The Body Keeps the Uniform: PTSD and Biology in Veterans

10-05-2025

By Dr. Howard Friedman MD | Veteran | U.S. Army Medical Corps | Internal Medicine | HHOM LLC

The battle doesn’t end when the uniform comes off. PTSD lives in biology — in hormones, nerves, and sleep — just as much as in memory. Veterans carry their service in body and spirit, and true healing begins when we recognize both. — Dr. Howard Friedman, M.D.

The battle ends, yet not inside,

in cells and nerves the echoes hide.

The body wears what memory knows,

a uniform the spirit shows.

----Dr Howard Friedman, M.D.

Thesis

PTSD is too often misunderstood as “just in the mind.” In truth, it is written into the body as much as memory. Stress hormones, inflammation, and sleep disruption reshape biology, leaving scars no less real than those on the skin. For veterans, this truth matters: their struggles are not weakness, but the body’s imprint of service.

Introduction – Beyond the Mind

When service ends, the battlefield doesn’t always fade. PTSD lingers not only in memory but in muscle tension, heart rhythms, digestion, and immune defenses. Biology becomes the second battlefield. Veterans often describe fatigue, illness, and pain without realizing that their nervous system, hormones, and mitochondria are carrying the trauma as faithfully as the mind.

The Stress Hormone Loop

In PTSD, cortisol and adrenaline remain high long after danger has passed. This “fight-or-flight” chemistry sharpens survival in combat, but over time it batters the body. Elevated stress hormones damage blood vessels, impair memory, and weaken immunity. It is why veterans with PTSD face higher rates of hypertension, diabetes, and cardiovascular disease.

The HPA Axis – Biology of a Memory

At the core of PTSD lies the hypothalamic-pituitary-adrenal (HPA) axis, the body’s central stress-response system. Under threat, the hypothalamus signals the pituitary to release ACTH, which drives the adrenal glands to flood the body with cortisol and adrenaline. In combat, this cascade saves lives.

In PTSD, the HPA axis does not turn off. Cortisol remains high, damaging blood vessels, impairing sleep, and disrupting metabolism. Worse, the brain’s memory centers — the hippocampus, amygdala, and prefrontal cortex — are reshaped by this chemical storm:

• The amygdala becomes hyperactive, firing fear circuits at minor triggers.

• The hippocampus, which normally helps distinguish past from present, shrinks under chronic cortisol exposure.

• The prefrontal cortex, the rational “braking system,” loses its ability to calm the amygdala.

The result: a brain that cannot let go of trauma. A sound, a smell, or a flash of memory can unleash the same cascade as if the battlefield were still present. PTSD memories are not just stories — they are biological imprints.

The Many Faces of PTSD

No two veterans carry trauma the same way. Symptoms differ, yet the isolation often feels the same.

• Emotional Symptoms: nightmares, flashbacks, avoidance, guilt, shame, hyper-vigilance.

• Biological Symptoms: high blood pressure, chronic pain, digestive problems, headaches, inflammation.

• Hidden Symptoms: brain fog, memory lapses, irritability, a loss of joy in daily life.

Combat is not the only cause. Military sexual trauma, moral injury, accidents, and even years of cumulative stress can write the same story in the body. If you recognize one of these symptoms in yourself — you are not alone.

Numbing the Flame – Alcohol, Cannabis, and Suppression

Alcohol and cannabis are common tools veterans reach for when symptoms feel overwhelming. A drink slows racing thoughts; a joint blunts hyper-vigilance. Relief arrives — but only for a moment.

• Alcohol disrupts REM sleep, the very stage when the brain processes trauma. Instead of healing, the trauma cycle strengthens.

• Cannabis can calm anxiety in the short-term, but heavy use blunts memory consolidation and prevents emotional processing.

  
  

But it is not only substances. Suppression itself — the instinct to push emotions down, to appear unshaken, to “soldier on” — carries its own damage. When grief, anger, or fear are buried instead of expressed, they do not vanish. They fester, reemerging as rage, depression, or illness years later. The body cannot hold trauma in storage forever.

Veterans are often taught suppression as survival — on the battlefield it keeps focus sharp and emotions in check. But in peacetime, suppression turns against the body. Elevated cortisol persists, sleep fractures, and inflammation climbs. Trauma silenced is trauma sustained.

True healing requires integration, not suppression. The nervous system only resets when memories are processed and released, not when they are drowned, dulled, or hidden.

Sleep as a Casualty

One of the most devastating effects of PTSD is fractured sleep. Nightmares, vigilance, and intrusive memories rob the body of its repair cycles. Veterans often wake more exhausted than when they went to bed. Without restorative sleep, the brain cannot reprocess trauma, and the body cannot heal.

The Path Toward Healing

Biology cuts both ways. Just as trauma reshapes the body, healing practices can begin to restore it. Consistent sleep, structured exercise, nutrition that fuels cellular repair, and therapies that integrate rather than suppress trauma all help the nervous system recalibrate. Substances may numb, but only processing allows biology to reset.

The body keeps what service gave,

in bone and breath, both scar and wave.

The flame endures through shadowed years

and healing waits beyond the fears.

Not drowned, not dulled, not buried away

—but faced, released, to light the day.

---Dr. Howard Friedman, M.D.

—Dr. Howard Friedman, M.D.

Board-Certified | Internal Medicine | Veteran | U.S. Army Medical Corps

Founder of Howard’s House of Medicine (HHOM LLC)

https://www.hhomllc.com

Frequently Asked Questions:

Q: Is PTSD just a psychological condition?

A: No. PTSD is not only “in the mind.” It leaves measurable biological marks — changes in cortisol, adrenaline, sleep cycles, immune function, and even brain structure. The body records trauma as clearly as memory does.

Q: Why do veterans with PTSD often have health problems like high blood pressure or diabetes?

A: Chronic stress hormones from an overactive HPA axis damage blood vessels, disrupt metabolism, and weaken immunity. This is why veterans with PTSD have higher rates of hypertension, cardiovascular disease, and metabolic disorders.

Q: Can suppression or alcohol actually make PTSD worse?

A: Yes. While alcohol, cannabis, or emotional suppression may bring temporary relief, they prevent the nervous system from processing trauma. This keeps cortisol elevated, fractures sleep, and fuels inflammation — prolonging suffering instead of resolving it.