Service members and veterans may face some different health issues than civilians. Their families may also face some unique challenges, such as:

• Being separated from their loved ones.
• Worrying about a loved ones' safety in combat zones.
• Coping as a single parent while their partner is deployed.
• Having to move frequently.
• Helping their loved one deal with Illnesses and injuries from combat, including disabilities. This can lead to caregiver stress.
• Helping their loved one cope with the mental health effects of military service. These could include depression and post-traumatic stress disorder (PTSD).

Dealing with these challenges can be difficult. Some possible sources of help include:

• Getting support from your family and community
• Using military outreach programs, which help families feel less isolated
• Professional counseling

When a Service member deploys, a family faces change and stress. In times of war or conflict, emotions may be even higher. Learn about common challenges families face during a deployment cycle.

What Are the Effects of Deployment on Families?

Even when we are not at war, military families often deal with stresses such as frequent moves or the absence of a parent. Deployment to war creates additional issues for a family to handle.

Families face a number of challenges before, during, and after deployment. This emotional cycle of deployment begins when news of deployment is released to the family. It starts with a short period of strong emotions, such as fear and anger. As departure grows closer, a period of detachment and withdrawal may occur. This can happen to prepare for the person being physically gone.

During the deployment, family members have a range of feelings and experiences, including:

• Concern, worry, or panic
• Loneliness, sadness
• Added family duties and responsibilities
• Learning new skills, making new friends
• Fear for their Service member's safety
• Feeling overwhelmed
• Financial difficulties
• Dealing with problems on their own
• Understanding what your loved ones have been through
• Concern over being needed and loved

Children's reactions to a parent's deployment vary with each child. Reactions depend on age, maturity, and any other behavioral or mental health problems the child might have. The mental health of the at-home parent often affects the child's distress level. This is especially true for young children. If parents successfully handle the stress of deployment, their children are less likely to have mental health or behavior problems. For more information see Children Coping with Deployment.

What Happens After the Deployed Service member Returns?

Experiences during deployment have helped make your family and Service member more responsible. You have grown, but you have also faced many challenges. Remember, readjustment following deployment takes time. Even if your Service member has been called up before, you may find that new challenges arise with each reunion. Reunions can be happy and stressful. There is usually a "honeymoon" phase shortly after demobilization, but it will probably be temporary. Children have grown. Your Service member has been through traumatic experiences. You have had to face new situations in your Service member's absence. You might also feel angry because you had to handle so much on your own while they were away.

Family members at home have changed, too. You may have developed new relationships. You may be feeling pride in what you were able to accomplish while your Service member was away. For some couples, issues of infidelity may have arisen. Partners may need to talk about each other's commitment to the relationship.

Family members are affected by the common stress reactions (en Español) that occur after a Service member spends time in a war zone. Know what types of reactions to expect. These symptoms often have more to do with deployment to war than with the family, and remember that it takes time to readjust. Certain symptoms seem to have the greatest impact on relationships. The most troublesome for newer Veterans following time in Afghanistan and Iraq seem to be sleep problems, dissociative symptoms (problems with knowing who or where you are), and sexual problems. If symptoms continue, PTSD can develop and cause other problems.

Parents and other family members of Service members must make many of the same readjustments as partners. They, too, will have to realize that everybody has grown and changed. Their relationship with the returning Service member will also be different. While they take time to get reacquainted, they will need to be aware of boundaries. It's easy for parents and others who have cared for a Service member in the past to fall into old patterns. They want to take care of their loved one again in ways the person no longer needs or wants.

Impact of PTSD and Other Mental Health Problems on Families

Many Service members returning from deployment to the recent conflicts are reporting family adjustment issues. Some Veterans report shouting with, shoving, or pushing current (or former) partners. Some Veterans say that their partner or children are afraid of them.

When the common reactions to war don't get better over time, or get worse, it may indicate more serious problems. If reactions are impacting life at home, work, or school it is time to seek assistance. For more information, see Effects of PTSD on Families (en Español).

Summary

The effects of war can extend far beyond the deployed Service member. Children and families can struggle with changes resulting from an absent parent or spouse. Families can also face problems when the absent Service member returns.

The mental health of the at-home parent plays a key role in how children cope with deployment. The mental health of the returning Service member also affects the children and indeed the whole family. The needs of the entire family are important. Resources are available both within and outside VA to help families.

The children of military personnel face many challenges because of deployment to war. Kids need to understand why their parent has to leave, where they are going, and how long they will be away. If you are being deployed, take time to talk to your children about your feelings, what you do on your military job, and what you think of your job. Help them know where you will be and plan ahead to keep in touch regularly and often.

Children also need to understand what will happen when the deployed person returns home. The amount kids can understand and how they cope depends on age and how mature they are.

Protecting Children from Fear

We cannot protect our children from all that is bad. Yet we can learn to talk to our children about war. Use language that is easy to understand and does not hide the truth. Protect children from needless worries and concerns. Provide them with a sense of security and safety. Children should be assured that everything is being done to bring their loved one home safely and to protect families at home.

It is important to take the time to discuss and share our own concerns and fears. Do this with other adults, loved ones, friends or counselors, and this will help make it easier on children. Seeking social support from adults outside of the family is one way to manage our own stress. Researchers have found that parents who are able to handle upsetting, traumatic, or conflicting issues can serve as a buffer for the child.

