Combat stress reaction - AbsoluteAstronomy.com

Combat stress reaction in the past commonly known as shell shock or battle fatigue, is a range of behaviours resulting from the stress of battle which decrease the combatant's fighting efficiency. The most common symptoms are fatigue, slower reaction times, indecision, disconnection from one's surroundings, and inability to prioritize. Combat stress reaction is generally short-term and should not be confused with acute stress disorder, post-traumatic stress disorder

Post-traumatic stress disorder

Posttraumaticstress disorder is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. This event may involve the threat of death to oneself or to someone else, or to one's own or someone else's physical, sexual, or psychological integrity,...

, or other long-term disorders attributable to combat stress, although any of these may commence as a combat stress reaction.

The ratio of stress casualties to battle casualties varies with the intensity of the fighting, but with intense fighting it can be as high as 1:1. In low-level conflicts it can drop to 1:10 (or less).

In World War I

World War I

World War I , which was predominantly called the World War or the Great War from its occurrence until 1939, and the First World War or World War I thereafter, was a major war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918...

, shell shock was considered a psychiatric illness

Mental illness

A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...

resulting from injury to the nerves during combat. The horrors of trench warfare

Trench warfare

Trench warfare is a form of occupied fighting lines, consisting largely of trenches, in which troops are largely immune to the enemy's small arms fire and are substantially sheltered from artillery...

meant that about 10% of the fighting soldiers were killed (compared to 4.5% during World War II) and the total proportion of troops who became casualties (killed or wounded) was 56%. Whether a shell-shock sufferer was considered "wounded" or "sick" depended on the circumstances. The large proportion of World War I veteran

Veteran

A veteran is a person who has had long service or experience in a particular occupation or field; " A veteran of ..."...

s in the European population meant that the symptoms were common to the culture.

History

The name "shell shock" was given during World War I due to a belief at the time that the condition resulted from trauma to the nervous system caused by shock waves from artillery shells. The history of combat stress reactions has shown a remarkable variation and subvariation in the interest and knowledge of those whose tasks it has been to deal with them. Kardiner and Spiegel writing in 1947 stated:
During the American Civil War

American Civil War

The American Civil War was a civil war fought in the United States of America. In response to the election of Abraham Lincoln as President of the United States, 11 southern slave states declared their secession from the United States and formed the Confederate States of America ; the other 25...

two conditions, “soldier's heart

Da costa's syndrome

Da Costa's syndrome, which was colloquially known as soldier's heart, is a syndrome with a set of symptoms that are similar to those of heart disease, though a physical examination does not reveal any physiological abnormalities...

” and “nostalgia”, were basically CSRs. Various epidemics of psychological

Psychology

Psychology is the study of the mind and behavior. Its immediate goal is to understand individuals and groups by both establishing general principles and researching specific cases. For many, the ultimate goal of psychology is to benefit society...

disorders (e.g. passengers with railway spine

Railway spine

Railway spine was a nineteenth-century diagnosis for the post-traumatic symptoms of passengers involved in railroad accidents.The first full length medical study of the condition was John Eric Erichsen's classic book, On Railway and Other Injuries of the Nervous System...

) were recognised in the 1800s.

The Russians in the Russo-Japanese War

Russo-Japanese War

The Russo-Japanese War was "the first great war of the 20th century." It grew out of rival imperial ambitions of the Russian Empire and Japanese Empire over Manchuria and Korea...

(1904-1905) were the first to specifically diagnose mental disease

Mental illness

as a result of war stress and try to treat it. It was not until World War I that the high level of cases with "shell shock" (also referred to as traumatic war neurosis and neurasthenia

Neurasthenia

Neurasthenia is a psycho-pathological term first used by George Miller Beard in 1869 to denote a condition with symptoms of fatigue, anxiety, headache, neuralgia and depressed mood...

) really surprised commanders and doctors.

