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a mental health condition that can trigger flashbacks to a traumatic event or cause one to feel distant and angry

It’s of great concern that Veterans who have nightmares are at higher risk for suicide and suicidal thoughts.

Understanding the origin of nightmares may offer clues in how to address the serious consequences of the dreams and the damage they can do.

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Many Veterans with combat-related PTSD experience nightmares. (Photos: ©iStock/Koldunov; National Archives)

PTSD nightmares: Is there an effective treatment?
March 13, 2019 By Mike Richman
VA Research Communications

"We recommend starting with one of the behavioral treatments when a patient has access to a qualified therapist and is willing to commit to that therapy."

The scientific community has made major strides in recent years to untangle PTSD, a mental health condition that can trigger flashbacks to a traumatic event or cause one to feel distant and angry. Advancements have been made to understand the reasons behind PTSD, where the condition takes hold in the brain, and which therapies work best.

But uncertainty exists in how to best treat nightmares, a hallmark symptom of PTSD. Research results on therapies for PTSD patients who are experiencing nightmares have been inconsistent. That shortcoming applies to Veterans, active-duty service members, and civilians, all of whom have been diagnosed with the disorder.

Dr. Ali El-Solh is a pulmonologist and sleep specialist at the VA Western New York Healthcare System in Buffalo. (Photo by Terry McGuire)

Dr. Ali El-Solh, a pulmonologist and sleep specialist at the VA Western New York Healthcare System in Buffalo, is hoping to improve the lives of Veterans with PTSD who are battling nightmares. He authored a review that explores why nightmares are a characteristic of PTSD, examines the health risks linked to PTSD and nightmares, elaborates on psychological and drug treatments for these nightmares, and identifies future research needs.

El-Solh's review appeared online in the journal Nature and Science of Sleep in November 2018. He discussed his work with VA Research Currents.
Why is it important to highlight the connection between PTSD and nightmares?
I wrote the review largely because of the profound impact of nightmares on the quality of life of Veterans with PTSD and the inconsistent results of available treatments for this disorder. It's of great concern that Veterans who have nightmares are at higher risk for suicide and suicidal thoughts. Understanding the origin of nightmares may offer clues in how to address the serious consequences that stem from these distressing events. But the disheartening reality is that our approach to the treatment of nightmares is limited by the fact that we have no objective tools [like a brain scan] to assess their extent and severity. In addition, it's more apparent that nightmares are not experienced alike. They are shaped by the traumatic events and underlying behavioral and medical conditions of each person.
You say there's no single strategy that holds the most promise for alleviating nightmares in people with PTSD. Why is that?
It's hard to single out one therapy because the choice of the therapy depends on a patient's preferences and the availability of expertise to deliver the treatment. We recommend starting with one of the behavioral treatments when a patient has access to a qualified therapist and is willing to commit to that therapy. We also advocate lifestyle modifications that promote good sleep, such as stress relief exercises, an avoidance of alcohol and caffeine, and a refrain from using electronic media close to bedtime. A drug can also be prescribed. In order to promote adherence to medications, we go over the expectations intended from the patient and discuss potential side effects. Frequent monitoring following completion of any therapy is key to assessing whether a satisfactory response has been achieved or whether another treatment should be used.