Non-military kids

Civilian children may be concerned and feel afraid too. They may be learning about war from TV, radio, online, or from other sources like friends and school. Children may know someone who has a parent or loved one who went to war. They may be concerned for that person's safety. Parents will need to respond to these concerns. The everyday security of family life may be challenged.

Listen and watch

All parents need to take the time to listen, observe, and talk to their children about what is happening around them. This can teach children good listening and communication skills, respect and support for differing opinions, and ways to manage fears and anxieties.

Even if you prepare and talk to a child, he or she will still be affected. Look for signs of stress. If children have been through trauma in their lives or have difficulties in school or with friends, they may be particularly open to feeling any changes in their sense of safety.

The Effects of Deployment on Children

Researchers have found that children with parents who are deployed to war tend to worry more and be afraid and sad. During war, a child may feel their world is less safe and predictable. Children may fear that the parent or other loved family member who is deployed may die in the war. Even if no close family member is affected, they may still feel unsafe.

• Very young children may show fear or upset at being separated from their parent. Infants (twelve months and younger) may react to changes in their schedule, physical environment, or the caretaker's mood. They may be uninterested, refuse to eat, or even lose weight.
• Toddlers (one to three years) may sulk, cry, throw temper tantrums, or not sleep well if their caretaker is having problems or is not available.
• Preschoolers (three to six years) might think their parent was deployed because "I was bad." They may react with toileting issues, thumb sucking, sleep problems, clinginess, and separation anxiety. They may also be touchy, depressed, aggressive, or complain about aches and pains.
• Very often, preschool and school-age children also worry about the safety of the parent at home.
• School age children (six to twelve years) may perform more poorly in school. They may become moody, aggressive, or whiny. They may get stomachaches, headaches, etc.
• Teens may become angry and act out. They can also withdraw or act like they don't care about things. Adolescents may also not like new family roles and responsibilities after the deployed parent returns home.

Children may play at war, acting out both sides, and creating good outcomes where the "bad guys" are beaten. This does not mean that they are comfortable with or understand real events. Children play best and most creatively when they feel safe. When they feel real threats or the danger of losing a parent, their play is more likely to be anxious and sad. Play doesn't really give them the answers they need for their fear and worry. Children need adults who can help them work through their fears.

Teenagers may deal with anxiety by engaging in risky behaviors. Teens may be better able to understand these events, but even they will need to be assured and comforted.

Is my child okay?

Make sure you are available for your kids. Be there to listen. Parents should pay attention to how their children are playing. If games end with emotions like sadness, aggression, or worry, help the child work out more positive solutions. Above all, kids need to be sure that adults will take care of them as well as they can.

These are some things to watch for:

• Bad temper, difficulties being soothed
• Tearfulness, sadness, talking about things that scare them
• Anger toward people, picking on minority groups
• Getting irritated and fighting with others
• Changes in sleep patterns, trouble sleeping
• More clinging behaviors at home, not wanting to go to school
• Physical complaints (stomachaches, etc.)
• Wanting attention

Talk to Help Children Deal with War

Take the time to talk about war and deployment. Remember that talking can only make your family stronger. Don't ignore the subject. Do not minimize your child's concerns or stressors. Many parents would like to ignore the situation because thinking about war makes them feel vulnerable and powerless to protect their children.

Children need a real message about what is happening around them. Children are very good at knowing when things are being hidden from them. Be truthful and honest regardless of the age of your child, without overburdening him or her.

Children in different age groups will understand differently:

• Very young children are concerned with present everyday life. They need to feel safe. They are affected by the presence or absence of loved ones.
• Younger children may be confused by names of people and places that mean little to them. They may need help in forming basic ideas and understanding.
• Preteens and adolescents will be developing more abstract thinking about ideas and issues and concern for world events. They will be forming strong opinions they want recognized as their own. They may hear ideas from their peers. These ideas and feelings may be in agreement with their families' opinions or not. Yet their ideas and thoughts need to be heard and respected.

Talk about feelings

Encourage your children to freely talk about their concerns and feelings. All children want to be included in family matters. They want to be listened to and understood. They have ideas and feelings but may not know how to express them, or how to handle them. "If war is bad, why is mommy going to war?" "If war is bad, why are we doing it?" "Is killing other people ok?"

Don't be afraid to talk about your feelings, even if you are conflicted or confused. If children know adults are being honest and respectful to them, they will feel safer. Do the best you can, even when you don't know all the answers.

Make your child feel as secure as possible

Make your child feel as secure as possible without changing the facts. For example, you might say to a very young child, "War is happening in another country, far away. But you are safe here and we will take care of you." Or, "Your (dad, mom) will be serving with men and women who will do the best job possible to protect (him, her) and bring (him, her) home safely."

Provide reassurance about the future. Be hopeful about the future. "Yes these are hard times, but we are hopeful that people will be able to overcome their differences and live more peacefully in the future."

Accept different opinions

Try to look at and explain the points of view from all sides of a conflict. Teach the importance of respect and give and take. Be sure that children understand that violence is not always the best solution. Whether you are for or against war, take the time to explain how democracy works. Explain how to respect all points of view, just as in your family, each person wants their opinion to be respected and heard.

Explain why you agree or disagree with war in terms your child can understand. For example: "I don't like war, but it seems this is the best way to keep us safe," or "I understand why some people want to fight, but I believe that the only way to peace is negotiation, not violence."

