The Purple Heart is one of the most respected military honors in the United States Armed Forces. Originally introduced as the Badge of Military Merit by George Washington during the American Revolutionary War, this medal is awarded to United States Army, United States Navy, United States Marine Corps, United States Air Force, United States Coast Guard, United States Space Force, and National Guard members who have been wounded or killed in action. Receiving this military medal represents courage, sacrifice, and dedication to one’s country.

But while the Purple Heart honors physical injuries, many veterans carry emotional and psychological wounds that awards can’t reveal. These invisible wounds—including post-traumatic stress disorder ( PTSD), moral injury, major depressive disorder, and anxiety disorder—often linger long after physical injuries have healed.

This blog explores the psychological aftermath of combat trauma among Purple Heart recipients. It highlights the importance of recognizing and treating mental health challenges through support from a mental health professional. Not all wounds are visible, but every soldier deserves to heal—inside and out.

What does it mean to be a Purple Heart recipient?

Purple Heart recipients are honored for enduring physical injuries during war. These injuries include gunshot wounds, burns, or traumatic brain injuries—visible marks of extreme courage. However, the scars of combat go beyond the surface.

Psychological wounds like moral injury, mental disorder, and combat stress reaction can develop due to the horrors of battle. The trauma of violence, assault, or witnessing death can result in flashbacks, nightmares, and deep emotional suffering. These mental health conditions don’t appear on medical scans, yet they inflict long-term pain.

Friends and family often cannot see these internal wounds. Veterans may mask their suffering due to social stigma or fear of judgment. Left untreated, these wounds may lead to mental health conditions like substance abuse, suicidal ideation.

Institutions like the National Purple Heart Hall of Honor, Purple Heart Foundation, and Military Order of the Purple Heart help raise awareness, but getting support and treatment from health professionals is vital to addressing the complex psychological effects of combat. Access to trained clinicians, psychiatrists, and mental health professionals ensures that veterans receive evidence-based care—ranging from medication and counseling to trauma-informed therapies—that can help them manage symptoms, regain stability, and rebuild their lives with dignity and hope.

What is post-traumatic stress disorder (PTSD)?

PTSD is a mental illness caused by going through really traumatic events—the kind that shake you to your core. For many veterans, it’s often triggered by combat, sexual abuse, military sexual trauma, or surviving something as terrifying as an ambush. These experiences can overwhelm your brain’s natural ability to handle fear, emotion, and memory, making it hard to feel safe, even long after the trauma ends.

Sometimes PTSD shows up right away, but it can also take years to surface. And when it does, it can impact everything—your relationships, how you sleep, how you think, and even how you react to the world around you.

The American Psychiatric Association recognizes PTSD as a serious, diagnosable mental health condition. PTSD isn’t about being weak—it’s a real disease tied to changes in neurotransmitter activity, like serotonin, norepinephrine, and cortisol. These stress hormones affect the amygdala, prefrontal cortex, and hippocampus—parts of the brain that help control fear, regulate emotion, and store memories.

Researchers continue to learn more about PTSD through epidemiology, neuroscience, and clinical trials, and that knowledge helps guide better treatment every day.

How can you tell if you have PTSD? 

If you’re a veteran who’s constantly on edge, struggling with insomnia, avoiding reminders of war, or feeling emotionally numb, you might be dealing with PTSD—a form of acute stress reaction. It’s important to know this isn’t a sign of weakness. These symptoms are your body’s way of coping with overwhelming stress hormones like cortisol and norepinephrine, which flood your system after going through trauma.

That fight-or-flight response is meant to protect you, but when your body stays stuck in that survival mode long after the danger is gone, it can start to take a toll. Simple things like a crowded grocery store or the sound of fireworks can suddenly feel like real threats, triggering anxiety, panic, or even flashbacks.

