Understanding Military Mental Health
Education is an important part of creating change. Understanding the effects of military service, combat exposure, trauma, and mental health challenges can help reduce stigma, encourage earlier intervention, and improve the way we respond when a service member is struggling.
Aaron’s Wish is committed to providing evidence-based information for service members, veterans, military families, leaders, healthcare professionals, and communities.
Post-Traumatic Stress Disorder (PTSD)
What is PTSD?
Post-Traumatic Stress Disorder (PTSD) can develop after experiencing or witnessing a traumatic event. For service members, repeated exposure to combat, life-threatening situation, loss, and other traumatic experiences can increase the risk of developing PTSD.
Common Symptoms
Intrusive memories, nightmares, or flashbacks
Avoidance of reminders of traumatic experiences
Hypervigilance or feeling constantly “on guard”
Sleep disturbances
Irritability, anger, or difficulty concentrating
Emotional numbness or detachment
Negative changes in mood, thoughts, or beliefs
PTSD in Military and Combat Settings
Military-related PTSD can be especially complex because traumatic exposure may occur repeatedly over the course of training, deployments, and combat operations. Service members may also experience the loss of teammates, moral injury, survivor guilt, and prolonged exposure to life-threatening environments.
Combat-related symptoms may continue after a service member returns home, even when the immediate danger has ended. Behaviors that were protective in combat - such as hypervigilance, emotional suppression, rapid threat assessment, and constant readiness - can become difficult to manage in everyday life.
Why Combat Context Matters
Combat exposure can shape how symptoms appear and how a service member communicates distress. A person may continue functioning at a high level professionally while experiencing significant psychological symptoms privately.
Understanding the combat context helps healthcare professionals and military leaders look beyond behavior alone and consider whether changes in behavior, performance, substance use, relationships, or discipline may also signal an underlying mental health need.
Treatment and Support
PTSD is treatable. Evidence-based treatments can help individuals process traumatic experiences, reduce symptoms, and improve daily functioning.
Treatment may include trauma-focused psychotherapy, medication, or a combination of approaches. For military members, effective care should also consider combat experiences, military culture, operational demands, and other conditions that may occur alongside PTSD, including traumatic brain injury, depression, and substance misuse.
Sources
U.S. Department of Veterans Affairs -
National Center for PTSD
Defense Health Agency
U.S. Department of Defense
Traumatic Brain Injury (TBI)
What is TBI?
Traumatic Brain Injury (TBI) is caused by a bump, blow, jolt, or other injury to the head that disrupts normal brain function. TBI can range from mild, such as a concussion, to more severe injuries that can result in lasting changes in thinking, behavior, mood, and physical functioning.
For service members, TBI may occur during combat, training, blast exposure, vehicle accidents, falls, or other operational events.
Common Symptoms
Headache or pressure in the head
Dizziness or problems with balance
Difficulty concentrating or remembering
Confusion or slowed thinking
Sleep disturbances
Irritability, anxiety, depression, or mood changes
Sensitivity to light or noise
Fatigue or decreased energy
TBI in Military and Combat Settings
Service members may be exposed to unique causes of brain injury, including blasts, explosions, repeated exposure to weapons fire, training accidents, vehicle incidents, and other combat or operational events. Some injuries may occur without an obvious external wound.
Repeated blast exposure and multiple mild TBIs may have cumulative effects. Symptoms can also overlap with PTSD, depression, sleep disorders, and substance misuse, making recognition and appropriate evaluation especially important.
Why TBI Can Be Difficult to Recognize
TBI symptoms may not always be immediately visible. A service member may appear physically recovered while continuing to experience problems with memory, concentration, sleep, mood, judgement, or impulse control.
Because may TBI symptoms overlap with PTSD and other mental health conditions, changes in behavior or performance should be considered in the context of the service member’s history of combat, blast exposure, and previous brain injuries.
Treatment and Support
TBI treatment depends on the severity of the injury and the symptoms a person is experiencing. Care may include neurological evaluation, rehabilitation, cognitive therapy, treatment for headaches or sleep problems, and mental health support.
For service members with both TBI and conditions such as PTSD, depression, or substance misuse, coordinated care is especially important. Treatment should consider the full clinical picture rather than addressing each condition is isolation.