World War I

In 1915 The British Army

British Army

The British Army is the land warfare branch of Her Majesty's Armed Forces in the United Kingdom. It came into being with the unification of the Kingdom of England and Scotland into the Kingdom of Great Britain in 1707. The new British Army incorporated Regiments that had already existed in England...

in France

France

The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...

was instructed that:
In August 1916 Charles Myers was made Consulting Psychologist to the Army. He hammered home the notion that it was necessary to create special centres near the line using treatment based on:

Promptness of action.
Suitable environment.
Psychotherapeutic measures.

He also used hypnosis

Hypnosis

Hypnosis is "a trance state characterized by extreme suggestibility, relaxation and heightened imagination."It is a mental state or imaginative role-enactment . It is usually induced by a procedure known as a hypnotic induction, which is commonly composed of a long series of preliminary...

with limited success.

In December 1916 Gordon Holmes

Gordon Holmes

Gordon Holmes may refer to:* The pseudonym of the journalist Louis Tracy * Sir Gordon Morgan Holmes , British neurologist.* Gordon Holmes a 55-year-old lab technician who shot a home video he claims may show the Loch Ness Monster...

was put in charge of the northern, and more important, part of the western front. He had much more of the tough attitudes of the Army and suited the prevailing military mindset and so his view prevailed. By June 1917 all British cases of “Shell-shock” were evacuated to a nearby neurological centre and were labelled as NYDN – Not Yet Diagnosed Nervous”. "But, because of the Adjutant-General’s distrust of doctors, no patient could receive that specialist attention until Form AF 3436 had been sent off to the man’s unit and filled in by his commanding officer." This created significant delays but demonstrated that between 4-10% of Shell-shock W cases were "commotional" (due to physical causes) and the rest were "emotional". This killed off shell-shock as a valid disease and it was abolished in September 1918.

During the war, 266 British soldiers were executed for "Desertion", 18 for "Cowardice", 7 for "Quitting a post without authority", 5 for "Disobedience to a lawful command" and 2 for "Casting away arms", some of whom may have been victims of shell shock. Controversially, on 7 November 2006 the government of the United Kingdom gave them all a posthumous conditional pardon.

Proximity by circumstance

Because of the delays AF 3436 was producing, medical officers started keeping their men in their units. This was perhaps the practical beginning of the concept of proximity. Col. Rogers, RMO 4/Black Watch

Black Watch

The Black Watch, 3rd Battalion, Royal Regiment of Scotland is an infantry battalion of the Royal Regiment of Scotland. The unit's traditional colours were retired in 2011 in a ceremony led by Queen Elizabeth II....

wrote,

PIE principles

The PIE principles were now in place for the "not yet diagnosed nervous" (NYDN) cases:

Proximity - treat the casualties close to the front and within sound of the fighting
Immediacy - treat them without delay and not wait until the wounded were all dealt with
Expectancy - ensure that everyone had the expectation of their return to the front after a rest and replenishment

United States medical officer Thomas W. Salmon is often quoted as the originator of these PIE principles. However, his real strength came from going to Europe and learning from the Allies and then instituting the lessons. By the end of the war, Salmon had set up a complete system of units and procedures that was then the “world’s best practice”. After the war he maintained his efforts in educating society and the military. He was awarded the Distinguished Service Medal

Distinguished Service Medal (United States)

The Distinguished Service Medal is the highest non-valorous military and civilian decoration of the United States military which is issued for exceptionally meritorious service to the government of the United States in either a senior government service position or as a senior officer of the United...

for his contributions.

The effectiveness of the PIE approach has not been confirmed by studies of CSR, and there is some evidence that it is not effective in preventing PTSD.

The US services now use the more recently developed BICEPS principles:

Brevity
Immediacy
Centrality or Contact
Expectancy
Proximity
Simplicity

Between the wars

The British government produced a Report of the War Office Committee of Enquiry into "Shell-Shock" which was published in 1922. Recommendations from this included:

In forward areas

No soldier should be allowed to think that loss of nervous or mental control provides an honourable avenue of escape from the battlefield, and every endeavour should be made to prevent slight cases leaving the battalion or divisional area, where treatment should be confined to provision of rest and comfort for those who need it and to heartening them for return to the front line.

