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What is combat stress?

Frequently overlooked are the many adaptive or "good" combat stress reactions. These might include increased alertness, exceptional strength, heightened endurance or tolerance to pain and hardship.

"Combat stress" is a term used to describe normal physiological, behavioral, and psychosocial reactions experienced before, during or after combat. In the past, it was thought that service members experiencing combat stress reactions were mentally ill.

Experience has shown this is not the case. Most conditions related to stress during combat are normal reactions to the abnormal circumstances of war. Typical (maladaptive and adaptive) combat stress reactions include difficulty concentrating, extreme anxiety or "fright," diarrhea, regression, and marked sadness, and are often not mental illness at all.

Is combat stress that big a deal?
Proper management of battle fatigued military members has reduced the rate of chronic mental illness following combat.
Yes! Failing to prevent or effectively manage combat stress reactions has resulted in significant preventable combat losses. During World War II an average of one combat stress casualty for every four wounded typically occurred. However, in battles such as Okinawa, involving particularly heavy fighting, a ratio as high as one stress casualty for every two wounded was possible.

Past experience has proven that dedicated combat stress control efforts have prevented unnecessary evacuation of battle fatigued service members and has led to greatly increased return to duty rates for affected members.

What is "battle fatigue"?
Battle fatigue is the term used by the Army to describe combat stress casualties—that is, service members experiencing combat stress reactions to the point where they are no longer combat effective. Battle fatigue is not a disease. It is a transient state and a normal response to the abnormal circumstances of war.
How are battle fatigued service members managed?
Battle fatigued service members are most often managed using the four R's. Rest, Replenishment, Reassurance, and Restoration.
  • Rest: Minimum of rest (4-6 hours) and respite (or shelter from heat, cold, rain, snow).
  • Replenishment: Provide plenty to drink, a hot meal, a wash, as possible to restore the service member's energy level and hygiene.
  • Reassurance: Reassure the military member that he/she is OK and allow him/her to verbalize what happened. Members (75-95 percent) experiencing battle fatigue are experiencing a normal response brought about by a combat situation and not necessarily suffering from a mental illness or a "weakness." The fact is most of these military members can return to duty, with no ill-effects, within 24-72 hours. In the past, when a member has been labeled as sick or disturbed, he/she was more likely to develop a real psychological problem and less likely to return to duty.
  • Restoration: Engage the military member in tasks which restore his/her identity as an active duty member (rather than a patient) and that restores his/her sense of competency as a capable, combat effective member of the team.

Although these are the basics used in managing battle fatigue casualties, there of course will be service members who also require a brief medical or neuropsychiatric evaluation to rule out serious physical/mental illness or injury.

If I experience combat stress, does that mean I have a mental problem?
No! As mentioned above, most service members who experience combat stress reactions are not mentally ill and make a full recovery within 24-72 hours. This is because the majority of combat stress reactions are simply related to fatigue or are normal reactions to abnormally stressful or traumatic situations.

Source: 528th Medical Detachment, Fort Bragg, U.S. Army

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