Sources
U.S. Department of Veterans Affairs -
National Center for PTSD
Defense Health Agency - Traumatic Brain
Injury Center of Excellence
U.S. Department of Defense
Centers for Disease Control and Prevention
Substance Misuse and Mental Health
What is Substance Misuse?
Substance misuse refers to the use of alcohol, prescription medications, or other substances in ways that can negatively affect a person’s health, safety, relationships, work, or daily functioning. Substance misuse can range from unhealthy patterns of use to a substance use disorder.
For service members and veterans, substance use may sometimes develop or increase as a way of coping with symptoms associated with combat exposure, PTSD, traumatic brain injury (TBI), depression, chronic pain, sleep problems, or other stressful experiences.
Common Warning Signs
Increasing amount or frequency of alcohol or substance use
Using substances to cope with stress, trauma symptoms, pain, or sleep problems
Difficulty reducing or controlling use
Changes in mood, behavior, judgment, or relationships
Problems at work or difficulty meeting responsibilities
Risk-taking or unsafe behavior while using substances
Continuing to use despite negative health, legal, occupational, or relationship consequences
Substance Misuse in Military and Combat Settings
Military service can involve repeated exposure to combat, trauma, injury, chronic pain, sleep disruption, loss, and prolonged operational stress. Some service members may use alcohol or other substances in an attempt to manage distressing memories, anxiety, hyperarousal, pain, insomnia, or other symptoms.
When substance misuse occurs alongside PTSD, TBI, depression, or other mental health conditions, the symptoms can interact and become more difficult to recognize and treat. Changes in alcohol or substance use may therefore be an important clinical warning sign that warrants assessment of the service member’s overall mental and physical health.
When Substance Misuse and Mental Health Intersect
Substance-related behavior can result in serious safety, occupational, disciplinary, or legal consequences. At the same time, those consequences do not rule out an underlying mental health condition. Substance misuse may occur alongside PTSD, TBI, depression, chronic pain, sleep disorders, or other conditions that require clinical assessment and treatment.
For service members, addressing misconduct and addressing health needs should not be viewed as mutually exclusive. When significant changes in substance use or behavior occur - particularly in someone with known trauma exposure, TBI, or mental health concerns - a comprehensive clinical evaluation can help identify contributing conditions and appropriate treatment needs.
Treatment and Support
Substance misuse and substance use disorders are treatable. Treatment may include counseling, behavioral therapies, medication when appropriate, peer support, recovery programs, or a combination of approaches.
When substance misuse occurs alongside PTSD, TBI, depression, or other mental health conditions, integrated treatment that addresses both substance use and co-occurring conditions can be important. Effective care should consider the individual’s complete clinical picture, including trauma history, physical injuries, mental health symptoms, and substance use.
Sources
U.S. Department of Veterans Affairs -
National Center for PTSD
Substance Abuse and Mental Health
Services Administration (SAMHSA)
U.S. Department of Defense / Defense Health Agency
Depression in Military and Combat Settings
What is Depression?
Depression is a mental health condition that can affect how a person feels, thinks, and functions. It can involve persistent sadness, loss of interest or pleasure, low energy, difficulty concentrating, changes in sleep or appetite, feelings of hopelessness or worthlessness, and thoughts of death or suicide.
For service members, depression may develop alongside experiences such as combat exposure, traumatic brain injury, PTSD, chronic pain, sleep disruption, loss, relationship difficulties, or prolonged operational stress.
Common Symptoms
Persistent sadness, emptiness, or hopelessness
Loss of interest or pleasure in activities
Fatigue or decreased energy
Difficulty concentrating or making decisions
Changes in sleep
Changes in appetite or weight
Feelings of worthlessness, guilt, or helplessness
Irritability or restlessness
Thoughts of death or suicide
Depression in Military and Combat Settings
Military service can involve experiences that increase vulnerability to depression, including combat exposure, traumatic loss, physical injury, chronic pain, sleep disruption, repeated deployments, relationship strain, and prolonged operational stress.
Depression may also occur alongside PTSD, TBI, or substance misuse. When these conditions overlap, symptoms can become more complex and may affect mood, judgment, relationships, occupational functioning, and a service member’s ability to seek or engage in care.