In neurological centres

When cases are sufficiently severe to necessitate more scientific and elaborate treatment they should be sent to special Neurological Centres as near the front as possible, to be under the care of an expert in nervous disorders. No such case should, however, be so labelled on evacuation as to fix the idea of nervous breakdown in the patient’s mind.

In base hospitals

When evacuation to the base hospital is necessary, cases should be treated in a separate hospital or separate sections of a hospital, and not with the ordinary sick and wounded patients. Only in exceptional circumstances should cases be sent to the United Kingdom, as, for instance, men likely to be unfit for further service of any kind with the forces in the field. This policy should be widely known throughout the Force.

Forms of treatment

The establishment of an atmosphere of cure is the basis of all successful treatment, the personality of the physician is, therefore, of the greatest importance. While recognising that each individual case of war neurosis must be treated on its merits, the Committee are of opinion that good results will be obtained in the majority by the simplest forms of psycho-therapy, i.e., explanation, persuasion and suggestion, aided by such physical methods as baths, electricity and massage. Rest of mind and body is essential in all cases.

The committee are of opinion that the production of hypnoidal state and deep hypnotic sleep, while beneficial as a means of conveying suggestions or eliciting forgotten experiences are useful in selected cases, but in the majority they are unnecessary and may even aggravate the symptoms for a time.

They do not recommend psycho-analysis in the Freudian sense.

In the state of convalescence, re-education and suitable occupation of an interesting nature are of great importance. If the patient is unfit for further military service, it is considered that every endeavour should be made to obtain for him suitable employment on his return to active life.

Return to the fighting line

Soldiers should not be returned to the fighting line under the following conditions:- If the symptoms of neurosis are of such a character that the soldier cannot be treated overseas with a view to subsequent useful employment. If the breakdown is of such severity as to necessitate a long period of rest and treatment in the United Kingdom. If the disability is anxiety neurosis of a severe type. If the disability is a mental breakdown or psychosis requiring treatment in a mental hospital.

It is, however, considered that many of such cases could, after recovery, be usefully employed in some form of auxiliary military duty.

Part of the concern was that many British veterans were receiving pensions and had long-term disabilities.

By 1939, some 120,000 British ex-servicemen had received final awards for primary psychiatric disability or were still drawing pensions – about 15% of all pensioned disabilities – and another 44,000 or so … were getting pensions for ‘soldier’s heart’ or Effort Syndrome. There is, though, much that statistics do not show, because in terms of psychiatric effects, pensioners were just the tip of a huge iceberg.”

War correspondent Philip Gibbs wrote:

Something was wrong. They put on civilian clothes again and looked to their mothers and wives very much like the young men who had gone to business in the peaceful days before August 1914. But they had not come back the same men. Something had altered in them. They were subject to sudden moods, and queer tempers, fits of profound depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...

alternating with a restless desire for pleasure
Pleasure
Pleasure describes the broad class of mental states that humans and other animals experience as positive, enjoyable, or worth seeking. It includes more specific mental states such as happiness, entertainment, enjoyment, ecstasy, and euphoria...

. Many were easily moved to passion
Passion (emotion)
Passion is a term applied to a very strong feeling about a person or thing. Passion is an intense emotion compelling feeling, enthusiasm, or desire for something....

where they lost control of themselves, many were bitter in their speech, violent in opinion, frightening.

One British writer between the wars wrote:

There should be no excuse given for the establishment of a belief that a functional nervous disability constitutes a right to compensation. This is hard saying. It may seem cruel that those whose sufferings are real, whose illness has been brought on by enemy action and very likely in the course of patriotic service, should be treated with such apparent callousness. But there can be no doubt that in an overwhelming proportion of cases, these patients succumb to ‘shock’ because they get something out of it. To give them this reward is not ultimately a benefit to them because it encourages the weaker tendencies in their character. The nation cannot call on its citizens for courage and sacrifice and, at the same time, state by implication that an unconscious cowardice or an unconscious dishonesty will be rewarded.

