Diagnostics and assistance in wartime conditions
In the conditions of war, military personnel face not only physical injuries and wounds. The so-called combat psychological trauma (CPT) is a widespread phenomenon experienced by many individuals involved in active combat zones. It is characterized by a pronounced disturbance of the psyche resulting from factors within the combat environment. Such a condition requires timely provision of qualified psychological assistance and accurate diagnosis, as it is often confused with concussions and injuries of somatic origin.
Historical Aspect
The psychological peculiarities of military personnel first caught the attention of the scholar Jacob Mendes da Costa, who described psychosomatic disorders in participants of the Civil War in the United States. One of the disorders he described was termed “soldier’s heart.” Although the description focused significantly on cardiological symptoms, this pathology resembled CPT in many ways. The term itself first appeared during World War I, the deadliest conflict compared to previous wars. It was coined by the British psychiatrist Charles Myers and originally referred to as “shellshock.”
During World War II, the study of similar disorders continued, and the term “war neurosis” became prevalent. In 1952, the American Psychiatric Association officially recognized this condition and included it in the DSM-2 classification as a “reaction to severe emotional and physical stress.”
Causes of Occurrence
The main and immediate cause of psychological trauma is considered to be the perception of intense danger directly threatening the life and health of individuals in combat. Therefore, it is most commonly diagnosed in those who spend prolonged periods in high-risk situations without proper psychological preparation, bear increased responsibility, and are forced to make quick decisions even in the absence of necessary information.
Psychological factors contributing to combat psychological trauma are exacerbated by physical factors. These include severe fatigue (combat fatigue), lack of even minimal rest, disrupted sleep patterns, and inadequate nutrition. Conditions of combat activity, influencing combat stress, also play a role. For example, if a military personnel performs functions not typical for them, or if climate, terrain features, and personal problems affect the execution of combat tasks.
Clinical Manifestations
The symptoms of CPT may vary, as the disorders can be of two types:
- Acute psychological trauma occurring directly without a traumatizing situation. In this case, it is an acute condition where the military personnel may fall into a stupor and practically not react to external stimuli. This state needs to be distinguished from ordinary bewilderment, where a person can recover from a slap or cold water. In CPT, such methods should not be used as they can worsen the individual’s condition. Another reaction to CPT is excessive excitement, where the military personnel may become agitated, shout, and even become physically aggressive towards others. In particularly severe clinical cases, problems with vision, hearing, or coordination may arise.
- Gradual development of CPT over time due to regularly repeated factors. In this case, it is more challenging to recognize, as the individual’s condition worsens gradually. The military personnel becomes more gloomy, aggressive towards others, and often isolates themselves.
As the clinical presentation of CPT varies, the primary responsibility for recognition falls on the commander. They must promptly identify issues in their subordinates and evacuate them from the battlefield for necessary assistance. Therefore, attention should also be paid to certain physical signs characteristic of CPT, such as diarrhea, frequent urination, and a pale complexion. The so-called ‘thousand-yard stare,’ coined by American psychologists, is a noticeable symptom characterized by a distant and vacant look. Additionally, there is the ‘combat smile,’ appearing on the face as a form of passive aggression.
Classification of Combat Psychotraumas
CPT is classified primarily based on the severity of symptoms. According to this criterion, there are three degrees:
- Mild form: the individual suffers from migraines, appetite worsens, and fatigue increases;
- Moderate form: characterized by hysterical behavior, aggressiveness, fear, a sense of derealization, and neuroticism;
- Severe form: serious disorders of hearing, vision, coordination, and pronounced changes in the psychoemotional state.
It is essential to remember that modern psychiatry considers CPT as one of the varieties of post-traumatic stress disorder (PTSD).
Assistance for CPT
If a soldier experiences combat trauma, and their combat readiness does not recover within a few hours, immediate assistance must be provided. Ideally, they should be transported to a medical unit, battalion, or military hospital. However, immediate aid can be provided by those in the vicinity, especially the commander, who should be familiar with the specifics of psychological disorders in military personnel. Initially, efforts should be made to stop the panic attack. Breathing techniques, grounding, and visualization can be effective for this purpose. Additionally, peppermint candy, strong sweet tea, or a regular ice cube can help alleviate the panic state.
The treatment for CPT is individually tailored based on symptoms. Typically, it involves psychotherapy, medication, adherence to a daily routine, occupational therapy, art therapy, and more. Recovery for a soldier usually takes around 10 days. However, in cases of severe conditions or when CPT is complicated by physical trauma, a significantly longer psychological rehabilitation may be required, which can be pursued at Molfa Hub.”