Why Depression Can Be Difficult to Recognize
Depression does not always appear as obvious sadness. In service members, it may present as irritability, withdrawal, sleep problems, loss of motivation, increased substance use, risk-taking behavior, difficulty concentrating, or changes in work performance.
A service member may continue to perform at a high level while experiencing significant depression privately. In military environments where strength, reliability, and readiness are highly valued, symptoms may be minimized, hidden, or attributed to disciplinary or performance problems rather than an underlying mental health condition.
Depression and Suicide Risk
Depression is an important risk factor for suicide, particularly when it occurs alongside other concerns such as PTSD, TBI, substance misuse, chronic pain, relationship difficulties, legal or occupational stress, or feelings of hopelessness.
Changes such as increasing isolation, hopelessness, substance misuse, reckless behavior, giving away possessions, talking about death, or expressing that others would be better off without them should be taken seriously. A significant change from a service member’s usual behavior may also warrant further assessment.
Treatment and Support
Depression is treatable. Treatment may include psychotherapy, medication, peer support, lifestyle interventions, or a combination of approaches based on the individual’s needs and circumstances.
For service members experiencing depression alongside PTSD, TBI, substance misuse, chronic pain, or other conditions, coordinated care is especially important. Treatment should consider the full clinical picture and changes in functioning, behavior, and suicide risk over time.
Early recognition, appropriate assessment, continued connection to care, and ongoing support can be important components of recovery.
Sources
U.S. Department of Veteran Affairs -
National Center for PTSD
National Institute of Mental Health (NIMH)
U.S. Department of Defense / Defense Health Agency
Centers for Disease Control and Prevention (CDC)
Understanding Combat Trauma
What is Combat Trauma?
Combat trauma refers to the psychological and physiological effects that can result from exposure to life-threatening, violent, or highly stressful experiences during combat and military operations.
Service members may experience events rarely encountered in civilian life, including direct threats to their own lives, witnessing severe injury or death, losing teammates, engaging an enemy, treating casualties, handling human remains, or functioning for prolonged periods under conditions of danger and uncertainty.
Combat-related stress does not affect every service ember in the same way, and experiencing combat stress does not automatically mean that a person has PTSD or another mental health disorder. Some reactions are normal responses to extraordinary circumstances. However, when symptoms persist, intensify, or begin interfering with daily functioning, relationships, judgment, sleep, or well-being, further evaluation may be important.
Combat and Operational Stress Reactions
During combat and military operations, the body and brain may adapt to repeated or prolonged danger. Heightened alertness, rapid decision-making, emotional control, and an increased awareness of potential threats can be protective and necessary in an operational environment.
After returning from combat or leaving a high-threat environment, some of these responses may continue. A service member may experience:
Hypervigilance or feeling constantly “on guard”
Irritability or anger
Difficulty sleeping or nightmares
Increased startle response
Difficulty relaxing
Emotional numbness or detachment
Problems concentrating
Anxiety or persistent feelings of danger
Avoidance of reminders of traumatic experiences
Changes in alcohol or substance use
These reactions can occur after exposure to combat or other operational stress and do not necessarily indicate PTSD. However, persistent or worsening symptoms - particularly those affecting functioning, relationships, safety, or well-being - may warrant further evaluation.
How the Brain and Body Adapt to Combat
Repeated exposure to danger can train the brain and body to respond rapidly to potential threats. In combat, heightened awareness, quick reactions, emotional control, vigilance, and the ability to function under extreme stress may help a service member survive and perform effectively.
These adaptations may not immediately disappear when the danger ends. Responses that were useful in combat - such as constantly scanning the environment, reacting quickly to perceived threats, suppressing emotions, or remaining highly alert - may continue in everday life.
This can contribute to difficulty sleeping or relaxing, irritability, emotional detachment, problems concentrating, heightened reactions to unexpected sounds or movements, and difficulty adjusting to environments that no longer require the same level of vigilance.
These responses should be understood in the context in which they developed. Behaviors that appear problematic outside of combat may have originated as adaptations to repeated exposure to danger and operational stress.
Why Combat Trauma May Be Difficult to Recognize
Combat-exposed service members may continue to function at a very high level despite experiencing significant psychological distress. Training, discipline, teamwork, and a strong sense of responsibility can allow someone to continue performing while symptoms remain largely unseen.