American

At the outbreak of World War II

World War II

World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...

most in the United States military had forgotten the treatment lessons of World War I. Screening of applicants was initially rigorous but experience eventually showed it to not have great predictive power.

The US entered the war in December 1941. It was not until November 1943 that a psychiatrist

Psychiatrist

A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...

was added to the table of organization of each division, and this policy was not implemented in the Mediterranean Theatre

Mediterranean Theatre

The Mediterranean Theatre is the war zone covering the Mediterranean Sea. It has seen at least two wars spanning the whole of the sea:*Mediterranean theatre of World War I*Mediterranean, Middle East and African theatres of World War II...

until March 1944. By 1943 the US Army was using the term "exhaustion" as the initial diagnosis of psychiatric cases and the general principles of military psychiatry

Military psychiatry

Military psychiatry covers special aspects of psychiatry and mental disorders within the military context. The aim of military psychiatry is to keep as many serving personnel as possible fit for duty and to treat those disabled by psychiatric conditions....

were being used. General Patton's slapping incident was in part the spur to institute forward treatment for the Italian invasion of September 1943. The importance of unit cohesion

Unit cohesion

Unit cohesion is a military concept, defined by one former United States Chief of staff in the early 1980s as "the bonding together of soldiers in such a way as to sustain their will and commitment to each other, the unit, and mission accomplishment, despite combat or mission stress"...

and membership of a group as a protective factor emerged.

Airmen flew far more often in the Southwest Pacific than in Europe, and although rest time in Australia was scheduled, there was no fixed number of missions that would produce transfer out of combat, as was the case in Europe. coupled with the monotonous, hot, sickly environment, the result was bad morale that jaded veterans quickly passed along to newcomers. After a few months, epidemics of combat fatigue would drastically reduce the efficiency of units. The men who had been at jungle airfields longest, the flight surgeons reported, were in bad shape:

Many have chronic dysentery or other disease, and almost all show chronic fatigue states. . . .They appear listless, unkempt, careless, and apathetic with almost masklike facial expression. Speech is slow, thought content is poor, they complain of chronic headaches, insomnia, memory defect, feel forgotten, worry about themselves, are afraid of new assignments, have no sense of responsibility, and are hopeless about the future."

British

Unlike the Americans, the lessons of World War I were firmly in British Governmental minds. It was estimated aerial bombardment would kill up to 35,000 a day but the entire Blitz killed 40,000. The expected torrent of civilian mental breakdown did not occur. The Government turned to World War I doctors for advice on those who did have problems. The PIE principles were generally used. However, in the British Army

British Army

, since most of the World War I doctors were too old for the job, young, analytically trained psychiatrists were employed. Army doctors “appeared to have no conception of breakdown in war and its treatment, though many of them had served in the 1914-1918 war.” The first Middle East Force psychiatric hospital was set up in 1942. With D-Day

D-Day

D-Day is a term often used in military parlance to denote the day on which a combat attack or operation is to be initiated. "D-Day" often represents a variable, designating the day upon which some significant event will occur or has occurred; see Military designation of days and hours for similar...

for the first month there was a policy of holding casualties for only 48 hours before they were sent back over the Channel

English Channel

The English Channel , often referred to simply as the Channel, is an arm of the Atlantic Ocean that separates southern England from northern France, and joins the North Sea to the Atlantic. It is about long and varies in width from at its widest to in the Strait of Dover...

. This went firmly against the expectancy principle of PIE.

