Understanding PTSD in Service and Military: Why Specialised Treatment Matters

For people who spend their working lives responding to traumatic events, the expectation can be to face what happened, return home and carry on as normal. But repeated exposure to trauma can take a cumulative toll. For some, the impact builds quietly over months or years before symptoms become difficult to manage.

What does PTSD look like in first responders, veterans and defence personnel?

PTSD, or post-traumatic stress disorder, develops following exposure to trauma. However, trauma does not affect everyone in the same way.

As Dr Al Griskaitis, Consultant Psychiatrist and Director of Trauma Services at South Coast Private Hospital, explains:

“What’s traumatic to one person might not be traumatic to another person. Or something that is traumatic that didn’t seem to affect you 10 years ago might suddenly start affecting you now.”

For first responders, veterans and defence personnel, exposure to trauma can be cumulative. Police, firefighters, paramedics, defence personnel and veterans may encounter graphic, distressing or high-pressure situations repeatedly throughout their careers.

A person may continue functioning well for years before their capacity to cope begins to erode.

Common signs of PTSD can include:

• Hypervigilance – constantly scanning for danger, feeling on edge or finding it difficult to relax.
• Physical stress symptoms – increased heart rate, sweating, shakiness or persistent muscle tension.
• Intrusive memories – unwanted or distressing memories of traumatic experiences.
• Nightmares – distressing dreams that may relate to themes associated with the trauma.
• Triggers – sounds, smells, places or situations that prompt a strong emotional or physical response.
• Irritability or anger – sometimes noticed by partners, family members or colleagues before the person recognises it themselves.
• Emotional exhaustion – feeling flat, disconnected or no longer enjoying things that were once important.

Symptoms can also present through sleep difficulties, headaches, relationship problems, concentration difficulties or changes in mood and behaviour.

Dr Griskaitis describes how significant the mental and emotional fatigue can become:

“Sometimes it’s literally the mental fatigue is so bad that you just can’t concentrate. You can’t read a page of text anymore. And the emotional fatigue can be so bad that you just become extremely irritable, get angry really easily.”

Importantly, someone experiencing PTSD may not recognise their symptoms as PTSD.

“People don’t always come in saying, ‘Hey, I’ve got PTSD, doc.’ They come in, their wife might drag them in saying, ‘What the hell’s wrong with my husband? Something’s wrong with him,’” explains Dr Griskaitis.

This is why occupational and trauma history matter when assessing mental health. When someone has a history of high-trauma work and is experiencing changes in sleep, mood, relationships, concentration or behaviour, PTSD should be considered as part of the clinical picture.

Why can PTSD be different for first responders, veterans and defence personnel?

First responders, veterans and defence personnel may bring a distinctive combination of occupational culture, identity, cumulative trauma exposure and expectations around resilience to treatment.

Being resilient is an important strength. But a culture of self-reliance can also make it difficult to recognise when support is needed.

People may continue working, caring for their families and meeting their responsibilities while privately experiencing significant symptoms.

Dr Griskaitis explains:

“The problem with being very tough is you can absorb a lot of trauma over 10 years, 20 years or more. And then when the wheels kind of fall off, there’s a lot of damage that needs to be repaired.”

By the time someone seeks treatment, they may be dealing with not only PTSD symptoms, but also disrupted relationships, sleep difficulties, emotional exhaustion, occupational concerns or other mental health challenges.

Identity can also become part of the recovery process

For many people in first responder and defence roles, their occupation is closely connected to their identity and sense of purpose.

Allira Watts, Clinical Psychologist and Trauma Program Coordinator at South Coast Private Hospital, says this can create an additional challenge during recovery.

“If I’m seeking this treatment and I’m hoping to get better, and a lot of my symptoms are wrapped up in what I do for work and my identity is wrapped up in what I do for work, it can be really hard for them to navigate.”

Recovery can therefore raise difficult questions: Who am I if I can’t do this work? What does getting better mean for my career? What happens if I’m no longer the person my family or colleagues rely on?

For someone whose role is central to their sense of purpose and identity, PTSD can feel like more than a health problem. It can feel like a threat to who they are.

Shame, pride and self-reliance can also delay help-seeking, particularly for people who have spent years being the dependable person in difficult situations.

This is one reason a specialised approach can be valuable.

Why specialised PTSD treatment matters

Effective PTSD treatment is not simply about addressing a single traumatic memory. For people with a long history of occupational trauma, treatment may need to consider cumulative exposure, identity, relationships, emotional regulation, avoidance and the impact of trauma on everyday functioning.

A specialised trauma program can provide an environment where people do not have to explain the culture of their work before they can begin talking about their experiences.

Treatment may include evidence-based psychological therapies such as trauma-focused CBT or EMDR, alongside psychiatric assessment, medication where appropriate, skills development and support with broader recovery goals.

Just as importantly, treatment should recognise the person beyond the diagnosis.

Recovery does not necessarily mean returning to exactly who someone was before the trauma.

As Dr Griskaitis puts it:

“You don’t exactly go back to who you were before. You become who you’re going to become.”

That can be difficult to accept, particularly when someone's identity has been closely tied to their role. But it can also provide a different way of thinking about recovery: not as losing who you were, but as developing the skills, understanding and support needed to move forward.

Taking the first step

Seeking help can be difficult, particularly for someone who has spent years managing difficult situations independently.

A GP can be an important first point of contact for discussing changes in mood, sleep, behaviour, relationships or functioning and determining whether further assessment or treatment is appropriate.

For people who are not yet ready to make an appointment, reputable online resources can also provide information and a starting point for understanding symptoms. These may include evidence-based online psychological programs and resources specifically developed for veterans and first responders.

However, self-help resources should not replace professional assessment when symptoms are persistent, worsening or significantly affecting everyday life.

PTSD doesn't have to be carried alone

First responders, veterans and defence personnel do not need more pressure to simply “tough it out”.

They need early recognition, appropriate assessment and support from clinicians who understand the culture of their work, the impact of cumulative trauma and the complexities of identity and recovery.

Seeking help is not a sign of weakness. It is a practical decision to protect health, relationships, work and the future.

For those experiencing PTSD, specialised trauma treatment can provide a structured pathway towards recovery, with evidence-based therapy, psychiatric support, practical skills and an environment designed to understand the unique experiences of those who have served and responded to others in times of crisis. 

Listen to the full podcast: Understanding PTSD in First Responders, Veterans & Defence Personnel: Why Specialised Treatment Matters