Combat trauma & feeling safe at home

The military calls reactions to combat “combat and operational stress reactions”. They are seen as a normal response, and having them does not mean you have a mental health disorder.

Common reactions after trauma

• Being easily startled or always on guard
• Feeling numb, detached or irritable
• Intrusive memories or dreams
• Pulling away from people
• Trouble sleeping or concentrating

VA says reactions after trauma gradually decrease over time for most people. Recovery is a process, not a switch. You may never forget what happened, and that is not the goal.

With PTSD, survival mode can stay switched on long after the danger is gone. The risk is higher after intense or long-lasting trauma, combat or being injured. Support from others after trauma helps protect against it.

Some trauma is not one bad day. When danger goes on for a long time or happens again and again, people can carry extra struggles, like trouble managing strong feelings, feeling distant from others and trouble trusting people.

Watching every doorway, hand and car kept you alive. At home, it can make it hard to relax at all, and it wears the body out over time.

VA explains that trauma can leave people feeling they must control their surroundings and that others can’t be trusted. At home that can turn into strict rules, checking up on people or snapping about safety.

When the body stays in survival mode, everyday stress can feel like a threat, and anger comes fast. More than half of combat veterans in one VA study said they had trouble controlling anger since coming home.

About a third of Iraq and Afghanistan combat veterans in one VA study said they had driven dangerously since deployment. Driving fast, straddling lanes or tensing at debris can all be habits from the road over there.

Pushing feelings aside helped you do the job. Back home, the same switch can turn off love and joy too, and loved ones may feel cut off from you.

In a unit, you trusted people with your life. At home it can feel like nobody else understands. Pulling away from others is a common reaction after trauma, but it tends to make things harder.

Night can feel like the most dangerous time, so the body stays alert. Lying awake listening for sounds, getting up to check, or waking at every noise all make sleep harder, and poor sleep then makes everything else harder.

Small steps that can help

• Do one planned lock-up check before bed, then stop
• If you can’t sleep, get up and do something soothing, then try again
• Keep a regular bedtime and wake time
• Skip alcohol, caffeine and heavy exercise close to bedtime

Checking and avoiding can bring quick relief. But the more we avoid what is safe-but-scary, the bigger the fear can grow, and avoidance is one of the main things that keeps PTSD going.

Staying on guard all the time can lead to exhaustion, sleep problems, eating changes and stomach trouble. Needing constant reassurance can also wear out the people who love you.

• Agree with family on a few simple safety habits, so you are not the only one on watch
• Choose one room or chair where you practice letting your guard down
• Cut back on caffeine and alcohol, which can feed anxiety
• Try grounding, slow breathing or counting when you notice yourself scanning
• When you feel the urge to check again, name three things that show you are safe right now

VA’s suicide prevention report lists unsecured firearms at home among the common risk factors in veteran suicides. Keeping firearms securely stored, especially during hard times, is one way to keep yourself and your family safer.

VA suggests reminding yourself that the panic comes from having the dream, not from danger in the room right now. Getting up, turning on a light and doing something calm can help your body catch up.

Unwanted memories are just that: memories. Pushing them away hard often makes them come back stronger. Naming them, “There’s that memory again”, and turning back to what you were doing can take some of their power.

Families may read trauma-driven behavior as rejection if they don’t know where it comes from. A short explanation on a calm day can help them respond with care.

You could tell them

• “If I go quiet and stare, I might be somewhere else for a minute.”
• “Say my name and where we are, calmly. Don’t grab me.”
• “After a bad night, I may need a slow morning. It isn’t about you.”

If memories, flashbacks or nightmares get in the way of your relationships, work or sleep, it is time to talk with a counselor or doctor. Trauma-focused therapy is designed to make these memories less powerful.

• Doing risky things just to feel something
• Feeling flat at happy events, like a birthday or a wedding
• Feeling like a stranger in your own family
• Loved ones saying you seem distant
• Not caring about things you used to love

VA suggests keeping up activities you enjoy or used to enjoy, even if the enjoyment isn’t there yet. Pleasure may return once you are doing them again.