Things to Do to Help Children Cope with War

• Provide extra attention, care, and physical closeness.
• Understand that they may be angry (and perhaps rightly so).
• Limit exposure to news, especially when news repeats and is violent. Younger children should be shielded from this kind of news as much as possible. It will needlessly increase their worry of events they don't understand.
• Respect your child's timing and ways of coping. Very young children may want to close their eyes or just go out and play. Don't confront children or force them to talk about things when they don't want to.
• Keep an open door for the absent parent or loved one. Talk with him or her as often as possible, and for important dates like birthdays, holidays, etc. Talk about what it will be like when that person returns and what it would be like if they were here now. This is really important for younger children who may not understand why their loved one is not here.
• Help your children develop and enjoy fun activities. Distraction can make time go by faster.
• Stick to routines and plan for upcoming events.
• Suggest positive and creative ways of coping for older children and adolescents (create scrapbooks and videos, write letters, take photos).
• Discuss things. Let kids know they can talk about how they feel. Accept how they feel and don't tell them they should not feel that way.
• Tell kids their feelings are normal. Be prepared to tell them many times.

If stress becomes too hard to handle, Military OneSource can help you locate military family support resources. For example, it may be helpful for children to talk in groups with other children whose parents are deployed.

When a family member goes to war, the impact on those left at home can be challenging. Readjusting after your Service member returns can also take time. Know that the entire cycle of deployment can be a painful and frightening time, particularly for children. Family members need to be heard without judging or criticizing what they say. People may need to just express themselves during this time. The more family members can communicate with one another, the less long-term strain there will be on the family.

Support from others is important. Spend time with people. Coping with stressful events is easier when in the company of caring friends. Ask for support from your family, friends, church, or other community group. Peer-support groups, led by spouses of deployed Service members, can be helpful. Spouses can share ideas with each other, trade childcare or other responsibilities, and encourage each other if they are feeling taxed. It is helpful to find ways you and your family can productively channel energy. Helping other families and organizing neighborhood support groups or outings can help everyone involved.

Tips for Family Members to Cope with Deployment

• Remind yourself that even though you hear regularly about deaths in the military, the vast majority of deployed troops are not harmed.
• Keep up routines. Try to stick to everyday routines. Familiar habits can be very comforting.
• Take time out for fun. Don't forget to do things that feel good to you. Take a walk, spend time with your pets, or play a game you enjoy.
• Take time to listen to each other.
• Emotions such as fear, anger, and feeling "numb" are normal and common reactions to stress. Family members need to make sure these emotions aren't turned against one another in frustration. It will help you to manage tension if you share feelings, recognize that they are normal, and realize that most family members feel the same way.
• Limit watching news media programs. Families should minimize TV, radio, and web exposure related to the war. News often uses fearful content and images to create a "story".

When children worry about war, acknowledge children's fears, and let them know that parents, teachers, and police are here to protect them. Find ways to keep the deployed member visible to the family. For example, keep out photographs of your loved one. For more information see Children Coping with Deployment.

The more caring and stable the remaining caretaker is, the less stress the children will feel. However, trying to "do it all" can lead to exhaustion. Signs of caregiver stress include feeling as though you are unable to cope, feeling constantly exhausted, or feeling as though you no longer care about anything. It is especially important for caretakers to devote time to themselves, exercise, and get plenty of rest.

Get Professional Help If Needed

When stress becomes overwhelming, don't be afraid to seek professional help. Ongoing difficulties such as exhaustion, apathy, worry, sleeplessness, bad dreams, irritability, or anger-outbursts need the attention of a professional counselor.

Use military outreach programs. Military outreach programs are in place to help families prevent social isolation. Interventions for military families are especially important for younger families and those without a prior history of deployments.

Healthy Reintegration

When your Service member safely returns home, take time to reconnect:

• Make sure that your Service member has the opportunity to spend one-on-one "downtime" with every family member and close friend.
• Provide support to your Service member to interact with others, and also spend time alone as needed. Some time with war zone comrades is good, but balance with family is also important.
• Experiment with different communication styles. Your Service member has been used to operating in the military "need-to-know" mode. They may need to relearn the importance of sharing information.
• Don't be afraid to ask about the war or how your Service member is doing. Know that they may not want to talk at first. You may have to approach talking indirectly. You can arrange activities that foster conversation instead of watching movies or television. Examples are walking together, working on a project together, or playing a game.
• Express confidence that you will be able to work things out, and make a happy home for yourselves again.

Share changes with one another. Be prepared for changing household roles and new personality traits. Talk about what skills each of you now has, and which responsibilities you'd both prefer. Compromise if necessary. Both of you should feel that needs are understood and respected.

Take care of yourself by doing healthy things to relieve stress:

• Exercise, including yoga.
• Meditate, do breathing exercises.
• Get enough sleep (8-9 hours per night).
• Drink alcohol only in moderation – it's important not to use alcohol as a way go to sleep, as it can get in the way of deeper sleep, or as a way of avoiding problems that may need to be faced. Using alcohol for these reasons tends to lead to more problems in the long run.

Things to Avoid When Talking

The habits that your Service member formed while away can make communication stressful once he or she is home. When talking with your returning Service member, try not to:

• Pressure your Service member to talk. They may never feel comfortable talking with you about what happened during their deployment. Rather than pushing them, offer options, such as talking with peers, or dealing with stress in other ways besides talking.
• Make statements that might be perceived as judgmental (for example, don't say things like, "what you had to do is so awful!").
• Stop him or her from talking.
• Tell your Service member what they "should" do.
• Use cliches or easy answers (for example, try not to say things like "war is hell" or "now that you're back, you can put it behind you"). Instead, let them know that you feel for what they went through, you love them, and you're there for them whenever they need anything.
• Give your Service member advice without listening thoroughly.
• Rush things. It takes time to get to know and feel comfortable with one another again.

