LIBERTY UNIVERSITY
RAWLINGS SCHOOL OF DIVINITY
Research Paper
PTSD in Military Veterans
Submitted to Dr. Farid Awad
in partial fulfillment of the requirements for the completion of
CRIS607 – D02
PTSD and Combat Related Trauma
by
Jonathan Langley
April 24, 2022
Contents
Introduction....................................................................................................................................1
After the War.................................................................................................................................2
PTSD — Definition and Symptoms...............................................................................................3
PTSD — Treatment Options..........................................................................................................5
What Does Scripture Tell Us?.......................................................................................................6
Conclusion.....................................................................................................................................7
Bibliography...................................................................................................................................8
1
Introduction
War…what is it good for? While I may not be able to answer the question posed in the
lyrics to Edwin Starr’s song, I can say that war is the cause of a lot of mental health concerns.
War is the cause for many veterans needing to seek help regarding anxiety, depression,
sleeplessness, and various other medical and mental health issues. Being in the military can be
mentally taxing when not engaged in combat. Once the stressors of combat and being absent
form home/family are added into the equation, oftentimes it ends up causing long-term mental
health challenges. The rates of military veterans who have been in combat is shocking.
In a seminal study by Hoge and colleagues (2004) from the Walter Reed Army Institute
of Research, four U.S. combat infantry units were given an anonymous survey either
before their deployment to Iraq (n = 2,530) or, in a different cohort of troops, 3–4 months
after their return from combat duty in Iraq or Afghanistan (n = 3,671). Results indicated
that service members deployed to Iraq screened positive for PTSD at rates of 18–20%
and those from Afghanistan at approximately 12%. Using the Post- Deployment Health
Assessment (PDHA), Hoge, Auchterlonie, and Milliken (2006) found that approximately
10% of Iraq veterans and 5% of Afghanistan veterans screened positive for PTSD.1
The purpose behind this paper is to look at some of the mental health concerns linked to
veterans who have served in combat primarily. Some of the topics may be more generalized
when speaking of the military, but the main group focused on will be combat veterans
specifically. Many veterans suffer from PTSD, but there are ways to get them help and
treatment. PTSD can be debilitating if it goes without treatment and it can also cause the person
dealing with it troubles in other areas of their life. Learning coping mechanisms and ways to
reduce the symptoms can allow these individuals a better chance of living with the trauma of
combat and war.
1 Bret A Moore, Walter Penk and Matthew J Friedman, Treating PTSD In Military Personnel, 2nd ed.
(New York, NY: The Guilford Press, 2019), 2.
2
After the War
Service members often return home from combat damaged. Whether it be physically or
mentally, the tides of war take a toll on people. While recounting his own story in the book After
the War, Stéphane Grenier states:
It was clear from my own experience, and that of many other soldiers during the 1990s,
that the military needed to prevent soldiers from going from the regimented and
sometimes harrowing environment of deployment to the tranquil and happy environment
of “home” without any sort of interim adjustment period.2
Coming home with no assistance to work through the emotions and trauma of war can be
a metaphorical mental health time bomb. Soldiers often times do not know of all the resources
available to them or are so afraid of the recourse due to stigmas, that they do not seek help of the
right type. Many turn to substances to aid in “numbing” the trauma and to prevent themselves
from reexperiencing the event/s. Combat veterans often bring home trauma that they are not sure
how to express or communicate. In some cases, the veteran is unable to share due to suppression
of the memories or because the trauma is so intense that they are not able to control the emotions
when they do bring it to light.
While telling the story of her return home from the war in Iraq, Brooke King exhibited
this exact behavior. She had started attending an MFA in creative writing and a professor asked
her to write about the nonfiction in her life instead of writing fiction. Her response to this tells of
the struggle that vets face sometimes in trying to recount their trauma.
When I was attending the MFA, I bounced the question off my shoulders, avoiding it by
simply saying I knew how to write nonfiction and that I wanted to learn something new,
but the truth was that I was scared to write nonfiction. I hadn’t processed enough of my
deployment to handle writing it all down and sharing it with anyone.3
2 Stéphane Grenier and Adam Montgomery, After the War (Regina, Saskatchewan, Canada: University of
Regina Press, 2018), 65.
