When post-traumatic stress disorder (PTSD) in veterans goes untreated, it doesn’t just go away or fix itself. It becomes a chronic, far-reaching part of people’s lives, families, and communities. The chances of PTSD lingering and wreaking silent havoc are high, and often people don’t even realize they’re dealing with a chronic, progressive disease that can be effectively treated. Everyone hurts, but no one knows what to do about it.
Chronic PTSD occurs when symptoms last for three or more months after someone experiences trauma. However, I’ve seen PTSD symptoms last for years. The number of veterans who struggle with long-term, chronic PTSD may be higher than we realize. A 2015 study by the National Vietnam Veterans Longitudinal Study (NVVLS), a congressionally mandated assessment of 2,348 Vietnam vets that measured PTSD symptoms over a 25-year period, found that 16 percent of respondents reported an increase in severity of PTSD symptoms over time, even 40 years after they fought.
Obviously, PTSD isn’t something veterans simply walk away from. It is a disease that can take a while to set in, though. Why is that, and what does that mean for veterans with PTSD who might need treatment?
Late-Onset PTSD in Veterans
Sometimes it takes a while for the full impact of trauma to sink in. In fact, most people don’t initially fit the criteria for PTSD. In a study of United States troops who’d been severely wounded, 78.8 percent who could be diagnosed with the condition at seven months did not fit the criteria for the disorder at one month. Similarly, other studies show that PTSD symptoms in veterans increased in severity over the six-month period after they were deployed.
PTSD a progressive disease. Over time, veterans with PTSD experience more and more dysregulation in their brains because of repeated triggers in the environment. Specifically, high rates of interpersonal violence among veterans and their partners might have something to do with the eventual emergence of PTSD symptoms in some people.
Late-onset PTSD in veterans is common, making research and treatment even more difficult. Many people don’t realize PTSD can take years to show itself, so they don’t know what they can do about it if anything.
“One of the greatest challenges to the field of traumatic stress has been the observation that many individuals who coped at the time of their traumatic exposure became unwell at a later date.”Alexander C. McFarlane, director of the University of Adelaide’s Centre for Traumatic Stress Studies
For a long time, I suspected that PTSD could take a while to set in. When I met my veteran, he’d been out of the Army for five years, but he had only begun to feel the pain he’d buried beneath the surface. Before then, I don’t think he could process what had happened and what he was feeling as a result. It was just too much.
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Why PTSD Becomes Chronic in Veterans
There are a few reasons why PTSD becomes chronic in veterans. For one, they face barriers to accessing treatment, such as the requirement they have a general or honorable discharge to use medical benefits through the Department of Veterans Affairs (VA), the stigma surrounding mental illness in the military, long waiting lists at the VA, and a shortage of doctors at VA facilities. To top it off, less than a third of vets being treated for depression and PTSD get evidence-based care.
Once veterans start treatment for chronic PTSD, the experience can also be emotionally brutal. My husband has tried to get help before, but the process was too much for him. He had to dredge up memories his brain had purposely buried for years, and then he had to go home to his family and try to live his life. He felt like his PTSD symptoms were getting worse–not better–so he stopped going. Even though he stopped addressing his PTSD, though, it has continued to stain everyone and everything in his life. Why is that?
The “Ripple Effect” of Chronic PTSD in Veterans
Matthew Tull, Ph.D., director of the Personality and Emotion Research and Treatment laboratory at the University of Toledo, may be able to answer that question. He says that PTSD has a “ripple effect”–similar to other diseases of distress–colliding with everyone and everything in a veteran’s life. That’s the nature of the beast in psychologically wounded veterans’ lives–and those of their people.
I can attest to this after watching my husband struggle with his PTSD for the past seven years. Directly or indirectly, the effects of his PTSD have bled into every aspect of his life: his job, my job, his criminal background, our marriage, the relationship he has with our son. Nothing and no one goes untouched. Chronic PTSD results in physical, psychological, and social consequences that can quietly splinter everyone’s lives.
“Untreated PTSD from any trauma is unlikely to disappear and can contribute to chronic pain, depression, drug and alcohol abuse, and sleep problems that impede a person’s ability to work and interact with others.”American Psychological Association (APA)
Sometimes all I see is chaos, not what’s causing the chaos–my veteran’s chronic PTSD. I can clearly see that everyone is fighting. I can tell my veteran is drunk again, but I can’t always figure out why. A lot of the time I don’t think he knows why. We can feel the ripple, but we don’t know where the wave is coming from. How do we keep from drowning?