Canadian

The Canadian Army recognized combat stress reaction as "Battle Exhaustion" during the Second World War and classified it as a separate type of combat wound. Historian Terry Copp has written extensively on the subject. In Normandy, "The infantry units engaged in the battle also experienced a rapid rise in the number of battle exhaustion cases with several hundred men evacuated due to the stress of combat. Regimental Medical Officers were learning that neither elaborate selection methods nor extensive training could prevent a considerable number of combat soldiers from breaking down."

Germans

In an interview, Dr Rudolf Brickenstein stated that:
However as the war progressed there was a profound rise in stress casualties from 1% of hospitalisations in 1935 to 6% in 1942. Another German psychiatrist reported after the war that during the last two years, about a third of all hospitalisations at Ensen were due to war neurosis. It is probable that there was both less of a true problem and less perception of a problem.

In his history of the pre-Nazi Freikorps

Freikorps

Freikorps are German volunteer military or paramilitary units. The term was originally applied to voluntary armies formed in German lands from the middle of the 18th century onwards. Between World War I and World War II the term was also used for the paramilitary organizations that arose during...

paramilitary organizations, "Vanguard of Nazism", historian Robert GL Waite describes some of the emotional effects of World War I on German troops, and refers to a phrase he attributes to Goering: men who could not become "de-brutalized".

Finns

The Finnish attitudes to "war neurosis" were especially tough. Psychiatrist Harry Federley, who was the head of the Military Medicine, considered shell shock as a sign of weak character and lack of moral fibre. His treatment for war neurosis was simple: the patients were to be bullied and harassed as long as they were unwilling to return to front line service.

Earlier, during the Winter War

Winter War

The Winter War was a military conflict between the Soviet Union and Finland. It began with a Soviet offensive on 30 November 1939 – three months after the start of World War II and the Soviet invasion of Poland – and ended on 13 March 1940 with the Moscow Peace Treaty...

, several Finnish machine gun operators on the Karelian Isthmus theatre became mentally unstable after repelling several unsuccessful Soviet human wave assaults

Human wave attack

Human wave attack, also known as human sea attack, is an offensive infantry tactic, in which an attacker conducts an unprotected frontal assault with densely concentrated infantry formations against the enemy line, intended to overrun the defenders by engaging in melee combat.-Definition:According...

on fortified Finnish positions.

Post-World War II developments

Simplicity was added to the PIE principles by the Israel

Israel

The State of Israel is a parliamentary republic located in the Middle East, along the eastern shore of the Mediterranean Sea...

is. This principle meant that treatment should be brief and supportive and could be provided by those without sophisticated training.

Peacekeeping stresses

Peacekeeping

Peacekeeping is an activity that aims to create the conditions for lasting peace. It is distinguished from both peacebuilding and peacemaking....

provides its own stresses with its emphasis on rules of engagement

Rules of engagement

Rules of Engagement refers to those responses that are permitted in the employment of military personnel during operations or in the course of their duties. These rules of engagement are determined by the legal framework within which these duties are being carried out...

providing a containment of the roles for which soldiers are trained. Causes include witnessing or experiencing the following:

Constant tension and threat of conflict.
Threat of land mines
Land mine
A land mine is usually a weight-triggered explosive device which is intended to damage a target—either human or inanimate—by means of a blast and/or fragment impact....

and booby trap
Booby trap
A booby trap is a device designed to harm or surprise a person, unknowingly triggered by the presence or actions of the victim. As the word trap implies, they often have some form of bait designed to lure the victim towards it. However, in other cases the device is placed on busy roads or is...

s.
Close contact with dead people and the severely injured.
Deliberate maltreatment and atrocities, possibly involving civilians.
Cultural issues, e.g. male dominant attitudes towards women in different cultures.
Separation and home issues.
Risk of disease including HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...

.
Threat of exposure to toxic agents.
Mission problems.
Return to service.

A notable case of CSR in peacekeeping operations is that of Canadian General Roméo Dallaire

Roméo Dallaire

Lieutenant-General Roméo Antonius Dallaire, is a Canadian senator, humanitarian, author and retired general...