3 Brooke King, War Flower (Lincoln, NE: Potomac Books, 2019), 261.
3
PTSD — Definition and Symptoms
What exactly is this PTSD that combat veterans and many other people are diagnosed
with in regard to traumatic events? The Diagnostic and Statistical Manual, Third Edition (DSM-
III) was published in 1980 and was the first diagnostic manual to outline the diagnosis of
posttraumatic stress disorder (PTSD).4 According to the fourth edition, text revision of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), PTSD is comprised of
two main components:
1. An individual is exposed to a traumatic event that involves either directly
experiencing or witnessing death, serious injury, or threat to physical integrity, and
his or her response involves intense fear, helplessness, or horror.
2. Reactions involve symptoms of reexperiencing, avoidance and numbing, and
hyperarousal.5
After facing the trauma of war, service members are highly likely to return home with
some sort of PTSD. Some data that has been collected shows the following:
Numerous reports in the popular press have made the public aware of issues indicating
that military personnel have returned home with posttraumatic stress disorder (PTSD)
and other mental health diagnoses, such as major depressive disorder, anxiety, substance
use disorder, and suicidal ideation. As early as 2004, it was estimated that over one-
fourth of troops returning from OEF and OIF were suffering from mental health disorders
(Hoge et al., 2004). Later estimates suggested that one-fifth of the troops reported
symptoms of PTSD or depression and about the same fraction experienced a probable
traumatic brain injury (TBI) during deployment (Tanielian and Jaycox, 2008). RAND
reports note that a full one-third of returning OEF and OIF service members reported
symptoms of mental health or cognitive problems (Hosek, 2011; Tanielian and Jaycox,
2008).6
4 Laura Weiss Roberts and Christopher H Warner, Military and Veteran Mental Health New York, NY:
Springer Science+Business Media, LLC, 2018, 10.
5 Adam Cash and Irving B Weiner, Wiley Concise Guides to Mental Health: Posttraumatic Stress Disorder
Hoboken, NJ: John Wiley & Sons, 2006, 10.
6 National Academies of Science, Engineering, and Medicine, Evaluation of The Department of Veterans
Affairs Mental Health Service (Washington, D.C.: National Academies Press, 2018).
4
The studies show that service members are at great risk of experiencing PTSD if they
have been exposed to combat. Even without the combat exposure, many veterans suffer from
PTSD due to the mental stress that this type of work/lifestyle puts on them. The leadership of
these types of individuals must be aware and alert to help watch out for signs that a service
member might be suffering from PTSD.
Some of the troubles with veterans returning home is that the support system and
stability of the deployment are lost, and it causes the service member to become frustrated and
secluded. In her article on the intensive outpatient program for combat vets with PTSD, Amy
Cameron shares that:
Many veterans returning from deployment are coming from a highly cohesive, tight-knit
unit where expectations of themselves and others are clear and unambiguous. Adjustment
to a noncombat zone is often difficult (Sammons & Batten, 2008), particularly for those
who return with PTSD and are struggling with reminders of the event, poor sleep,
hypervigilance, and increased anxiety (American Psychiatric Association, 2013). The loss
of trusted social support, coupled with intense psychiatric symptoms, may exacerbate the
urge to avoid any potential negative experiences, leading to increased isolation, decreased
functioning, and diminished ability to create a meaningful life.7
Without an idea of how to find support when they return home, these veterans are left
without any direction and often find “misguided” ways to cope and try to ease the severity of
PTSD. Some of the primary categories of symptoms related to PTSD can be intrusion symptoms,
avoidance symptoms, negative alterations in cognitions and mood, and alterations in arousal and
reactivity.8 Under these categories are multiple symptoms that are associated with these
categories. Individuals who experience PTSD may show symptoms immediately following the
traumatic event or the onset may be delayed by months or possibly years. There are also risk
7 Amy Y. Cameron, Christy Capone and Daria Mamon, "Evaluation Of An Intensive Outpatient Program
For Combat Veterans With PTSD", Military Behavioral Health 6, no. 4 (2018): 280-289,
doi:10.1080/21635781.2018.1436479.
8 Matthew J Friedman, Posttraumatic and Acute Stress Disorders (Switzerland: Springer International
Publishing, 2015), 16-19.
5
factors that can be associated with those who will possibly be at greater risk to experience PTSD.
