Combat stress reaction

Combat stress reaction
Image from World War I taken in an Australian dressing station near Ypres in 1917. The wounded soldier in the lower left of the photo has a dazed thousand-yard stare, a frequent manifestation of "shell-shock".
Classification and external resources
MeSH	D003130
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Combat stress reaction (CSR) is a term used within the military to describe acute behavioral disorganization seen by medical personnel as a direct result of the trauma of war. Also known as "combat fatigue" or "battle neurosis", it has some overlap with the diagnosis of acute stress reaction used in civilian psychiatry. It is historically linked to shell shock and can sometimes precurse post-traumatic stress disorder.

Combat stress reaction is an acute reaction that includes a range of behaviors resulting from the stress of battle that decrease the combatant's fighting efficiency. The most common symptoms are fatigue, slower reaction times, indecision, disconnection from one's surroundings, and inability to prioritize. Combat stress reaction is generally short-term and should not be confused with acute stress disorder, post-traumatic stress disorder, or other long-term disorders attributable to combat stress, although any of these may commence as a combat stress reaction. The US Army uses the term/acronym COSR (Combat Stress Reaction) in official medical reports. This term can be applied to any stress reaction in the military unit environment. Many reactions look like symptoms of mental illness (such as panic, extreme anxiety, depression, and hallucinations), but they are only transient reactions to the traumatic stress of combat and the cumulative stresses of military operations.

In World War I, shell shock was considered a psychiatric illness resulting from injury to the nerves during combat. The horrors of trench warfare meant that about 10% of the fighting soldiers were killed (compared to 4.5% during World War II) and the total proportion of troops who became casualties (killed or wounded) was 56%. Whether a shell-shock sufferer was considered "wounded" or "sick" depended on the circumstances. When faced with the phenomenon of a minority of soldiers mentally breaking down, there was an expectation that the root of this problem lay in character of the individual soldier, not because of what they experienced on the front lines during the war. These sorts of attitudes helped fuel the main argument that was accepted after the war and going forward that there was a social root to shell shock that consisted of soldiers finding the only way allowed by the military to show weakness and get out of the front, claiming that their mental anguish constituted a legitimate medical diagnosis as a disease. The large proportion of World War I veterans in the European population meant that the symptoms were common to the culture.

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