The Cost of Chronic Stress

Have you ever heard of “Allostatic Load” and “Operator Syndrome?”

I stumbled across the work of Christopher Frueh while researching physiological, psychological and hormonal stress mitigation. Frueh, along with his team of researchers, psychologists and former SOF operators, has been exploring the human mind, defining PTSD and outlining Special Operator’s Syndrome. This is one of the only programs in the country specifically designed to help those suffering from this condition.

“Allostatic load” is the cost on your body of chronic stress and physical demands of a career with the military special forces, according to Science Direct. The military recipe for “burning the candle at both ends” includes high-intensity physical fitness training, the high stress of operations and being away from home, the trauma of witnessing death, war or injury. Add in the inability to sleep or eat well, and the operator limits the two main recovery responses, which leads to chronic stress. This adds up to allostatic overload.

Operator Syndrome, then, may be understood as the natural consequences of an extraordinarily high allostatic load. Clinical research and comprehensive, intensive immersion programs are needed to meet the unique needs of this community, according to The International Journal of Psychiatry in Medicine.

Symptoms of Operator Syndrome

Frueh’s findings are based on a screening of former SOF operators and resulted in a list of psychophysiological symptoms and side effects that came from a career working within SOF units.

“This list contains interrelated health and functional impairments including traumatic brain injury effects; endocrine dysfunction; sleep disturbance; obstructive sleep apnea; chronic joint/back pain, orthopedic problems and headaches; substance abuse; depression and suicide; anger; worry, rumination, and stress reactivity; marital, family and community dysfunction; problems with sexual health and intimacy; being “on guard” or hypervigilant; memory, concentration and cognitive impairments; vestibular and vision impairments; challenges of the transition from military to civilian life; and common existential issues.” (The International Journal of Psychiatry in Medicine)

Creating a list of indicators and naming it “Operator Syndrome” allows for active-duty service members and veterans to get treatment and health-care coverage for various psychophysiological conditions at once. The process of healing has to be a holistic approach with the operator and medical community attacking this issue together.

Monitoring and Addressing Stress Before Allostatic Overload Occurs

The Marine Corps has a program called Operational Stress Control and Readiness Training Guidance (OSCAR). In fact, “OSCAR III (2020) is designed to provide selected Marines, sailors, medical professionals, religious ministry teams and mental health professionals with information and resources needed to help Marines and Sailors prevent, identify and manage combat and operational stress issues as early as possible, before they become medical problems. The course emphasizes implementation of OSCAR principles and designates time for participants to start developing a plan of action. OSCAR GEN III, which runs a minimum of four hours, features engaging practical applications, discussions and critical thinking scenarios.”

Education after the fact is critical to help operators not only to self-assess but also to assess others and urge them to seek assistance. Operators typically are not self-aware when in a high stress state.

With the proper education and systems in place, the military can become better at monitoring operators during their career and seeing whether they stay physiologically in sync.

The Air Force Special Warfare Human Performance Program is creating such a monitoring system that stays with the operator throughout their career. For the psychological and psychophysiological ends of the candle, operators should take regular endocrine and hormone tests. Endocrinology is the perfect marker to assess the physical and psychological status of an individual, because each hormone has a physical and psychological purpose. For example, testosterone and cortisol markers can show when operators need better recovery tools and smart, physician-regulated down time.

The Big Three Recovery Tools

Sleep, nutrition and mindfulness can ensure that an operator is recovering properly and maintaining their ability to perform. As mentioned in the three phases of tactical fitness, phase three, the operator phase, is focused on maintaining physical abilities to do the mission but also on mitigating stress through a constant active pursuit of recovery methods. Once sleep and nutrition are obstructed, it is only a matter a time before chronic stress symptoms appear, especially when on deployment.

The mind and body have many responses to stress, both good and bad. The body produces stress hormones that act as a performance enhancer when needed, but the physiological and behavioral response to traumatic stress can manifest through flashbacks, avoidance of similar events and increased hyperarousal.

Simply put, these are survival skills. You are not crazy because you have some of these symptoms, but you can learn to deal with those symptoms with a multi-tiered approach by using these big three tools.

Frueh is taking stress recovery to new levels. Operator self-care is a start, but comprehensive medical care also is needed in order to address the multiple challenges of stress mitigation in the hypervigilant.