Such complementary techniques as acupuncture, herbal medicine, yoga, massage, and support groups have been described as other potential therapies for treating nightmares. However, these reports are anecdotal and included a limited number of participants. Nonetheless, patients are encouraged to pursue complementary therapies if they alleviate nightmares.
Your review notes that imagery rehearsal therapy (IRT) is considered the "preferred empiric treatment" for PTSD-related nightmares. What is IRT?
Imagery rehearsal therapy is a behavioral therapy that's based on the premise that nightmares can be altered through daytime rehearsal of dreams. In other words, the script of a reoccurring nightmare can be modified into a new scenario with a non-frightening ending. The new script is rehearsed daily and can be practiced in a group or individual format. In contrast to medication, imagery rehearsal therapy has been shown in randomized controlled trials to ease the anxiety emanating from nightmares. The beneficial effect can last for more than 12 months and unlike drugs used for nightmares, IRT has no side effects. Other behavioral therapies for nightmares like systematic desensitization and exposure, relaxation, and rescripting therapy have been as effective as IRT. But head-to-head comparisons between those treatments are rare. The choice of the behavioral therapy depends on the doctor's expertise, the willingness of the patient to return for follow-up visits, and the patient's ability to cope with the stressful response that may result from recalling distressing events.
In terms of drugs, the alpha-1 blocker prazosin has been widely used in VA to help ease PTSD nightmares. But a large clinical trial sponsored by VA's Cooperative Studies Program (CSP) found that prazosin did no better than placebo, although the researchers did say the drug worked better in a certain subgroup of patients. Is prazosin still the most promising drug for treating PTSD-related nightmares?
The failure of prazosin in the CSP trial makes behavioral therapy the treatment of choice for this disorder. But the inability of prazosin to improve sleep-related problems in the trial may not be surprising, given that PTSD produces many symptoms that may be only partially responsive to treatment. Our approach has been to continue prazosin in Veterans who have experienced improvement or resolution from nightmares, while discontinuing it in those who have not benefited from it.

I should add that combining drugs with a behavioral therapy for treating PTSD-related nightmares is an area of active investigation. While preliminary data suggest that this approach may be beneficial, large randomized controlled trials are needed to confirm these observations.
You say in the review that given the "intricate relationship between PTSD and nightmares," future clinical trials must adopt a more pragmatic approach focused on therapies linked to one's socioeconomic background. What do you mean by that?
Most clinical studies have been designed to compare one therapy versus a placebo, or one treatment versus another treatment, irrespective of the nature of the event responsible for triggering the nightmares. As a result, these studies have often been inconclusive or not reproducible when used to address the nightmares of another Veteran. We've proposed that future studies should include a combination of existing treatments targeted to specific groups with similar backgrounds or experiences. In the absence of an objective test to measure and quantify these events, any reported improvement can't be applied to another case.

There has also been a lack of large randomized controlled trials to assess health outcomes in patients with PTSD who are experiencing nightmares. That's because of the difficulty in measuring and assessing nightmares objectively. Current studies must rely on a patient's response to gauge the effectiveness of a therapy. These responses are influenced by cultural, socioeconomic, and personal factors. Most of these studies are also limited by small sample size.
What hope is there for Veterans coping with this debilitating problem?
Nightmares may fade over time. Although there is nothing to identify patients who'll respond to treatment or in whom nightmares will resolve themselves, a happy ending is always possible. Keeping a positive attitude may help to ease the intensity of these events. Studies have shown that personality traits, such as optimism and pessimism, can affect many areas of health and well-being. The positive thinking that usually comes with optimism, for example, is a key part of managing negative emotions related to nightmares.
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PTSD nightmares: Is there an effective treatment?

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A review article by a VA clinician-researcher explores why nightmares are a hallmark of PTSD, examines the associated health risks, discusses the best treatments, and identifies future research needs.

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Results showed that schema therapy can lead to beneficial effects in disorder-specific symptoms and early maladaptive schemas.

Schema therapy is a promising treatment for anxiety, OCD, and PTSD.

there is a systematic problem in the quality of research despite growing clinical interest and application.

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Affiliations

¹ Pro Persona Overwaal Centre for anxiety, OCD and PTSD, Nijmegen, The Netherlands.

² Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.

³ Behaviour, Health and Psychopathology, KU Leuven, Leuven, Belgium.

Free PMC article

Abstract

Objectives: We reviewed the evidence regarding the effectiveness of schema therapy for anxiety disorders, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD).

Methods: This systematic review followed the recommendation of the PRISMA guidelines. A database search (PsycINFO, MEDLINE, EMBASE, WEB OF SCIENCE, and Academic Search Ultimate) was conducted to identify eligible studies up until 2 April 2021. The search included the keywords ('schema therap*' or 'schema group therap*' or 'schema mode therap*' or 'schema focused' or 'young's model') and ('anxiety disorder*' or 'anxiety-related disorder*' or 'agoraphobia' or 'health anxiety' or 'phobi*' or 'panic disorder' or 'obsessive compulsive disorder' or 'OCD' or 'posttraumatic stress' or 'post traumatic stress' or 'PTSD' or 'hypochondria' or 'axis 1'). Included studies were appraised on methodological quality according to the Psychotherapy Outcome study Methodology Rating Form.

