The document discusses clinical presentations of stress during combat and deployment. It describes a range of stressors soldiers face during combat, deployment, and after returning home. Physical stressors can cause fatigue, shaking, digestive issues, rapid heartbeat, and sleep disturbances. Mental stressors are also discussed. Responses to stress range from adaptive to maladaptive behaviors and include irritability, depression, risk-taking, panic, and conditions like PTSD and TBI. Soldiers may experience a variety of psychological and physical impacts from the significant stress of combat.

1. CLINICAL PRESENTATION
OF STRESS DURING
COMBAT & DEPLOYMENT
DR VARUN S MEHTA
ASSISTANT PROFESSOR OF PSYCHIATRY
CELEBRATING 100 GLORIOUS YEARS

2. INTRODUCTION
 In today’s battlefield, everyone is a soldier. Whether serving in the infantry,
providing healthcare, or providing logistical support, all armed personnel
face the threat of attack from a dedicated enemy
 Routine existence in a combat zone places them at risk for exposure to a
range of significant stressors
 The effects of COS are experienced by all personnel although not everyone

3. WHEN DOES THE STRESS
EMERGE?
 These stressors are greatest during actual combat, but often begin with
notification of a deployment. It often continues after the fighting is over as
the participants deal with the aftermath of deployment
 Deployment is also associated with increased symptoms of mental health
problems

4. SOURCES OF STRESS
Combat Stressors Operational Stressors (Prolonged)
 Personal Injury  Extreme geographical environments
Killing of combatants
 Reduced QOL communication
resources
Witnessing death of an
individual
 Poor communication systems
Death of another unit

5. PHYSICAL STRESSORS

6. MENTAL STRESSORS

7. MANIFESTATIONS OF STRESS
 Stress has both physical & behavioral effects. Stress may increase disease
rates by disrupting hygiene & protective measures, as well as impairing the
body’s immune defenses
 It may progress to behavioral health disorders, including suicidal or
homicidal behaviors
 Stress can also result in battle & nonbattle injuries through inattention,
clumsiness, & reckless
behavior, including equipment loss and friendly fire incidents

8. COMBAT & OPERATIONAL STRESS
BEHAVIOURS
It covers the range of reactions from adaptive to maladaptive behaviors

9. COMBAT & OPERATIONAL STRESS
REACTION (COSR)
 POTENTIALLY TRAUMATIC EVENT (PTE): It is an event which causes
an individual or group to experience intense feelings of terror,
horror, helplessness, and/or hopelessness
 It is an event that is perceived & experienced as a threat to one’s safety
or to the stability of one’s world
 COSR is used in reference to negative adaptation to high-stress events
&
PTE exposures

10. HOW TO IDENTIFY?
Combat and operational stress behaviors may take many forms and
can range from subtle to dramatic. Trying to memorize every possible
sign and symptom is less useful than being alert for sudden,
persistent, or progressive changes in a Soldier’s behavior, especially if

11. MISCONDUCT STRESS
BEHAVIORS
 It is a form of COSR that is most likely to occur in poorly trained,
undisciplined soldiers under extreme combat stress
 Even so, highly trained, highly cohesive units, and individuals under
extreme combat and operational stress may also engage in
misconduct
 It may range from minor breaches in unit orders or regulations to
serious violations of the law
 Such units may come to consider themselves entitled to special

12. DISTRESS RESPONSES/MILD
STRESS REACTIONS
 Mild stress reaction may be signaled by changes in behavior and
discernible only by the individual or by close comrades
 Without self-report, it can be difficult to observe stress-related
changes
 The responses may be physical or emotional in nature. Symptoms of
distress are usually mild, and go away after several weeks
 If these problems last longer than a month or two months after
returning home, a medical professional should be consulted

13. WHAT ARE THE RESPONSES
LIKE?
Fatigue
Slow reaction time
Difficulty sorting out priorities
Difficulty starting routine tasks
Excessive concern with seemingly minor issues
Indecision and difficulty focusing attention
Loss of initiative with exhaustion

14. WHAT ARE THE RESPONSES
LIKE?
Muscular tension:
 Often increases strain on the scalp & spine (backache) and often
leads to headaches, pain,
and cramps.
 The inability to relax wastes energy and leads to fatigue and
exhaustion
Shaking and tremors:
 During incoming rounds, the individual may experience mild shaking.

