Combat PTSD vs. Civilian PTSD: Understanding the Difference
When the war follows you home, understanding your unique trauma is the first step toward healing.
The alarm clock sounds at 0530, and for a split second, you're back in the FOB. You wake up in a sweat. You’re disoriented. Your heart is pounding. Slowly, reality crashes back—you're safe in your bed, not deployed. But your nervous system doesn't know that. If you're reading this, chances are you or someone you love is struggling with the invisible wounds of combat, and you're trying to make sense of why traditional approaches to PTSD treatment might not be working.
As both a specialized trauma therapist and the spouse of a Purple Heart combat veteran with PTSD, I understand this reality from two perspectives that most clinicians can't offer: the clinical expertise of years of specialized training in combat trauma, and the lived experience of loving someone whose war still has not ended. I've seen the 3 AM wake-ups, the hypervigilance at the grocery store, the convoy driving, and the exhaustion that comes from a nervous system in overdrive. I also know, as a spouse, how personal that can all feel.
Combat PTSD isn't just "regular" PTSD with a military twist; it’s a distinct constellation of symptoms, triggers, and challenges that require specialized understanding and treatment approaches. Let me walk you through what makes combat trauma different and why that difference matters for your healing journey.
The Unique Nature of Combat Trauma
Extended Exposure to Life-Threatening Situations
Unlike civilian trauma, which can involve isolated incidents, combat trauma often involves months or years of sustained exposure to life-threatening situations. Your nervous system adapted to survive in an environment where hypervigilance, quick decision-making, and aggressive responses were essential for survival.
This extended exposure creates a unique "survival mode programming." Your brain learned to operate in a constant state of threat assessment, and that programming doesn't automatically switch off when you return home. You also learned that not having this vigilance could cost you or your teammate their life. The chronic exposure to your own death, your friends’ death, and being openly targeted wherever you went recalibrates your sense of safety.
The Moral Injury Component
Combat trauma often includes moral injury—the psychological damage that occurs when you're forced to act in ways that violate your moral code, witness atrocities, or fail to prevent harm to others. This isn't addressed in traditional PTSD treatment models, but it's a crucial component of combat trauma that requires specialized attention.
Moral injury can manifest as:
Persistent guilt about actions taken or not taken
Feeling like you're fundamentally changed or "broken"
Difficulty trusting your own judgment
Questioning your worth or value as a person
Spiritual or existential crisis
The Brotherhood Factor
Military culture creates bonds that civilians often can't understand. You've shared experiences with your brothers and sisters in arms that created a level of trust and connection that's rare and forged in blood. Coming home can feel isolating because few people understand what you've been through or the intensity of those relationships.
This isolation is compounded by:
Feeling like you can't relate to civilian concerns
Missing the clear mission and purpose of military life
Grieving the loss of that brotherhood
Struggling with survivor's guilt if you lost team members
How Combat PTSD Manifests Differently
Hypervigilance in Civilian Environments
Your combat-trained awareness doesn't just turn off because you're at Target; in fact, it heightens. You automatically scan for exits, position yourself with your back to the wall, and feel uncomfortable in crowds. The vigilance serves to protect against all the people and variables you cannot control, but it is exhausting and steals from moments you’re trying to be present in.
Emotional Numbing as a Survival Strategy
In combat, emotional numbing is adaptive. You can't process the full emotional weight of what you're experiencing while you're in the middle of it. But when you come home, that same numbing that helped you survive can prevent you from connecting with your spouse, children, and civilian life.
Anger and Aggression Responses
In combat, aggressive responses can save lives. At home, that same intensity can feel overwhelming to both you and your loved ones. You might find yourself having disproportionate reactions to minor irritations, or your family might feel like they're walking on eggshells around you. What do you do when you’ve been trained to respond with violence?
Sleep Disruption and Nightmares
Combat nightmares often involve reliving specific traumatic events, but they can also include more general themes of threat, helplessness, or failing to protect others. The sleep disruption from combat trauma is often more severe and persistent than civilian PTSD because your nervous system learned to stay alert even during rest periods.
The Ripple Effect on Military Families
For Military Spouses
As a military spouse myself, I know the unique challenges you face. You've held down the home front during deployments, managed everything alone, and now you're trying to reintegrate with a partner who might feel like a stranger. You might be dealing with:
Secondary trauma from hearing about their experiences
Feeling like you're competing with their military identity
Confusion about why they can't just "snap out of it"
Your own grief about the person they were before deployment
Isolation from friends and family who don't understand
For Military Children
Children in military families face unique challenges, too. They might struggle with:
A parent who seems emotionally unavailable
Confusion about why daddy or mommy seems angry or sad
Their own anxiety about their parents' well-being
Difficulty forming secure attachments due to disrupted bonding during early deployments
Why Traditional PTSD Treatment Falls Short
Lack of Military Cultural Competency
Most civilian therapists have never served and don't understand military culture, hierarchy, or the unique bonds formed in combat. They might not grasp why "just talking about it" feels impossible when you've been trained that showing vulnerability is weakness.
