Combat Stress Versus Post Traumatic Stress Disorder

Cmdr. Carrie Kennedy, PhD, ABPP, Navy Medicine Live
Combat Stress Versus Post Traumatic Stress Disorder

It seems like the terms combat stress and PTSD are everywhere these days; it’s hard to go a few days without seeing a news story about veterans and these issues.  But what are these concepts?  Do they mean the same thing? And perhaps most important what can be done?

Combat stress and PTSD are VERY different things. Unfortunately, sometimes they look quite similar which makes them somewhat complicated.

By definition, combat stress is an expected and predictable reaction to combat experiences. After being in a combat zone where people are under constant physiological stress (for example, poor diet, extreme temperatures, little opportunity for good personal hygiene, etc.) and psychological stress (for example, concerns about the presence of improvised explosive devices or snipers or the death of fellow service members), it is expected that most people will experience a number of responses.

These responses often show up as hyperstartle (that exaggerated response when something surprises you — often a loud noise), hypervigilance (being always on guard or super-alert), bad dreams/nightmares, irritability, sleep problems, etc.  While these sound negative, some of these reactions are actually considered adaptive, notably hyperstartle and hypervigilance, as well as other benefits of combat stress, including increased physical strength, better endurance and enhanced feelings of competency (not all combat stress is bad).

PTSD, on the other hand, refers to a psychiatric disorder which impairs functioning. It is considered very serious whereas combat stress is considered standard.

To receive a diagnosis of PTSD, a number of specific symptoms have to be present following a traumatic event in which death, serious injury or sexual violation occurred or was a real possibility. These include re-experiencing symptoms (such as recurrent dreams, flashbacks or intrusive images), avoidance symptoms (such as avoiding conversations about the event or people associated with the event, memory loss, etc.) as well as other problems such as sleep disturbance, irritability/anger problems, concentration difficulties, hypervigilance or hyperstartle.

You’ll notice some overlap between combat stress responses and PTSD symptoms, but that doesn’t mean they are addressed in the same way.Keep in mind that combat stress isn’t considered a medical problem or something that needs treatment. For many war veterans, combat stress simply wears off after being back in the states for a few weeks to months. However, if service members don’t do certain things, combat stress can persist or morph into something else (like PTSD, depression, an alcohol problem, etc.). Letting people know what responses are expected and giving some brief education about them can help to prevent problems.

Because of destigmatization programs and policies, service members are becoming more likely to question whether or not their combat stress reactions should worry them. Military mental health providers and psychiatric technicians can provide one or two sessions of psychoeducation discussing what combat stress is and what the usual reactions are, assist in processing difficult experiences, and teach how to proactively address combat stress (for example, maintaining contact with other veterans, having a plan for anniversaries of friends’ deaths, keeping alcohol use low, etc.). For those with normal reactions, this is often all it takes to make a smooth transition from the combat zone.

However, the real key to effective management of combat stress and long term adjustment is something that veterans have known through the ages — namely – veterans have to be in regular contact with other veterans. Talking over difficult experiences with members of the same unit is the best way to process combat experiences, stay grounded, get rid of lingering doubts and concerns and prevent the development of abnormal problems. This is done somewhat constantly while in the combat zone and should continue upon return from the warzone. Other good people to talk to are veterans of the same war even though they may have served in a different unit or branch of service as well as veterans of any other war.  While warfare changes somewhat over time, the basic stressors are enduring. American Legions, Veterans of Foreign Wars (VFWs) and other veteran-centric groups are significant assets in effectively dealing with combat stress.

What about PTSD? While treatment for PTSD will involve some of the same concepts as those necessary to effectively manage combat stress, the primary interventions need to be done with a mental health provider. The good news is that there is very effective treatment available — therapies such as Cognitive Processing Therapy and Exposure Therapy are provided by just about every mental health department in military/VA hospitals and clinics. These treatments help with not only symptom resolution but also lifelong strategies for the effective management of disturbing wartime experiences, decreasing the likelihood of symptom recurrence.

In short, combat stress is a reaction which through some basic self-implemented strategies, in addition to the passage of time, wears off. Terrible experiences and memories will always be troubling to think about — the goal is never to make these kinds of experiences easy. However, through observation of anniversaries, life-long interactions with members of the unit and involvement with other veterans, veterans typically move into different phases of their lives without difficulty.

PTSD is a higher hurdle, but not one which is impossible to get over. New, empirically validated treatments effectively address PTSD, even for veterans of prior wars and it is highly recommended that veterans experiencing PTSD go get the help they deserve.