Results: We identified 41 studies that were eligible based on the topic. However, only six (comprising 316 anxiety, OCD, and PTSD patients) could be included despite lenient methodological inclusion/exclusion criteria. Results showed that schema therapy can lead to beneficial effects in disorder-specific symptoms and early maladaptive schemas. Yet, we also uncovered substantial methodological limitations in most studies.

Conclusions: Schema therapy is a promising treatment for anxiety, OCD, and PTSD. Yet, there is a systematic problem in the quality of research despite growing clinical interest and application. We therefore concluded with a research agenda presenting recommendations for future research that will be crucial for building a solid evidence-base for schema therapy in chronic anxiety, OCD, and PTSD.

Practitioner points: A systematic review on the effectiveness of schema therapy for anxiety disorders, OCD, and PTSD. Preliminary but limited evidence that schema therapy leads to beneficial effects in disorder-specific symptoms. Preliminary but limited evidence that schema therapy leads to beneficial effects in early maladaptive schemas in anxiety, OCD, and PTSD. More research of higher methodological quality is needed to provide more conclusive empirical support for the use of schema therapy for anxiety, OCD, and PTSD.

Keywords: anxiety disorders; obsessive-compulsive disorder; posttraumatic stress disorder; schema therapy.

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Conflict of interest statement

All authors declare no conflict of interest.

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References

American Psychological Association (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD). Washington, DC: Author. Guideline Development Panel for the Treatment of Posttraumatic Stress Disorder in Adults, 139, 10.1162/jocn - DOI

Arntz, A. , Rijkeboer, M. , Chan, E. , Fassbinder, E. , Karaosmanoglu, A. , Lee, C. W. , & Panzeri, M. (2021). Towards a reformulated theory underlying schema therapy: Position paper of an international workgroup. Cognitive Therapy and Research. 10.1007/s10608-021-10209-5. Online ahead of print. - DOI

Atkins, P. W. B. , Ciarrochi, J. , Gaudiano, B. A. , Bricker, J. B. , Donald, J. , Rovner, G. , ... Hayes, S. C. (2017). Departing from the essential features of a high quality systematic review of psychotherapy: A response to Öst (2014) and recommendations for improvement. Behaviour Research and Therapy, 97, 259-272. 10.1016/j.brat.2017.05.016 - DOI - PubMed

Blackwell, S. E. , Woud, M. L. , Margraf, J. , & Schönbrodt, F. D. (2019). Introducing the leapfrog design: A simple bayesian adaptive rolling trial design for accelerated treatment development and optimization. Clinical Psychological Science, 7(6), 1222-1243. 10.1177/2167702619858071 - DOI

Chambless, D. L. , Caputo, G. C. , Bright, P. , & Gallagher, R. (1984). Assessment of fear of fear among agoraphobics: The body sensations questionnaire and the agoraphobic cognitions questionnaire. Journal of Consulting and Clinical Psychology, 6, 1090-1097. 10.1037//0022-006x.52.6.1090 - DOI - PubMed

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national center for biotechnology information

# data[].attributes.attachment_link.title
The effectiveness of schema therapy for patients with anxiety disorders, OCD, or PTSD: A systematic review and research agenda - PubMed

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A systematic review on the effectiveness of schema therapy for anxiety disorders, OCD, and PTSD. Preliminary but limited evidence that schema therapy leads to beneficial effects in disorder-specific symptoms. Preliminary but limited evidence that schema therapy leads to beneficial effects in early m ...

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"You jolt awake, ready to keep sprinting, ready to fight until you can't move. That's when the sweat runs down your forehead and chills you."

It takes a minute for your room to come to focus and your heart to go back to the normal beat. You start to remember your in your own home and your house. Even when your fully calmed down the dream still affects you and it sticks in your mind like a movie.