How I Cope with My Veteran Spouse’s Chronic PTSD
My veteran has struggled with PTSD for almost 20 years, and we’ve been together for about seven years. Our relationship has taught me to take life day by day. My husband has hard days–or sometimes hard weeks–but I know he’ll always find his way out. I’ve seen him do it before. I know he’s strong enough to do it again.
I know I’m strong enough, too. I’m strong enough to handle the fallout from my veteran’s PTSD. This is the job I signed up for when I married him. Sometimes I just have to remind myself how truly capable I am of fulfilling that commitment.
I also have to continually remind myself that I’m married to a veteran with chronic PTSD. It helps me keep everything in perspective. My husband isn’t drunk or angry because it’s fun or because that’s who he is. It’s because he’s tired after a decades-long battle he’s had with himself. Instead of fighting with him or feeling sorry for myself, I can simply be there. After all, compassion is way easier to feel than anger.
Chronic PTSD in Veterans Is a Public Health Crisis
Countless people suffer just like my husband and I do, and the societal burden is huge. Treatment for Iraqi and Afghanistan war vets in the first year alone at the VA costs more than $2 billion. Chronic PTSD in veterans is a public health crisis, not a personal one, and needs to be treated accordingly. Luckily, there are steps we can take as a society to help our veterans who are haunted by chronic PTSD.
- We need more research on the long-term effects of chronic PTSD in veterans. How does chronic PTSD change a vet’s life, family, and physical and mental health? What therapeutic approaches work best with individual people and their unique situations? How do we reach them and encourage them to get help? How do we effectively treat the neurobiology underlying chronic PTSD in veterans? These are just a few questions that can be answered with more research.
- We need more awareness of what chronic PTSD in veterans looks like. Vets need to know that what they’re experiencing is PTSD and that they can get help to ease their symptoms. If they don’t know what the problem is, then they can’t work on a solution. They need to know that their lives are crumbling apart not because there’s anything wrong with them as people, but because they’re sick.
- Treatment needs to focus on the emotional and physical aspects of chronic PTSD. Not only do veterans experience changes in their brains, but they have higher rates of chronic pain, heart disease, obesity, high blood pressure, high cholesterol, and other physical problems. All of these interconnected issues need to be addressed in order to help a veteran with chronic PTSD. Such a holistic approach has also been shown to bust the stigma associated with mental health treatment in the military community.
- We need to pay attention to acute stress in veterans just returning home from deployment since they’re likely to struggle with PTSD at a later time. This was probably the case for my husband. He experienced problems when he first came home from Iraq, but over time his symptoms got worse until he was forced to get some help. If someone had tried to help him 15 years ago. a lot of tragedy could’ve been avoided.
- There shouldn’t be so many requirements for veterans to get treated for PTSD. They’ve earned the right to treatment, and there is no truly valid reason to take that away. They’re in distress because they served. They should get help because they served.
- Treatment for chronic PTSD in veterans needs to be evidence-based. All treatment needs to be firmly grounded in concrete evidence. Treatment is a waste of everyone’s time if it isn’t proven to work.
- We need to study traits and factors that lead up to the development of PTSD so we can keep it from happening in the first place. Preventing problems is easier and less expensive than rectifying them. The more we know about the risk factors associated with PTSD in veterans, and the more attention we pay to vets’ mental health early on in their military careers, that much more human suffering never has to happen.
- Changes need to be made in community mental health settings. Studies have shown that techniques like telehealth and the intermarriage of physical and mental health care that the VA has started using work for veterans with chronic PTSD. Unfortunately, though, community mental health facilities aren’t equipped to deal with these vets and their unique issues, even though more veterans and their families are turning to community mental health centers than ever before. More grants need to be funneled into these community settings, specifically for vets with PTSD and especially in rural areas.
“More research is needed to better understand…risk factors for PTSD and to help clinicians and other care providers offer the necessary treatment before symptoms become chronic.”Miriam Reisman, medical writer
Chronic PTSD in veterans is a public health crisis with societal causes and effects. We owe it to these men and women to effectively treat an illness they got from serving us, and we have to do that together. They were there when we needed them the most. Now we need to be there when they need us the most.