*Military OneSource does not provide medical counseling services for issues such as depression, substance abuse, suicide prevention or post-traumatic stress disorder. The article below is intended for informational purposes only. Military OneSource can provide referrals to your local military treatment facility, TRICARE or another appropriate resource.
It's not unusual for a service member participating in combat (or seeing its aftermath) to be filled with complicated and conflicting emotions, often including fear, sadness, helplessness, and horror. Strong reactions are natural when a person is confronted with danger or other traumatic experiences.
Reactions to combat stress can be unsettling, especially in a situation that requires people to appear unruffled or undisturbed by it. It's important to learn to recognize the signs of combat stress in yourself, another service member, or a family member who has returned from a war zone. If you can identify combat stress for what it is, you may be more likely to recognize it as a serious problem that may be managed or resolved with professional help, bringing you peace of mind and improved quality of life.
Defining combat stress
Combat stress is a term that describes the natural responses of the body and brain to the stressors of combat, traumatic experiences, and the wear and tear of extended and demanding operations. Combat stress is not a sign of weakness: nearly everyone in combat situations will be affected to some extent, including many strong and courageous service members.
Whereas combat stress can have some physical symptoms, stress injuries actually involve physical changes in the brain itself, altering the way it processes information and handles stress. This can change the way a person functions mentally, emotionally, behaviorally, and physically. Like a sprained ankle, a combat stress injury will often heal if you take proper care of it, but without intervention, chances are it won't. Symptoms can remain persistently painful or disabling in daily life until you seek professional help.
The likelihood of having a combat stress injury rises as combat exposure increases. Combat stress injuries often aren't fully recognized until after a service member returns home and notices that symptoms aren't going away, even with rest and recuperation.
Signs of combat stress
The signs that someone is suffering from combat stress are many, ranging from loss of motivation to hallucinations, and they may change over time. But these key symptoms are common to most cases:
- problems sleeping
- uncharacteristic irritability or angry outbursts
- unusual anxiety or panic attacks
- signs of depression (such as apathy, loss of interest in things once enjoyed, poor hygiene)
- other changes in behavior, personality, or thinking
A stress reaction can last from a few days to a few weeks. Symptoms may be severe and persistent, with re-experiencing of events and hyper-arousal that interferes with the ability to work or interact with people. These are signs of a more serious injury that requires professional help to heal.
Risk factors for stress injuries
It isn't clear why some people have more severe stress reactions than others. Even the strongest and most seasoned service member can have a severe reaction under certain conditions. Many great war heroes have suffered for years in silence from the effects of combat stress, even though they performed admirably.
One thing is clear - pre-existing stress, such as sleep deprivation, exhaustion, excessive heat or cold, and distraction by problems back home can reduce a person's ability to absorb the extreme stress of combat or other traumatic experiences. Think of a rubber band that has been stretched too far - it can't stretch much farther without breaking. When each new stressor occurs, the person's body and brain don't have the resiliency needed to absorb the stress, and an injury occurs. Also, the nature and intensity of the combat situation or environment itself may play the most obvious role. The list of related risk factors includes, among others:
- crowded living conditions and lack of privacy
- fatigue-inducing events and activities
- long, ongoing deployments
- immobility during static or heavy fighting
- lack of information
- limited time to address personal issues
Delayed stress reactions
In many cases, the effects of combat stress are subtle and may not become obvious to you until you're back home and things have calmed down. You may be irritable or edgy, or have trouble with things like sleeping, forgetting events, or getting along with others.
People may not understand why you continue to react to certain things as you did while you were deployed - for example, dropping to the ground when you hear a loud noise or feeling uneasy when you see something out of place along the side of the road. Behavior that was adaptive in combat may seem abnormal to others back home. You may also have trouble adapting to civilian attitudes, the boredom of a routine job, and life at home in general.
When and where to seek professional help
If you're suffering from a combat stress injury that interferes with your work or interpersonal relationships, it's important to get professional help as soon as possible. The earlier you identify the signs of a stress injury, the more quickly you may be able to fully recover. You'll also lower your risk for developing more chronic and hard-to-treat problems such as post-traumatic stress disorder (PTSD). Finding help is the right thing to do.
Combat Stress Control Teams - Available to service members during deployments, Combat Stress Control (CSC) teams are made up of mental health professionals who support the emotional well-being of service members. They provide on-site support when service members may be experiencing combat or stress injuries.
Your unit chaplain - Military chaplains can provide counseling, guidance, and referral on many issues that affect deployed or returning service members and their families.
Military and Family Life Consultants - As licensed professionals, Military and Family Life Consultants (MFLC) provide short-term non-medical counseling free of charge to military members and their families. To find an MFLC, contact your installation Family Support Center.
Military OneSource - Professional counselors can also provide free, short-term non-medical counseling services to military members and their families. Services are available face-to-face in your local community (through a referral), by phone with a trained counselor, or online in a real-time chat format. For more information visit the Military OneSource website or call 1-800-342-9647.
Department of Veterans Affairs - The Department of Veterans Affairs (VA) provides free readjustment counseling to combat veterans and their families, including those still on active duty. The services are provided at more than 200 community-based Vet Centers by counselors who, as veterans themselves, understand the issues service members and their families face.
TRICARE or your nearest Military Treatment Facility - Medical counseling services may be available through TRICARE, either at a military treatment facility (MTF) or through a network provider in your area. Your Primary Care Manager can refer you to appropriate counseling, or you may contact your regional TRICARE office.
Outside military support channels - In some cases, service members choose to find help outside military support channels. If you do, be sure you understand the costs before you begin a treatment program.
Finding out that you're suffering from combat stress or a stress injury is no more a reflection on your character or courage as a service member than if you had asthma or pneumonia. What does define you as a service member is what you do what about it. Real power comes from recognizing that you have this condition, then seeking the treatment you need to overcome it.