Ask the Expert - Brian Klassen, PhD: What Are the Top Reasons People in the Military Develop PTSD?

What are the primary reason veterans and service members develop PTSD? Dr. Klassen, an expert on mental health issues and treatment, says that, to date, there is no one concrete formula outlining the primary reasons why people develop PTSD, and there may never be. PTSD is a complex condition and affects each person differently based on many factors such as an individual’s genetics, early-life experiences, traumas in combat, culture, and coping mechanisms among others.

Brian Klassen, PhD, is the Clinical Director of the Road Home Program, part of the Wounded Warrior Project's Warrior Care Network.

For information about treatments for PTSD please visit The Treatment Hub.

Hi, I’m Dr. Brian Klassen. I’m a clinical psychologist and here’s our question: “There seem to be so many mysteries and variables around PTSD. What are the top four reasons why people in the military get PTSD?”

This is a great question because I think as the question indicates, there are a lot of variables, there are a lot of mysteries around PTSD. And I think to be completely honest with you, I don't know that the scientific community has really agreed yet on a sort of concrete formula or concrete way to answer this question. I also don't know that there ever will be because I think people are so complex.

The situations they encounter are so complex that when a person develops PTSD, it’s usually a mixture of like their genetics, their early life experiences, the particular trauma that they’ve experienced, sort of the aftermath or their coping with the trauma afterwards, as well as things like culture, as well as things like their social environment - and I could go on.

So, you kind of get the idea; there’s a lot of layers to this sort of seemingly, I think, very simple and very valid question of like “why would someone develop PTSD or not develop PTSD?” I think particularly in the military, though, what we do know is that combat is a major reason that people develop PTSD.

And, you know, I think an interesting development in the past few years is that the mental health community and the scientific community have been very interested in breaking apart different experiences in combat that can sort of result in PTSD. So, I think oftentimes people think about kind of the classic firefight or an improvised explosive device, or IED sort of exploding in a convoy. And that these are very kind of classic, sort of fear-based scenarios, right? And that PTSD is a disorder of fear. Somebody is trying to kill you or harm you and this makes you afraid and anxious. Right?

That certainly happens all the time in combat, but I think what we’re starting to see more and more, especially with the most recent conflicts and really kind of talking with veterans of those conflicts and their stories, is that there are some other nuances as well. One of those nuances is traumatic loss. Right?

And so I think while firefights, bombs exploding, people trying to kill you, can certainly result in PTSD, the other thing that often does result in PTSD and that many, many veterans and service members are struggling with, is the sudden violent death of someone in their unit, someone that they were close with.

And I’ve been doing this work long enough to know that many veterans have stories of their friends being hit by a sniper next to them, or, you know, just the way the roster worked is they were in the vehicle that got hit by the bomb when the veteran was supposed to be in that vehicle or something like that. And just that kind of survivor’s guilt, that sense of like :I wish it was me instead” I think is very pervasive, and can also contribute to what I see as PTSD.

Another nuance is this idea of moral injury and that there are many experiences in modern combat scenarios that are ethically very murky. Right? And I think this is just the nature of a protracted kind of occupation that we’re dealing with now, where there’s not sort of uniformed militaries going up against each other, but it’s a sort of uniformed military occupying another country, where there’s a lot of insurgent kind of terrorist activity, that often involves people that aren’t traditionally combatants, like women and children.

And so, I think a lot of the stories that I’m hearing from veterans are stories about some very intense guilt and shame about things that they did or things that they saw that really violated the core of like who they were and what they thought was right.

So things like shooting when you shouldn’t have shot or not shooting when you should have shot. Or, you know, kind of, “I should have spoken up when I saw that something was wrong.” Or “I saw my unit doing something or taking things too far with somebody, like an insurgent, that we had captured, and I didn’t say anything about it.”

And so these aren’t classically thought of as traumas, but I’m here to tell you that they absolutely are and they can result in PTSD just like the classic sort of fear-based traumas. The other thing I’ll say too is, a major reason that people in the military get PTSD is from this group of experiences that we term military sexual trauma which we know is rampant in the military.

And I think recent statistics are, I think one in four women, one in 100 men, have experienced military sexual trauma, which can be sort of coerced sex, sexual assault, rape, kind of protracted sexual harassment. That these are things also that can result in PTSD.

And I think what’s really difficult is that these things often happen on deployment as well. So, you may have somebody exposed to combat and military sexual trauma in the same deployment. And so, I think the common thread through all of these traumas is that they’re done by other people, too, which is, I think, the particularly difficult part is, trauma can mean a lot of different things. It could mean a natural disaster, it could mean a car accident, it could mean sort of a workplace accident, or it could mean combat, it could mean a sexual assault. And combat and sexual assaults have a very different meaning because they’re done to someone by another person.

And so, kind of wrapped up in that, there’s issues of safety, there’s issues of trust. I think many veterans after experiencing difficulties in combat and with military sexual trauma, often wonder are they to blame for what happened as well? And it’s just not, sort of not to gloss over the trauma of natural disasters or accidents, but it’s the meaning of those things is just not the same for combat, for military sexual trauma, for things people encounter in the military.

We also know, through some very good research that’s been done on service men and women who deployed in support of Operation Iraqi Freedom and Operation Enduring Freedom, that about 20 percent of those  military personnel do develop PTSD. And so, it’s a large problem that I think we have to kind of respond to with the best we can in terms of clinical care, in terms of the science, in order to help these men and women find some relief and reconnect with their families and reconnect with their communities. And it’s an excellent question and thank you so much for asking it.

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Posted on BrainLine October 12, 2021. Reviewed October 12, 2021.

About the author: Brian Klassen, PhD

Brian Klassen, Ph.D., is the Clinical Director for The Road Home Program: The National Center of Excellence for Veterans and Their Families at Rush University in Chicago, Illinois. Brian spent his formative years training at the Jesse Brown VA Medical Center, completing rotations in chronic pain management, residential substance use disorder treatment, and PTSD. Brian has special expertise in providing front-line treatments for PTSD, including Prolonged Exposure and Cognitive Processing Therapy.

Headshot of Dr. Brian Klassen