Combat operational stress reaction
- David Benedek, MD
David Benedek, MD
- Professor and Deputy Chair
- Uniformed Services University School of Medicine
- Derrick Hamaoka, LtCol, USAF, MC, FS
Derrick Hamaoka, LtCol, USAF, MC, FS
- Assistant Professor
- Uniformed Services University of the Health Sciences
Every member of a military service who experiences combat is affected to some degree by exposure to combat and the deployment environment. These stressors can affect military personnel in a number of domains: emotional, cognitive, physiologic, and environmental.
Combat operational stress reaction (COSR) 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 US military uses the COSR designation to identify effected personnel and to intervene, generally with conservative measures such as rest and support.
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'.)
Combat operational stress reaction (COSR) is a term used by the US military to describe the wide range of maladaptive mental and behavioral symptoms (see 'Clinical manifestations' below) that can emerge in response to combat. The COSR designation is limited to individuals with some of these symptoms for the first 72 hours following their onset or identification. (See 'Clinical manifestations' below.)
The effects of cumulative battlefield stress on military personnel have been recognized for over one hundred years. Older terms to describe the syndrome include “shell shock” [1,2], “soldier’s heart” , “battle fatigue” , and “psychoneuroses” . The United States (US) military adopted the term “combat stress reaction” to describe the syndrome in 1999, which was later revised to “combat operational stress reaction” (COSR) .
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- Conceptual framework
- - Combat stress
- - Responses to combat stress
- - Development over time
- - Possible risk factors
- CLINICAL MANIFESTATIONS
- OVERLAP WITH PSYCHIATRIC AND MEDICAL CONDITIONS
- INITIAL MANAGEMENT
- Conservative measures
- Persistent symptoms
- SUMMARY AND RECOMMENDATIONS