Operator Syndrome

In the words of Dr. Chris Frueh, the psychologist who published the groundbreaking Operator Syndrome (OS) paper with others in 2020, OS is a “unique constellation of medical and behavioral healthcare needs of military Special Operation Forces”. His groundbreaking paper was published in 2020 and is available for free on the Resources page.

A syndrome is a collection of medical problems and needs that frequently co-occur among a group of individuals. OS is, therefore, a collection of medical problems that co-occur frequently among Operators. The frequency of their co-occurrence tells us there is a shared root-cause that is unique to the group of individuals.

We believe OS is the result of the grinding, relentless stress that Operators experience, which creates physical and brain wear-and-tear. Stress-induced wear-and-tear is called allostatic load. In this case, Operators experience allostatic overload.

SOF stress is physical, emotional, and psychological, unrelenting in nature, and comes from injuries, poor recovery, sympathetic overstimulation, and, essentially, burning the candle at both ends. OS occurs most frequently among those who have experienced a brain injury or repeated, low-level blast exposure (which, anecdotally, comprises 85% or more of all Operators), but any seasoned Operator may experience OS. Former SEAL Stew Smith wrote an excellent article about it in Military.com, which is available on the Resources page.

Head injuries seem to be the most frequent cause of allostatic overload among SOF, and OS seems to occur most persistently among SOF who have been operating (and thus exposed to head injuries) for a number of years. Impact TBIs are the most well known of head injuries, but we believe the low-frequency blast and concussive waves SOF experience routinely are more often to blame for the symptoms associated with OS. Examples of blast waves include the blast of firing weapons, breaching actions, and IED explosions. Stewart & Trujillo (2020) published a visual of the difference in brain change that result from blast TBIs vs. impact TBIs. Of note, repeated blast TBIs cause scarring on the brain.

The link between head injuries and Operator Syndrome is this: Head injuries disrupt important pathways within the brain. When brain disruption becomes chronic, the endocrine system is also chronically disrupted. The brain likes normality, and thus it begins accommodating the disruptions by changing how the endocrine system works. Changes in the endocrine system account for almost all of the Operator Syndrome symptoms.

For more reading and and to view the sources discussed on this page, please visit the Articles & Reading tab.

Common Symptoms & Problems Associated with Operator Syndrome:

  • Brain injury effects due to a TBI, anoxic/hypoxic injury, concussions, or any other source:
    • Headaches, memory loss, cognitive changes, worry & rumination, and physical brain changes that progress, like in the case of CTE and dementia.
  • Brain & cognitive changes:
    • Cognitive/thinking problems, memory problems, headaches, changes in thinking patterns, brain fog, etc.
    • Worry, rumination, and obsessively thinking about specific concerns, especially regarding new cognitive deficiencies.
    • In the words of a patient, “My brain isn’t working like it used to.”
  • Chronic pain resulting from an injury or with no clear cause.
    • Headaches, joint pain, muscle pain, shooting or burning pain, and any number of other chronic pain sensations. Anecdotally, this pain is often resistant to treatment with drugs.
  • Endocrine dysfunction that may be indicated by:
    • Poor sleep, poor recovery, impaired focus & concentration, insatiable fatigue, changes in body fat (belly & pectoral areas are common), changes in skin texture & new acne, changes in appetite, low energy, and changes in mood.
  • Emotion & mood changes:
    • Rage & anger, depression, suicidal or morbid thoughts, irritability, anxiety, short fuse, etc.
  • Substance use:
    • New reliance on caffeine (commonly to make-up for poor recovery and fatigue), new use of tobacco and other substances, OTC sleep aids, and binge drinking or “functional” alcoholism.
    • Anecdotally, substances are often used to self-treat or escape symptoms of OS.
  • Sleep disturbance:
    • Trouble falling asleep, trouble staying asleep, awakening too early, oversleeping, and non-restive sleep.
    • There seems to be a trend of Operators developing obstructive sleep apnea, which worsens their OS symptoms. Unlike civilians, the apnea may be a result of injury to their brain stem and other brain structures.
  • “The Dark Stuff”, as coined by one of Rebecca’s patients:
    • Suicidal & morbid thoughts (“I wouldn’t care if I died tomorrow”, etc), depression or feeling down every day, survivor’s guilt, preoccupation with existential questions, and other kinds of grief and mourning.
  • Sex & intimacy changes:
    • Low libedo, inability to get or maintain an erection, avoidance of or reluctance to engage in intimacy, feelings of wanting to have sex but an inability to become aroused, less frequent interest in sex, low sperm count and fertility problems, changes in arousal, etc.
  • Relationship challenges, especially with family and SOCOM community:
    • New or increased disagreements, estrangement from loved ones, feelings of an inability to connect or relate, divorce, new or worsening interpersonal problems at work, career dysfunction, etc.
  • Vestibular & vision changes, which may or may not be overtly related to an injury.
  • Trauma symptoms:
    • Hypervigilance, inability to relax, exaggerated situational awareness, nightmares, irritability, focus & concentration problems, rumination on 1 or more concerns, overwhelming worry and/or anxiety, anger, rage, exaggerated stress responses, survivor’s guilt, etc.
    • It is rare for Operators to develop what is traditionally known as PTSD, likely due to innate and/or learned resilience. More information on this topic is available on the resource page.
  • Worry, rumination, & stress reactivity:
    • Hyperfocus on 1 or more specific concerns, outsized reactivity to even small stressors, catastrophic thinking, jumping to conclusions, constant & repetitive thoughts, preoccupation with stressors, and inability to stop thinking about stressors.

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