I have worked for 15 years treating veterans in the VA with PTSD. We have effective evidence-based PTSD treatments that significantly reduce symptoms in about 70 percent of the individuals who engage in them. And yet, in meta-analyses comparing military and civilian patients’ responses to evidence-based PTSD treatment, civilians had a significantly larger improvement than veterans, especially combat veterans (Straud et al., 2019). Additionally, after working extensively with operation forces (SOF) veterans who have experienced multiple combat tours and potentially hundreds of combat traumas, researcher Chris Frueh and colleagues (2020) observed unique symptom constellations that do not align well with PTSD criteria (Frueh et al., 2020). Emerging research has described operator syndrome as an experience that may be distinct from current diagnoses, calling for more extensive research and integrated care.

In 2020, Frueh and colleagues wrote a naturalistic observation of their assessment of over 50 special operations forces operators, coining the term "operator syndrome" to describe the widespread functional challenges they observed. A 2025 study (Adams et al., 2025) then examined 202 Special Operations Force (SOF) veterans with significant histories of combat trauma and TBI who completed a battery of assessments as part of their clinical care. The following five domains were experienced by nearly 90 percent of the participants, suggesting some possible criteria for operator syndrome:

Problems in these five domains account for nearly 70 percent of the dysfunction SOF veterans were reporting. Additionally, many SOF individuals also had endocrine dysfunction, cognitive impairments (memory and

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