Despite the diversity of the U.S. military members who have served in Afghanistan and Iraq, there still exists a popular misconception of the returning vet as the Marlboro man, a stoic figure wrestling alone with the after-effects of combat. After nearly a decade of providing mental health services to veterans, service members and their families, I know nothing is farther from the truth. Our returning service members are a reflection of the society they serve — male, female, young, old, representing every profession, personality type and ethnic group imaginable. They are us.

And their mental health struggles are ours as well. Of the 2.6 million men and women who have served in Iraq and Afghanistan since 2001, some 20-35 percent will suffer some form of post-traumatic stress (PTS). In treating this population and their affected family members, we must also work from facts and avoid misconceptions. It is also important to differentiate between post-traumatic stress and the more commonly-known disorder PTSD. Post-traumatic stress is an understandable reaction to the horror of war or rape or surviving a natural disaster. It develops into a disorder if those suffering don’t get the support and assistance they need. While we have all read headlines about returning veterans who have “snapped,” it is critical to understand that violence is not a symptom of post-traumatic stress. Those who make national news, or any news at all, are the extreme minority. With post-traumatic stress, there is most commonly the wish to get away from stimulation, to numb, to shut down, to avoid others. There may be depression, anxiety, listlessness, an inability to concentrate, and bad dreams, all of which can interfere with healthy relationships, enjoying kids and partners and engaging in the workplace.

So how do we understand the relationship between post-traumatic stress and domestic violence? The answer is carefully, with great awareness and compassion. I have seen many individuals with PTS who do not engage in aggressive or violent behavior — they suffer and isolate themselves. Post-traumatic stress does not directly cause domestic violence, but it can create conditions that may contribute to domestic violence. Risk factors include irritability, agitation, hyper-vigilance, a flattening of affect, so the person doesn’t feel much of anything, including empathy for loved ones. In addition, the experience of post-traumatic stress can lead some sufferers to self-medicate using alcohol or drugs (prescription or illegal) which results in poor impulse control and poor judgment. Post-traumatic stress places a person at greater risk for many things, including dysfunctional and destructive behavior.

And that affects our collective mental health. When you consider the family members of our returning service members, there are millions of Americans directly affected by combat half a world away. They live in our communities, and they need community-based support. Too often we are uncomfortable, we are too busy, and we think “it doesn’t affect me personally.” It’s easy to turn the other way. But given the millions of veterans, service members and their family members who need — and deserve — mental health care, it’s not a real option. That’s one reason I created Give An Hour ( — to provide free, confidential mental health services to military personnel and their families. Since 2005, more than 6,700 mental health professionals have joined the Give an Hour network and are providing free mental health services across the country. Collectively, our providers have now donated over 82,000 hours — valued at approximately $8 million — of care and support to those who have given so much to our nation.

You don’t have to be a mental health expert to make a difference. So often when it comes to mental health issues or partner violence, people suffering will say, “No one wanted to hear, no one tuned in, people turned the other way.” We are uncomfortable, afraid, and so we don’t do anything. All of us have experiences, painful aspects of relationships we try to keep shoved in a corner in a box. Talking is not only good for potential victims, but it’s empowering for us. It leads to our own mental health improvement.

Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.

Need help? In the U.S., call 1-800-799-SAFE (7233) for the National Domestic Violence Hotline.

Dr. Barbara Van Dahlen is a Washington, D.C.-area psychologist who founded Give An Hour, a private non-profit group that pairs volunteer mental-health professionals with U.S. military personnel back from war.

For more by Barbara Van Dahlen, Ph.D., click here.

For more on PTSD, click here.