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
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