Over time, PTSD can actually change how your brain works. Areas like the amygdala, which processes fear, and the prefrontal cortex, which helps with decision-making and behavior, can become overactive or underactive. These changes don’t just affect how you feel—they can affect how you live. But understanding what’s happening inside your brain is the first step toward healing.

What happens when PTSD is triggered? 

Triggers—such as loud noises, the smell of burning fuel, or even a sudden movement—can activate the brain’s fight-or-flight response. This can cause hypervigilance, vivid flashbacks, panic attacks, or emotional shutdowns, forcing the veteran to relive the trauma as if it were happening in real time. These episodes are not just memories; they are visceral, terrifying, and deeply rooted in the veteran’s nervous system.

What are the symptoms of PTSD?

Hypervigilance

Constantly scanning the environment for threats, feeling unable to relax.

Nightmares

Disturbing dreams that replay the trauma or generate feelings of helplessness and fear.

Emotional numbness

An inability to feel joy, connection, or love; often leads to detachment from family, community, or social networks.

Avoidance

Steering clear of places, people, conversations, or even news coverage that remind you of the trauma.

Irritability and aggression

Sudden anger outbursts, difficulty concentrating, and a short temper can strain relationships and affect job performance.

What is the difference between moral injury and PTSD?

Moral injury refers to the spiritual and emotional suffering caused by actions that violate one’s moral code. 

It is a distinct psychological wound that often arises during military service, particularly among infantry, sergeants, and other military personnel who are placed in complex, high-stakes environments where split-second decisions can have life-or-death consequences. This trauma is rooted in ethical dilemmas faced during service moments when actions taken or witnessed deeply conflict with a person’s fundamental beliefs, values, or sense of right and wrong.

Examples include killing civilians, failing to stop a preventable tragedy, or experiencing betrayal by trusted leadership. These morally compromising experiences can result in profound shame, guilt, and a loss of faith in one’s values, unit, or mission. For many, this type of trauma isn’t about what was done to them, but about what they were forced to do—or failed to do—under extreme pressure. The inner conflict that follows can feel isolating, confusing, and overwhelming.

Unlike PTSD, which involves fear-based symptoms such as hypervigilance, flashbacks, and nightmares, moral injury centers on an intense internal conflict. The distress is not always visible but can run just as deep. It may also increase the risk factor for depression, alcohol and substance abuse, suicidal ideation, and spiritual crisis. Over time, this can lead to mental health conditions like major depressive disorder, adjustment disorder, or even personality disorder, especially when left unaddressed.

Scholars like Jonathan Shay, who coined the term, and veterans like Ron Kovic, author of Born on the Fourth of July, have contributed significantly to the understanding of this condition through research, literature, and public advocacy. Their work has helped to differentiate moral injury from other mental disorders, and has pushed for tailored interventions.

Yet, despite increased awareness, many veterans remain silent about their moral pain. Due to social alienation, bias, and enduring stigma, they may fear being misunderstood by civilians or even their fellow soldiers. As a result, moral injury often goes unreported, untreated, and unspoken—creating a hidden burden that weighs heavily on the soul.

Recognizing moral injury as a legitimate and serious consequence of war is crucial. Addressing it through therapy and trauma-informed care can provide a path toward forgiveness, understanding, and healing.

Anxiety and depression in Purple Heart recipients

Years of military service—especially during wars like Vietnam, Iraq, or Afghanistan—can lead to lasting mental distress. Anxiety disorder and major depressive disorder (MDD) often develop among Purple Heart recipients after returning home, but for some veterans, the seeds of these disorders may already be present long before deployment.

Many service members enter the United States Armed Forces with prior life experiences that make them more vulnerable to developing mental health conditions. These can include childhood trauma, exposure to domestic violence, sexual abuse, neglect, or even a family history of mental illness. The intense psychological and physical demands of combat may not create these conditions from scratch, but instead, they may act as a catalyst, exacerbating or unmasking underlying vulnerabilities. The repeated exposure to violence, the constant state of alert, and the moral complexities of battle intensify existing emotional wounds, making recovery more difficult.

