FM 22-512-12
FM 22-51potential harm to the soldier, others, or themission. Warning signs do not necessarily meanthe soldier must be relieved of duty or evacuatedif they respond quickly to helping actions.However, soldiers may need evaluation at medicaltreatment facilities to rule out other physical ormental illness. If the symptoms of battle fatiguepersist <strong>and</strong> make the soldier unable to performduties reliably, then medical treatment facilities,such as clearing station <strong>and</strong> specialized <strong>combat</strong><strong>stress</strong> control teams, can provide restorativetreatment. At this point, the soldier is a battlefatigue casualty. For those cases, prompttreatment close to the soldier’s unit provides thebest potential for returning the soldier to duty,See Chapter 5 for a detailed discussion of battlefatigue.2-10. Overlapping of Combat Stress BehaviorsThe distinction between positive <strong>combat</strong> <strong>stress</strong>behaviors, misconduct <strong>stress</strong> behaviors, <strong>and</strong> battlefatigue is not always clear. Indeed, the threecategories of <strong>combat</strong> <strong>stress</strong> behaviors mayoverlap, as diagramed in Figure 2-3. Soldierswith battle fatigue may show misconduct <strong>stress</strong>behaviors <strong>and</strong> vice versa. Heroes who exemplifythe positive <strong>combat</strong> <strong>stress</strong> behaviors may suffersymptoms of battle fatigue <strong>and</strong> may even be battlefatigue casualties before or after their heroicdeeds. Excellent <strong>combat</strong> soldiers may commitmisconduct <strong>stress</strong> behaviors in reaction to the<strong>stress</strong>ors of <strong>combat</strong> before, during, or after theirotherwise exemplary <strong>performance</strong>. Combat<strong>stress</strong>, even with good <strong>combat</strong> behavior, does notexcuse criminal acts. However, it could be takeninto account as an extenuating circumstance forminor (noncriminal) infractions or in determiningnonjudicial punishment under Article 15, UCMJ,for minor offenses.2-11. Post-Traumatic Stress DisorderPost-traumatic <strong>stress</strong> symptoms are normalresponses after extremely abnormal <strong>and</strong>di<strong>stress</strong>ing events.a. Post-Traumatic Stress DisorderSigns <strong>and</strong> Symptoms. As with battle fatigue,post-traumatic <strong>stress</strong> symptoms come in normal/common <strong>and</strong> warning signs. These signs <strong>and</strong>symptoms do not necessarily make the sufferer acasualty or deserve the label of disorder. It isnormal for the survivor of one or more horribleevents to have painful memories; to have anxiety(perhaps with jumpiness or being on guard); tofeel guilt (over surviving or for real acts of omissionor commission); <strong>and</strong> to dream unpleasantdreams about it. This becomes <strong>PTSD</strong> only wheneither the pain of the memories or the actions theperson takes to escape the memories (such assubstance abuse, avoidance of reminders, socialestrangement, <strong>and</strong> withdrawal) interfere with occupationalor personal life goals.b. Post-Traumatic Stress DisorderPreventive Measures. As with battle fatigue,there is no virtue in suffering, ignoring, neglecting,or hiding post-traumatic <strong>stress</strong> symptoms.2-13
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