Back to Top Skip to main content Skip to sub-navigation

Invisible wounds: understanding PTSD

Service member appearing distressed with hand on head. Post-traumatic stress disorder develops in some people after exposure to a traumatic event. It affects approximately 8 million Americans and can interfere with a person’s daily life and impact personal relationships. (U.S. Air Force photo by Senior Airman Christian Clausen/Released)

Recommended Content:

Posttraumatic Stress Disorder

In the United States, 60% of men and half of all women experience at least one traumatic event in their lives, according to the Department of Veterans Affairs' National Center for PTSD. Roughly 8 million adults live with post-traumatic stress disorder.

Trauma exposure itself doesn’t mean everyone will experience PTSD. “We know that a number of variables put people at risk: prior trauma history, lack of social support, suffering an injury as a result of the trauma, and preexisting mental health issues,” said Holly O’Reilly, a clinical psychologist. The effects of trauma also accrue over time, she added, “So repeated trauma exposure will increase the likelihood of developing post-traumatic symptoms.”

PTSD is a mental health condition that some people develop following exposure to a traumatic event, said O’Reilly, who works at the Psychological Health Center of Excellence, a division of the Defense Health Agency Research and Development Directorate. Although anxiety and depression can overlap with PTSD symptoms, the conditions are different. Anxiety is a pattern of worrying or being fearful of something that could happen while depression refers to a depressed mood for two weeks or more, explained O’Reilly. “Individuals with symptoms of PTSD continue to be anxious as a result of a prior trauma experience or exposure,” she said.

An official diagnosis of PTSD requires exposure to a traumatic event and symptoms from four different categories. They include reliving trauma through intrusive memories; avoidance of any reminders of trauma; persistent negative thoughts and emotions associated with the trauma; and hyperarousal, which is consistently feeling “on edge,” particularly in response to reminders of the trauma. People may be easily startled, feel irritable, or have difficulty falling asleep.

PTSD can interfere with a person’s daily life and impact personal relationships. “Individuals who have symptoms of PTSD may demonstrate difficulty completing everyday tasks, experience persistent anxiety, or have upsetting reminders of previous traumatic events,” said O’Reilly.

As people practice social distancing, social isolation may contribute to PTSD symptoms, she cautioned. If a person used social activity to avoid intense emotions, the loss of social activity could lead to thinking about past trauma and a worsening of symptoms.

“Research has shown that PTSD can be treated successfully via evidence-based psychotherapy,” she said. “The best way for individuals to fully recover is to fully participate in evidence-based psychotherapy, allowing them to process their response to the trauma and learn skills to move forward.”

A common misconception is that a diagnosis of PTSD will negatively impact a person’s career, but without treatment, symptoms will persist and may even worsen. PTSD treatments work and people can fully recover, said O’Reilly. Even years after the initial trauma, people can still benefit from treatment, but the sooner a person seeks therapy, the better. Many types of evidence-based PTSD treatment usually take two to three months to complete and occur in weekly individual sessions. O’Reilly encourages practicing new therapy skills outside of the sessions.

PTSD can result in changes to changes in the brain, but it may not be permanent, said Dr. Robert Ursano, director of the Uniformed Services University of the Health Sciences’ Center for the Study of Traumatic Stress, who spoke recently at a PTSD roundtable. “We know specifically three primary and several other areas in the brain but principally the prefrontal cortex, the hippocampus and the medulla show alterations in those with PTSD versus that those who don't,” he said. “We also have data that showed that after treatment the brain can change back again.” PTSD is a highly treatable disorder with effective medications and psychotherapies, he added.

“If you or someone you care about has symptoms of PTSD and they cause distress or interfere with daily activities, you should seek help from your local behavioral health clinic,” said O’Reilly, adding all military hospitals and clinics have PTSD experts available. “You may also connect through Military One Source, or the inTransition program,” she added. Resources on PTSD treatment are available on the Psychological Health Center of Excellence website.

You also may be interested in...

DHA AI 1020.01: Reasonable Accommodations (RA)

Policy

This Defense Health Agency-Administrative Instruction (DHA-AI), based on the authority of References (a) through (c), and in accordance with the guidance of References (d) through (s), establishes the Defense Health Agency's (DHA) procedures to: a. Set procedures, responsibilities, and implement guidance for administering the DHA RA Program in accordance with federal guidelines. b. Provide, submit, and respond to requests for RAs of qualified individuals with disabilities who are employees or applicants for employment. c. Process RA requests for DHA employees and applicants with disabilities to ensure an appropriate response in a timely manner. Further, these procedures establish criteria for collecting and annually reporting data on the numbers and types of request for RA considered.

  • Identification #: DHA AI 1020.01
  • Date: 11/2/2020
  • Type: Administrative Instructions
  • Topics: Physical Disability

DHA PM 6025-01: Primary Care Behavioral Health (PCBH) Standards

Policy

This Defense Health Agency-Procedures Manual (DHA-PM), based on the authority of References (a) and (b), and in accordance with the guidance of References (c) through (i), establishes the Defense Health Agency’s (DHA) procedures to establish required standards for: a. Military Medical Treatment Facilities (MTFs) and primary care clinics for adult, child and adolescent, health behavior, behavioral medicine, and behavioral health services in primary care. b. Behavioral Health Consultants (BHCs). c. Behavioral Health Care Facilitators (BHCFs). d. External Behavioral Health Consultants (EBHCs). e. Primary Care Clinic Leaders.

