Friday, July 28, 2006

Dear Counselor Shelley,

The hero of my book is a police officer who was involved in a shoot-out with a bad guy, but an innocent bystander was killed accidentally. He’s tormented by what has happened and it’s affecting his personal and professional life. I’m guessing this would get classified under "Post Traumatic Stress Disorder." I need to know how to best get this across in the book. What kind of outward signs would he have? I need something more than just nightmares.....

It sounds like you are off to a good start and definitely on the right track. The Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV) does a great job of describing, in detail, how the symptoms of Post Traumatic Stress Disorder (PTSD) usually manifest. Since the DSM IV does such a good job, I will answer your question by quoting a section straight from the DSM IV:

"Commonly the person has recurrent and intrusive recollections of the event or recurrent distressing dreams during which the event is replayed. In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment. Intense psychological distress or physiological reactivity often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g. anniversaries of the traumatic event; cold, snowy weather oruniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any
elevator for a woman who was raped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event and to avoid activities, situation, or people who arouse recollections of it. This avoidance of reminders may include amnesia for an important aspect of the traumatic event. Diminished responsiveness to the external world, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities, of feeling detached or estranged from other people, or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness, and sexuality). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span).
The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. These symptoms may include difficulty falling or staying asleep that may be due to recurrent nightmares during which the traumatic event is relived, hypervigilance, and exaggerated startle response. Some individuals report irritability or outbursts of anger or difficulty concentrating or completing tasks. Individuals with Posttraumatic Stress Disorder may describe painful guilt feelings about surviving when others did not survive or about the things they had to do to survive. Phobic avoidance of situations or activities that resemble or symbolize the original trauma may interfere with interpersonal relationships and lead to marital conflict, divorce, or loss of job."

Please keep the great questions coming!




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