, commander of the UN-run operation in Rwanda, UNAMIR. Unable to intervene to prevent the ensuing Rwandan Genocide

Rwandan Genocide

The Rwandan Genocide was the 1994 mass murder of an estimated 800,000 people in the small East African nation of Rwanda. Over the course of approximately 100 days through mid-July, over 500,000 people were killed, according to a Human Rights Watch estimate...

, Major-General Dallaire was forced to watch as almost a million Tutsis were brutally killed. On return to Canada, feeling that he had not done enough to halt the genocide, and haunted by the images of dismembered victims, Dallaire contemplated suicide; in June 2000 he was found in a public park near Ottawa's Rideau Canal, drunk and overdosing from anti-depressant medication. This very public incident highlighted the impact of difficult sub-combat operations on soldiers and awoke the public's awareness to CSR (or, as it is often referred to by the public, post-traumatic stress disorder).

Signs and symptoms

Combat stress reaction symptoms align with the symptoms also found in psychological trauma

Psychological trauma

Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event...

, which is closely related to post-traumatic stress disorder (PTSD). CSR differs from PTSD (among other things) in that a PTSD diagnosis requires a duration of symptoms over one month, which CSR does not.

Fatigue related symptoms

The most common stress reactions include:

The slowing of reaction time
Slowness of thought
Difficulty prioritising tasks
Difficulty initiating routine tasks

Preoccupation with minor issues and familiar tasks
Indecision and lack of concentration
Loss of initiative with fatigue
Exhaustion

Autonomic arousal
Autonomic nervous system
The autonomic nervous system is the part of the peripheral nervous system that acts as a control system functioning largely below the level of consciousness, and controls visceral functions. The ANS affects heart rate, digestion, respiration rate, salivation, perspiration, diameter of the pupils,...

Headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...

s
Back pain
Back pain
Back pain is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine.The pain can often be divided into neck pain, upper back pain, lower back pain or tailbone pain...

s
Inability to relax
Shaking and tremor
Tremor
A tremor is an involuntary, somewhat rhythmic, muscle contraction and relaxation involving to-and-fro movements of one or more body parts. It is the most common of all involuntary movements and can affect the hands, arms, eyes, face, head, vocal folds, trunk, and legs. Most tremors occur in the...

s
Sweat
SWEAT
SWEAT is an OLN/TSN show hosted by Julie Zwillich that aired in 2003-2004.Each of the 13 half-hour episodes of SWEAT features a different outdoor sport: kayaking, mountain biking, ice hockey, beach volleyball, soccer, windsurfing, rowing, Ultimate, triathlon, wakeboarding, snowboarding, telemark...

ing
Nausea
Nausea
Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...

and vomiting
Loss of appetite
Abdominal distress
Frequency of urination
Urination
Urination, also known as micturition, voiding, peeing, weeing, pissing, and more rarely, emiction, is the ejection of urine from the urinary bladder through the urethra to the outside of the body. In healthy humans the process of urination is under voluntary control...
Urinary incontinence
Urinary incontinence
Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...

Heart palpitations
Hyperventilation
Hyperventilation
Hyperventilation or overbreathing is the state of breathing faster or deeper than normal, causing excessive expulsion of circulating carbon dioxide. It can result from a psychological state such as a panic attack, from a physiological condition such as metabolic acidosis, can be brought about by...
Dizziness
Dizziness
Dizziness refers to an impairment in spatial perception and stability. The term is somewhat imprecise. It can be used to mean vertigo, presyncope, disequilibrium, or a non-specific feeling such as giddiness or foolishness....
Insomnia
Insomnia
Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...
Nightmare
Nightmare
A nightmare is an unpleasant dream that can cause a strong negative emotional response from the mind, typically fear or horror, but also despair, anxiety and great sadness. The dream may contain situations of danger, discomfort, psychological or physical terror...