Veterans who return from deployment are faced with making the transition from being a combat service member to participating in civilian life. This means making adjustments in areas such as employment, family life, and school. This readjustment can be stressful, difficult, and challenging.

Treatment for Veterans who are having readjustment difficulties includes individual and group counseling, medications, and stress management techniques.

The Department of Veterans Affairs has Vet Centers located throughout the country to assist Veterans with issues related to readjustment. These centers are specifically for combat Veterans and are staffed by professionals who are well-trained to provide the following services:

• Individual and group counseling
• Marital and family counseling
• Bereavement counseling
• Medical referrals
• Assistance in applying for VA Benefits
• Employment counseling, guidance, and referrals
• Alcohol/drug assessments, information, and referrals to community resources
• Military sexual trauma counseling and referral
• Community outreach and education

PTSD can make somebody hard to be with. Living with someone who is easily startled, has nightmares, and often avoids social situations can take a toll on the most caring family. Early research on PTSD has shown the harmful impact of PTSD on families.

This research showed that Vietnam Veterans have more marital problems and family violence. Their partners have more distress. Their children have more behavior problems than do those of Veterans without PTSD. Veterans with the most severe symptoms had families with the worst functioning.

How does PTSD have such a negative effect? It may be because those suffering with PTSD have a hard time feeling emotions. They may feel detached from others. This can cause problems in personal relationships, and may even lead to behavior problems in their children. The numbing and avoidance that occurs with PTSD is linked with lower satisfaction in parenting.

Common Reactions of Family Members

Family members of a person with PTSD may experience the following:

Sympathy

You may feel sorry for your loved one's suffering. This may help your loved one know that you sympathize with him or her. However, be careful that you are not treating him or her like a permanently disabled person. With help, he or she can feel better.

Negative feelings

PTSD can make someone seem like a different person. If you believe your family member no longer has the traits you loved, it may be hard to feel good about them. The best way to avoid negative feelings is to educate yourself about PTSD. Even if your loved one refuses treatment, you will probably benefit from some support. If you care for a family member with PTSD also see Partners of Veterans with PTSD.

Avoidance

Avoidance is one of the symptoms of PTSD. Those with PTSD avoid situations and reminders of their trauma. As a family member, you may be avoiding the same things as your loved one. Or, you may be afraid of his or her reaction to certain cues. One possible solution is to do some social activities, but let your family member stay home if he or she wishes. However, he or she might be so afraid for your safety that you also can't go out. If so, seek professional help.

Depression

This is common among family members when the person with PTSD causes feelings of pain or loss. When PTSD lasts for a long time, you may begin to lose hope that your family will ever "get back to normal."

Anger and guilt

If you feel responsible for your family member's happiness, you might feel guilty when you can't make a difference. You could also be angry if he or she can't keep a job or drinks too much, or because he or she is angry or irritable. You and your loved one must get past this anger and guilt by understanding that the feelings are no one's fault.

Health problems

Everyone's bad habits, such as drinking, smoking, and not exercising, can get worse when trying to cope with their family member's PTSD symptoms. You may also develop other health problems when you're constantly worried, angry, or depressed.

Summary

Family members may feel hurt, alienated, or discouraged because your loved one has not been able to overcome the effects of the trauma. Family members frequently devote themselves totally to those they care for and, in the process, neglect their own needs.

Social support is extremely important for preventing and helping with PTSD. It is important for family members to take care of themselves; both for their own good and to help the person dealing with PTSD.

PTSD can affect how couples get along with each other. It can also directly affect the mental health of partners.

If you need support you can:

• Get information at: VA Caregiver Support website
• Call the VA Caregiver Support Line: 1-855-260-3274

For help with talking to a Veteran about getting needed care, you can contact VA's Coaching Into Care program: 1-888-823-7458.

What Are the Most Common Relationship Problems for People with PTSD?

PTSD can affect how couples get along with each other. It can also affect the mental health of partners. In general, PTSD can have a negative effect on the whole family.

Male Veterans with PTSD are more likely to report the following problems than Veterans without PTSD:

• Marriage or relationship problems
• Parenting problems
• Poor family functioning

Most of the research on PTSD in families has been done with female partners of male Veterans. The same problems can occur, though, when the person with PTSD is female.

Effects on marriage

Compared to Veterans without PTSD, Veterans with PTSD have more marital troubles. They share less of their thoughts and feelings with their partners. They and their spouses also report more worry around intimacy issues. Sexual problems tend to be higher in combat Veterans with PTSD. Lower sexual interest may lead to lower satisfaction within the relationship.

The National Vietnam Veterans Readjustment Study (NVVRS) compared Veterans with PTSD to those without PTSD. The findings showed that Vietnam Veterans with PTSD:

• Got divorced twice as much
• Were three times more likely to divorce two or more times
• Tended to have shorter relationships

Family violence

Families of Veterans with PTSD experience more physical and verbal aggression. Such families also have more instances of family violence. Violence is committed not just by the males in the family. One research study looked at male Vietnam Veterans and their female partners. The study compared partners of Veterans with PTSD to partners of those without PTSD. Female partners of Veterans with PTSD:

• Committed more family violence than the other female partners
• Committed more family violence than their male Veteran partners with PTSD

Mental health of partners

PTSD can affect the mental health and life satisfaction of a Veteran's partner. The same research studies on Vietnam Veterans compared partners of Veterans with and without PTSD. The partners of the Vietnam Veterans with PTSD reported:

• Lower levels of happiness
• Less satisfaction in their lives
• More demoralization (discouragement)
• About half have felt "on the verge of a nervous breakdown"

These effects were not limited to females. Male partners of female Veterans with PTSD reported lower well-being and more social isolation.