Generic Treatment Approaches
Traditional PTSD treatment often uses one-size-fits-all protocols that don't account for the complexity of combat trauma. They might focus on symptom management rather than addressing the underlying moral injury, betrayal, identity issues, and cultural factors that make combat trauma unique.
Missing the Systemic Impact
Combat trauma affects the entire family system, not just the service member. Treatment that doesn't address the family dynamics and secondary trauma often fails to create lasting change.
My Approach to Combat Trauma Treatment
Specialized Training in Combat Trauma
I've invested years in specialized training in combat trauma, including intensive work like EMDR and exposure therapy specifically adapted for military populations. But more importantly, I approach this work with the understanding that comes from living it.
EMDR and Exposure Therapy
I utilize different exposure therapies, including EMDR, which are evidence-based treatments that have shown significant success with combat trauma. These approaches help your nervous system process traumatic memories without becoming overwhelmed by them.
Intensive Treatment Options
I offer 3-hour, 6-hour, and multi-day intensive sessions for rapid improvement, because sometimes the traditional 50-minute hour isn't enough to create breakthrough moments. Intensives allow us to go deeper, more quickly, and maintain momentum in your healing process.
Addressing Moral Injury
I don't just treat symptoms—I help you process the psychological injury that often accompanies combat trauma. This includes helping you:
Understand that moral injury is a normal response to abnormal situations
Develop self-compassion for difficult decisions made in impossible circumstances
Reconnect with your values and sense of purpose
Find meaning in your experiences
Understanding the Difference Matters
It's Not About Being "Tougher"
Combat trauma isn't about being weak or strong. You survived situations that would break most people. The fact that you're struggling now doesn't diminish your courage or service—it means we need to reframe what saved you, reclaim what you’ve lost, and recommit to a future that looks more hopeful, energized, and connected, while remaining the Protector.
Specialized Treatment Gets Better Results
When you work with someone who understands and lives with combat trauma, you don't have to explain why crowds feel threatening or why you can't just "get over it." You can bring your humor, wit, and authenticity into the room.
Your Family Deserves Specialized Support Too
Military spouses and children need support that acknowledges their unique experiences. I understand what it's like to love someone with combat PTSD because I live it every day.
The Path Forward
Assessment and Understanding
The first step is a comprehensive assessment that looks at your unique trauma history, symptoms, and goals. I want to understand your specific experiences and how they're affecting your life.
Customized Treatment Planning
Based on your assessment, we will develop a treatment plan that's specifically tailored to your needs.
Ongoing Support and Adjustment
Healing from combat trauma isn't linear. I provide ongoing support and adjust our approach as needed. Some days you'll feel like you're making progress, and other days you might feel like you're back at square one. That's normal, and I'm here to support you through all of it.
For the Spouses Reading This
I see you. I know you might be the one researching therapists, reading articles, and trying to figure out how to help your warrior. You're exhausted, frustrated, and maybe feeling hopeless. You might be wondering if this is just your life now.
It doesn't have to be. Combat trauma is treatable, and your marriage can heal. But it requires specialized care from someone who understands both the clinical aspects of trauma and the lived experience of loving someone with PTSD.
You deserve support, too. Secondary trauma is real, and your struggles are valid. I work with military spouses because I know how isolating and difficult this journey can be.
Taking the Next Step
If you're ready to invest in specialized treatment that addresses the unique aspects of combat trauma, I'm here to help. My practice, Rose on Rainier, specializes exclusively in working with combat veterans, special operators, first responders, and their families.
I see clients in person in Colorado Springs and provide telehealth services to 42+ states, including military SOF hotbeds like Kentucky, North Carolina, Virginia, and Florida. Whether you're stationed at Fort Carson, Peterson Space Force Base, or anywhere else in the country, I can provide the specialized care you need.
My office includes a service dog who can provide comfort to clients during difficult sessions. Sometimes the presence of a calm, accepting companion can help create the safety needed for healing.
I'm not a generalist who treats everything—I'm a specialist on combat trauma and the unique challenges facing military families. I bring clinical expertise, personal experience, and a deep understanding of military culture to every session.
This isn't about finding the cheapest option or the most convenient appointment time. This is about making an investment in your healing, your relationships, and your future. Combat trauma doesn't get better on its own, but with the right support, it can be treated effectively.
Ready to Begin?
If you're ready to work with someone who truly understands combat trauma and the unique challenges facing military families, I invite you to explore my website for more information about my services, scheduling, and investment options.
You've already shown incredible courage by serving our country. Now it's time to show that same courage in pursuing healing. You deserve specialized care that honors your service and addresses your unique needs. With the right support and treatment, you can reclaim your life and your relationships. Let's begin that journey together.
Dr. Bartel specializes in combat trauma and PTSD treatment for military service members, veterans, and their spouses and families. She provides in-person therapy in Colorado Springs and telehealth services across 42+ states.