These conditions can stem from survivor’s guilt, unresolved grief, and ethically painful experiences that lead to moral injury. Depression impairs cognition, affects mood, and causes fatigue, anhedonia (loss of interest in things once enjoyed), and amnesia. Anxiety may cause phobia, increased heart rate, panic attacks, sleep disturbances, and constant hyper-alertness, which can feel like never leaving the battlefield, even in civilian life.

Without timely intervention by a mental health professional, these disorders often worsen over time. Untreated, they increase the likelihood of homelessness, suicide, and breakdowns in community and family structures. Veterans may also turn to substance abuse, including alcohol or drugs, as a way to numb emotional pain, which introduces further health, legal, and social consequences.

Understanding that anxiety and depression can emerge from both pre-existing risk factors and the trauma of war is vital for building effective treatment strategies. Support through psychiatry, psychotherapy, and community-based programs—especially when trauma-informed—can help veterans regain control, improve quality of life, and rebuild relationships with themselves and others.

Stigma of mental health in the military

Within the United States Armed Forces, there is a deeply rooted code of conduct built around strength, discipline, and control. Service members are trained to endure extreme conditions without complaint, which often makes acknowledging emotional pain feel like a violation of military identity. As a result, veterans may avoid discussing mental health issues out of fear of appearing weak, being misunderstood, or risking changes to their military discharge status.

This silence is further reinforced by the misunderstanding from civilians and lingering outdated military norms that continue to prioritize stoicism over vulnerability. Many people—including some veterans themselves—are unfamiliar with clinical terms like psychotraumatology, prolonged grief disorder, or adjustment disorder, which can lead to misdiagnosis, social alienation, and internalized shame.

Thankfully, resources are expanding. National programs like 988, crisis intervention teams, and support from chaplains, caregivers, or social workers are designed to offer safe, confidential spaces where veterans can begin to speak openly about their experiences. Encouraging dialogue, building peer support networks, and increasing recognition by organizations such as the American Psychological Association are essential steps toward breaking the silence and eliminating stigma. Every veteran deserves the chance to heal without fear of judgment or retribution.

Therapy and trauma-informed care for veterans

Healing starts with compassionate, informed care. For veterans, that often means more than just standard treatment—it requires an approach that recognizes the deep and complex impact of trauma. Trauma-informed therapy is a framework that considers each veteran’s unique history, emotional needs, and potential triggers. Rather than asking, “What’s wrong with you?” this approach asks, “What happened to you?”

Trauma-informed care emphasizes safety, trustworthiness, choice, collaboration, and empowerment. It avoids re-traumatization by ensuring that therapeutic environments are supportive, predictable, and respectful. Clinicians trained in this model are sensitive to the effects of combat, moral injury, military sexual trauma, and mental distress, adapting treatments to meet each veteran where they are.

Effective therapies include:

Exposure therapy and desensitization, which gradually reduce fear by confronting painful memories in a controlled way

Cognitive Behavioral Therapy (CBT), which helps identify and change unhelpful thought patterns

Eye Movement Desensitization and Reprocessing (EMDR), which aids in processing traumatic memories

Complementary practices like exercise, yoga, and art therapy can also help build psychological resilience, regulate stress hormones like cortisol, and improve overall well-being.

When care is trauma-informed, veterans are more likely to feel understood, respected, and empowered to begin their healing journey.

Support and healing with Pacific Health Group

If you or someone you love is living with invisible wounds, know you’re not alone—and help is available.

At Pacific Health Group, we offer compassionate, trauma-informed care designed specifically for veterans. Our team of experienced mental health professionals provides specialized treatment for PTSD, moral injury, and major depressive disorder. Whether you’re seeking individual therapy, family support, or couples counseling, we tailor our services to meet your unique needs, with convenient telehealth options available for flexible access to care.

Call us today at 1-877-811-1217 or visit www.mypacifichealth.com to take the first step toward recovery.