Ideas

• A short walk with your partner or a friend
• Cooking a meal you used to like
• Fixing or building something with your hands
• Twenty minutes of a hobby you dropped

Even when it is hard to feel close, small gestures like writing a card or calling someone show loved ones you care.

Numbness that lasts a long time can be part of PTSD or depression. Talking with a provider can help, and trauma-focused therapy can help feelings come back.

VA suggests choosing your support people carefully, and not being afraid to ask them clearly for what you need. Start with one person who has shown they are steady.

A trust ladder

• Share a small, everyday worry and see how they respond
• Ask for one practical favor
• Tell them about a hard day, without details of combat
• Let them know one thing that helps you when you are triggered

Many veterans fear that if they let feelings out, they won’t be able to stop, or that people will see them differently. Hopelessness, fear, guilt and shame are all common reactions after trauma. Saying them out loud to the right person often makes them smaller, not bigger.

If you have hurt family or friends during a strong reaction, VA suggests talking with them about what happened and how you are coping. A simple repair can rebuild trust on both sides.

You could say

• “I snapped last night. That was my alarm, not you. I’m sorry.”
• “I’m working on this. Can we try again?”

Withdrawing from others is a common reaction after trauma. VA advises making the effort to be with others rather than isolating. People who feel more socially connected tend to report better wellbeing.

In an NIH-funded study of Vietnam-era twin veterans, those with PTSD were more than twice as likely to develop heart disease over 13 years as their twins without it. Researchers think repeated stress reactions may strain the heart.

Poor sleep, headaches, stomach trouble and using more alcohol, drugs or tobacco are common after trauma. Each one can make the others worse.

VA notes that PTSD symptoms can rise and fall over a lifetime. Retirement, health problems and losing loved ones can make them more noticeable later in life.

In a national study, about half of all U.S. veterans, and 72% of those who screened positive for PTSD, reported at least moderate growth after trauma. Social connection, faith and a sense of purpose were linked with more growth.

• Make a plan together for flare-ups or crises
• Keep doing things together, with smaller groups or shorter outings
• Look after your own needs, and think about your own counseling
• Set regular times to talk, and come back to hard topics if the timing is off

Peer support groups can help you feel less alone, pick up tips and practice asking for help. Many VA facilities have Peer Specialists: veterans with their own recovery experience. Peer groups are not a replacement for treatment.

The Vet Center Call Center (877-927-8387) is free, confidential and open 24/7, and its team includes combat veterans.

A study of veterans found that those who felt more socially connected had better quality of life and less distress. The authors suggest connections with both veteran groups and other social groups can help.

Vet Centers offer individual, group, marriage and family counseling at no cost to eligible veterans, service members (including Guard and Reserve) and their families.

PTSD Coach is a free VA app with information, symptom tracking and coping exercises. It does not replace treatment. AboutFace, from VA’s National Center for PTSD, shares video stories from veterans, families and clinicians about PTSD and treatment.

Military OneSource offers confidential help 24/7 at 800-342-9647. Retired and honorably discharged service members and their families can use it until 365 days after leaving service.

• Anger, drinking or drug use is going up
• Flashbacks, nightmares or memories get in the way of sleep, work or family
• Home never feels safe, and checking takes over
• You feel hopeless, or have thoughts of suicide
• You have pulled away from almost everyone

• Veterans Crisis Line: dial 988 then press 1, text 838255, or chat at VeteransCrisisLine.net
• Anyone in the U.S. can call or text 988
• If a life is in danger, call 911

You don’t have to be enrolled in VA benefits or health care to use the Veterans Crisis Line.

The National Domestic Violence Hotline is free, confidential and open 24/7 at 800-799-7233. If anyone is in danger, call 911.

• Talk with a fellow combat veteran 24/7 through the Vet Center Call Center: 877-927-8387
• Apply for VA health care by phone: 877-222-8387 (weekdays, 8 a.m. to 8 p.m. ET)
• Ask your primary care provider for a mental health referral

The Veterans Crisis Line chat works from anywhere with internet, and its website lists numbers for calling from overseas. You can also find a free local helpline at findahelpline.com.