Combat Stress: A Natural Result of Heavy Mental and Emotional Work

Combat stress (sometimes called combat and operational stress or combat and operational stress reaction) is a common response to the mental and emotional effort service members exercise when facing tough and dangerous situations. Simply put, combat stress is similar to the muscle fatigue and soreness experienced after a tough physical workout. The way your brain handles combat stress can be compared to the way your body may handle a physical workout; it all depends on your level of fitness/training.¹ [1]

Combat stress is not an illness and may be experienced by any service member during both peace and war, due to stressful conditions during training, deployment, humanitarian missions, government support missions and other assignments.² [2]

Recognizing Combat Stress: The brain is like a muscle. How can you tell when your mind is fatigued?

Not long after a new workout, your arms and legs may be so sore, you can barely perform everyday tasks without discomfort. You may soak in a warm bath or opt for a massage to ease the soreness. The signs are easy to spot because the physical pain is there.

Some signs and symptoms of combat stress may be harder to detect. Combat stress can cause problems with the way you think and respond to emotions. You may experience changes in your behavior, and sometimes the symptoms may manifest in physical form. Individuals respond differently to combat stress and display different symptoms. Some common symptoms of combat stress are listed below.^{1 [1], 4 [5], 5 [6], 6 [7]}

Thought Process

• Problems concentrating.
• Confusion.
• Having problems in making decisions or processing information.
• Memory loss.
• Having a hard time telling what is real.
• Re-experiencing events or flashbacks.
• Troubling memories or nightmares.
• Loss of trust.
• Hallucinations or delusions (that don’t go away with adequate sleep).

Emotions

• Unusual or excessive anxiety, fear, worry or nervousness.
• Depression, despair or unexplained sadness.
• Numbness and lack of interest in life.
• Agitation and intense anger or irritability.
• Guilt and shame or a sense of failure.
• Feeling overwhelmed.
• Feelings of isolation.
• Mood swings.
• Loss of confidence and trust.

Behavior

• Withdrawing and avoiding others.
• Restlessness or fidgeting.
• Being over-watchful or overly concerned about safety.
• Angry outbursts.
• Crying.
• Changes in diet.
• Risky or careless behaviors, such as increased smoking, drug or alcohol use, and reckless driving.
• Staring into space (the “thousand-yard stare”).

Physical Symptoms

• Problems sleeping.
• Exhaustion.
• Worsening health problems.
• Pounding heart and sweating; cold sweats.
• Problems with eating or digestion.
• Nausea, frequent urination or diarrhea.
• Trembling hands.
• Numbness, tingling or loss of function in limbs or other body parts.
• Headaches.
• Changes in vision.

Symptoms may be noticeable immediately following a stressful event, but can take several days — even months — to manifest. Oftentimes, troops first notice symptoms soon after returning home. Symptoms that continue for weeks or months, become increasingly worse or include violent or self-destructive behavior call for immediate medical evaluation and assistance.

The U.S. Department of Defense (DoD) offers a confidential tool for service members and families who want to perform a self-assessment for symptoms that may result from combat stress. Visit the afterdeployment.org self-assessment page [8].

Additionally, a confidential self-assessment tool sponsored by the Department of Defense [10] is available online.

More Help for Assessing Combat Stress: You know yourself best, but sometimes a second opinion helps

A medical evaluation can be helpful for anyone affected by combat stress. Many symptoms are the same as those for physical conditions — so it’s important to rule out any health problems. Seek help if symptoms continue for more than a few weeks after returning home or disrupt daily work and life.

For symptoms that are more serious, getting help is critical to the strength of your military and family units and to the health of relationships with friends. Seeking help early can help avoid stress reactions from worsening or becoming long-term.

As a first step, service members might talk to a chaplain or other spiritual advisor, family members or friends about the symptoms. Each of the Armed Services offers special support services in the field (Service Combat Stress Control Teams for the Army and Air Force, Operational Stress Control and Readiness teams in the Navy/Marine Corps). These teams evaluate, treat and educate troops affected by combat stress, and in most cases help them return to their units without referring them to higher-level care.

Photo by Pfc. Eric D. Arndt

Non-deployed service members and families can seek assistance through installation medical and counseling services (a medical treatment facility, clinic or hospital) or a local civilian mental health clinic or community mental health center. The TRICARE Network of providers [11] is a good starting point when seeking care. Active duty, Guard or reserve personnel can also get assistance through the Veterans Health Administration [12] including Readjustment Counseling Service Vet Centers and post-traumatic stress disorder treatment programs.

"We … talked about removing the stigma and recognizing the extraordinary pressure our force is under and figuring out a way that we can say, 'It's OK, I need some help.’ We need to be making sure we take care of each other, particularly when we come back from time in combat, and that we reintegrate well.”

Admiral Michael G. Mullen, Chairman of the Joint Chiefs of Staff, speaking at the opening of the Behavioral Health Department’s Wilcox facility at Fort Drum.⁷ [13]

Additional Resources

All Audiences

• Guide to Coping with Deployment and Combat Stress [14] [PDF 2.5MB]
• TRICARE Assistance Program (TRIAP) [15]

For Service Members

• Department of Defense Combat/Operational Stress Page [16]
• Army Combat/Operational Stress Control Resources [17]
• Army National Guard Combat Stress Page [18]
• Marine Corps Combat Operational Stress Program [19]
• Navy and Marine Corps Deployment Health Home Page [20]
• Armed Forces Crossroads Deployment Sustainment Resources [21]
• Comprehensive Soldier Fitness [22]

For Veterans

• U.S. Department of Veterans Affairs’ Mental Health Home [23]
• Returning Service Members (OEF/OIF) [24]
• Vet Center Home [25]
• Women Veterans Health Care [26]

For Family and Friends

• Returning from the War Zone: A Guide for Families of Military Members [27] [PDF 2.2MB]

Sources

¹Army Hooah 4 Health website, Combat Stress Page [18], last accessed 3/25/09
²Army Behavioral Health website, Combat and Operational Stress General Information [28], last accessed 2/10/09
³Stars and Stripes, “A General Battles Post-Combat Stress [3]," last accessed 1/12/09
⁴Uniformed Services University, Center for the Study of Traumatic Stress, “Understanding Post Deployment Stress Symptoms [29]" [PDF 168KB]
⁵Walter Reed Army Institute of Research, Land Combat Study Team, Spouse “Resilience Training: Transitioning from Combat to Home [30] [PDF 312KB], last accessed 3/24/10
⁶Navy and Marine Corps Public Health Center, Deployment Health Home Page, “Dealing with Combat and Operational Stress [31] [PDF 112KB], last accessed 2/10/09
⁷Watertown Daily Times (online), “Mullen: mental health care is key [32]," last accessed 2/11/09