Partners often say they have a hard time coping with their partner's PTSD symptoms. Partners feel stress because their own needs are not being met. They also go through physical and emotional violence. One explanation of partners' problems is secondary traumatization. This refers to the indirect impact of trauma on those close to the survivor. Another explanation is that the partner has gone through trauma just from living with a Veteran who has PTSD. For example, the risk of violence is higher in such families.

Caregiver burden

Partners have a number of challenges when living with a Veteran who has PTSD. Wives of PTSD-diagnosed Veterans tend to take on a bigger share of household tasks such as paying bills or housework. They also do more taking care of children and the extended family. Partners feel that they must take care of the Veteran and attend closely to the Veteran's problems. Partners are keenly aware of what can trigger symptoms of PTSD. They try hard to lessen the effects of those triggers.

Caregiver burden is one idea used to describe how hard it is caring for someone with an illness such as PTSD. Caregiver burden includes practical problems such as strain on the family finances. Caregiver burden also includes the emotional strain of caring for someone who is ill. In general, the worse the Veteran's PTSD symptoms, the more severe is the caregiver burden.

Why Are These Problems So Common?

The exact connection between PTSD symptoms and relationship problems is not clearly known. Some symptoms, like anger and negative changes in beliefs and feelings, may lead directly to problems in a marriage. For example, a Veteran who cannot feel love or happiness may have trouble acting in a loving way towards a spouse. Expression of emotions is part of being close to someone else. Not being able to feel your emotions can lead to problems making and keeping close relationships. Numbing can get in the way of intimacy.

Help for Partners of Veterans with PTSD

The first step for partners of Veterans with PTSD is to gather information. This helps give you a better understanding of PTSD and its impact on families. Resources on the National Center for PTSD website may be useful.

Some effective strategies for treatment include:

• Education for the whole family about the effects of trauma on survivors and their families
• Support groups for both partners and Veterans
• Individual therapy for both partners and Veterans
• Couples or family counseling

VA has taken note of the research showing the negative impact of PTSD on families. PTSD programs and Vet Centers have begun to offer group, couples, and individual counseling for family members of Veterans.

Overall, the message for partners is that problems are common when living with a Veteran who has been through trauma. The treatment options listed above may be useful to partners as they search for better family relationships and mental health.

As a parent with PTSD, you may find that your children respond to you differently. They may not understand the changes and symptoms they see. Learn about common ways children respond to a parent's PTSD and read tips about how you can help them cope better.

How Might a Parent's PTSD Symptoms Affect His or Her Children?

PTSD includes a range of symptoms that can have an effect on family members. The following are some examples of how certain kinds of PTSD symptoms can affect children.

Re-experiencing symptoms

People who have PTSD often "re-experience" traumatic events through memories or dreams. This can happen quickly and can seem to come out of nowhere. These symptoms often come with strong feelings of grief, guilt, fear, or anger. Sometimes the experience can be so strong that you may think the trauma is happening again. These symptoms can be scary not only for you but also for your children. Children may not understand what is happening or why it is happening. They may worry about their parent or worry that the parent cannot take care of them.

Avoidance and numbing symptoms

Because the re-experiencing symptoms are so upsetting, people with PTSD try not to think about the event. If you have PTSD, you may also try to avoid places and things that remind you of the trauma. Or you may not feel like doing things that used to be fun, like going to the movies or your child's event. It can also be hard for people with PTSD to have good feelings. You may feel "cut off" from family and children. As a result, children may feel that the parent with PTSD does not care about them.

Hyperarousal symptoms

People with PTSD tend to be anxious and "on edge." With PTSD, you might have trouble sleeping or paying attention. You might be grouchy or angry much of the time. You may be easily scared, or overly worried about your safety or the safety of your loved ones. It is easy to see how these problems can affect family members. For example, acting grouchy can make a parent seem mean or angry. Since they do not understand the symptoms of PTSD, children may wonder whether the parent loves them.

How Do Children Respond?

A parent's PTSD symptoms are directly linked to their child's responses. Children usually respond in certain ways:

• A child might feel and behave just like their parent as a way of trying to connect with the parent. The child might show some of the same symptoms as the parent with PTSD.
• A child may take on the adult role to fill in for the parent with PTSD. The child acts too grown-up for his or her age.
• Some children do not get help with their feelings. This can lead to problems at school, sadness, anxiety (worry, fear), and relationship problems later in life.

Children of Veterans with PTSD

Social and behavior problems

Some research shows that children of Veterans with PTSD are more likely to have problems with behaviors and school and problems getting along with others. Their parents see them as more sad, anxious, aggressive, and hyper than children of Veterans who do not have PTSD. Some research has also found that PTSD in a parent is related to violence in the home and to children acting violent. But it is important to note that most Veterans have homes without violence.

Emotional problems and secondary traumatization

Some children of combat Veterans with PTSD are more sad and anxious than children of non-combat Veterans who do not have PTSD. Although not common, children may start to have symptoms like the ones the parent has. For example, a child may have nightmares about the parent's trauma.

