Combat Neurosis

Combat neurosis describes behavioral health disturbances related to the stress of military combat, particularly for individuals unaccustomed to active military duty or inexperienced in wartime settings. Alternative terms are combatfatigue syndrome, shell shock, operational or battle fatigue, combat exhaustion, Gulf War syndrome, and war neurosis.

Combat neurosis describes any behavioral health disturbance that represents a response to the stress of war or any combat setting. Witnessing any war-related act, whether actual battle, acts of terror, torture, killing of military personnel or civilians, or widespread environmental or human devastation, may cause combat neurosis. It is closely related to post-traumatic stress disorder (PTSD), and there is evidence to suggest that war-related disorders can progress to fullblown PTSD if not promptly and effectively treated. Symptoms may appear during the combat-related experience or may not become apparent until days, weeks, months, or even years later.

An estimated 10% of all personnel who fought in World War II (1939–45) experienced symptoms of combat neurosis, known then, according to the American Psychiatric Association, as gross stress reaction. This term was also applied to personality disturbances resulting from catastrophes other than war. Subsequently, considerable attention from both the general public and the behavioral health and medical communities focused on the combat neuroses experienced by those who fought during the Vietnam, Persian Gulf, Iraq, Iran, Afghanistan and other Middle Eastern conflicts. Although there is no specific set of symptoms that are triggered by war or combat, in most cases the disturbance begins with feelings of anxiety, depression, or other mood disturbance.

Symptoms of combat neuroses vary considerably. Some of the most frequently reported early signs, in addition to mood changes, are increased irritability and problems with sleep. As the disturbance progresses, symptoms include increased depressive symptoms, bereavement-type survivor guilt reactions, vivid and recurrent nightmares, and persistent terrifying daytime flashbacks. Markedly decreased attention/ concentration and inability to focus, often accompanied by memory deficits are very commonly reported. Emotional blunting, apparent indifference, frank apathy, withdrawal, lack of attention to personal hygiene and appearance, and potentially self-injurious behaviors are also associated with combat neurosis.

Individuals with combat neurosis often use alcohol, illicit drugs, or prescription medication to self-medicate in order to achieve some symptomatic relief. Combat neurosis can be a cause of significant severe mental and emotional distress. The potential for successful treatment, when the individual is amenable to help, varies considerably. Some individuals are treated successfully with psychotropics, most frequently antidepressant and antianxiety medications. Often, a multidisciplinary approach combining medication with group and individual therapies, substance abuse treatment as needed, and assistance with occupational and life skills development are successful in an outpatient setting. For a small percentage, inpatient treatment may be necessary.

See also Anger ; Anxiety and anxiety disorders ; Depression ; Mood stabilizers .



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