Posted on BrainLine October 3, 2013.

This blog post is from Navy Medicine Live, written by Cmdr. Carrie Kennedy, a neuropsychologist and aerospace experimental psychologist with Marine Corps Embassy Security Group. Kennedy describes the similarities and differences of combat stress and posttraumatic stress disorder (PTSD) to help you prevent or effectively manage both.

Used with permission from Navy Medicine Live.

Comments (17)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

I am also a PhD, and I have to say that I don't agree with your information on behalf of combat veterans with PTSD. 

PTSD stems from prolonged exposure to combat stress, and the symptoms are quite the same.  My husband did 9 combat tours (Force Recon), and due to his very poor treatment from military "professional psychologists"...mismanagement of VA issued medications...six month delays in being able to get an appointment and repeated prolonged exposure therapy, he too became increasingly aggressive, violent, depressed, and eventually took his own life.  We as professionals spend a great deal of time "over thinking" and spending too much time deciding what box to put combat veterans in when they show signs of stress. Instead we should be developing logical care plans to help them learn to recondition their minds and learn to live again.  WWII, and Vietnam Veterans took the brunt of our "professional guessing games" and we still have not managed to help them.  I would like to read more about what veterans want as far as treatment instead of reading about what we think they need...and many of us "professionals" have never been to combat.  No offense CMDR, but military officials are their own worst enemies when it comes to helping their soliders...remember PTSD was a taboo topic until someone from the outside forced the concept down the throats of superiors who told soldiers to "get over it"...(even though combat stress was recognized in the early works of Aristotle, we still could not accept the severity of repeated combat exposure?).  I think we need to be asking veterans "How can we help you?"  "What do you need from us?"  And allow them to self-develop with guidance...not re-exposing them over and over to their combat experiences...did we not learn anything from evolution?  If we continuously re-expose someone to fear stimuli, it does not get "easier" to deal becomes an implanted maladaptive reaction to fear that you will NOT be able to change.  Thus the reason we continue to have between 20 and 26 military suicides each day.  We are not on the right path, and the only ones who can help us fix this problem is the combat veterans themselves.  Everyone experiences trauma differently, so why are we using the same treatments for everyone?   If we can put people in space...we should be able to figure this out...right?  In memory of my husband SSGT D9, U.S. Marine Corps, and in memory of all soldiers who took their own are not forgotten, and we will make the right changes on behalf of what we learn from you.  Titles do not mean experience folks...I have a title, and I learn more from people who have worked in the trenches, and I thank those veterans for teaching me!

As a Retired (Female) Veteran with 3 deployments (3 yrs) I agree with you. I also want to give my condolences to you and your family. I am so sorry your husband wasn't able to get the quality care he needed. He's in a better place now but his spirit will always live on with you as his wife. RIP

My son who was also a Marine is struggling with the same issues that your husband did. I’m so worried about him.

I agree with your comments to the commander, I too think that the everyone who is willing to help should first step back and listen to the Combat Veteran himself and proceed from there.

Dear phd, I was a marine. I went five times. Thank you so much for saying so much that I feel about the system I find myself in now. I thought after five trips I'd get some physical therapy and maybe something about how I feel. I've received only some canned public school factory type approach to becoming as healthy as I was. I learned that the wars we fight are about making a select group wealthy, and not much else. I am loath to profane the memory of your husband like that but my heart is broke because of this. I actually believed we were doing something noble. I learned we were meat. Then and now. I apologize for the lack of eloquency. I have a graduate degree but I was a grunt. There is no way to make it ok. There are only a small percentage of people that can croak other humans and be "normal" after. It's just not in us. I suspect your husband was normal and maybe noble as well and he just couldn't swallow the lie that we have some sort of "right of kings" to beat up and steal from people so some vampires we follow can be what they are. Somehow we have to stop it or we won't make it as a species.