Children may have PTSD symptoms related to watching their parent's symptoms. For example, a child might have trouble paying attention at school because she is thinking about her parent's problems. The impact of a parent's PTSD symptoms on a child is sometimes called "secondary traumatization.”

Since violence occurs in some homes in which a parent has PTSD, the children may also develop their own PTSD symptoms related to the violence. A child's PTSD symptoms can get worse if there is not a parent who can help the child feel better.

Problems may continue into teenage years

Teenage children of Veterans with PTSD can also be affected by their parent's symptoms. One research study compared teens of non-Veteran fathers to those with Vietnam combat Veteran fathers. The teens of the Vietnam combat Veterans showed worse attitudes toward school and toward their fathers. They were more sad and anxious and were less creative. Their mothers also rated them as having more problem behaviors.

However, their behavior at school and their social functioning looked like the children of non-Veterans. This might be because the fathers in this study were not actually diagnosed with PTSD. Overall, teens' problems are much more likely when the parent Veteran has mental health issues, such as PTSD.

Can Children Get PTSD from Their Parents?

Although not common, it is possible for children to show signs of PTSD because they are upset by their parent's symptoms. Trauma symptoms can also be passed from parent to child or between generations. This is called "intergenerational transmission of trauma." This has been seen in the families of WWII Holocaust survivors. It is also seen in the families of combat Veterans with PTSD. Here is how it happens:

• When a family silences a child, or teaches him to not talk about disturbing events, thoughts, or feelings, the child's anxiety gets worse. He may start to worry about causing the parent's symptoms if he talks about the trauma. He may create his own ideas about what happened to the parent, which can be worse than what actually happened.
• Sometimes parents share too many full details about the events. Children then can start to experience their own set of PTSD symptoms in response to these terrible images.
• A child may begin to share in her parent's symptoms as a way to connect with the parent.
• Children may also repeat or re-do some aspect of the trauma because they see that their parent has difficulty separating the past trauma from the present moment.

How Can I Help?

Parents can help children by using the information provided on this page along with other resources. Parents or professionals can talk to family members about the possible impact of a parent's PTSD on children. It can help for family members to learn how traumatic reactions can be passed from parent to child.

A good first step in helping children cope with a parent's PTSD is to explain the reasons for the parent's difficulties. Be careful not to share too many details of the event(s) with the child. How much you say depends on your child's age and maturity level. It is important to help children see that your symptoms are not their fault. Some parents want help with what to say to their children, and a counselor could help with this.

Treatment options

There are also many treatment options. Treatment can include individual treatment for the Veteran or adult with PTSD as well as family therapy. Family therapy supports the parent with PTSD and teaches family members how to get their own needs met.

Children may benefit from their own therapy as well, which might differ based on the child's age. Each family is different, and decisions about what kind of treatment to seek, if any, can be hard. The most important thing is to help each member of the family, including the children, say what he or she needs.

Military service includes risks, even for those who do not deploy to combat zones. It may be hard for Veterans to adjust after service, and you may not know how to talk about it. Learn some tips and resources to help you get a Veteran access to care and services.

What Is It Like After Service?

Leaving military service can be planned (like retirement) or it may be sudden, for example, if a service member gets injured. The transition out of service can be hard for anyone, even if it is what the person wants. If you notice a difference in a Veteran after service, it might be worth talking to them about what they are experiencing.

"Normal" is different for everyone, but there are signs a Veteran you care about may need help. Some examples are sleep problems, feeling down or depressed, becoming angry easily or always being on edge, difficulties at work or school, problems with relationships, excessive drinking or drug use, or reckless driving.

We Know Each Other So Well. Why Can't We Seem to Talk about This?

It can be hard to tell someone that you think they need help. It can be difficult to say what you mean if you are worried. Also, it can be hard for someone to listen if they are anxious, nervous or even angry.

What Can I Do or Say to Support Them Getting Help?

Mental health care is helpful only if a service member or Veteran makes that decision for themself. Someone can accept making changes only when they truly feel there is a choice. Here are some tips for you to make it easier for a Veteran you care about to get help:

• Express your support or concern. Try saying, "I know things are not going how you like right now, but know that I'd like to help."
• Set a time to talk about your concerns so your loved one feels prepared.
• Bring up your concerns and then find another time to talk again, instead of trying to resolve everything at once.
• You don't need to ask about what happened to support a Veteran. If you do not have military experience, you can say something like, "I'm sure you went through things while serving that would be hard for me to understand, so maybe talking to someone at the VA or a Vet Center might help?"
• "Demanding" someone seek help can backfire, making them less likely to go for help.
• Avoid using threatening language or making ultimatums. Try not to say, "You need to go for help, or else." But it is okay to let someone know how their behavior is affecting you.
• Talk about choices. You can say, "I know it's your call whether you go to see somebody, but if there's something I can do to help, let me know."

When someone has PTSD, it can change family life. The person with PTSD may act differently and get angry easily. Your loved one may not want to do things you used to enjoy together.

You may feel scared and frustrated about the changes you see in your loved one. You also may feel angry about what's happening to your family, or wonder if things will ever go back to the way they were. These feelings and worries are common for people who have a family member with PTSD.

It is important to learn about PTSD so you can understand why it happened, how it is treated, and what you can do to help. You also need to make time to take care of yourself. Changes in family life are stressful, and taking care of yourself will make it easier to cope.

How Can I Help?

You may feel helpless, but there are many things you can do. Nobody expects you to have all the answers.

