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Military Stress Description High Operational Tempo (OPTEMPO)28,29 Excessive work Short notice changes to plans Continuous operations Day-to-day demands Long-range work requirements Perception of work overload Separation from family Decreased communication with family Unpredictability28,30–37 Rapid mobilization Phone or internet unavailability Stand-by status Reception by the public Deployments10,38–41 Combat missions Humanitarian missions Peace-keeping missions Austere environments Servicemember casualties Human remains Death of enemy combatants Civilian noncombatant casualties Life threatening experiences Training42–46 Novelty Inability to anticipate requirements Time management pressure Sleep deprivation Inexperience with roles and responsibilities Continuous stress Physical exertion Toxic Leadership47 Inexperienced managers Late decisions Frenzied, micromanaged climate Indifferent leaders Abusive leaders Culture of distrust Central Nervous System Effects Clinical Manifestation Amygdala47–50 Hypersensitivity to stimuli coupling with dACC Hypervigilance Enhanced responses to future stress Poorly regulated fear response HPA Axis51–54 Overexposure to glucocorticoids Depression Altered gene expression Panic Loss of negative feedback mechanism Obsessive-compulsive symptoms Sensitization to stimuli Fatigue Habituation to cortisol or overproduction of cortisol Hippocampus55 Atrophy of Ammon’s Horn Decreased declarative, contextual, and spatial memory Reduced excitability Inhibited neurogenesis Decreased hippocampal volume Allostasis51,52,56,57–59 Allostatic overload New stress baseline Inability to maintain homeostasis Inefficient management of stress response Wear and tear of physiological systems Obesity Neuronal remodeling Cognitive impairment dACC = dorsal anterior cingulate cortex
HPA = hypothalamic-pituitary-adrenal
Significant time in military (> 15 years) Exposure to chronic or traumatic stress History of ongoing coping attempt Awareness of distress History of deliberate avoidance of treatment Hyperarousal symptoms Cognitive complaints Anxiety due to identity Anxiety due to increased intimacy Mourning processes Peer and family concerns “Where do I begin?” quality < 5 years in military Disciplinary problems Acquiescence to symptom review Decreased content associated with symptoms Normal occurrences presented as evidence of disorder Acute anxiety Overly inclusive quality of reported symptoms < 15 years in military Medical retirement First visit to mental health during medical retirement Stereotyped symptoms Decreased content associated with symptoms Emphasis on a single event as the cause of symptoms