Some service members may minimize symptoms, avoid discussing traumatic experiences, or hesitate to seek help because of concerns about stigma, career consequences, loss of responsibilities, or how they may be perceived by their unit
Changes may instead appear through behavior - such as increased irritability, withdrawal, sleep problems, substance misuse, risk-taking, relationship difficulties, or changes in work performance.
A change in behavior should not automatically be viewed as a disciplinary or performance problem. When there is a history of combat exposure, trauma, TBI, or other mental health concerns, changes in behavior may also warrant consideration of the service member’s ovreall clinical picture.
Combat Trauma, PTSD, TBI, and Substance Misuse
Combat-related mental health concerns rarely exist in isolation. A service member may experience combat trauma alongside PTSD, TBI, depression, chronic pain, sleep disturbance, or substance misuse.
Symptoms can overlap. Problems with sleep, concentration, memory, irritability, impulsivity, mood, anxiety, and emotional regulation may have more than one contributing cause. Alcohol or other substances may also be used in an attempt to manage distressing memories, anxiety, pain, insomnia, or other symptoms.
Because these conditions can interact, focusing on a single symptom or behavior may not reveal the full clinical picture. Comprehensive assessment can be especially important when significant behavioral changes occur in a combat-exposed service member.
The Importance of Combat-Informed Care
Effective care for combat-exposed service members requires an understanding of the environments in which their experiences occurred. Combat can involve repeated exposure to danger, loss, injury, morally difficult situations, prolonged stress, and the responsibility for the safety and lives of others.
A combat-informed approach considers the service member’s military role, deployment and combat history, blast or injury exposure, operational experiences, losses, and the culture of the unit in addition to current symptoms.
Understanding this context can help clinicians distinguish among overlapping symptoms and recognize how combat experiences may influence behavior, relationships, substance use, sleep, and response to stress.
The goal is not to assume that every difficulty is caused by combat, but to ensure that combat and operational experiences are not overlooked when evaluating the whole person.
Why Connection and Support Matter
Recovery from combat-related trauma can be influenced not only by treatment, but also by a service member’s sense of connection, purpose, belonging, and support.
Changes in duty status, separation from a unit, loss of responsibilities, relationship difficulties, disciplinary or administrative problems, and other major life transitions can occur at the same time a service member is experiencing psychological distress.
For someone already struggling with combat trauma, PTSD, TBI, depression, or substance misuse, increasing isolation or loss of meaningful connection may add to an already complex situation.
Maintaining appropriate connection to care, supportive relationships, and meaningful sources of belonging can be an important part of supporting a service member experiencing psychological distress.
Treatment and Support
Combat-related psychological distress is treatable. Support may include psychotherapy, trauma-focused therapies, medication when appropriate, treatment for co-occurring conditions, peer support, rehabilitation services, and other interventions based on the individual service member’s needs.
For combat-exposed service members, effective care should consider the full clinical picture, including combat and deployment history, TBI, physical injuries, sleep problems, substance use, depression, PTSD, relationships, occupational stressors, and changes in behavior or functioning.
Treatment needs may change over time. Some individuals may benefit from outpatient care, while other experiencing more severe or complex symptoms may require higher level of care or more intensive treatment.
Early recognition, comprehensive assessment, appropriate treatment, and continued connection to care and support can help promote recovery and protect the well-being of combat-exposed service members.
Sources
U.S. Department of Veterans Affairs -
National Center for PTSD
War and Combat
U.S. Department of Veterans Affairs -
National Center for PTSD
Trauma, PTSD and Treatment
U.S. Department of Defense - Defense
Health Agency, Psychological Health Center of Excellence
Combat and Operational Stress Reactions
U.S. Department of Defense - Defense
Health Agency, Psychological Health Center of Excellence
Combat and Operational Stress Control
Department of Defense Instruction 6490.05
Maintenance of Psychological Health in Military Operations
The Silent Load
Mental Health in Special Operations Forces
A narrated educational presentation from Aaron’s Wish Foundation exploring the unique psychological burdens carried by Special Operations Forces, barriers to seeking help, and opportunities for earlier recognition and intervention.