Post­-Combat Syndromes from the Boer War to the Gulf War: A Cluster Analysis of their Nature and Attribution

Abstract: Investigated whether post-combat syndromes have existed after modern wars and what relation they bear to each other. Medical and military records were reviewed for 1,856 veterans randomly selected from war pension files awarded from 1,872 and from the Medical Assessment Programme for Gulf war veterans. The authors examined characteristic patterns of symptom clusters and their relation to war, diagnosis, predisposing physical illness, and exposure to combat. Servicemen's changing attributions for post-combat disorders were also studied. Three varieties of post-combat disorder were identified--a debility syndrome (associated with the 19th and early 20th centuries), somatic syndrome (related primarily to WWI), and a neuropsychiatric syndrome (associated with WWII and the Gulf conflict). The era in which the war occurred was overwhelmingly the best predictor of cluster membership. The authors conclude that all modern wars have been associated with a syndrome characterized by unexplained medical symptoms. The form that these assume, the terms used to describe them, and the explanations offered by servicemen and doctors seem to be influenced by advances in medical science, changes in the nature of warfare, and underlying cultural forces.