Combat Stress and PTSD: Knowing the Difference

WASHINGTON (Army News Service, March 18, 2008) - For thousands of Soldiers returning home this spring, homecoming and reintegrating with Family and friends will be more challenging than hugs and parades, the result of stress that begins in-theater.

Combat stress is a natural result of the heavy mental and emotional work required when facing danger in tough conditions--Soldiers just don't feel right or can't do everything they're used to doing. This is a common issue that all Soldiers experience, to some extent, while deployed.

"The current assessment of the mental health among the Soldiers within the division is really good," said Maj. Chris Ivany, division psychiatrist, 4th Infantry Division and Multi-National Division - Baghdad. "Most of the Soldiers are adjusting adequately and are settling into their roles of the deployment. That's one of the largest things that can help ease the stresses of combat, is to become adjusted to the overall environment.

"However, we must continue to look after the well-being of the Soldiers and eliminate as much unnecessary stress during the deployment as possible; and (for) those Soldiers currently experiencing an insurmountable level of stress, we need to continue to provide them with the care they need to remain healthy."

Leaders need to be the first line of defense to prevent unnecessary stress on their Soldiers and to help prevent high levels of combat stress, he said, leaders can ensure they are providing ample time for Soldiers to take care of their personal needs, which includes time to decompress after missions and opportunities to communicate with Family and friends at home.

Leaders can also rotate duties so Soldiers don't become stuck in one place, said Ivany. It is also important for leaders to tell their Soldiers how important the jobs they are doing are, both as individuals, and as part of the team.

"Leaders need to recognize possible signs of battle-related stress and help to prevent eventual issues regarding the Soldier's mental health," said Command Sgt. Maj. John Gioia, the senior enlisted leader of MND-B. "All Soldiers need to be healthy, both physically and mentally, in order to perform the number of tasks that are required of them. It is the leaders who are responsible for ensuring each of their Soldiers are taken care of to the greatest extent possible.

"Additional stress comes in depending upon what type of environment we operate," said Command Sgt. Maj. Thomas Capel, senior-enlisted Soldier for the 82nd Airborne Division, currently in Afghanistan. "If you're in a well-trained, well-disciplined unit, your battle fatigue is going to be low because you know for a fact that any enemy you go up against, you're going to take them out."

"After a traumatic event, such as the death of a fellow comrade, other members of the unit will often experience a wide array of different emotions and reactions in response to the event," said Ivany.

Some danger signs of Soldiers struggling with stress after a traumatic event could include: re-experiencing the event or over-reacting when faced with reminders of the event, feeling emotionally numb or disconnected from others, and "keyed up" or "jumpy," having troubles concentrating on specific tasks.

It's important for Soldiers facing a traumatic event to stick together, both in and out of theater.

"The battle buddy is going to be the most important part of the chain," said Capel.

"I encourage people to continue to talk with people from their unit, especially people who have been through the traumatic events with them," said Air Force Maj. Kellie Griffith, a psychiatrist at the Combat and Operational Stress Control Clinic at Bagram Airfield, Afghanistan.

If Soldiers are still having problems, they need to get help from a chaplain, medical provider or behavioral-health professional.

"We [define] post-traumatic stress as issues that individuals can't deal with on their own," Capel said.

The three primary symptoms of PTSD are: re-experiencing, or reliving a traumatic event through nightmares, flashbacks or intrusive images; hyper-vigilance, which includes irritability and jumpiness; and avoidance, not wanting to think about the trauma again and doing anything to avoid it, Griffith said.

Another common symptom is a sense of foreshortened future. It's the belief that the future is not going to work out, that it's going to be cut short.

Soldiers may be reluctant, but they should try to get help instead of self-medicating with alcohol or other drugs.

"People will feel that since they're a platoon leader they should have their stuff together. They feel like they can't come in there, that it's showing that they're weak, that nobody else in their unit is seeking help. That's not true," Griffith said. "I've seen everybody from all different ranks come on in here."

Often Soldiers are hesitant to seek help fearing possible professional retribution, but of those seeking help, treatment affects the careers of less than 5 percent of servicemembers, according to Griffith.

"Nobody here is trying to fire anybody for going to see mental hygiene or get help because they're suffering from some type of post-traumatic stress - nobody," Capel said.

For Soldiers dealing with symptoms of PTSD, there is a pre-screening program in place to determine an individual's stress levels at the Army's Medical Protection System through Army Knowledge Online Web site. Soldiers must complete the screening before returning home.

Any questionnaire for future military employment divulging your mental-health history will be sent to a health care professional such as a flight surgeon for review, Griffith said.

Treatments include combinations of therapy, sleep medication and medication specifically for PTSD.

"The gold standard is exposure therapy," Griffith said. "The concept behind PTSD is that in your brain you have normal memories and you have abnormal memories - traumatic memories. The normal memories are stored in such a way that they're filed away appropriately. They don't intrude upon your day-to-day life. Traumatic memories are more like they're hanging around your neck. They can come up and intrude upon your day-to-day life at any moment.

"Exposure therapy seeks to bring up the memory, have you look at it, have you remember what you're able to tolerate ... face it, [realize] it's not going to kill you. It's not going to make it happen all over again," Griffith said. "Eventually, patients get to a point where it is better filed, it is more likely to just stay in their brain and not intrude upon their day-to-day life."

(Sgt. Thompson serves with the MND-B Public Affairs Office and Pfc. Rangel serves with the 22nd Mobile Public Affairs Detachment in Bagram Airfield, Afghanistan. Their reports were combined for this story.)