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The Onset of War-Zone Stress Effects

Depending on their experiences and their bodies’ responses to stress, some Service Members begin to experience symptoms of anxiety, depression, acute stress reactions, and/or acute stress disorder (ASD) in the theater of war.


View the DSM-IV Diagnostic Criteria for Acute Stress Disorder


ASD appears within four weeks of traumatic experience and includes clinically significant distress or the impairment of one’s ability to pursue necessary tasks.  If the ASD symptoms do not resolve within a four-week period, they meet the criteria for a diagnosis of posttraumatic stress disorder (PTSD)


View the DSM-IV Diagnostic Criteria for Posttraumatic Stress Disorder


And depending largely on levels of shame and stigma toward combat stress reactions—stigma embraced by the Service Member and/or the Unit—they may or may not speak of, or even admit to themselves, their acute stress reactions.  If they do speak or show their symptoms, they set in motion the multi-level military responses to these symptoms described under “Care for War-Zone Stress in the Theatre of War.”  If they do not receive help, their risk of developing posttraumatic stress disorder (PTSD) is increased (VA, 2004).

In other Service Members, as long as they remain in the war zone, the constant rush of stress chemicals creates a sort of false equilibrium—a bit like the forces in the old cartoon that kept the Road Runner afloat until he realized he had run off the cliff and the earth was a long way below him.  This relentless state of “hypervigilance” may continue to burden and compromise the Service Member’s stress systems more and more, but in some cases it may also delay formation of acute and post-trauma symptoms.  For those who choose to “self-medicate” these symptoms, alcohol is also readily available in Iraq, though a standing order prohibits the use of any alcohol or illegal drugs in deployed environments (VA, 2004).

It is after they leave the war zone—with no more constant surge of stress chemicals to “keep them afloat”—that many Service Members and veterans first experience their worst combat stress injuries or post-traumatic stress effects.  Depending on their chemical reactions to stress, their experiences in and after the war zone, and the levels of support around them, it might take weeks, months, or even years for the symptoms of post-deployment effects to surface.  There may not be enough time between deployments for these symptoms to emerge, or the symptoms may emerge among people who are about to be redeployed.  Depending on symptom severity and manageability, and on many decision-making processes, redeployment may or may not take place.

If the diagnosis is PTSD and symptoms last less than three months, it is considered “acute” PTSD.  If it lasts three months or more, it is considered “chronic.”  If symptoms do not begin until at least six months after the experience of trauma, PTSD is considered to have “delayed onset” (APA, 1994).

In the Iraq War Clinician Guide, the Department of Veterans Affairs wrote that “The chronic phase of adjustment to war is well-known to VA clinicians;  it is the burden of war manifested across the life-span.  It is important to note that psychosocial adaptation to war, over time, is not linear and continuous.  For example, most soldiers are not debilitated in the immediate impact of days, but they are nevertheless at risk for chronic mental health problems implicated by experiences during battle.  Also, although ASD is an excellent predictor for chronic PTSD, it is not a necessary precondition for chronic impairment—there is sufficient evidence to support the notion of the late PTSD.  Furthermore, the majority of people who develop PTSD did not meet the full diagnostic criteria for ASD beforehand.  It is also important to appreciate that psychosocial and psychiatric disturbance implicated by war-zone exposure waxes and wanes across the life-span (e.g., relative to life-demands, exposure to critical reminders of war experiences, etc.)” (VA, 2004, pp. 23-24).


Next: The Variety of War-Zone Stress Effects

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The material on all of the Clinical Pages is taken directly from the draft version of Finding Balance After the War Zone:  Considerations in the Treatment of Post-Deployment Stress Effects, a manual under development for the Great Lakes Addiction Technology Transfer Center and Human Priorities.  This draft is copyright © 2008, Pamela Woll.  Reprint permission is universally granted, but attribution is requested.
Click here for References and Other Resources.
Click here to link to a PDF file of the current version of the clinician’s manual draft.
Click here to link to a PDF file of the accompanying booklet for veterans.

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