DHA PI 6490.02: Behavioral Health (BH) Treatment and Outcomes Monitoring

Policy

This Defense Health Agency-Procedural Instruction (DHA-PI), based on the authority of References (a) and (b), and in accordance with the guidance of References (c) through (k): a. Establishes the Defense Health Agency’s (DHA) procedures for the collection and analysis of BH outcome data. b. Addresses how DoD will standardize BH outcome data collection to: assess variations in mental health and substance use care among in-garrison medical treatment facilities (MTFs) and clinics; assess the relationship of treatment protocols and practices to BH outcomes; and identify barriers to provider implementation of evidence-based clinical guidance approved by DoD. c. Designates the Army as the DoD lead Service for maintenance and sustainment of the Behavioral Health Data Portal (BHDP) in specialty care mental health and substance use clinics, referred to collectively as BH clinics, until BHDP functionality can be integrated with GENESIS or another electronic health record (EHR) system managed by DHA. d. Designates DHA Information Operations (J-6) as lead on transitioning BHDP functional requirements related to outcomes monitoring to future EHR data collection platforms and processes.

  • Identification #: DHA PI 6490.02
  • Date: 7/12/2018
  • Type: DHA Procedural Instruction
  • Topics: Substance Abuse

DoD Instruction 6490.10: Continuity of Behavioral Health Care for Transferring and Transitioning Service Members

Policy

In accordance with the authority in Reference (a), this Instruction establishes policy for the Military Departments, assigns responsibilities, and prescribes guidelines for establishment of Military Department policy and procedures to ensure continuity of behavioral health (BH) care at the losing and gaining installations when Service members transition from one health care provider (HCP) to another when transferring to a new duty station or transitioning out of the Service.

  • Identification #: DoD Instruction 6490.10
  • Date: 10/28/2015
  • Type: Instructions
  • Topics: N/A

DoD Instruction 6490.15: Integration of Behavioral Health Personnel (BHP) Services Into Patient-Centered Medical Home (PCMH) Primary Care and Other Primary Care Service Settings

Policy

This instruction establishes policy, assigns responsibilities, and prescribes procedures for attainment of inter-Service standards for developing, initiating, and maintaining adult behavioral health services in primary care.

  • Identification #: DoD Instruction 6490.15
  • Date: 11/20/2014
  • Type: Instructions
  • Topics: N/A

DoD Instruction 6490.05: Maintenance of Psychological Health in Military Operations

Policy

This instruction establishes policy and assigns responsibilities in accordance with References (c), (d), and (e) for developing combat and operational stress control (COSC) programs within the Military Departments, the Combatant Commands, and joint Service operations.

  • Identification #: DoD Instruction 6490.05
  • Date: 10/2/2013
  • Type: Instructions
  • Topics: N/A

DoD Instruction 6490.12: Mental Health Assessments for Service Members Deployed in Connection with a Contingency Operation

Policy

This instruction establishes the policy for person-to-person deployment mental health assessments for each member of the Military Services deployed in connection with a contingency operation according to Section 1074m of Title 10, United States Code (Reference (b)).

  • Identification #: DoD Instruction 6490.12
  • Date: 10/2/2013
  • Type: Instructions
  • Topics: N/A

DoD Instruction 6490.04: Mental Health Evaluations of Members of the Military Services

Policy

Reissues DoD Instruction 6490.4 (Reference (b)), establishing policy, assigning responsibilities, and prescribing procedures for the referral, evaluation, treatment, and medical and command management of Service members who may require assessment for mental health issues, psychiatric hospitalization, and risk of imminent or potential danger to self or others.

  • Identification #: DoD Instruction 6490.04
  • Date: 4/3/2013
  • Type: Instructions
  • Topics: N/A

Guidance for Providers Prescribing Atypical Antipsychotic Medication 12-003

Policy

Articles in popular media, and the concern of several national and military leaders in recent months, have raised the question of whether certain psychoactive medications are inappropriately prescribed for post-traumatic stress disorder (PTSD) and commonly comorbid conditions.

DoD Instruction 6490.08: Command Notification Requirements to Dispel Stigma in Providing Mental Health Care to Service Members

Policy

This instruction provides guidance for balance between patient confidentiality rights and the commander’s right to know for operation and risk management decisions.

  • Identification #: DoD Instruction 6490.08
  • Date: 8/17/2011
  • Type: Instructions
  • Topics: N/A

Mental Health Assessments for Members of the Armed Forces Deployed in Connection with a Contingency Operation

Policy

Policy Guidance for Deployment-Limiting Psychiatric Conditions and Medications

Policy

This policy provides guidance on deployment and continued service in a deployed environment for military personnel who experience psychiatric disorders and/or who are prescribed psychotropic medication.

HA 97-017: Policy for Post-Deployment Mental Health Screening in the Bosnian Theater

Policy

This memo describes a change in procedure for medical surveillance of U.S. forces deploying to Bosnia.

  • Identification #: HA 97-017
  • Date: 11/25/1996
  • Type: Memorandums
  • Topics: Deployment Health
Showing results 1 - 13 Page 1 of 1

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.