When PTSD shows up years later

A major review found that about a quarter of PTSD cases were delayed. The authors concluded that delayed PTSD usually represents earlier symptoms getting worse, rather than something appearing from nothing.

A study of veterans in VA primary care found the same thing: PTSD that started with no earlier symptoms long after the trauma was very rare.

Many veterans spend years busy with jobs, kids and responsibilities. Staying busy all the time so memories can’t catch up is a common form of avoidance. When life slows down, what was held back can come forward.

VA says PTSD symptoms can be long-lasting, can go up and down over time, and can return after earlier treatment. A return of symptoms doesn’t mean earlier care failed. It means you may need support again.

Military combat exposure was one of the factors linked with higher rates of delayed PTSD across studies. Among veterans with delayed PTSD in VA primary care, most had been through several traumas, and most of those traumas were combat-related.

Retirement and doing fewer activities can leave more unstructured time, which can make symptoms more noticeable. In a study of 562 older combat veterans, late-life combat memories and stress were closely linked with worries about retirement.

Health problems, pain and reduced mobility become more common with age and often occur alongside PTSD. Feeling physically vulnerable, or ending up in a hospital, can echo old feelings of danger and helplessness.

VA reviews of veteran suicides found that pain, sleep problems, more health problems and recent declines in physical ability were among the most common risk factors. That is why these changes deserve attention and care.

Losing a spouse, partner, family members or friends can bring sadness and loneliness. Losing fellow veterans can also bring back memories of those lost in service.

News coverage of war can bring back your own military experiences, especially when it closely mirrors what you went through. VA suggests limiting TV news and taking breaks when you notice anger, worry or low mood.

Distress around the anniversary of a trauma is common, and emotionally powerful symbols and veteran gatherings can bring symptoms back. Most people feel better within a week or two after the date.

Quiet time and reflection in later life can bring back unwanted memories. Researchers describe older veterans revisiting wartime experiences as they look back on their lives, often trying to make sense of them.

In a study of 562 older combat veterans, this pattern was more closely tied to worries about retirement, and less tied to depression and anxiety, than PTSD was. It seemed closer to milder, below-threshold symptoms than to full PTSD.

In 2016 the researchers broadened the idea and renamed it “later-adulthood trauma reengagement”. They suggest that aging challenges, like role changes, losses and physical decline, can prompt veterans to revisit wartime memories.

Many veterans rework these memories to find meaning and feel more whole. The researchers see this as a chance to support healthy aging, not only a problem.

Revisiting memories can lead to peace and meaning, or it can bring more distress. If memories bring more nightmares, low mood, drinking or pulling away, that is a sign to get support.

Trouble sleeping and dreams about what happened are common reactions after trauma. Poor sleep then makes mood and memory harder to manage.

Feeling irritable, hopeless, guilty or numb, or being easily startled, can all be reactions to trauma, even old trauma. Families may notice these changes before the veteran does.

Using more alcohol, drugs or tobacco, and avoiding people or reminders, are common after trauma. They can feel like relief, but they usually make things worse over time.

In the Vietnam veterans study, about a third of those with current war-zone PTSD also had major depression. Health problems and pain often travel with PTSD too, so it is easy to miss.

Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) and EMDR have the most research support. They usually take about 8 to 16 sessions.

If getting to appointments is difficult, ask your provider whether video visits (telehealth) are an option.

Health problems and pain often come alongside PTSD in later life. Telling every provider about all your conditions helps your care fit together.

• Call someone you trust
• Keep your eyes open and look around you
• Remind yourself: “This is a memory. I am safe now.”
• Say where you are and today’s date

PTSD Coach is a free app with coping tools and symptom tracking. VA also publishes a free booklet, “Understanding PTSD and Aging”. AboutFace shares video stories from veterans who got help.

VA suggests social support, staying connected, and volunteer or group activities for older adults with PTSD. Pleasant, active days give the mind something besides memories to hold onto.

Some veterans write about their service, or record it for their family. The Library of Congress Veterans History Project preserves firsthand stories of U.S. veterans, gathered by volunteers, families and communities.

Families may have wondered for years about changes they saw. Sharing even a little, without graphic details, can help them understand and feel closer.

Looking back can bring up guilt or shame about things you did, saw or couldn’t stop. Guilt and shame are common reactions after trauma, and they can ease with support.

Things you could say

• “I know things are hard right now, and I’d like to help.”
• “I may not understand what you went through. A Vet Center counselor might.”
• “It’s your call. I’m here however you want me to be.”

What to avoid

• Demanding that they get help
• Threats or ultimatums

Peer support groups can help veterans feel less alone and practice talking about hard experiences. They are not a replacement for treatment. The Vet Center Call Center (877-927-8387) connects you with a fellow combat veteran, 24/7.

VA has Caregiver Support Program teams at each VA medical center, and a National Caregiver Support Line at 1-855-260-3274.

Vet Centers offer individual, group, marriage and family counseling at no cost to eligible veterans, service members and their families, including help with PTSD.

You can apply for VA health care online or by phone at 877-222-8387 (Monday to Friday, 8 a.m. to 8 p.m. ET).

You may qualify for VA disability benefits for PTSD if the stressor happened during your service and a doctor has diagnosed you with PTSD. Combat, fear of hostile activity and serving in an imminent danger area are among the stressors VA lists.

An accredited Veterans Service Organization (VSO) representative can help you gather evidence and file, and their help on VA claims is always free.

• Drinking more, or using drugs to cope
• Feeling hopeless, or thinking about death or suicide
• Memories or nightmares that won’t ease
• Pulling away from family and friends
• Reactions that get in the way of relationships or daily life

• 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.

• Talk with a fellow combat veteran 24/7: Vet Center Call Center, 877-927-8387
• Apply for VA health care: 877-222-8387 (weekdays)
• Ask your primary care provider about a mental health check

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.