Clinician Guide: The Stress of Preparing, Journeying to Battle

This is the first in a series of small chunks of information I'll be sharing with you from time to time to help arm yourself with as much combat PTSD knowledge as possible.

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You can find this passage in the Executive Summary of the Department of Veterans Affairs Iraq War Clinician Guide [p.7-8]:

During missions such as Operation Iraqi Freedom there are multiple stages and types of conflict. Throughout an operation, these stages can overlap depending on the location and mission of assigned forces. Each form of conflict may contribute to different forms or expressions of stress. It is therefore valuable to determine precisely the nature and duration of exposures for returning troops.

Pre-deployment phase. During pre-deployment phase military members face uncertainty and worry. Deployment orders change routinely, sometimes with multiple revisions of deadlines and locations. Service members worry about the safety of themselves as well as their family members. They struggle to ensure that finances, healthcare, childcare, and pets all will be managed in their abscence. In the current climate, deploying service members may have additional concerns about terrorist activities in the United States during the period of deployment. Pre-deployment can be extremely stressful on single parents, reserve forces, and military members who have not previously deployed. It is often difficult during this phase to determine the difference between reasonable anxiety and an excessive reaction or the development of recurrence of psychiatric illness.

Deployment phase. The deployment phase carries many additional pressures. The stress of traditional, high-intensity warefare leads to fear and uncertainty. Operational plans change constantly; knowledge of enemy capabilities is unclear; equipment breaks down; and logistical supply lines are uncertain. Combatants face the threat of their own death or injury and also witness the death, wounding, and disfigurement of their companions, enemy forces, and civilians. During this heightened physiologic state, the high level of emotion, and the intensity of sensory exposure may lead to heightened levels of arousal, attempts to avoid emotion, and intrusive recollections of events. The novelty of the situation may also contribute to symptoms of dissociation. The severity and duration of symptoms will vary among individuals. This phase of combat is highly conducive to acute stress disorder and posttraumatic stress disorder in military members.