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You jolt awake, ready to keep sprinting, ready to fight until you can't move. That's when the sweat on your forehead chills you, like shards of ice melting. Your room comes into focus, the bed you start to remember lying down in, the door you shut before you turned the light out.
Another nightmare.
Now you can start to calm down, to breathe and let the safety of your bedroom wrap around you like the twisted sheets and blankets on your bed, if only for a little while. But it's still upsetting, the dream is still there, cooling off in your mind like the embers of a fire.
No matter how good your day was you just can't seem to shake these nightmares from your post-traumatic stress disorder (PTSD).
You're not alone and there are things you can do about them.

What Is PTSD?

Post-traumatic stress disorder is something that can affect anyone who experiences trauma. This doesn't mean the trauma has to happen to you either, it can be a situation where you witness something traumatic.

Car crashes, natural disasters, and the events of September 11th (even for people not in New York) are the types of situations that can result in PTSD.
Also, remember this: experiencing PTSD does not mean you're weak, or failed, or are damaged in some way.
There's not really a common length of time for recovering from PTSD because everyone's bodies, minds, and experiences are so different. Some people could use therapy to help them get over it in a year and others could struggle for longer.

Bad Dreams Trying to Sleep

If you are dealing with nightmares resulting from PTSD you are most definitely not alone. The U.S. Department of Veterans Affairs has done a lot of research on PTSD. Their data shows that, of people who aren't dealing with PTSD, only 5% report persistent nightmares.
Compared to the people struggling with PTSD, where anywhere from 70% to 96% are dealing with nightmares, it is obvious the problem is widespread and common.
"Every time I close my eyes, I would have a nightmare," said Valerie Ovalle of the U.S. Army. It can have massive impacts on our overall health when one of our ultimate forms of comfort and rest is taken from us.

Similarly, P.K. Philips wrote "I saw violent images every time I closed my eyes," after experiencing many different traumas. For her the nightmares were only one part of her struggle; other symptoms followed along.

One thing you might experience, or see and read about from others who suffer from PTSD nightmares, is how they stick with you. If you wake up right in the middle of a nightmare the chances are high your brain won't let go of those details quickly.

This can disrupt your entire night of sleep and then affect the next day even. It's a horrible cycle that might seem like it's never ending.

But there is help!

How Does It Affect Sleep - the Mental Pain and Signs
You can do a lot to start changing how your brain and body prepare for sleep, but also how they react to nightmares.
Doctors and scientists are still not 100% sure why we dream. In the case of PTSD nightmares though, they actually can trace the dream's influence to the trauma involved. This means there's a way forward, a way to get some relief.

The Scottish charitable organization PTSD UK investigated a lot of ways someone can start to treat their PTSD nightmares right from home.

First, they recommend avoiding temperatures that are too hot or too cold. You want your sleeping area to be right in that Goldilocks zone: juuuuust right. Second, if you are experiencing painful joints or general pain from your PTSD, then it might be a great idea to check with a doctor what to do.

They also recommend keeping a regular relaxation routine before bed. You should seriously consider not using your phone after a specific time in the night-to get your eyes/bed ready for sleep-as well as ensuring you are sleeping in total darkness.

A lot of things can throw off your sleep pattern and also lead to stress before bed. You want to hit that mattress as calm and relaxed as possible, so think about meditation which can be anything from sitting silently and breathing purposefully, to closing your eyes and going through guided meditation.

Some Therapeutic Nightmare Sleep Treatments

You've got the room just the right temperature, you've relaxed by meditating, and there's no light streaming in from the lamppost outside your window. So, why are you still having PTSD nightmares?

First, always remember: everyone heals at different paces. Second, it might be time to try some therapeutic forms of treatment.

One that gets recommended a lot for PTSD nightmares is called Image Rehearsal Therapy (IRT). This is where you go over your nightmare and make up a new, positive and non-scary version. Once you have that in mind you write it out.

You'll do this every day, writing out a non-threatening, happy version of the nightmare where maybe instead of you being chased by something horrible you are being chased by a puppy or something else that makes you happy. This process helps you to replace the nightmare with imagery, thoughts, and associations you prefer.

IRT has been used quite a bit to help with PTSD nightmares. There is a lot of research about how it works and why it's so highly recommended. In fact, IRT has been so thoroughly researched it's usually considered the preferred treatment for PTSD nightmares.

You can work through IRT in a solo therapy session or with a group and most treatments finish up in under 12 weeks. If that seems long, don't worry, there's also been research that has shown significant improvements in sleep and fewer nightmares after one IRT session. That doesn't mean you should stop the treatment though!

