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

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

Anyone Can Experience Combat Stress

General Carter Ham, the Commander of the U.S. Army in Europe, experienced combat stress upon his return from an Iraq deployment. He and his wife spoke candidly about the experience, his treatment and recovery in a January 2009 Stars and Stripes article.³

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, 4, 5, 6}

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 interactive diagnostic tool for service members and families who want to evaluate combat stress symptoms at AfterDeployment.org. Visit the DoD resource for the After Deployment Diagnostic Tool.

AfterDeployment.org is a mental wellness resource for service members, veterans and military families. If you’ve deployed, or know someone who has, you know that spending time in a war zone means being changed in some way. Some of these changes are good. But some of these changes may be causing problems for you or for someone you know. Having problems after a deployment is common. Unfortunately, less than half of the service members having difficulty after a deployment seek services.

AfterDeployment’s mission is to assist you and the people close to you with managing your after-deployment concerns. We believe that working on solutions is a sign of strength, and the time you spend here is a positive step in ensuring a smooth and healthy transition back to home life.

Additionally, a confidential self-assessment tool sponsored by the Department of Defense 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 is a good starting point when seeking care. Active duty, Guard or reserve personnel can also get assistance through the Veterans Health Administration 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