{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T05:13:44Z","timestamp":1792646024387,"version":"4.5.0"},"reference-count":55,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2020,2,13]],"date-time":"2020-02-13T00:00:00Z","timestamp":1581552000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Psychiatry Med"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>U.S. military special operation forces represent the most elite units of the U.S. Armed Forces. Their selection is highly competitive, and over the course of their service careers, they experience intensive operational training and combat deployment cycles. Yet, little is known about the health-care needs of this unique population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Professional consultations with over 50 special operation forces operators (and many spouses or girlfriends) over the past 6 years created a naturalistic, observational base of knowledge that allowed our team to identify a unique pattern of interrelated medical and behavioral health-care needs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified a consistent pattern of health-care difficulties within the special operation forces community that we and other special operation forces health-care providers have termed \u201cOperator Syndrome.\u201d This includes 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 \u201con guard\u201d or hypervigilant; memory, concentration, and cognitive impairments; vestibular and vision impairments; challenges of the transition from military to civilian life; and common existential issues.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\u201cOperator Syndrome\u201d may be understood as the natural consequences of an extraordinarily high allostatic load; the accumulation of physiological, neural, and neuroendocrine responses resulting from the prolonged chronic stress; and physical demands of a career with the military special forces. Clinical research and comprehensive, intensive immersion programs are needed to meet the unique needs of this community.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0091217420906659","type":"journal-article","created":{"date-parts":[[2020,2,13]],"date-time":"2020-02-13T08:07:03Z","timestamp":1581581223000},"page":"281-295","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":53,"title":["\u201cOperator syndrome\u201d: A unique constellation of medical and behavioral health-care needs of military special operation forces"],"prefix":"10.1177","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6218-8358","authenticated-orcid":false,"given":"B Christopher","family":"Frueh","sequence":"first","affiliation":[{"name":"Department of Psychology, University of Hawaii, Hilo, HI, USA"},{"name":"Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA"},{"name":"Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alok","family":"Madan","sequence":"additional","affiliation":[{"name":"Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA"},{"name":"Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J Christopher","family":"Fowler","sequence":"additional","affiliation":[{"name":"Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA"},{"name":"Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasha","family":"Stomberg","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Major","family":"Bradshaw","sequence":"additional","affiliation":[{"name":"Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA"},{"name":"Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Warfighter Performance, Naval Health Research Center, San Diego, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Weinstein","sequence":"additional","affiliation":[{"name":"Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA"},{"name":"Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan","family":"Luttrell","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Summer G","family":"Danner","sequence":"additional","affiliation":[{"name":"Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah C","family":"Beidel","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Central Florida, Orlando, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,2,13]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.3109\/00048670903393597"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2010.09.006"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1037\/11118-000"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-2389.2008.00412.x"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1037\/e660562010-001"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1037\/a0016908"},{"key":"e_1_3_6_8_2","volume-title":"Translational research in traumatic brain injury","author":"Howlett JR","unstructured":"Howlett JR, Stein MB. 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