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Combat stress, sometimes called combat and operational stress or combat and operational stress reaction, is a common response to the mental and emotional effort active duty personnel exercise when facing tough and dangerous situations. Combat stress is similar to the muscle fatigue and soreness experienced after a tough physical workout.

Combat stress is not an illness and may be experienced by active duty personnel during both peace and war, due to stressful conditions during training, deployment, humanitarian missions, government support missions and other assignments.

For assistance with combat operational stress please call the Community Counseling Program at (760) 763-3222.

Risk Factors

All active duty personnel are at risk for stress injuries, no matter how strong, seasoned or experienced. Everyone has a breaking point, and for everyone, that breaking point changes over time due to many internal and external factors, including:

  • Duration of current deployment greater than six months
  • Repeat deployments without sufficient time to recover
  • Sleeping less than 6-8 hours per day on average
  • Witnessing death close up, especially of other active duty personnel or civilian non-combatants
  • Being responsible for the death or serious injury of a non-combatant or allied combatant
  • Losing a close friend or valued leader in combat or other operations
  • Witnessing or participating in violations of the Law of War and the Marine Corps Code of Conduct
  • Being physically injured, especially if seriously
  • Sustaining a traumatic brain injury
  • Close brushes with death, especially if the individual believed they were going to die
  • Handling remains, especially of other active duty personnel
  • History of previous stress injuries, whether sustained during or prior to service
  • Previous mental health problems
  • Being new to the unit or lacking mutual trust with other unit members
  • Being impacted by family, relationship, or other home front stressors
  • Being young and inexperienced

Signs and Symptoms

Signs and symptoms of combat stress may be harder to detect. Common symptoms of combat stress can include:

Thought Process

  • Problems concentrating
  • Confusion
  • Having problems in making decisions or processing information
  • Memory loss
  • Having a hard time telling what is real
  • Re-experiencing events or flashbacks
  • Troubling memories or nightmares
  • Loss of trust
  • Hallucinations or delusions (that don’t go away with adequate sleep)


  • Unusual or excessive anxiety, fear, worry or nervousness
  • Depression, despair or unexplained sadness
  • Numbness and lack of interest in life
  • Agitation and intense anger or irritability
  • Guilt and shame or a sense of failure
  • Feeling overwhelmed
  • Feelings of isolation
  • Mood swings
  • Loss of confidence and trust


  • Withdrawing and avoiding others
  • Restlessness or fidgeting
  • Being over-watchful or overly concerned about safety
  • Angry outbursts
  • Crying
  • Changes in diet
  • Risky or careless behaviors, such as increased smoking, drug or alcohol use, and reckless driving
  • Staring into space (the “thousand-yard stare”)

Physical Symptoms

  • Problems sleeping
  • Exhaustion
  • Worsening health problems
  • Pounding heart and sweating; cold sweats
  • Problems with eating or digestion
  • Nausea, frequent urination or diarrhea
  • Trembling hands
  • Numbness, tingling or loss of function in limbs or other body parts
  • Headaches
  • Changes in vision

Resiliency Factors

All active duty personnel possess traits and abilities that make them resilient to the potentially damaging effects of combat and operational stress. All leaders are responsible for promoting resiliency in their units. Resiliency factors include:

  • Tough and realistic training
  • Knowing what to expect, at every turn
  • Being more mature
  • Having served in a previous operational deployment without physical or stress injury
  • Having faith in God, the Marine Corps, leaders, and peers
  • Being physically fit
  • Having a stable and supportive home and family life
  • Being good at pushing self-defeating thoughts or perceptions out of conscious awareness
  • Tending to cope with problems by taking action
  • Having an optimistic attitude

COS Continuum

The Marine Corps views combat operational stress along a continuum. It is a representation of how you or others are functioning with deployment-related stress:

COS Continuum Graphic

Why Active Duty Personnel May Not Seek Help

Due to the stigma that surrounds behavioral health and stress problems, particularly among Marines, who pride themselves in their ability to endure extreme stress, fighting stigma begins with understanding its causes, which include:
  • Not understanding that stress injuries are like other physical injuries — treatable and not the individual’s fault
  • Believing that adverse reactions to stress are a sign of weakness or personal failure
  • Not knowing that even the h4est active duty member can suffer a stress injury
  • Fearing that having an emotional problem or getting help for it will negatively impact their careers
  • Fearing their peers will think less of them because they got help for a stress injury
  • Fearing their peers or leaders won’t trust them as much in future tough situations if they admit to having suffered a stress injury
  • Not understanding that the longer they wait to get help for stress injuries that don’t heal quickly on their own, the less likely they are to heal fully
  • Not realizing that avoiding getting help may place their unit members at risk because of decreased readiness and performance caused by untreated stress injury symptoms
  • Not realizing that avoiding getting help for persistent stress injuries can hurt their careers, relationships, and future health more than accepting help will
  • A command climate that discourages getting help or tells active duty personnel to just “suck it up” or “get over it”


Just as it is the responsibility of all leaders to protect the physical health and welfare of their active duty personnel, it is also their responsibility to prevent stress injuries as much as possible. The following are leader actions to prevent Combat Operational Stress Continuum (COSIs):

  • Tough, realistic training
  • Maintain unit cohesion
  • Ensure adequate sleep
  • Limit unnecessary exposure to terror and horror
  • Keep your Marines/Sailors informed
  • Hold regular “hot wash” After-Action Reviews (AARs)
  • Maintain physical fitness
  • Reduce unnecessary stress during operations
  • Ensure rest and recuperation after intense and prolonged actions
  • Encourage time for spiritual renewal

For assistance with combat operational stress please call the Community Counseling Program at (760) 763-3222.

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