15. WHAT ARE THE RESPONSES
LIKE?
Digestive and urinary systems:
 Nausea (butterflies in the stomach) is a common stress feeling. Vomiting may
occur as a result of an extreme experience like that of a firefight, shelling, or in
anticipation of danger
 Appetite loss may result as a reaction to stress. It becomes a significant
problem if rapid weight loss
 Acute abdominal pain (knotted stomach, heartburn) may occur during combat.
Persistent & severe abdominal pain is a disruptive reaction and may indicate a

16. WHAT ARE THE RESPONSES
LIKE?
Circulatory and respiratory systems:
 Rapid heartbeat (palpitations), a sense of pressure in the chest, occasional
skipped beats, and sometimes chest pains are common with anxiety or fear
 Hyperventilation is identified by rapid respiration, shortness of breath,
dizziness, and a sense of choking.
It is often accompanied with tingling and cramping of fingers and toes
 Faintness and giddiness reactions occur in tandem with generalized muscular
weakness, lack of

17. WHAT ARE THE RESPONSES
LIKE?
Sleep disturbance:
Difficulty falling asleep; staying asleep or waking early and not being able to
get back to sleep
Terror dreams, battle dreams, and nightmares of other kinds cause
difficulty in staying asleep
Sleep disturbances in the form of dreams are part of the coping process
Individuals exhibiting a need for excessive sleep may be exhibiting
symptoms of combat stress;

18. WHAT ARE THE RESPONSES
LIKE?
Visual/hearing problems and partial paralysis:
Stress-related blindness, deafness, loss of other sensations, and partial
paralysis are not true physical injuries, but physical symptoms that
unconsciously enable the individual to escape or avoid a seemingly
intolerably stressful situation
A physical cause should always be ruled out at the outset

19. WHAT ARE THE RESPONSES
LIKE?
Hyperalert:
 This refers to being distracted by any external stimuli that might signal
danger & overreacting to things that are, in fact, safe. The hyperalert
individual is not truly in tune with the environment
 The hyperalert Soldier is likely to overreact and consequences can range
from firing at an innocent noise to designating an innocent target as hostile,
or misinterpreting reassuring information as threats, and reacting without
adequate critical thinking

20. WHAT ARE THE RESPONSES
LIKE?
Startle reactions:
This is part of an increased sensitivity to minor external stimuli (on-guard
reactions)
 Leaping, jumping, jerking, or other forms of involuntary self-protective motor
responses to sudden noises are noted
 Sudden noise, movement, and light cause startle reactions; for example,
unexpected movement of an animal (or person) precipitates weapon firing

21. WHAT ARE THE RESPONSES
LIKE?
Irritability:
 Mild irritable reactions range from sharp, verbal overreaction to normal,
everyday comments or incidents; flare-ups involving profanity; and crying in
response to relatively slight frustrations
 Severe irritability includes sporadic and unpredictable explosions of
aggressive behavior (violence) which can occur with little or no provocation
 Mixing anger with alcohol can be particularly troublesome since the
individual loses the ability to understand his/her behavior or its consequences

22. WHAT ARE THE RESPONSES
LIKE?
Depression:
 Low energy level- Decreased effectiveness on the job, decreased ability to
think clearly, excessive sleeping or difficulty falling asleep, and chronic
tiredness can occur
 Social withdrawal- The individual is less talkative & shows limited response
to jokes or cries
 He is unable to enjoy relaxation and companionship
 Change in outward appearance- There may be disheveled appearance &

23. WHAT ARE THE RESPONSES
LIKE?
Risk Behaviors
People returning from combat deployment can sometimes start or increase
the frequency of behaviors that compromise their health and the
health/safety of those around them.
o Cigarette Smoking — often starts or increases in the combat zone, and
continues or increases upon return home
o Alcohol Use — Upon return, alcohol use may start or continue as a
misguided means of reducing stress

24. WHAT ARE THE RESPONSES
LIKE?
 An individual may panic and become confused. The term panic run refers
to a person rushing about without self-control
 His mental ability becomes impaired to the degree that he cannot think
clearly or follow simple commands. He stands up in a firefight because his
judgment is clouded & he cannot understand the likely consequences of his
behavior
 In combat, such a soldier can easily compromise his safety and could
possibly get killed

25. WHAT ARE THE RESPONSES
LIKE?
Traumatic Brain Injury (TBI)
 It is a condition that results when personnel are exposed to explosive
events in the combat
 While many they may be aware that they have suffered from a head injury,
some who sustained mild injury may not
 Symptoms of mild TBI can include headaches, impulsive behavior, anger
outbursts, changes in personality or slowed thinking
 These symptoms can sometimes be difficult to distinguish from other

26. WHAT ARE THE RESPONSES
LIKE?
Post traumatic stress disorder (PTSD)
It is a condition that results when traumatic experiences (such as combat)
lead to lasting symptoms: nightmares, flashbacks, and unsettling memories
of the trauma
Other symptoms that are experienced and can be noticed by others include
excitability, nervousness, over anxiousness, hypervigilance, and avoidance
of people or social situations that can remind a person of the trauma
experience

27. WHAT ARE THE RESPONSES
LIKE?

28. THANK YOU
Email: vs_mehta@yahoo.co.in
Ph: 9204858189