Getting Back to Sleep and Having Good Dreams Again

Trust us, it's possible. The human brain is strong and we know your trauma doesn't define you. It might take a little bit, but once you begin focusing on healing the process has started.
Give us a call or shoot us an email if you have any questions. We know how trauma can overpower you sometimes and that is something you don't have to be ashamed of. Give us a call at 859-429-5188 and let's talk.
Frequently Asked Questions
Are Bad Dreams a Sign of PTSD?
They may be. Not all bad dreams are related to PTSD, and the difference between a "bad" dream versus a "nightmare" might be hard to pin down, but the person experiencing them will usually know which is which. Nightmares tend to be much, much more disruptive to sleep, and can kind of hang around your mind throughout the following day. If you are having bad dreams constantly or at least commonly enough you start to get less sleep, it may be from PTSD. Another way to check is to try and think about any traumatic experience you have had recently, and then it might be easier to draw a line between when the bad dreams started and why they may be happening.
What Helps With PTSD Nightmares?
You can make sure your bedroom is not too cold or too hot; start a nightly relaxation routine to prepare for sleep; ensure there isn't light in your room keeping you from sleeping deeply; exercise daily; talk about your dreams; and engage in Image Rehearsal Therapy (IRT). Everyone's brain and body is different so the exact combination of treatments for you will most likely not be the same as someone else dealing with PTSD nightmares.
How Do You Sleep With PTSD Nightmares?
You may have to ask your doctor for help and you may have to begin therapy in order to work through the trauma that is causing the nightmares. The methods listed above can offer some help, but Image Rehearsal Therapy (IRT) specifically is a therapy you can get great benefits from when you work with a therapist. It might seem hard-or even on some nights impossible- to fall asleep, but staying calm and trying to focus on relaxation, as well as rerouting your thoughts to positivity are all ways you can begin the process of getting to sleep. It may take a dedicated therapeutic treatment to get you past the nightmares in the long run. The good news is, there are well-researched methods for helping, like (IRT).

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How to Deal With PTSD Nightmares - SUN Kentucky

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No matter how good your day was you just can't seem to shake these nightmares from your post-traumatic stress disorder (PTSD).

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Image rehearsal therapy is a cognitive-behavioral treatment for reducing the number and intensity of nightmares, such as those experienced by people with post traumatic stress disorder (PTSD).

Image Rehearsal Therapy can help veterans who tend to have nightmares nightly, It could most likely help them feel comfortable to sleep instead of taking pills or other types of drugs to make them sleep for a few hours a night.

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Since 2010 more than 65,000 veterans have died from suicide this is more than the total number of deaths from combat during the Vietnam War and the operations in Iraq and Afghanistan combined.

One main solution that was improved is lethal. "Suicide crises are often brief, and evidence suggests they can be prevented if the individual in crisis lacks immediate access to the means for self-harm. The strategy identifies ways to ensure time and space between a person in crisis and their access to lethal means, including firearms and medications."

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Suicide among service members, veterans, and their families is a public health and national security crisis. Far too many of our nation's veterans and service members have died at their own hands, an overwhelming majority of them as the result of a firearm. Since 2010, more than 65,000 veterans have died by suicide - more than the total number of deaths from combat during the Vietnam War and the operations in Iraq and Afghanistan combined. These women and men volunteered to serve their country, often in dangerous conditions. We owe them, their families, and their fellow service members and veterans a better, more coordinated response to address the military and veteran suicide crisis.
Suicide is a complex problem, with no single cause and no single solution. But it is preventable. Given the multiple factors that may lead to suicide, preventing suicide requires a comprehensive public health approach that harnesses the full breadth of the federal government.

Today, the Biden-Harris Administration is announcing a series of priority goals and executive actions that will drive suicide prevention efforts moving forward. These goals are outlined in a new national strategy, "Reducing Military and Veteran Suicide: Advancing a Comprehensive, Cross-Sector, Evidence-Informed Approach."

