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Post-Traumatic Stress Disorder (PTSD)

PTSD (posttraumatic stress disorder) is a mental health problem that some people develop after experiencing or witnessing a threatening event, like combat, a natural disaster, a car accident, or sexual assault. For some people, symptoms may start later on, or they may come and go over time.

If you are providing care to a Veteran displaying symptoms of PTSD and need guidance, please fill out our contact form and we will connect you with support as quickly as possible.

Note: this information is described as applying to Veterans, but is applicable to any individual. Anyone who has gone through a life-threatening event can develop PTSD.

The number of Veterans with PTSD varies by service era and symptoms do not always present themselves in a typical manner at the end of life. If you are providing care to a Veteran and need guidance on general issues, please contact us. Support from the VA’s PTSD Consultation Program is available to any provider, whether inside the VA or not.

Some examples of life-threatening events may include:

  • Combat or military exposure
  • Child sexual or physical abuse
  • Terrorist attacks
  • Sexual or physical assault
  • Serious accidents, such as a car wreck
  • Natural disasters, such as a fire, tornado, hurricane, flood, or earthquake

After the event, the Veteran may feel scared, confused, or angry. If these feelings don’t go away or they get worse, the symptoms may disrupt the person’s life, making it hard to continue daily activities. All Veterans with PTSD have lived through a traumatic event that caused them to fear for their lives, see horrible things, and feel helpless. Strong emotions caused by the event create changes in the brain that may result in PTSD. Most Veterans who go through a traumatic event have some symptoms at the beginning. Yet only some will develop PTSD; the reason for this is not clear. How likely someone is to get PTSD depends on many things:

  • How intense the trauma was or how long it lasted
  • If someone close was lost hurt
  • Proximity to the event
  • Strength of the reaction to the event
  • How much the Veteran felt in control of events
  • How much help and support the Veteran got after the event

Many who develop PTSD may improve, though about 1 out of 3 with PTSD may continue to have some symptoms. Even with continued symptoms, treatment can help; symptoms don’t have to interfere with everyday activities, work, and relationships.

Recommended Resources

Get more resources

Education

Training videos on supporting PTSD at the end of life.

Best Practices

Caring for Veterans with Posttraumatic Stress Disorder at the End of Life: Tips for recognizing trauma-related symptoms

Caring for Veterans

Understanding PTSD and PTSD Treatment

Caring for VeteransEducation

Veterans Issues at the End of Life

Symptoms of PTSD

PTSD symptoms usually start soon after the traumatic event, but they may not occur until months or years later. They also may come and go over many years. If the symptoms last longer than 4 weeks, cause great distress, or interfere with work or homelife, the individual probably has PTSD. There are four types of PTSD symptoms:

1.  Reliving the event (also called re-experiencing symptoms):

Bad memories of the traumatic event can return at any time. The Veteran may feel the same fear and horror as when the event took place. He/she may have nightmares or may feel like he/she is going through the event again. This is called a flashback. Sometimes there is a trigger — a sound or sight that causes the Veteran to relive the event. Triggers might include:

  • Hearing a car backfire, which can bring back memories of gunfire and war for a combat Veteran.
  • Seeing a car accident, which can remind a crash survivor of his or her own accident
  • Seeing a news report of a sexual assault, which may bring back memories of assault for a woman who was raped

2.  Avoiding situations that are reminders of the event:

The Veteran may try to avoid situations or people that trigger memories of the traumatic event, and even avoid talking or thinking about the event. For example:

  • A person who was in an earthquake may avoid watching television shows or movies in which there are earthquakes.
  • A person who was robbed at gunpoint while ordering at a hamburger drive-in may avoid fast-food restaurants.
  • Some people may keep very busy or avoid seeking help. This keeps them from having to think or talk about the event.

3.  Feeling numb:

The Veteran may find it hard to express feelings. This is another way to avoid memories. He/she may not:

  • have positive or loving feelings toward other people and may stay away from relationships
  • be interested in previously enjoyed activities
  • be able to remember parts of the traumatic event or be able to talk about them

4.  Feeling keyed up (also called hyper-arousal):

The Veteran may be jittery, or always alert and on the lookout for danger. This is known as hyper-arousal. It can cause:

  • Sudden anger or irritation
  • Difficulty sleeping and concentration
  • Fear for personal safety and a constant need to be on guard
  • Overreaction when something surprises him/her.

Other common problems

People with PTSD may also have other problems. These include:

  • Drinking or drug problems
  • Feelings of hopelessness, shame, or despair
  • Employment problems
  • Relationship problems, including divorce and violence
  • Physical symptoms

Treatment

When a Veteran has PTSD, dealing with the past can be difficult, and feelings are generally kept “bottled up”. Treatment must be provided by qualified hospice or VA staff. See PTSD Related Resources for additional information.