Someone might be sent for treatment for alcohol or drug abuse or seek help for domestic issues when PTSD is the underlying problem.
If diagnosing PTSD is tough, getting people with the disorder to seek help has proved even more difficult, said Col. Charles Engel, a psychiatric epidemiologist who directs the U.S. Army's Deployment Health Clinical Center.
“The average between someone showing symptoms of PTSD and first treatment is 12 years,” Engel said. “The average service in the military is only five years. Good intentions are not enough.”
The military has tried “resilience training,” intended to prevent people from getting PTSD by teaching them how to deal with traumatic events.
Paula Schnurr, deputy executive director of the Veterans Affairs National Center for PTSD, said resilience training was a popular idea several years ago, but “we just don't have the evidence that it works.”
Prevention of PTSD remains elusive.
“That isn't the $50,000 question — it is the $50 million question,” Borja said. “We haven't found a magic preventer.”
Drugs can be effective for some people, but they don't work for everyone and can be a risky way to treat PTSD when so many patients also have some form of alcohol or drug abuse.
The most effective treatment for PTSD remains psychotherapy, preferably soon after the traumatic event is experienced, mental health professionals agree.
“Unfortunately, that's not realistic,” Borja said. “We don't have the resources to give every soldier that intense treatment. Where the field is going, is to try to predict who is likely to develop the disorder. We're just not very good at it yet.”
The military still relies on service members and their families to ask for help, which doesn't always work. The good news is that those who seek therapy from a qualified professional have a good chance at a normal life, and resources are available for those who need help.
“Recovery is possible,” Schnurr said. “We can see recovery even in Vietnam veterans who have had a lifetime of PTSD.”