Understanding Post-Traumatic Stress Disorder In Military Veterans: PTSD Vs Combat Stress

Post-traumatic stress disorder can, we all know, develop after someone's lived through trauma — and it remains most closely associated, in many people's minds, with combat veterans. Not all combat-related stress reactions are PTSD, however. Most people who see combat will go through some level of combat stress, both in the moment and in the immediate aftermath. Though that doesn't mean they'll go on to develop post-traumatic stress disorder, some will. Knowing the difference is important. 

What is combat stress?

Combat stress goes by many different names. During the American Civil War, it was identified simply as homesickness or nostalgia. During World War I, the more familiar term "shell shock" was used, alongside lesser known ones like effort syndrome and gas hysteria. In World War II, new terms like battle fatigue, combat exhaustion, and operational fatigue were preferred. You may come across terms like combat stress reaction and combat operational stress reaction, too, with the exact words largely depending on the war a person served in. 

People experiencing combat stress may notice a range of physical reactions — like fatigue, an upset stomach, nausea, being unable to eat and sleep, and general jumpiness. They may have headaches, or aches and pains caused by tension, and start shaking. Mentally, they may find themselves unable to concentrate and have an impaired decision-making capacity, as well as being plagued by flashbacks, suffering memory problems, and feeling suicidal. Feelings like anger, shame, fear, guilt, panic, depression, and emotional numbness are also common. 

Though combat stress is not a clinical diagnosis, nearly all military personnel and their loved ones will be familiar with it — as are militaries across the globe. The US Marine Corps, for instance, divides levels of operational stress into color-coded "zones":

• The green zone means the Marine is "ready" — they may be under some stress, but are able to manage it well and are fully functional as well as in good spirits. 
• In the yellow zone, the Marine is "reacting" — suffering temporary stress that may reduce their ability to function, usually in reaction to something new. Continued training can make someone less vulnerable to this kind of stress. 
• The orange zone starts signaling some real distress — the person is now emotionally or spiritually "injured". More than some temporary grumpiness and fatigue, they are exhibiting some of the symptoms of combat stress mentioned above. They'll need to be evaluated, as they are at risk of worsened symptoms that may interefere with their ability to carry out their duties. 
• The red zone is one of diagnosible distress, which means the person isn't able to function well in their duties, and significant efforts may be required to help them recover. The most well-known diagnosis in this situation is post-traumatic stress disorder, but other disorders would include major depressive disorder, generalized anxiety disorder, and also substance use disorders. 

Because combat stress is used to refer to the kind of stress a person goes through during and immediately after a traumatic event, it has some things in common with the DSM-5 diagnosis of acute stress disorder. This diagnosis describes reactions and symptoms that are very much like PTSD, but in the first month following trauma. It's important to note, though, that combat stress and acute stress disorder are not synonymous — whatever name may be used, combat stress is unique to people who experience combat. 

What are the signs of post-traumatic stress disorder?

Possible manifestations of PTSD include:

• Intrusive memories of the trauma, physical reactions like a fast heartbeat when you're reminded of the trauma, flashbacks, and nightmares. 
• Trying your best to avoid reminders of the trauma, whether that's by staying away from external reminders like people, places, and events, or banishing internal reminders, like thoughts and feelings, from your mind. 
• Finding yourself unable to remember significant aspects of the trauma. 
• Distrusting yourself and the people around you, having negative feelings about the world, blaming yourself, or feeling guilty. 
• A chronic state of anger, irritation, fear, or horror, which may include being unable to experience any sort of positive emotion. 
• Feeling alienated and detached from the (civilian) world around you, feeling like you're not quite there, and having little motivation to participate in events. 
• Reckless and self-destructive behavior, like picking fights or drinking way too much. 
• Hypervigilance — always being on guard, ready for the next threat — and being quick to startle. 
• Being unable to concentrate or sleep well. 

PTSD is debilitating, leaving those affected unable to function optimally, and messing with all areas of their life. Though combat stress can come with many of the same symptoms, it can be temporary and subside without treatment. The same is often untrue for PTSD.

What can you to to optimize your quality of life?

Returning military personnel who are still transitioning back to civilian life can take some steps to keep healthy. They include:

• Being aware of their stress levels. Seeking help when it gets too much. 
• Give yourself time to transition.
• Making time for recreational activities, whether something physically active or something else they enjoy. This can help boost mood and morale. 
• After serving, civilian life can feel extremely strange. Some people may find meaning in volunteering, continuing to be of service in some way — whether that's coaching a sports team, giving blood, or any other way that means something to the person. 
• Some people will find comfort and connection in attending a religious community. 
• When you notice you're struggling hard, and can't handle it on your own, reach out for help. Many services will be available.