Here are ways you can help:

• Learn as much as you can about PTSD. Knowing how PTSD affects people may help you understand what your family member is going through. The more you know, the better you and your family can handle PTSD.
• Offer to go to doctor visits with your family member. You can help keep track of medicine and therapy, and you can be there for support.
• Tell your loved one you want to listen and that you also understand if it's not the right time to talk.
• Plan family activities together, like having dinner or going to a movie.
• Take a walk, go for a bike ride, or do some other physical activity together. Exercise is important for health and helps clear your mind.
• Encourage contact with family and close friends. A support system will help your loved one get through difficult changes and stressful times.

Your family member may not want your help. If this happens, keep in mind that withdrawal — or pulling away — can be a symptom of PTSD. A person who withdraws may not feel like talking, taking part in group activities, or being around other people. Give your loved one space, but also say that you will be ready to help at another time.

How Can I Deal with Anger or Violent Behavior?

Your family member may feel angry about many things. Anger is a normal reaction to trauma, but it can hurt relationships and make it hard to think clearly. Anger also can be frightening.

If anger leads to violent behavior or abuse, it's dangerous. Go to a safe place and call for help right away. Make sure children are in a safe place as well.

Set a time-out system

It's hard to talk to someone who is angry. One thing you can do is set up a time-out system. This helps you find a way to talk even while angry. Here are some tips on how to do this:

• Agree that either of you can call a time-out at any time.
• Agree that when someone calls a time-out, the discussion must stop right then.
• Decide on a signal you will use to call a time-out. The signal can be a word that you say or a hand signal.
• Agree to tell each other where you will be and what you will be doing during the time-out. Tell each other what time you will come back.

While you are taking a time-out, don't focus on how angry you feel. Instead, think calmly about how you will talk things over and solve the problem.

After a time-out

• Take turns talking about solutions to the problem. Listen without interrupting.
• Use statements starting with "I," such as "I think" or "I feel." Using "you" statements can sound accusing.
• Be open to each other's ideas. Don't criticize each other.
• Focus on things you both think will work. It's likely you will both have good ideas.
• Together, agree which solutions you will use.

How Can I Communicate Better?

You and your family may have trouble talking about feelings, worries, and everyday problems. Here are some ways to communicate better:

• Be clear and to the point.
• Be positive. Blame and negative talk won't help the situation.
• Be a good listener. Don't argue or interrupt. Repeat what you hear to make sure you understand, and ask questions if you need to know more.
• Put your feelings into words. Your loved one may not know you are sad or frustrated unless you are clear about your feelings.
• Help your family member put feelings into words. Ask, "Are you feeling angry? Sad? Worried?"
• Ask how you can help.
• Don't give advice unless you are asked.

If your family is having a lot of trouble talking things over, consider trying family therapy. Family therapy is a type of counseling that includes your whole family. A therapist helps you and your family communicate, maintain good relationships, and cope with tough emotions.

During therapy, each person can talk about how a problem is affecting the family. Family therapy can help family members understand and cope with PTSD.

Your health professional or a religious or social services organization can help you find a family therapist who specializes in PTSD.

How Can I Take Care of Myself?

Helping someone with PTSD can be hard on you. You may have your own feelings of fear and anger about the trauma. You may feel guilty because you wish your family member would just forget all the problems and get on with life. You may feel confused or frustrated because your loved one has changed, and you may worry that your family life will never get back to normal.

All of this can drain you. It can affect your health and make it hard for you to help your loved one. If you're not careful, you may get sick yourself, become depressed, or burn out and stop helping your loved one.

To help yourself, you need to take care of yourself and have other people help you.

Tips to care for yourself

• Don't feel guilty or feel that you should know it all. Remind yourself that nobody has all the answers. It's normal to feel helpless at times.
• Don't feel bad if things change slowly. You cannot change anyone. People must change themselves.
• Take care of your physical and mental health. If you feel yourself getting sick or often feel sad and hopeless, see your doctor.
• Don't give up your outside life. Make time for activities and hobbies you enjoy. Continue to see your friends.
• Take time to be by yourself. Find a quiet place to gather your thoughts and "recharge."
• Get regular exercise, even just a few minutes a day. Exercise is a healthy way to deal with stress.
• Eat healthy foods. When you are busy, it may seem easier to eat fast food than to prepare healthy meals. But healthy foods will give you more energy to carry you through the day.
• Remember the good things. It's easy to get weighed down by worry and stress. But don't forget to see and celebrate the good things that happen to you and your family.

Get Help

During difficult times, it is important to have people in your life who you can depend on. These people are your support network. They can help you with everyday jobs, like taking a child to school, or by giving you love and understanding.

You may get support from:

• Family members
• Friends, coworkers, and neighbors
• Members of your religious or spiritual group
• Support groups
• Doctors and other health professionals

It is not always clear how to help someone manage grief. You may have to make choices about how to offer support to someone after a loss. Learn about factors that may affect your options and some ways you can be there for someone who is grieving.

Strategies for Offering Support

When you reach out to help someone who is grieving a loss, a number of things can affect your choices. These factors can include the amount of time that has passed since the loss, your personality, the grieving person's personality, the nature of your relationship, your past experiences, and the amount of time and energy you may have to be of support. Supporting someone who is grieving a death resulting from a disaster or public health crisis presents its own challenges, perhaps making it difficult to physically be together. Here are a few strategies that may be helpful:

Let the person know you are there for them

Sometimes friends, family, and coworkers can disappear after a loss. They may not know what to say, worry they will say the wrong thing or overstep, fear causing more pain, feel somehow guilty about the death, or fear they can't do enough to make the grieving person feel better. Some people may see a person drowning in sorrow and then worry that they will be dragged under too. Don't let these doubts and fears get in the way of reaching out to let the person know you care. Even people who have endured the worst suffering often can benefit from an expression of caring, or from practical assistance, being included in activities, or a simple conversation.

