Newsfeed display by CaRP Mental health experts don't know what combat stress reactions to expect from service members returning from the war in Iraq. And it's not just stress reactions from actual combat, according to Army Dr. (Lt. Col.) Elspeth Cameron Ritchie.

Some could be disturbed or demoralized by stressors from the consequences of combat, such as handling remains of civilians, enemy soldiers or U.S. and allied personnel. Or they could come from dealing with POWs, witnessing homes and villages destroyed by bombing or a number of other battlefield stressors.

"Combat stress reactions, which are psychological reactions to fierce combat or operations other than war, are both physical and psychological," said Ritchie, program director, DoD mental health policy and women's issues for the Office of the Assistant Secretary of Defense for Health Affairs. "Physical reactions are things like your hands sweating and trembling and your heart racing, or a need to go to the bathroom a lot."
The psychological reactions include things like anxiety, hypervigilance, difficulty concentrating, or sleeping, irritability and sadness. Ritchie emphasized that combat stress reactions are normal reactions to abnormally stressful or traumatic situations.

However, Ritchie, a psychiatrist, said, "If these reactions go on for long periods of time or get in the way of job performance, it's important to get treatment."

She said soldiers and Marines can recognize in themselves or their buddies the anxiety and irritability that combat stress reactions can cause. "When things get in the way of functioning, that's when a little more help is needed," Ritchie noted.

Some people returning from Operation Iraqi Freedom may not want to talk about what happened for a while, she pointed out. "But if you notice that one of your loved ones is having difficulty, maybe they're losing their temper a lot, or they are sort of detached and doesn't seem to relate, you should encourage them to seek mental health help," she said.

Even though the extent of psychological reactions service members might have from Iraq is unknown, Ritchie said, "What we may see is people who are repeatedly seeing the images of battle.

She pointed out that there's a lot of overlap between combat stress and the stress of everyday activity. "What differentiates combat stress is usually the intensity of what has happened," the doctor noted. "Sometimes you'll have repeated memories and intrusive thoughts focusing on what happened."

Long-term reactions to combat stress could lead to post traumatic stress disorder, she noted. "By definition, PTSD is supposed to happen a month or more after the event," Ritchie said. "There can be some similarities in the symptoms of combat stress and PTSD - nightmares, insomnia, anxiety, numbness, hypervigilance and intrusive thoughts."
Some service members may only have some symptoms of PTSD and by difficulty functioning. Some people maybe troubled by an occasional nightmare, which isn't classified as PTSD.

"But other folks might feel that they're so scared that they can't get to work," she said. "That is a problem and we want them to seek treatment."

However, she said some of these reactions are common; therefore, she doesn't advocate necessarily seeking treatment immediately. "However, if the symptoms keep going on, such as nightmares night after night, they should seek help," Ritchie said.

Some healthcare providers and family members make the common mistake of encouraging people to talk about everything that happened before the patient is ready to talk, Ritchie noted. "I wouldn't push the returning soldier or Marine to talk about what happened right away," she said. "But I would be there for him or her when he or she is ready to talk."

There's also concern about service member's reactions to changed family situations. Those returning from the battlefield often envision everything at home is going to be perfect, like a flawless honeymoon. But often things are a little bit different, Ritchie said.

She said, "The kids may have grown. They may not respect authority in the same way. The spouse may have more independence. He or she may have needed to make some decisions that the soldier or Marine weren't part of. So often there is some friction when the soldier or Marine gets home.

"Families should expect a little bit of friction so it doesn't spook them," she emphasized. "So they don't think, 'Oh, no! My marriage is coming apart!' It's part of the reintegration process."
Modern day transportation plays a major role in creating the problem, she noted. "In World War I and World War II and Korea, people came home by ship that took two or three weeks," Ritchie said. "They had a chance to get rested and talk to their unit about what had happened and prepare to reintegrate with the family.

"Nowadays, people have been on the battlefield one day and maybe at home or the shopping mall in a day or two. That reintegration is just a little bit too fast. In some cases, it could be jarring."