment.

Contributors

Matthew A. Robinson, PhD