Know what is most helpful

Two things people in pain commonly want to know are that they're not "crazy" to feel the way they do, and that they have support. Those who are grieving don't expect you to "fix" their pain but do need to know that you are with them in their suffering. You can say something like, "I know you have to be hurting, and maybe you don't know what will happen next, and neither do I. But you won't go through this alone. I will be there with you."

Particularly if you are not close to the person, it may be tempting to quickly say, "I'm sorry for your loss," or offer platitudes—or common statements—like, "It's going to be okay," which can leave a person wondering, "How do you know it is going to be okay?" of saying, "You will get through this," which may be hard for the person to believe under the circumstances, let them know that you're in it with them, by saying something like, "We're here for you, whatever you need." Or you can send text messages, emails or cards with the message: "You are not alone," "I'm thinking of you," or, "We're here for you."

A survey of people who were grieving studied what they felt was helpful and what was not, particularly soon after a loss. Helpful support included direct expressions of empathy, willingness to talk about the deceased (including saying their name), offers of practical support, asking about the impact of the death, and acknowledgement of the difficulty of the situation. Less appreciated were a casual or passive attitude, statements that the death was in any way for the best or acceptable (e.g., "It was their time to go," "It's God's will"), avoiding talking about the death or the person who died, and assumptions that the bereaved person was strong and could get through grief period. If the grieving person expresses these thoughts, you can respectfully acknowledge the feeling or thought, but don't begin with statements like these yourself.

Be sincerely interested and caring

Be an "opener." Openers are people who ask questions and listen to the answers without judging. They are naturally curious and enjoy learning about and feeling connected to others. In helping others through grief, the most effective openers don't always have to be the closest of friends. Openers can make a big difference in times of crisis, especially for those who are normally reserved, or worried about being a "burden" on others by starting conversations about their feelings.

When asking questions, it's important to convey sincere interest or your questions may come across as insincere. Simply asking, with real feeling, "How are you today?" shows that you are aware that a person may be struggling to get through their day. It also shows understanding that the most intense levels of grief might not be constant or permanent.

Offer empathy

If you do not feel comfortable asking questions or starting a conversation with the grieving person, you could send a text message with something simple like, "I know I can't possibly know what you're going through, but I'm here for you. I've been thinking about you." Offer empathy with the message that the person is not alone. If you have been through a similar loss, you might let the person know, without sharing too much of your own story at first but offering to talk more if it would help.

Offer a menu of options for support

Rather than making assumptions about whether the person wants to talk, offer a menu of options and see if they take any of them. Simply showing up can make a huge difference. Say, "I'm here if you ever want to talk—now, later, even in the middle of the night. Whatever would help you." You can let the person know that if they need you, they can call any time. Just knowing it's an option may be enough for the person to feel better, even if they never take you up on the offer.

Often, you might sincerely ask, "Is there anything I can do?" but the person does not have an answer. The question may make the person feel as if they should know what they need, even if they don't. Or, they might know of things that would be helpful but feel that it would be too much to ask of you. It may be more helpful for you to offer some practical or supportive action. Rather than offering to do "anything," offer to do something specific—like mowing the lawn, picking up family, holding the person's hand, or bringing food. Or you can just make the choice to do something for the person but give them some measure of control in the process. Specific acts help because instead of trying to fix the problem, they free up the person to have more time to grieve in their own way.

Most importantly, show up over and over, and make it clear that you will be there when the person needs you.

Be genuine and reliable

Grieving can come in waves and last a long time. Continue to check in with the person regularly. Make it clear that you truly want to help, so they don't feel like a burden. Convey the message, "I'm checking in because I care about you. I just want to let you know that I'm here." Or find ways to spend time with them without the need for talking. Caring for someone in this way means that when they are hurting, you cannot imagine being anywhere else.

Many who are grieving find that they really appreciate contact months later, when most interest has dropped off. This is especially true on anniversaries, birthdays, or holidays that remind them of their loss. A text, call, card, or email can be a much-needed reminder that even over time, they are not alone.

As the worst of the grief fades, the person may feel the need to restore balance in their friendships, so they don't feel one-sided. They may want those close to them to know they are there to help carry their troubles too. Make sure you allow this shift and let them offer help or assistance in other ways, so that they benefit from feeling like they have something to contribute to the friendship.

Be sensitive to unique factors that affect the person

There's no one way to grieve and there's no one way to comfort. And what helps a person one day might not help that person the next day. When someone is suffering, instead of following the Golden Rule, follow the Platinum Rule, which is: treat others as they want to be treated. The person who is grieving may worry about stigma and feel less able to talk openly as a result. They may experience anger, lower functioning, or illness. Try to avoid judgment. Take your cues from the person and respond with understanding or action that meets their needs.

Help challenge the person

Some people might need to be reminded that, though grieving, they still need to set and achieve goals at work, school, or in other areas of their lives. Challenging someone could backfire, but if you know the person well enough, encouragement like this might provide a needed jolt of confidence. A gentle reminder that they could fail by failing to try may help. You may also challenge them to reach out for more formal help from a mental health professional, mentor, or clergy member, if they are experiencing a significant amount of emotional pain or struggling to function for an extended period of time.