Not just combat-related: PTSD and the military

There’s no question that San Diego is a military town. With roughly 110,000 active military personnel and 240,000 veterans living in the county, the area is known as a proud hub for the military — and has been for more than 100 years.

However, according to the Armed Forces Benefit Association, over 23% of those service members will be diagnosed with post-traumatic stress disorder (PTSD). The disorder is a reaction to experiencing a highly stressful event with symptoms that include depression, anxiety, flashbacks and recurrent nightmares.

Rates for PTSD are higher among service members than U.S. civilians. For those who served in some combat zones, a two- to four-fold increase in the prevalence of PTSD has been demonstrated.

Despite these realities, Julia Kulewicz, LCSW, a psychiatric social worker at Sharp Mesa Vista Hospital, says stigma surrounding talking about our experiences with mental health — particularly the trauma that's faced within the context of military — is an incredible barrier to accessing care and getting support, both of which are essential.

PTSD: Beyond combat

According to Kulewicz, when the general public hears about PTSD in relation to veterans and the military population, thoughts often automatically go to combat experiences. While combat is a source of trauma for many people, several other experiences can be traumatic, including:

• Military sexual or physical assault

• Prolonged exposure to a stressful environment

• Witnessing or experiencing an accident or natural disaster

“There are many different things that could contribute to trauma,” Kulewicz says. “And if a person has not experienced combat, the assumption is that it can’t be PTSD. But that’s just not the case.”

Treating trauma

Kulewicz believes that therapy can be beneficial for individuals in or out of the military. However, when it comes to members of the military experiencing PTSD, education on different types of trauma therapies can help inform the services that individuals seek. “There are a lot of different types of therapies that can be used to help treat trauma and manage symptoms of PTSD,” she says.

According to Kulewicz, common treatments can include:

Cognitive processing therapy (CPT)

The American Psychological Association (APA) describes CPT as therapy that helps a person learn how to challenge and change unhelpful beliefs related to their trauma to create a new understanding of the traumatic event and reduce its negative effects on their life.

Somatic therapy

The APA defines this type of treatment as methods that directly influence the body. This therapy may also be known as “somatic experiencing.” The goal is to help an individual increase awareness of how emotions show up in their body. Traumatic experiences or unresolved emotional issues can become stored in the body, and somatic therapy helps individuals learn how to gradually release and process these emotions through a combination of body awareness and traditional counseling.

Prolonged exposure therapy (PE)

Provided in a safe and structured environment, PE teaches individuals to gradually approach their trauma-related memories, feelings and situations, according to the APA. As individuals gradually confront their triggers, they learn how to process their trauma and reduce overall emotional distress associated with them.

Helping a loved one with PTSD

Because PTSD can look different across individuals, symptoms in a loved one can be difficult to recognize, Kulewicz says. However, they might include:

• Hypervigilance — A person is excessively aware of their surroundings.

• Avoidance — A person avoids people, places and things that remind them of a traumatic event.

• Flashbacks — A person feels like they are experiencing a traumatic event again.

• Nightmares — A person’s dreams include re-experiencing traumatic events.

• General mood changes — A person may get angry more quickly, have difficulty managing their emotions, or withdraw from people or things they used to enjoy.

“Support is essential, but it can be daunting to ask about a loved one’s mental health for fear of not knowing how to respond to their answer,” Kulewicz acknowledges. “However, it's not your job to be a therapist or to know all the interventions to help manage PTSD. Just showing up and being in this person's life is such an important piece.”

Kulewicz recommends regularly checking in on your loved ones. “Ask how they're doing, maybe offer to research resources or make calls together,” she says. “That personal support can help decrease some of the anxiety or fear that a loved one feels when talking about their trauma or thinking about getting support.”

She also notes that there are local resources available to members of the military, both active and retired. Along with the Sharp Mesa Vista Trauma and PTSD Intensive Outpatient Program, Sharp’s behavioral health teams have the special training and expertise to treat patients with various psychiatric and mental health conditions. “Effective help is available for you if you are experiencing symptoms of PTSD,” she says.

Additional services can be found through the County of San Diego Office of Military and Veterans Affairs, Veterans Village of San Diego and the U.S. Department of Veterans Affairs (VA). If you or a loved one is experiencing an immediate mental health emergency, crisis services can be reached by calling the San Diego Access and Crisis Line (ACL) at 888-724-7240 or calling 911 and asking for the Psychiatric Emergency Response Team (PERT). The Veterans Crisis Line can be reached by calling or 988 and pressing 1, and the RAINN National Sexual Assault Hotline is available by calling 800-656-4673.

Learn more about mental health; get the latest health and wellness news, trends and patient stories from Sharp Health News; and subscribe to our weekly newsletter by clicking the "Sign up" link below.