The key components of this comprehensive strategy include:

Improving Lethal Means Safety
Suicide crises are often brief, and evidence suggests they can be prevented if the individual in crisis lacks immediate access to the means for self-harm. The strategy identifies ways to ensure time and space between a person in crisis and their access to lethal means, including firearms and medications. In implementing this strategy, the Departments of Defense (DOD), Health and Human Services (HHS), Homeland Security (DHS), Justice (DOJ), and Veterans Affairs (VA), as well as the Office of Emergency Medical Services within the Department of Transportation (DOT), will create and implement a coordinated approach for improving Lethal Means Safety. In the coming months, agencies will collaborate to raise awareness among service members, veterans, and their families; educate and train health care providers and crisis responders; and evaluate the effectiveness of existing and new programs that may reduce access to lethal means. This will include designing and launching a campaign to increase the safe storage of firearms and medications, and the use of safety planning interventions by providers.

Enhancing Crisis Care and Facilitating Care Transitions
Individuals at imminent or high risk of suicide need access to high-quality crisis care and follow-on support. The strategy elevates the need for improving care in emergency settings, as well as providing appropriate care and support as individuals transition from crisis care into follow-on settings, including other services that can help to de-escalate the crisis and facilitate access to outpatient care. Emergency care settings (emergency transport, urgent care, and emergency departments) play a critical role in stabilizing patients and connecting them to care, and HHS, VA, DOD, and DOT will collaborate to promote evidence-based risk-assessment and safety-planning are used by providers in these settings throughout the country. Agencies will also expand approaches to help identify service members, veterans and their family members at risk of suicide, enabling early intervention.

Increasing Access to and Delivery of Effective Care
Ensuring access to evidence-based care for mental health greatly reduces suicide risk among those with behavioral health problems, including depression, post-traumatic stress disorder, and addiction. The strategy is focused on reducing barriers to high quality mental health care and to encouraging help-seeking among service members, veterans, and their families. Strategies include eliminating or lowering co-payments for mental health treatment, increasing confidentiality, clarifying fitness for duty standards, and training of providers in evidence-based suicide risk assessment and care. Agencies will also identify and eliminate potentially discriminatory practices related to mental health care.

Addressing Upstream Risk and Protective Factors
Reducing the likelihood that an individual will experience a suicidal crisis requires addressing the factors-such as increased financial strain, lack of housing, food insecurity, unemployment, and legal issues-that may contribute to or increase risk for suicide. Conversely, improving coping and problem-solving skills and supporting connectedness are protective factors that can decrease risk. In driving this priority, HHS, DOD, VA, DHS, ED, and DOL will expand federal, state, territory, Tribal, and local public and private partnerships to address risk and protective factors for suicide. This will include increased emphasis on promoting economic well-being, reducing housing and food insecurity, and supporting service members, veterans, and their families in the transition to civilian life.

Increasing Research Coordination, Data Sharing, and Evaluation Efforts
The federal government invests significant resources in suicide prevention research and the collection of data on suicide risk factors and outcomes. Unfortunately, the data needed to monitor suicide risk and outcomes for service members, veterans, and their family members is not currently shared or integrated among the relevant agencies. The strategy will advance interagency research coordination, ensure integration of data, and encourage adoption of rigorous program evaluation across all prevention programs. These efforts will improve our understanding of the factors that lead to suicide in the military and veteran community, promote early identification of risk so that we can better support individuals and communities, and help ensure the effectiveness of suicide prevention programs. To achieve these goals, VA, HHS, DOD, and the Department of Energy (DOE) will coordinate research activities and program evaluation efforts. Agencies will also continue implementation of the National Research Strategy, improving access to and linkages of data to enable real-time surveillance.

These actions build upon an existing foundation of government programs and public-private partnerships, and will serve to accelerate efforts across the federal government. Moving forward, these federal priorities will be implemented in close coordination with states, territories, Tribes, and local governments, as well as in collaboration with industry, academia, communities and community-based organizations, families, and individuals.

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Fact Sheet: New Strategy Outlines Five Priorities for Reducing Military and Veteran Suicide | The White House

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Suicide among service members, veterans, and their families is a public health and national security crisis. Far too many of our nation's veterans and service members have died at their own hands, an overwhelming majority of them as the result of a firearm. Since 2010, more than 65,000 veterans have died by suicide - more...

