Service members, family members and veterans who suffer from posttraumatic stress disorder (PTSD) may repeatedly re-experience their ordeal as nightmares, flashbacks or frightening thoughts, especially when exposed to events that remind them of their original trauma, according to the Centers for Disease Control and Prevention.

They also may experience overanxious watchfulness or a tendency to withdraw or avoid situations and people that remind them of their traumatic experience, CDC said.

About 93,346 service members received care for PTSD in the MHS between fiscal year 2016 and fiscal year 2020, according to the Military Health System (MHS) Management Analysis and Reporting Tool (M2).

"Of that group, 19,114 were diagnosed prior to any deployment, and 74,232 were diagnosed during or following deployment," said Holly O'Reilly, a clinical psychologist and acting section chief for Implementation Clinical Care at the Psychological Health Center of Excellence in Silver Spring, Maryland.

Data available from the MHS Data Repository show that in 2019, approximately 1.8% of active-duty service members had a PTSD diagnosis, O'Reilly said.

The Department of Defense patient-centered medical home (PCMH) initiative includes mandatory annual screening for PTSD (among other mental health conditions) for all beneficiaries of the MHS.

Warning Signs

Medical providers and family members should be alert to the following symptoms that require attention:

• Pronounced desire to avoid other people that continues for weeks or months

• Increased jitteriness or jumpiness that does not go away after an initial transition home

• Unsettling memories or flashbacks to wartime events that do not resolve after the transition home

• Chronic headaches, unexplained personality or cognitive changes that could indicate a Traumatic Brain Injury

• A pervasive sense of sadness, guilt or failure that does not improve

• Angry outbursts, irritability, escalating family arguments or physical fighting that is uncharacteristic or prolonged

• Changes in alcohol use

• Risk-taking behaviors

• Thoughts of death or a death wish (Call 9-1-1 immediately)

"Recognizing that you may have symptoms of PTSD and reaching out for treatment is a sign of strength," O'Reilly said.

The DOD has been at the forefront of developing effective, evidence-based treatments for PTSD that reduce the severity and duration of PTSD symptoms.

"Improvement of symptoms can be seen relatively quickly," O'Reilly explained, with "many people noting a significant improvement after 5-6 sessions depending on the type of treatment and type of trauma."

"To relieve symptoms of PTSD, it's important to process the trauma and/or learn to think differently about the traumatic event," O'Reilly said.

"Evidence-based trauma-focused treatments can help you navigate through the traumatic memories and lead you to symptom improvement."

Some of these first-line treatments include: prolonged exposure, cognitive processing therapy, eye movement desensitization and reprocessing, brief psychotherapy, narrative exposure therapy and written narrative exposure, O'Reilly said.

First-line treatments for PTSD "typically lead to symptom reduction or resolution with 8-16 sessions using various combinations of exposure or cognitive restructuring."

Second-line treatment recommendations include drug treatment, or individual non-trauma-focused psychotherapy, such as stress inoculation training, present-centered therapy, and interpersonal psychotherapy, she added.

The COVID-19 pandemic also may have had a negative impact on those with PTSD symptoms, O'Reilly said.

"Many service members have been social distancing and complying with stay-at-home orders. The social isolation may contribute to feelings of alienation and disconnection," O'Reilly said.

"For some, feeling disconnected or alienated may contribute to PTSD symptoms through loss of social support or lead to a negative interpretation of other's behavior."

O'Reilly also said that for other people with symptoms of PTSD, "they might feel more anxious than usual. COVID-19 has serious health consequences and for many the stressors of the pandemic have been unpredictable and at times overwhelming."

When the pandemic began last year, many DOD mental health clinics quickly pivoted to provide telehealth treatment, she said.

Now, "as the pandemic restrictions are beginning to lift, some have returned to face-to-face treatment. Please reach out to your local clinic to see if telehealth options are available," O'Reilly suggested.

Overcoming Stigma to Promote Help-Seeking

Air Force Capt. Felicia Keith, a staff psychologist in the mental health clinic at the Spangdahlem Air Base, Germany, said that the stigma of mental health care has had an impact on getting PTSD sufferers into treatment.

"Often times, the concern about how mental health care can negatively impact their career keeps them from self-referring to the mental health clinic," she said.

"Anecdotally, I have noticed that the older population within active duty is more hesitant to seek care," she said, "while I believe for younger (populations) it seems more socially acceptable to be in therapy."

In her experience, "it is usually the older population that believes that they don't need therapy, or they can "tough it out." The younger generation seems to be more willing to come for help.

"However," Keith added: "That does seem to depend on the younger (service member's) cultural and familial background in that younger service members who come from families who do not "believe" in mental health treatment tend to struggle to ask for or accept treatment when needed."

"If you have PTSD, there is hope," O'Reilly stressed.

"First-line treatments can lead to symptom reduction even if treatment begins years after the traumatic event. Please don't hesitate - seek help, and talk to a mental health provider if you have symptoms of PTSD."