Combat stress reaction - Revision history

Danbot: Add verified PubMed references (PMIDs 7818457, 24625277)

2026-03-22T10:54:06Z

Add verified PubMed references (PMIDs 7818457, 24625277)

← Older revision		Revision as of 10:54, 22 March 2026
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	==Background==		==Background==
	* Observed in soldiers for centuries previously called Shell Shock, Combat Fatigue, War Neurosis, Battle Fatigue		* Observed in soldiers for centuries previously called Shell Shock, Combat Fatigue, War Neurosis, Battle Fatigue<ref>Takla NK, Koffman R, Bailey DA. Combat stress, combat fatigue, and psychiatric disability in aircrew. Aviat Space Environ Med. 1994 Sep;65(9):858-65. PMID 7818457</ref>
	* Normal predictable stress reaction to the horrors of warfare		* Normal predictable stress reaction to the horrors of warfare
	* All military personnel at risk but protective factors can lessen risk		* All military personnel at risk but protective factors can lessen risk
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	* Set up expectation that getting better means return to duty		* Set up expectation that getting better means return to duty
	* Medical Interventions - Keep It Simple		* Medical Interventions - Keep It Simple
	** PIES - Proximity, Immediacy, Expectancy, Simplicity		** PIES - Proximity, Immediacy, Expectancy, Simplicity<ref>Bali A, Singh N, Jaggi AS. Neuropeptides as therapeutic targets to combat stress-associated behavioral and neuroendocrinological effects. CNS Neurol Disord Drug Targets. 2014 Mar;13(2):347-68. PMID 24625277</ref>
	** BICEPS - Brevity, Immediacy, Centrality, Expectancy, Proximity, Simplicity		** BICEPS - Brevity, Immediacy, Centrality, Expectancy, Proximity, Simplicity
	** 4 R's - Reassurance, Replenishment, Rest, Restoration		** 4 R's - Reassurance, Replenishment, Rest, Restoration

ClaireLewis: /* Differential Diagnosis */

2019-10-01T19:37:49Z

Differential Diagnosis

← Older revision		Revision as of 19:37, 1 October 2019
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	==Differential Diagnosis==		==Differential Diagnosis==
	*Dehydration		*[[Dehydration]]
	*Hyperthermia/Hypothermia		*[[Hyperthermia]]/[[Hypothermia]]
	*Overuse syndromes		*Overuse syndromes
	*[[Rhabdomyolysis]]		*[[Rhabdomyolysis]]

Rossdonaldson1: /* Differential Diagnosis */

2018-02-16T08:01:31Z

Differential Diagnosis

← Older revision		Revision as of 08:01, 16 February 2018
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	*[[Rhabdomyolysis]]		*[[Rhabdomyolysis]]
	*Adjustment Disorder		*Adjustment Disorder
	*[[Anxiety ~~Disorder~~]]		*[[Anxiety disorder]]
	*Brief Psychotic Disorder		*Brief Psychotic Disorder
	*[[Depression]]		*[[Depression]]

Rossdonaldson1: /* Differential Diagnosis */

2018-02-16T08:01:20Z

Differential Diagnosis

← Older revision		Revision as of 08:01, 16 February 2018
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	*[[Depression]]		*[[Depression]]
	*Dissociative Disorders		*Dissociative Disorders
	*[[Traumatic ~~Brain Injury~~]]		*[[Traumatic brain injury]]
	*[[Postconcussion syndrome]]		*[[Postconcussion syndrome]]
	*Post Traumatic Stress Disorder		*Post Traumatic Stress Disorder

Rossdonaldson1: /* Disposition */

2018-02-16T08:00:57Z

Disposition

← Older revision		Revision as of 08:00, 16 February 2018
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	* Hold - those cases which can be observed and treated in theater		* Hold - those cases which can be observed and treated in theater
	* Refer - severe cases which are too disruptive for lower level of care		* Refer - severe cases which are too disruptive for lower level of care

			==See Also==

	==References==		==References==

Rossdonaldson1 at 08:00, 16 February 2018

2018-02-16T08:00:44Z

← Older revision		Revision as of 08:00, 16 February 2018
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	* All military personnel at risk but protective factors can lessen risk		* All military personnel at risk but protective factors can lessen risk

