For many who serve in our military, trauma experienced during deployment doesn’t end when they return home. Post-traumatic stress disorder is disturbingly common among veterans, particularly those who saw combat. For some, the disorder increases their risk of engaging in criminal behavior— and landing behind bars.
But emerging science may have an answer. Researchers may soon be able to use indicators in the body to test for PTSD in much the same way doctors check for the flu. These biomarkers could help us identify people at high risk, craft prevention strategies and fine tune treatments in ways conventional approaches cannot.
Such advancements could be transformational, reducing suffering among veterans and minimizing the odds that untreated PTSD will lead some to commit crimes. But progress requires expanded research of biomarkers and a commitment by clinicians to track innovations and integrate them into patient care.
In my work directing a PTSD treatment program at UCLA, I’ve seen how traumatic episodes can damage service — and the families to whom they return. PTSD symptoms range from re-experiencing the traumatic event to aggression, impulsivity, hypervigilance, fear and depression.
Roughly 8% of male veterans and 13% of females have PTSD, compared to 3% of male civilians and 8% of females. Among those who served in combat, PTSD prevalence may be as high as 29%. As of 2023, 1.5 million of the nation’s estimated 18.1 million veterans were receiving compensation for service-related PTSD.
Veterans with PTSD are more at risk of substance abuse, self-harm and suicide. They are also 61% more likely to end up in the justice system — and 59% more likely to be arrested for violent crimes —than those without PTSD.
Standard treatments relying on psychotherapy and medication can be a lifeline, but their effectiveness is uneven. Biomarkers, which include a wide range of measurable characteristics of the body’s biological processes, offer new hope.
Currently, clinicians seeking to diagnose PTSD must rely largely on their own judgment and patients’ self-reported symptoms. This approach is complicated and can create uncertainty. In addition, the stigma associated with mental health challenges in the military leads veterans to underreport symptoms.
A report from the Council on Criminal Justice Veterans Justice Commission, on which I serve, spotlights the dramatic potential of biomarkers. Its conclusion: Identifying biomarkers associated with PTSD would allow clinicians to test a patient for the disorder using saliva, blood or another marker in the same way doctors test patients for the flu.
With that in our toolbox, we could identify service at high risk for PTSD before they even deploy. Biomarkers could also help us develop prevention strategies and perhaps match patients to medications that prove most effective for them, reducing adverse effects.
Despite substantial effort, scientists have yet to identify clinically actionable biomarkers for PTSD. One hurdle is that patients can experience broad variation in symptoms. Many also face complicating mental health issues, along with medical and substance abuse problems that make it harder to pinpoint biomarkers.
But we do have promising leads. Levels of stress hormones, like cortisol, are getting increased attention from researchers, as are biomarkers like specific genes, neurotransmitters and the body’s physiological responses to trauma.
To unravel what roles these biomarkers may play, we need more research. Genetic studies involving large groups of patients can shed light on how genes and environmental factors contribute to the onset of PTSD. And machine learning, which permits the processing of vast scientific datasets, could yield breakthroughs by analyzing the interplay among multiple biomarkers.
The payoff could be profound, not just for those whose service inflicts trauma that can haunt them for life, but for communities victimized when PTSD causes veterans to break the law. At the very least, biomarkers can help undo harmful perceptions of PTSD as a character weakness, rather than an often devastating disorder that science is allowing us to better identify, understand and treat.
We certainly owe our veterans that.
Sornborger is a clinical psychologist and executive director of UCLA’s Operation Mend, which provides surgical and psychological care for veterans and their families. She serves on the Council on Criminal Justice’s Veterans Justice Commission and lives in Los Angeles.
