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Deployment Quarterly |
Deployment Quarterly
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Combat
Stress Symptoms by Rudi Williams |
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Mental health experts don’t know what combat stress reactions to expect from servicemembers returning from the war in Iraq. And it’s not just stress reactions from actual combat, according to Army Lt. Col. (Dr.) Elspeth Cameron Ritchie. Some could be disturbed or demoralized by stressors from the consequences of combat, such as handling remains of civilians, enemy soldiers or U.S. and allied personnel. Or they could come from dealing with POWs, witnessing homes and villages destroyed by bombing or a number of other battlefield stressors. "Combat stress reactions, which are psychological reactions to fierce combat or operations other than war, are both physical and psychological," said Ritchie, program director for Department of Defense’s mental health policy and women’s issues for the Office of the Assistant Secretary of Defense for Health Affairs. "Physical reactions are things like your hands sweating and trembling and your heart racing, or a need to go to the bathroom a lot." The psychological reactions include things like anxiety, hypervigilance, difficulty concentrating, or sleeping, irritability and sadness. Ritchie emphasized that combat stress reactions are normal reactions to abnormally stressful or traumatic situations. However, Ritchie, a psychiatrist, said, "If these reactions go on for long periods of time or get in the way of job performance, it’s important to get treatment."
She said soldiers and Marines can recognize in themselves or their buddies the anxiety and irritability that combat stress reactions can cause. "When things get in the way of functioning, that’s when a little more help is needed," Ritchie noted. Some people returning from Operation Iraqi
Freedom may not want to talk about what happened for a while, she pointed
out. Signs that a returning servicemember is having genuine difficulty, she said, could include temper outbursts, detachment or general difficulty interacting with family members. A loved one who seems to be having a hard time adjusting to life back at home, Ritchie said, should be encouraged to talk to a mental health professional. The extent of psychological reactions servicemembers might have from Iraq is unknown. "What we may see is people who are repeatedly seeing the images of battle," Ritchie said. She pointed out that there’s a lot of overlap between combat stress and the stress of everyday activity. "What differentiates combat stress is usually the intensity of what has happened," the doctor noted. "Sometimes you’ll have repeated memories and intrusive thoughts focusing on what happened." Long-term reactions to combat stress could lead to post-traumatic stress disorder, she noted. "By definition, PTSD [Post-Traumatic Stress Disorder] is supposed to happen a month or more after the event," Ritchie said. "There can be some similarities in the symptoms of combat stress and PTSD — nightmares, insomnia, anxiety, numbness, hypervigilance and intrusive thoughts." Some servicemembers may have only some symptoms of PTSD and have difficulty functioning. Some people may be troubled by an occasional nightmare, which isn’t classified as PTSD. "But other folks might feel that they’re so scared that they can’t get to work," she said. "That is a problem, and we want them to seek treatment." However, she said some of these reactions
are common; therefore, she doesn’t advocate necessarily seeking treatment
immediately.
"If the symptoms keep going on, such as nightmares night after night, they should seek help," Ritchie said. Some health care providers and family members make the common mistake of encouraging people to talk about everything that happened before the patient is ready to talk, Ritchie noted. "I wouldn’t push the returning soldier or Marine to talk about what happened right away," she said. "But I would be there for him or her when he or she is ready to talk." There’s also concern about servicemembers’ reactions to changed family situations. Those returning from the battlefield often envision everything at home is going to be perfect, like a flawless honeymoon. But often things are a little bit different, Ritchie said. "The kids may have grown. They may not respect authority in the same way. The spouse may have more independence. He or she may have needed to make some decisions that the soldier or Marine weren’t part of. So often there is some friction when the soldier or Marine gets home. "Families should expect a little bit of friction so it doesn’t spook them," she said. "So, they don’t think, ‘Oh, no! My marriage is coming apart!’ It’s part of the reintegration process." Modern day transportation plays a major role in creating the problem, she noted. "In World War I and World War II and Korea, people came home by ship that took two or three weeks," Ritchie said. "They had a chance to get rested and talk to their unit about what had happened and prepare to reintegrate with the family. "Nowadays, people have been on the
battlefield one day and maybe at home or the shopping mall in a day or
two. That reintegration is just a little bit too fast. In some cases,
it could be jarring."
Editor’s Note: If you feel the need to talk to someone about your deployment experiences or need information on where to seek physical and mental care, there are several resources available. Many family support centers on installations as well as chaplains and other clergy members in your local communities provide one-on-one counseling and group sessions with licensed, professional counselors. Mental health services that are available through your TRICARE medical benefits are also a resource to call if you need them. Log on to the TRICARE Web site at http://www.tricare.osd.mil . The Deployment Health Clinical Center at Walter Reed Army Medical Center joins with veterans, their families and their providers in an effort to find answers, improve health care and enhance quality of life after military deployments. You can reach them by calling toll-free (866) 559 – 1627 or on the Web at http://www.pdhealth.mil Another resource is the Direct Hotline for Servicemembers, Families and Veterans where contact managers are able to assist in answering deployment-related questions. You can call the toll-free hotline number (800) 497 – 6261 Monday through Friday from 9 a.m. to 9 p.m. Eastern Standard Time.
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