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After a traumatic event, like combat, it is common to have unwanted thoughts or memories about what happened. These are called intrusive thoughts. Because these thoughts can happen at any time you will see change in your loved one. It will make them very upset and it can sometimes turn into anger.

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Apply for and manage the VA benefits and services you’ve earned as a Veteran, Servicemember, or family member—like health care, disability, education, and more.

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Some factors in a combat situation may contribute to PTSD and other mental health problems, including military occupation or specialty, the politics around the war, where the war is fought, and the type of enemy faced.

Another cause of PTSD in the military can be military sexual trauma

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How Common is PTSD in Veterans?

When you serve in the military, you may be exposed to different traumatic events than civilians. The war you served in may also affect your risk because of the types of trauma that were common. War zone deployment, training accidents and military sexual trauma (or, MST) may lead to PTSD. Learn how many Veterans have PTSD.

Reading time: minutes

When you are in the military, you may see combat. You may have been on missions that exposed you to horrible and life-threatening experiences. Or you may have experienced a serious training accident. These types of events can lead to PTSD.

PTSD is slightly more common among Veterans than civilians. At some point in their life, 7 out of every 100 Veterans (or 7%) will have PTSD. In the general population, 6 out of every 100 adults (or 6%) will have PTSD in their lifetime. PTSD is also more common among female Veterans (13 out of 100, or 13%) versus male Veterans (6 out of 100, or 6%). We are learning more about transgender Veterans and those who do not identify as male or female (non-binary).

U.S. Veterans of Different Service Eras

The number of Veterans with PTSD varies by service era. The data below are from a large study of Veterans across the country:

Service Era

PTSD in the Past Year

PTSD at Some Point in Life
NOTE: The data in this table is from Veterans alive at the time of the study. As such, it does not include Veterans in any service area who have died and may have had PTSD.

Other data that is less recent than the study above suggest PTSD is more common among Veterans of different service eras, specifically Vietnam Veterans. Studies use different methods to get information which can affect findings. The timing of studies matters as well because PTSD is related to other health conditions that may affect mortality-or risk of dying. So, Veterans who are not alive to participate in a study may have a different rate of PTSD than those included in current research.

Military Risk Factors

Research shows that deployment increases risk of PTSD. In some studies, PTSD is 3 times more likely among Veterans who deployed compared to those who did not (of the same service era). Some factors in a combat situation may contribute to PTSD and other mental health problems, including military occupation or specialty, the politics around the war, where the war is fought, and the type of enemy faced.

Another cause of PTSD in the military can be military sexual trauma (MST). This is any sexual harassment or sexual assault that occurs while you are in the military. MST can happen to anyone and can occur during peacetime, training or war.

Veterans Who Use VA Health Care

Not all Veterans use VA health care, and we know that PTSD is more common among those who do. One study found that among Veterans using VA care, 23 out of every 100 (or 23%) had PTSD at some point in their lives, compared to 7 out of every 100 (or 7%) of Veterans who do not use VA for health care.

An annual report from VA also offers information about PTSD in Veterans using VA care. Of the 6 million Veterans served in fiscal year 2021, about 10 out of every 100 men (or 10%) and 19 out of every 100 women (or 19%) were diagnosed with PTSD.

One reason PTSD may be more common in women Veterans using VA care is military sexual trauma. PTSD is one of the most common mental health diagnoses related to MST. Although MST can happen to anyone in the military, it is much more commonly reported in women. About 1 in 3 women Veterans and 1 in 50 male Veterans report experiencing MST when screened (asked about MST experiences) by their VA provider.

Summary

Veterans are more likely to develop PTSD than civilians. Among Veterans, those who deploy are more likely to have PTSD than Veterans who do not. Also, Veterans who use VA for health care are more likely to be diagnosed with PTSD than those who use community health services. This may be due, in part, because VA screens for MST and PTSD for all Veteran patients.

Research is ongoing to better understand how PTSD affects Veterans of color, LGBTQ+ Veterans and those of other diverse backgrounds. These social factors impact risk of trauma and PTSD in civilian life and in the military.

To hear from diverse Veterans who have been there-those who have PTSD and turned their lives around with treatment-visit AboutFace.

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