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

The Impact of Invisible Injuries:
Helping Your Family and Children

The injuries of war change the lives ofinvisible injuries, unlike those that areTheinjuries
ofwarchangeservice members, families, and children.
visible (e.g., loss of limb, burns), do not
Invisible injuries such as post traumatic
invite the same level of support fromthe lives of service members,
stress disorder (PTSD) or mild traumatic
outsiders who may not even realize
families, and children.
brain injury (mTBI) can be especiallysomeone has a medical problem. The
difficult for families because they often
isolation caused by invisible injuries
result in significant changes in personality and behavior
creates additional stress for families and children.
without changes in one’s appearance. A service member
This fact sheet addresses the impact of the invisible
with PTSD or mTBI may have mood swings, or certain
injuries of war on military families and children, andenvironments may trigger responses that do not seem
provides some action steps that families can take toappropriate to the situation. These kinds of events can be
manage the challenges of dealing with a parental injury
especially troubling for children, and embarrassing forthat is not visible to the outside world.
the family. While injuries cannot be compared or judged,Children’s Reactions to Parental Injuries such as PTSD
and mTBI
Many children may start to have symptoms that mirror
the symptoms of their injured parent. An example might
be a young child having nightmares because of theirparent’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 due to their worry and identification
with their injured parent is sometimes referred to as“secondary traumatization.” A child’s symptoms can getworse if there is not a parent who can acknowledge theeffects of the parental injury and communicate with theirchildren to help them feel better.
If children show some of the signs and symptoms
below, they may be in distress and need professionalattention.
■ 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 parent’sappearance or behavior■ Misinterpreting parent fatigue and withdrawal 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

What Families Can Do to Help their Children
Understand the Injury and Cope
It is important for families to:
1. Seek out resources and instrumental support. Basic needsof families may be compromised due to the injury, andneed to be addressed in areas such as finance, medicalcare, military concerns, housing, education, and childcare.
Children may need special services and/or supports toaddress behavioral/mental health problems that may
develop or to connect them with community resources(e.g., sports organizations, educational programs, or
Boy/Girl Scouts) that provide them with social supportand structured activities.
Continued

2. Support children by helping them monitor changes orextremes in their emotional states. As children deal withstress, they may find it difficult to express emotions, torelax, or calm themselves. Parents can help children byteaching them to label and express their emotions andby giving them specific strategies (such as deep/ belly
breathing, muscle relaxation, or visualizing a safe space)for dealing with strong emotions and/or stress.
3. Share information with children about the injury ina way they can understand. 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.
4. Discuss the injury as a family and with others in thecommunity, including health care providers, in order toaccess resources or appropriate health care treatment.
Children should be encouraged to ask questions
about the injury among family members and withmedical providers, and they should be encouraged
to talk about the injury with people they trust (e.g.,other family members, close friends, and/or teachers).
Age-appropriate information should be provided tochildren and they should be encouraged to talk about
what they experiencing and feeling.
5. Help children develop problem solving skills and engage
in cooperative goal setting. Goal setting helps familiesidentify how they would like things to be different
and how to monitor change. Parents and children canselect family goals together and practice them as theyplan 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) forPsychological Health and Traumatic Brain Injury.

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