FAC T SHEET FOR PROVIDERS

A Health Campaign of Uniformed Services University, www.usuhs.edu, and theCenter for the Study of Traumatic Stress, Bethesda, Maryland, www.CSTSonline.org

The Invisible Injuries of War:Impact on Military Families and Children

This Courage to Care addresses theThe invisible injuries of service
The invisible injuries of service
vulnerabilities of children whose service
members resulting from our nation’s war
member parent suffered an invisibleon terrorism pose complex challenges
members resulting from ourinjury. This injury may include not onlyfor military families, especially militarynation’s war on terrorism pose
PTSD and mTBI, but also depression
children. With injuries such as postcomplex challenges for militaryand health risk behaviors (e.g., increased
traumatic stress disorder (PTSD) anduse of alcohol and illegal or prescription
mild traumatic brain injury (mTBI), therefamilies, especially military
medications, etc.) that are prevalent inare often dramatic changes in personality
children.
many returning service members. Healthand behavior without a change in one’s
professionals who work with military
appearance. This “injury duality” — looking
families and children should be alert to the effects ofthe same, but not acting the same — is troubling for family
these kinds of injuries on children and on parenting, asmembers, friends, and co-workers, and can be particularly
this essential component of healthy development is often
confusing for children who thrive on parental consistency,
disrupted due to the family’s injury experience.
trust, and safety.
Secondary Traumatization
Many children may develop symptoms that mirror thoseof their injured parent. An example might be a young childhaving nightmares because of their parent’s nightmares or
because they are worrying about their parent’s behavior.
A child may have trouble paying attention at school or
exhibit new behavioral problems because they are thinking
about their parent’s problems. This impact on a child dueto their worry and identification with their injured parent
is sometimes referred to as “secondary traumatization.”
A child’s symptoms can get worse if there is not a parent
who can acknowledge the effects of the parental injury andcommunicate with their children to help them feel better.
Impact of Invisible Injuries on Children
The unique nature of PTSD, mTBI, and disorders
such as depression – causing changes in personality and/or behavior without altering physical appearance — isespecially confusing for children of all ages. The following
signs and symptoms exhibited by children may indicate
distress and require professional assistance.
■ Increased acting out behaviors, such as disobedience,tantrums, or risk-taking behaviors■ Emotional distress, such as crying, increased anxiety, orwithdrawal■ Feelings of loss and grief related to the change in theinjured parent■ Feelings of isolation■ Feelings of embarrassment about the injured parents’appearance or behavior■ Misinterpreting parent mTBI-related fatigue and apathy

as indicators that the parent no longer loves them

■ Feelings of anger or resentment about new

responsibilities or changes in the family such as having
to care for younger children, or sharing in or taking on
the care of the injured parent■ Feelings of self-blame for the injured parent’s irritability

Helping Children Integrate the Parental Injury
Experience within the Family
Healthcare and family support professionals should
encourage families to:
1. Seek out resources and instrumental support. Families
may require that basic needs be met in the areas offinance, medical care, military concerns, housing,education, and child care. Children may need special
services and/or supports to address any behavioral/Continued

mental health problems that develop or to connect
them with community resources that provide themwith social support and structured activities.
2. Support and help monitor their children’s stress. As
children deal with stress, they may find it difficult toexpress emotions, relax, or calm themselves. Parents
can teach children to label and express their emotions
giving them specific strategies (e.g., deep/belly
breathing, progressive muscle relaxation, or visualizing
a safe space).
3. Share information with children about the injury in a
way they can comprehend it. Particularly important is
information that helps children understand what theinjury is, what the effects of the injury are in termsof parent functioning and/or symptoms, and what toexpect over time. Children may need reassurance thatthe injury is not their fault and that specific symptoms/
emotional changes in the parent are expected. This helps
to normalize and contextualize the family’s current

difficulties and helps children understand what ishappening in their family.
4. Develop problem solving skills and goal setting.
Particularly important is helping children identify
relevant problems, name their goals, brainstorm
possible solutions, and pick a solution to try out. Goal
setting helps families identify how they would likethings to be different, and how to monitor change.
Parents and children can select family goals together
and practice them as they plan for future challenges,
recognizing incremental improvements over time.
Resources■ Defense and Veterans Brain Injury Center		

https://dvbic.dcoe.mil/■ Military OneSource

https://www.militaryonesource.mil/

Courage to Care is a health promotion campaign of Uniformed Services University
and its Center for the Study of Traumatic Stress (CSTS). CSTS is the academic
arm and a partnering Center of the Defense Centers of Excellence 5DCoE) for
Psychological Health and Traumatic Brain Injury.

Center for the Study of Traumatic StressDepartment of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org