I like your comments

To the person  who on September the 5th 2016 wrote "I wish I had never joined the military, now I wish I were dead", I feel your pain and I hope you are still here. I have to experienced similar feelings/thoughts and no doubt will continue to until I do pass away, but not at my own hand. Be strong my friend, the strongest you have ever been mentally in your whole life before, don't take steps to slip away, fight with all the mental strength you can muster. You are a fighter, so much stronger than you really believe. Seek out that one day that sometimes comes out of the blue of being a perfect day both mentally and physically and allow that moment of mental and physical peace to embrace you fully  Soak up that beauty and rest your mind and soul for that period of time. You leaving will cause pain to others that you could not even imagine when you are unwell with this debilitating illness. You are so much better than that.  I am one of the thousands who suffer from combat related PTSD as well, who severed in the New Zealand Military. I'm tired of all these so called experts coming up with new names, classifications, miracle treatments and the constant rhetorical bullshit that goes with this life destroying illness. Spend a day in my shoes I say and I'm sure you will think twice about your self promoting brilliance of being the one to classify me in a tick box of symptoms and realise my illness cannot be quantified by a mental Heath classification book. But I have to keep fighting too, because when I get that once in a while day of clarity and beauty, my life seems perfect.  If only for a short period of time. Be strong my friend, please don't throw your life away. Take care, kea Kaha. 

I'm ashamed I'm so weak. Twenty years later and I don't think I'll ever be normal.

I wish i had never joined the military, now I wish I were dead.


from a quantitative EEG point of view both TBI and PTSD show evidence of elevated beta levels in the frontal lobes, also shows up on fMRI and other medical diagnostic instruments

kirtley thornton, phd

As a veteran of 25 years and a mental health counselor, I find the implication that PTSD occurs when the military member doesn't  do appropriate self-care is disrespectful to the member's situation and a deflection of responsibility for care by the very organization that is chartered to treat the PTSD! Treat the disorder; don't minimize it or blame the warrior for having it!!!

The problem I see with this is that the VA will consider all who suffer PTSD as suffering from CS (Combat Stress) and do the same thing they did back in the 60s, which was to tell us Nam vets that it was normal and to go home and it would go away. Well guess what we did, it didn't go away and you have hundreds of thousands of Nam vets struggling with it today. Many just couldn't deal with it and there have been more than 150,000 Nam vet suicides. For most, we handled It,  we were young but age makes you vulnerable to your thoughts and it resurfaced with a vengence.
This goes to the fact that there are those who consider PTSD as not being a disorder and trying to minimize what it is by calling it PTS or now it seems Combat Stress. Until everyone who has the symptoms are considered by VA and military Docs to have  PTSD regardless of the percentage and with treatment,diagnosis and healing programs can later be considered to have Combat Stress and therefore move on, only then should it be considered non life threatening.
Organizations like the VA are fueled by money and will jump on the Combat Stress idea and deny treatment disregarding the points made by the author concerning aftercare treatment and gradual reintegration, since in the article they intimate that it is not considered a disability, just a normal reaction. That's the VA and that's just the way it is folks, PTSD is not something you play around with with mind games especially if you suffer with PTSD it and are being told you don't.
PTSD and then CS, not CS and prove to me you got PTSD, which is where it is now and seems is headed for worse. Most PTSD sufferers are already in denial of it and most welcome and are relieved to be told they don't have it. In that scenario most vets will go with the latter, will not get treated, and you will see them in 30 or 40 years down the road.
We should be past that.

"For many war veterans, combat stress simply wears off after being back in the states for a few weeks to months. However, if service members don’t do certain things, combat stress can persist or morph into something else (like PTSD, depression, an alcohol problem, etc.)." .... As someone who suffers from PTSD as a result of combat in Iraq, I find this statement absolutely ridiculous. This statement suggests PTSD is a result of not taking the proper steps when you have Combat Stress. Yet, elsewhere in the article you state that Combat Stress doesn't need treatment. This is absurd. If you have Combat Stress, you should seek treatment. You need to process what you've encountered and receive therapy so you can begin to deal with those issues. Even then, however, PTSD is unavoidable if high-level or long-term trauma has altered brain functioning. It isn't the veteran's fault if they "don't do certain things."

I worry about are American soldiers part of it because they were trained to be tough & strong and sometimes I think their just scared to ask for help too they don't won't to be be treated different too in my eyes their Brave & Strong even if they get (P.T.S.D) they just need extra help & someone to talk to & lean on too

There are some people looking to change PTSD to just PTS. It is not a disorder, it is just combat stress carried beyond combat. Symptoms like excessive drinking, depression etc. occur during and post combat deployment.  

One of the best ways to handle stress is a Chinese Traditional Medical treatment called Qigong. It is best taught by someone who is an OMD, a long time martial artist and/or a veteran. The teacher needs to have a firm grounding in the principles of Chinese Traditional Medicine. The US NIH says that "Tai Chi" is an excellent treatment for stress, but "Tai Chi" isn't really the treatment, it is the Qigong portion of Tai Chi Quan training that is the actual beneficial element.