As a combat veteran, you have lived through events that most people can't understand. You and your friends were in danger. Life in the war zone was very different from life at home. Your daily routine could be interrupted by intensely stressful and chaotic events. In fact, you've likely been in or seen life-threatening situations. And you had to hide your feelings and reactions to stress. Now you're home. Even though you're safe, something's not right. You're having nightmares. Or unwanted memories of combat are popping into your head unexpectedly, sometimes set off by a sound or smell. You may feel anxious, angry, scared, guilty, or isolated. And the feelings won't go away. These are signs of posttraumatic stress disorder (PTSD).

PTSD is a state of heightened fear and anxiety. It develops after a traumatic, life-threatening event. It's normal to react to danger with fear and anxiety. But these feelings should fade after the danger has passed. With PTSD, your body and mind have trouble recovering from the trauma. The feeling that you're in danger can last for months or even years. Military combat is a common cause of PTSD.

Symptoms of PTSD last more than a month. They may include:

• Unwanted or intense memories of a trauma.
• Nightmares.
• Vivid memories (flashbacks) that make you feel like you're reliving the event.
• Feeling worried, fearful, anxious, or suspicious.
• Strong reactions when you're reminded of the trauma (or sometimes for no obvious reason at all).
• Intrusive thoughts about combat, death, or killing.
• Feeling disconnected or isolated, as if you're “not yourself.”
• Loss of interest in things you once enjoyed. You may hold in your emotions and feel numb.
• Feeling agitated, tense, on edge, or easily startled.
• Bursts of anger or irritation.
• Problems concentrating.
• Trouble falling or staying asleep.

With PTSD, things that remind you of the traumatic event can make you feel as if you're in danger again. These reminders are called triggers. They bring back memories, emotions, and physical reactions related to the trauma. In some cases, a trigger is obvious. The sound of thunder may recall gunfire. Or you may see debris on the side of the road and suddenly flash to a roadside bomb. Other times, the link is less clear. For example, a trigger could be the taste or smell of food that was common where you were deployed. Hearing a voice that sounds like someone you served with can trigger memories. Triggers can even appear in your dreams, causing you to react while you're asleep.

Though you're safe now, PTSD can make you feel as if you're in danger. When your brain senses danger, your body acts before you have time to think. When you encounter a trigger, you may suddenly become angry or afraid. Your body is flooded with anxiety and adrenaline. You may react very quickly. You may not even remember the trigger. This can lead to outbursts and behaviors that seem to have come “out of the blue.” When you have PTSD, you may:

• Stay away from triggers, such as people, places, and things that remind you of the trauma.
• React strongly to reminders of the trauma (such as TV news reports about war or conversations with others in the military).
• Constantly scan your surroundings for signs of danger.
• Put yourself at risk with sudden reactions to a perceived threat (such as veering to stay away from an overpass while driving).
• Abuse alcohol or drugs so you don't think about the trauma (self-medicating).
• Change your routine to avoid triggers.

You may think that asking for help is a sign of weakness. In fact, taking action to make your life better takes a lot of courage. Talking about a trauma can be hard, but it can make a big difference. The main treatment for PTSD is counseling. You'll work with a trained professional (therapist) to learn new ways to cope with your experiences. Medicine may also be prescribed to help with anxiety, depression, or sleep. Most people with PTSD benefit from a combination of counseling and medicine.

Counseling is done in a safe environment, either one-on-one or in a group. Group therapy is often done with other veterans who have been through combat. PTSD is often treated with one or more of the following forms of counseling. Talk to your doctor about your choices so you can decide on a counseling format that works for you.

• Cognitive processing therapy (CPT) helps you cope with negative thoughts related to the trauma. You'll work with a therapist to better understand how you think and feel about what happened. And you'll learn skills to help you cope better with the trauma. CPT won't make you forget about what happened. But it can make the memories easier to live with.
• Prolonged exposure therapy (PE) helps you deal with thoughts and situations related to the trauma in new ways. You'll learn breathing and relaxation methods to calm yourself when you encounter triggers. With your therapist's help, you may enter situations that remind you of the trauma (in vivo exposure). You'll learn to reduce your reactions over time. This can help with avoidance. You'll also talk about the trauma to help you gain control over how you think and feel about it (imaginal exposure).
• Other therapies for PTSD include:
  • Coping skills training.
  • Acceptance and commitment training.
  • Eye movement desensitization and reprocessing (EMDR).
  • Family counseling.
  • PTSD psychoeducation.

In combat, you've been through significant, life-changing events. These will likely affect you to some degree for the rest of your life. Even so, getting help is a big step in the right direction. Treatment will be tough, and healing takes time. Be patient with yourself. Though many people can't relate to your time in combat, you don't have to face PTSD alone. Accept help and support from your family, friends, and doctors. And stay connected with friends from the military. There are likely more people who can understand what you've been through than you think.

For more information and resources, contact the Veterans Crisis Line at 800-273-8255 or online at www.veteranscrisisline.net. You can also text 838255 for support. You don't have be enrolled in VA benefits or health care to connect to this support.

Ask for help now. There are many ways to ease your pain and manage the problems in your life. Talk to your doctor, your Veterans Administration (VA) suicide prevention coordinator, or a friend or family member right away. Don't wait.

If you have a plan or are thinking of harming yourself, call 988 and press 1 to connect to the Veterans Crisis Line. Or text 838255 from your mobile phone. You will be connected to trained crisis counselors who will help you. An online chat is also available at www.veteranscrisisline.net. The Veterans Crisis Line is free and available 24/7.