s
Restless sleep
Excessive sleep
Excessive startle
Hypervigilance
Hypervigilance
Hypervigilance is an enhanced state of sensory sensitivity accompanied by an exaggerated intensity of behaviors whose purpose is to detect threats. Hypervigilance is also accompanied by a state of increased anxiety which can cause exhaustion. Other symptoms include: abnormally increased arousal, a...
Heightened sense of threat

Anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
Irritability
Irritability
Irritability is an excessive response to stimuli. The term is used for both the physiological reaction to stimuli and for the pathological, abnormal or excessive sensitivity to stimuli; It is usually used to refer to anger or frustration....
Depression
Depression (mood)
Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...
Substance abuse
Substance abuse
A substance-related disorder is an umbrella term used to describe several different conditions associated with several different substances .A substance related disorder is a condition in which an individual uses or abuses a...
Loss of adaptability
Suicidality
Disruptive behaviour
Mistrust of others
Confusion
Extreme feeling of losing control

Battle casualty rates

The ratio of stress casualties to battle casualties varies with the intensity of the fighting. With intense fighting it can be as high as 1:1. In low-level conflicts it can drop to 1:10 (or less).
Modern warfare embodies the principles of continuous operations with an expectation of higher combat stress casualties.

The World War II European Army rate of stress casualties of 101:1,000 troops per annum is biased by data from the last years of the war where the rates were low.

Therapy

In the military, therapy

Psychotherapy

Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...

starts with prevention by training and providing good morale and support. Simple procedures like providing adequate rest, food and shelter are important. Relaxation exercises have a role as does critical event debriefing.

Once a service member has deteriorated beyond this they are usually relieved of duty and given support, dry clothes, food and rest. When appropriate they are given supportive counselling aimed at their speedy recovery. Some are prescribed psychotropic medications and simply discharged.

Treatment results

Figures from the 1982 Lebanon war

1982 Lebanon War

The 1982 Lebanon War , , called Operation Peace for Galilee by Israel, and later known in Israel as the Lebanon War and First Lebanon War, began on 6 June 1982, when the Israel Defense Forces invaded southern Lebanon...

showed that with proximal treatment 90% of CSR casualties returned to their unit, usually within 72 hours. With rearward treatment only 40% returned to their unit.

In Korea 85% of US battle fatigue casualties returned to duty within three days and 10% returned to limited duties after several weeks.

Although the PIE principles were used extensively in the Vietnam War

Vietnam War

The Vietnam War was a Cold War-era military conflict that occurred in Vietnam, Laos, and Cambodia from 1 November 1955 to the fall of Saigon on 30 April 1975. This war followed the First Indochina War and was fought between North Vietnam, supported by its communist allies, and the government of...

, the post traumatic stress disorder lifetime rate for Vietnam veteran

Vietnam veteran

Vietnam veteran is a phrase used to describe someone who served in the armed forces of participating countries during the Vietnam War.The term has been used to describe veterans who were in the armed forces of South Vietnam, the United States armed forces, and countries allied to them, whether or...

s was 30% in a 1989 US study and 21% in a 1996 Australian study.

Controversy

There is significant controversy with the PIE principles. Throughout a number of wars, but notably during the Vietnam War

Vietnam War

, there has been a conflict amongst doctors about sending distressed soldiers back to combat. During the Vietnam War this reached a peak with much discussion about the ethics of this process. Proponents of the PIE principles argue that it leads to a reduction of long-term disability but opponents argue that combat stress reactions lead to long-term problems such as post-traumatic stress disorder.

Recent research has caused an increasing number of scientists to believe that there may be a physical (i.e., neurocerebral damage) rather than psychological basis for blast trauma.

The source of this article is wikipedia, the free encyclopedia. The text of this article is licensed under the GFDL.

History

World War I

Proximity by circumstance

PIE principles

Between the wars

American

British

Canadian

Germans

Finns

Post-World War II developments

Peacekeeping stresses

Signs and symptoms

Fatigue related symptoms

Battle casualty rates

Therapy

Treatment results

Controversy

See also

Further reading

External links