The stress of operational deployment can challenge service members and their families like few other experiences in life.It can also change them in many significant ways. The changes caused by a tough deployment can often be positive, including developing a greater appreciation for life and relationships, a greater level of maturity, and a deeper spirituality. Sometimes, however, service members can return from a combat tour with painful and troubling memories, such as those caused by physical injuries or near-misses, or the death or injury of close friends or leaders. They may also come home from a combat deployment still feeling keyed up, on edge, and overly alert for danger. In a few cases, they may develop significant problems sleeping, staying calm, or controlling their emotions and behavior immediately after returning from a war zone.

Most of the stress-related problems service members may experience after returning from a tough deployment are just normal aspects of the process of readjusting to being back home. An example of a common readjustment problem they may experience after returning from an operational deployment is a recurrent feeling of uneasiness while driving a vehicle in traffic in the US, and a tendency to scan the roadside for potential dangers just as they did while deployed to an operational theater. With patience and time, however, most post-deployment readjustment problems get better and go away within a month or two. But occasionally, post-deployment stress problems don’t just fade away without help. And sometimes stress problems are so intense and troubling immediately after returning from deployment that it wouldn’t be wise to simply wait to see if they go away on their own. These two situations—stress problems that either don’t start to fade away after a service member has been back a month or more, and stress problems that are very intense and troubling soon after deployment—may be indications that a service member is dealing with a stress injury rather than just a readjustment problem.

Stress injuries are invisible but real injuries to the brain and mind that are caused by severe life challenges, such as can occur during an operational deployment. They can happen to anyone subjected to stress of sufficient intensity or duration. And like physical injuries, most stress injuries heal on their own if nothing gets in the way of healing.

But also just like physical injuries, stress injuries have a better chance of healing quickly and completely if they are recognized and given the proper care. There are three main causes or types of stress injury: (1) psychological trauma, (2) operational fatigue, and (3) grief from loss. The first type of stress injury, trauma, is an impact injury due to a specific event (or events) involving terror (actual fear that one would be killed), horror (witnessing gruesome scenes of carnage), or extreme helplessness. During a traumatic event, service members may experience brief loss of control of their thoughts, emotions, or behavior. Their minds may go “blank” for a short while, or they may briefly shake or lose control of their bodies in some other way. After a traumatic event, they may experience difficulty sleeping, nightmares, uncontrollable memories or images about the trauma, and a desire to avoid any reminders of what happened. They may also find that after a traumatic event they become more irritable and angry, or anxious and fearful than normal.

The second type of stress injury, fatigue, is a wear-and-tear injury due to the accumulation of smaller stressors over a long period of time, usually many months or even multiple deployments. The stressors that contribute to operational fatigue include not only the many hardships and hassles of operational deployment, but also the stressors associated with separation from family and friends, money and health problems, and everything else that makes life challenging. The greatest risk factor for operational fatigue is not getting enough sleep. Whereas traumatic stress comes on abruptly, after one or more specific events, fatigue stress comes on more gradually. The primary symptom of operational fatigue is not fatigue or tiredness, though. Rather, it’s worsening anxiety or anger that becomes increasingly inappropriate for present situations, and increasingly difficult to control. Service members with fatigue injuries sometimes develop panic attacks—episodes in which their hearts beat too fast for no reason at all, even while they are resting. This condition is not new and has been called “soldier’s heart” in the past.

The third type of stress injury, grief, is caused by the loss by death or serious injury of close friends, valued leaders, or others that are cared about. Everyone reacts to losses differently. Some people feel intense emotions of anger, sadness, or guilt after a death. Others don’t feel many emotions at all. But most people find that in order to come to terms with the death of someone they care about, they have to let themselves do the “work” of grieving — by allowing themselves to feel painful feelings when remembering the lost person, forgiving themselves or anyone else they feel may have contributed to the loss, and making some kind of sense out of the loss. All of this may take many months. During deployments, the proper care for stress injuries (sometimes called combat/operational stress reactions) often consists of little more than a period of rest and recuperation, followed by a gradual return to full duty. Sometimes, stress injuries in a war zone require greater attention from a chaplain or a medical or mental health professional.

Occasionally, medications will be prescribed during the deployment to promote healing or to help with sleep. Support from peers, leaders, and chaplains can do much to promote healing from a stress injury during a deployment. After the deployment ends, there are many things service members can do to help themselves heal from stress injuries:

• Get enough sleep every night, at least 6-8 hours
• P.T. regularly
• Don’t drink alcohol every day, and don’t use it to get to sleep
• Stay connected with the other service members they deployed with
• Talk to people you trust about what happened during the deployment — sometimes the only way to make sense out of and get over traumatic experiences is talk through them in detail with someone else.
• Take care of yourself spiritually, in whatever way works for you— by being active in a faith community, praying, meditating, or talking with spiritual leaders.

After returning from deployment, it’s a natural inclination to wait a while before seeking professional help for stress symptoms that don’t immediately go away. Many service members are reluctant to seek mental health care because they are afraid they would be seen as weak, or that being treated by a mental health professional would harm their careers. The problem with this reluctance is that those stress injuries that don’t quickly get better on their own sometimes get worse over time, and the longer they go without treatment, the less chance they have of healing completely. Here are a few signs that may indicate that professional help may be needed:

• You can’t get to sleep or stay asleep for at least 6 hours each night
• You have episodes of panic (anxiety, rapid heart rate, sweating, shortness of breath) that you can’t control
• You have outbursts of rage or intense anger that you can’t prevent or control
• You have thoughts of suicide or impulses to hurt or kill someone else You have any stress symptoms of any kind that don’t start to get better after you have been back for more than 30 days.

Remember, the sooner needed help is obtained, the more likely stress problems are to heal completely.