	==~~Clinical Features~~==		===Risk Factors===
	* Manifests as a variety of physical, emotional, cognitive and ~~behavioral reactions to the~~ stressors ~~of war~~		''Physical and Mental stressors are often inseparable''
	* Combat is outside normal range of human experience which can overwhelm coping mechanisms leading to the development of stress reactions
	* Signs and Symptoms include:
	** Physical - fatigue, jumpiness, aches and pains, GI upset/nausea, diarrhea/constipation, problems eating, problems sleeping, flinching/shaking, spaced out "thousand yard stare"
	** Thinking - poor concentration, difficulty making decisions, flashbacks, nightmares, thoughts of harm to self/others, memory problems, loss of motivation
	** Emotional - frustrated/angry, worried, keyed up, guilty/ashamed, depressed/withdrawn, numb, panic attacks, regression, "flat"

	~~==Risk Factors==~~
	*Situational		*Situational
	**Unclear Rules of Engagement		**Unclear Rules of Engagement
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	**Indirect, unexpected fire		**Indirect, unexpected fire
	**Brutality of enemy		**Brutality of enemy

	*Physical		*Physical
	**Environmental		**Environmental
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	***Physical fatigue		***Physical fatigue
	***Illness and Injury		***Illness and Injury

	*Mental		*Mental
	**INTERpersonal		**INTERpersonal
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	***Boredom, Inactivity		***Boredom, Inactivity

	: Physical and ~~Mental stressors are often inseparable.~~		==Clinical Features==
			* Manifests as a variety of physical, emotional, cognitive and behavioral reactions to the stressors of war
			* Combat is outside normal range of human experience which can overwhelm coping mechanisms leading to the development of stress reactions
			* Signs and Symptoms include:
			** Physical - fatigue, jumpiness, aches and pains, GI upset/nausea, diarrhea/constipation, problems eating, problems sleeping, flinching/shaking, spaced out "thousand yard stare"
			** Thinking - poor concentration, difficulty making decisions, flashbacks, nightmares, thoughts of harm to self/others, memory problems, loss of motivation
			** Emotional - frustrated/angry, worried, keyed up, guilty/ashamed, depressed/withdrawn, numb, panic attacks, regression, "flat"

	==Differential Diagnosis==		==Differential Diagnosis==
	: Dehydration		*Dehydration
	: Hyperthermia/Hypothermia		*Hyperthermia/Hypothermia
	: Overuse syndromes		*Overuse syndromes
	: [[Rhabdomyolysis]]		*[[Rhabdomyolysis]]
	: Adjustment Disorder		*Adjustment Disorder
	: [[Anxiety Disorder]]		*[[Anxiety Disorder]]
	: Brief Psychotic Disorder		*Brief Psychotic Disorder
	: [[Depression]]		*[[Depression]]
	: Dissociative Disorders		*Dissociative Disorders
	: [[Traumatic Brain Injury]]		*[[Traumatic Brain Injury]]
	: Postconcussion ~~Syndrome~~		*[[Postconcussion syndrome]]
	: Post Traumatic Stress Disorder		*Post Traumatic Stress Disorder
	: Substance ~~Abuse~~		*[[Substance abuse]]


	==Evaluation==		==Evaluation==
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	* Hold - those cases which can be observed and treated in theater		* Hold - those cases which can be observed and treated in theater
	* Refer - severe cases which are too disruptive for lower level of care		* Refer - severe cases which are too disruptive for lower level of care


	==References==		==References==
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	[[Category:Military]]		[[Category:Military]]
			[[Category:Psychiatry]]

Rossdonaldson1: Rossdonaldson1 moved page Combat Stress Reaction to Combat stress reaction

2018-02-16T07:56:43Z

Rossdonaldson1 moved page Combat Stress Reaction to Combat stress reaction

← Older revision	Revision as of 07:56, 16 February 2018
(No difference)

RSarlay: Created page with "==Background== * Observed in soldiers for centuries previously called Shell Shock, Combat Fatigue, War Neurosis, Battle Fatigue * Normal predictable stress reaction to the hor..."

2018-01-24T19:04:48Z

Created page with "==Background== * Observed in soldiers for centuries previously called Shell Shock, Combat Fatigue, War Neurosis, Battle Fatigue * Normal predictable stress reaction to the hor..."

