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Combat and operational stress reaction

Authors
David Benedek, MD
Derrick Hamaoka, LtCol, USAF, MC, FS
James C West, MD
Section Editor
Murray B Stein, MD, MPH
Deputy Editor
Richard Hermann, MD

INTRODUCTION

Military personnel who deploy to combat zones will experience some degree of combat and operational stress. Reactions to these stressors can affect individuals in a number of domains: Physiologic, emotional, cognitive, and behavioral.

Combat and operational stress reaction (COSR; or combat stress injury) is a term used to describe the wide range of anticipated, maladaptive psychological and behavioral symptoms, often transient, that may emerge in response to these stressors following exposure to combat or other particularly stressful military operations.

The epidemiology, pathogenesis, clinical manifestations, course, diagnosis, prevention, and treatment of COSR are described here. The epidemiology, pathogenesis, clinical manifestations, course, diagnosis, prevention, and treatment of psychiatric disorders related to stressful experiences, acute stress disorder, posttraumatic stress disorder, and other psychological sequelae of military combat are discussed separately. (See "Acute stress disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Treatment of acute stress disorder in adults" and "Posttraumatic stress disorder in adults: Epidemiology, pathophysiology, clinical manifestations, course, assessment, and diagnosis" and "Pharmacotherapy for posttraumatic stress disorder in adults" and "Psychotherapy for posttraumatic stress disorder in adults" and "Medical care of the returning veteran", section on 'Psychological sequelae'.)

DEFINITION

Combat and operational stress reaction (COSR) is a term used by the United States Army to describe the wide range of maladaptive mental and behavioral symptoms that can emerge in response to combat. The COSR designation is limited to individuals with COSR symptoms during the 72 hours from their onset or identification. (See 'Clinical manifestations' below.)

The effects of battlefield stress on military personnel have been recognized throughout the history of warfare. Older terms to describe the syndrome include “shell shock” [1,2], “soldier’s heart” [3], “battle fatigue” [4], and “psychoneuroses” [5]. The United States Army adopted the term “combat stress reaction” to describe the syndrome in 1999, which was later revised to “combat and operational stress reaction (COSR)” [6].

                
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Literature review current through: Nov 2017. | This topic last updated: Nov 30, 2017.
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