COMBAT FATIGUE

also called battle fatigue, or shell shock, a neurotic disorder caused by the stress involved in war. This anxiety-related disorder is characterized by (1) hypersensitivity to stimuli such as noises, movements, and light accompanied by overactive responses that include involuntary defensive jerking or jumping (startle reactions), (2) easy irritability progressing even to acts of violence, and (3) sleep disturbances including battle dreams, nightmares, and inability to fall asleep. Although persons in combat differ widely in their susceptibility to combat fatigue, because of hereditary factors and previous training, most cases result from exposure to physical hardship, prolonged and excessive exertion, and emotional conflicts. The emotional conflicts usually are related to loss of comrades, leaders, and group support, together with other precipitating events in the battle setting. Most individuals are best treated by being kept near the front lines and given rest, food, and sedation, provided they are permitted to stay with their units. U.S. armed forces in the late 1960s claimed to have nearly eliminated the occurrence of combat fatigue, attributing their success to practices such as frequent troop rotations, regular hot meals and other comforts for troops in combat areas, rest and recreation leaves away from the war zone, quick evacuation of wounded and good medical care, and application of psychiatric techniques to whole units as well as to individuals. Despite these claims, however, the Vietnam War, especially after 1969, produced a large number of American veterans with behavioral and drug-abuse problems.