Those who are tasked with diagnosing PTSD have multiple tools available. There are trauma
exposure scales, diagnostic instruments, and symptom severity scales which can be used to
diagnose and identify individuals with PTSD and its severity.9
PTSD — Treatment Options
Treating PTSD can be challenging. Just as every person reacts differently to the trauma,
each person also reacts differently to the treatments provided. Treatment length also varies from
case to case. Some individuals may find a treatment that works very well and be able to function
without it after a short period of time. Others may struggle for the rest of their lives to overcome
their symptoms. There are some basic principles that can be implemented to help guide the
treatment:
1. Treatment should be preferences. informed by the patient’s needs, abilities, and
2. Consider whether the treatment goals are attainable.
3. Define the focus. Is it stabilization, symptom reduction, or relapse prevention?
4. Does the patient first need to realize that he or she needs to address his or her PTSD and seek
help?
5. Are there other adjustment-related or circumstantial issues that need to be addressed first, such
as housing or medical care?10
There are multiple treatment options available and, depending on the individual, more
than one may be needed to normalize a person with PTSD. There are cognitive and behavioral
9 Ibid., 28.
10 Cash, Wiley’s Concise Guide to Mental Health, 182.
6
treatments, psychodynamic treatments, psychopharmacological treatments, and some other
lesser-known treatment options. Along with treatment options there are also various therapy
options. These therapies include cognitive-behavioral therapy (CBT), eye movement
desensitization and reprocessing (EMDR), family therapy, group therapy, and multiple other
therapies to assist in the treatment process.
What Does Scripture Tell Us?
Though it does not specifically mention PTSD, the Bible does tell us about people who
have suffered trauma. When reading about the Apostle Paul and the tortures and brutality
suffered by him, we can believe that he would have dealt with some form of PTSD. Some might
even believe that his “thorn in the flesh” mentioned in II Corinthians12:711 could be a form of
mental anguish, though it never states it clearly. The book of James tells us in 1:2-4 to “Count it
all joy, my brothers, when you meet trialsRof various kinds, for you know thatRthe testing of your
faithRproduces steadfastness. And let steadfastness have its full effect, that you may beRperfect
and complete, lacking in nothing.” Trusting in God’s plan is not always easy, but it is part of the
process to control your own mind. We cannot change the past, so we must trust in the future God
has for us. We must take the pain and trauma and refocus that energy into God’s path for us. In
the same manner, it is ok to seek help from outside sources. Letting doctors or health-care
professionals assist us as we use their knowledge alongside God’s guidance, we can overcome
the challenges that are faced in mental health. Jesus suffered pain and torture on the cross. He
11 Unless otherwise noted, all biblical passages referenced are in the English Standard Version (Wheaton,
IL: Crossway, 2008).
7
also suffered mental anguish (Mark 14:34-41) before His crucifixion. He was tempted just as we
are but was able to withstand those temptations (Hebrews 4:15).
Conclusion
PTSD is a mental health concern that continues to increase throughout the population.
Military members in particular deal with a steadily increasing risk of PTSD and its associated
symptoms. Veterans are often lost to their own resources when they return home from combat
and deployment. Leadership that makes their Soldiers the priority and shows them the path to
resources can help assure that service members are not isolated and left without assistance.
The options available to military are wide-ranging and most are covered in some way
through the VA or Tri-Care Insurance. Veterans are often dealing with several stressors that are
part of the PTSD in their lives. My hope is that those who need help seek help, and when they
seek help, there will be someone there able to assist them in working through the trauma.
8
Bibliography
Cameron, Amy Y., Christy Capone, and Daria Mamon. "Evaluation Of An Intensive Outpatient
Program For Combat Veterans With PTSD". Military Behavioral Health 6, no. 4 (2018):
280-289. doi:10.1080/21635781.2018.1436479.
Cash, Adam, and Irving B Weiner. Wiley Concise Guides To Mental Health: Posttraumatic
Stress Disorder. Hoboken, NJ: John Wiley & Sons, 2006.
Friedman, Matthew J. Posttraumatic And Acute Stress Disorders. Switzerland: Springer
International Publishing, 2015.
Grenier, Stéphane, and Adam Montgomery. After The War. Regina, Saskatchewan, Canada:
University of Regina Press, 2018.
King, Brooke. War Flower. Lincoln, NE: Potomac Books, 2019.
Moore, Bret A, Walter Penk, and Matthew J Friedman. Treating PTSD In Military Personnel.
2nd ed. New York, NY: The Guilford Press, 2019.
National Academies of Science, Engineering, and Medicine. Evaluation Of The Department Of
Veterans Affairs Mental Health Service. Washington, D.C.: National Academies Press,
2018.
Roberts, Laura Weiss, and Christopher H Warner. Military And Veteran Mental Health. New
York, NY: Springer Science+Business Media, LLC, 2018.
