Combat stress reaction

Combat stress reaction
A U.S. Marine, Pvt. Theodore J. Miller, exhibits a "thousand-yard stare": an unfocused, despondent and weary gaze which is a frequent manifestation of "combat fatigue".
Specialty	Psychiatry

Combat stress reaction (CSR) is acute behavioral disorganization as a direct result of the trauma of war. Also known as "combat fatigue", "battle fatigue", "operational exhaustion", or "battle neurosis", it has some overlap with the diagnosis of acute stress reaction used in civilian psychiatry. It is historically linked to shell shock and can sometimes precurse post-traumatic stress disorder.

Combat stress reaction is an acute reaction that includes a range of behaviors resulting from the stress of battle that decrease the combatant's fighting efficiency. The most common symptoms are fatigue, slower reaction times, indecision, disconnection from one's surroundings, and the inability to prioritize. Combat stress reaction is generally short-term and should not be confused with acute stress disorder, post-traumatic stress disorder, or other long-term disorders attributable to combat stress, although any of these may commence as a combat stress reaction. The US Army uses the term/initialism COSR (combat stress reaction) in official medical reports. This term can be applied to any stress reaction in the military unit environment. Many reactions look like symptoms of mental illness (such as panic, extreme anxiety, depression, and hallucinations), but they are only transient reactions to the traumatic stress of combat and the cumulative stresses of military operations.^[1]

In World War I, shell shock was considered a psychiatric illness resulting from injury to the nerves during combat. The nature of trench warfare 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 about 57%.^[2] Whether a person with shell-shock was considered "wounded" or "sick" depended on the circumstances. Soldiers were personally faulted for their mental breakdown rather than their war experience. The large proportion of World War I veterans in the European population meant that the symptoms were common to the culture.

In World War II it was determined by the US Army that the time it took for a soldier to experience combat fatigue while fighting on the front lines was somewhere between 60 and 240 days, depending on the intensity and frequency of combat. This condition isn't new among the combat soldiers and was something that soldiers also experienced in World War I as mentioned above, but this time around the military medicine was gaining a better grasp and understanding of what exactly was causing it. What had been known in previous wars as "nostalgia", "old sergeant's disease", and "shell shock", became known as "combat fatigue".^[3]