Honor, Courage, and Commitment: Institutional Betrayal and Military Identity in Veterans with Posttraumatic Stress Disorder

Military veterans diagnosed with posttraumatic stress disorder (PTSD) experience elevated suicide risk and face unique treatment barriers; however, few studies have examined the role of military-specific constructs in shaping these barriers. This quantitative-correlational study investigated the relationship between institutional betrayal, self-stigma, military identity, and help-seeking attitudes among a sample of U.S. military veterans with PTSD (N = 142). This study also applied semi-qualitative questions to explore military-related trauma themes, PTSD literacy, neuroplasticity, PTSD perceptions, and military acknowledgment. Statistical analysis using SPSS revealed significant positive correlations between institutional betrayal and self-stigma, and a negative relationship with help-seeking attitudes. Notably, the Department of Veterans Affairs (VA) was viewed as an extension of the military, and as such, institutional betrayal and its relationship to help-seeking attitudes became apparent. No significant relationship was found between institutional betrayal and military identity; however, military identity was inversely associated with self-stigma. Qualitative responses contextualized these findings based on six primary military-related trauma themes that emerged, including combat, military sexual trauma, non-combat deployment-related trauma, military-related casualty-bereavement, physical assault, and other military trauma-related experiences. Military acknowledgment of trauma was identified as an important and positive response to all trauma themes. Lastly, most participants expressed interest in learning more about PTSD as a neurobiological adaptation, rather than a purely psychological disorder, indicating an openness to psychoeducation. These results suggest that addressing perceived institutional betrayal and enhancing PTSD literacy may help reduce self-stigma and promote treatment engagement among veterans. Findings offer practical implications for clinicians, policymakers, and veteran-serving institutions.