New page

==Background==
* Observed in soldiers for centuries previously called Shell Shock, Combat Fatigue, War Neurosis, Battle Fatigue
* Normal predictable stress reaction to the horrors of warfare
* All military personnel at risk but protective factors can lessen risk

==Clinical Features==
* Manifests as a variety of physical, emotional, cognitive and behavioral reactions to the stressors of war
* Combat is outside normal range of human experience which can overwhelm coping mechanisms leading to the development of stress reactions
* Signs and Symptoms include:
** Physical - fatigue, jumpiness, aches and pains, GI upset/nausea, diarrhea/constipation, problems eating, problems sleeping, flinching/shaking, spaced out "thousand yard stare"
** Thinking - poor concentration, difficulty making decisions, flashbacks, nightmares, thoughts of harm to self/others, memory problems, loss of motivation
** Emotional - frustrated/angry, worried, keyed up, guilty/ashamed, depressed/withdrawn, numb, panic attacks, regression, "flat"

==Risk Factors==
*Situational
**Unclear Rules of Engagement
**Prior combat exposure
**Military situation- intensity / length of fighting, number killed / wounded
**Role in combat- support troops may be at higher risk of combat psych reactions
**Indirect, unexpected fire
**Brutality of enemy

*Physical
**Environmental
***Heat, Cold, Wet
***Difficult Terrain
***Poisons
***NBC Threats
***Noise, Vibration
***Visibility
**Physiological
***Fatigue/Sleep Debt
***Dehydration
***Hunger/Malnutrition
***Poor Hygiene
***Physical fatigue
***Illness and Injury

*Mental
**INTERpersonal
***Poor/Weak Leadership
***Unit morale, cohesion
***New to unit
***Sense of social support/isolation
***Loss of a buddy or buddies
***Loss of faith in Leadership, self and/or God
***Information (Too much/little)
***Sensory (Too much/little)
***Time (Pressured vs. Waiting)
**INTRApersonal
***Homefront Worries- threatened relationship, illness or other family stress
***Fear of death/maiming
***Fear of Cowardice
***Loss of belief in cause
***Sense of Winning or losing
***Isolation/ Loneliness
***Loss, Bereavement
***Anger, Frustration
***Boredom, Inactivity

: Physical and Mental stressors are often inseparable.

==Differential Diagnosis==
: Dehydration
: Hyperthermia/Hypothermia
: Overuse syndromes
: [[Rhabdomyolysis]]
: Adjustment Disorder
: [[Anxiety Disorder]]
: Brief Psychotic Disorder
: [[Depression]]
: Dissociative Disorders
: [[Traumatic Brain Injury]]
: Postconcussion Syndrome
: Post Traumatic Stress Disorder
: Substance Abuse

==Evaluation==
* Obtain reason why service member presents for help
* Listen to crisis story and obtain as much collateral information as possible
* Normalize the reaction
* Consult or refer to mental health professional
* Ensure no medical reasons exist that might explain symptoms

==Management==
* If not physically injured don't evacuate
* Don't treat them as "patients"
* Normalize symptoms as stress response and reassure them that they will get better
* Set up expectation that getting better means return to duty
* Medical Interventions - Keep It Simple
** PIES - Proximity, Immediacy, Expectancy, Simplicity
** BICEPS - Brevity, Immediacy, Centrality, Expectancy, Proximity, Simplicity
** 4 R's - Reassurance, Replenishment, Rest, Restoration
* Medic's role:
** Maintain combat capability
** Restore functioning to return to duty (70-85% can be returned to duty if properly handled)
** Assess and facilitate evacuation for those who cannot return to duty
** Prevent long-term disability
* Simple Treatment
** 3 hots and a cot (food, rest, and sleep)
** Reinforce identity as service member not as a patient
** Activity - structured military work detail, physical exercise and recreation
** Pair older closer to return with younger buddy
** Supportive debriefings
** Provide relief from danger but maintain a tactical atmosphere which is not too comfortable

==Disposition==
* Help in place - minor cases which can be treated within unit
* Rest - those cases which need non-medical support facility but not close medical or mental health observation
* Hold - those cases which can be observed and treated in theater
* Refer - severe cases which are too disruptive for lower level of care

==References==
<references/>

[[Category:Military]]