Examination of the Top Three Traumatic Experiences Among United States Service Members and Veterans with Combat-Related Posttraumatic Stress Disorder

Many trauma-focused psychotherapies for posttraumatic stress disorder (PTSD) focus on the most distressing trauma. However, military personnel are often exposed to multiple traumatic experiences. This study aimed to evaluate and categorize the top three traumatic experiences identified by United States (U.S.) military service members seeking treatment for PTSD and compare frequency of trauma types by demographic/military characteristics. Active duty service members and veterans (N = 110) with PTSD identified and ranked their top three most distressing experiences. Behavioral health professionals classified experiences according to one categorical and four dichotomous classification schemes. The categorical scheme included life threat to self, life threat to others, aftermath of violence, traumatic loss, moral injury by self, and moral injury by others. The Life Threat to Self classification represented the largest portion of categorical experiences (43%). Most experiences were dichotomously classified as military-related (86%), combat-related (70%), non-sexual (91%), and trainability (versus futility; 71%). Women were more likely to report sexual traumatic experiences and less likely to report military- and combat-related experiences. Military occupational specialty, number of deployments, time in military, active duty status, and marital status were also associated with different classification rates. There was noteworthy variability in types of experience across top three traumas, especially among certain subpopulations.