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TIP: If you already have a claim pending for compensation and/or pension with the VA and need to provide information or upload attachments, you can use VA Form 21-4138, Statement in Support of Claim, available in VONAPP. When uploading attachments, include a statement that you are attaching evidence to support your claim. After completing the form, you will have the opportunity to attach your documents. You can attach up to 5 electronic files to any VONAPP application before you submit it using VONAPP. The total size of all attachments must be 1 megabyte or less and must be one of the following file types: .doc, .xls , .gif, .jpeg, .jpg, .bmp, .tif , .txt , .pdf . TIP: One of the harsh realities of working with any bureaucratic system is the culture of apathy. Inherent in the VA culture is the absence of built-in incentives to do a job well. Missing is the motivation to go the extra mile, above and beyond the call of duty, if you will. Granted, there are some who rise above the sluggish indifference of the VA culture. Most, however, just stagger through their daily routines with very little concern for those they are working for. Oftentimes, the details of a claim that determine if a veteran is to be awarded benefits are missed by those who lack the drive to search for data needed to award a claim. Therefore, our research indicates that a veteran must take the initiative to make sure details of his claim are seen, viewed, and processed. One way of doing that is to highlight all relevant information. For instance, a veteran who experienced combat trauma must highlight the details on his C-file or stressor letter. If a veteran was wounded in a firefight, he must highlight the details of the battle. Yellow highlighters seem to work best. Like a moth to a flame, raters are drawn to bright colors. Never assume the raters or your Veterans Service Officer (VSO) will highlight your data for you. For best results, you must do it yourself. Main page of the VA web site: http://wwwva.gov VA Handbook can be viewed on line: http://www.vfw657.org/va_benefit_handbook.html Some Private web sites about benefits http://www.veteranprograms.com Or http://www.military.com/benefits Getting started at the VA: Pursuing A Claim For Post Traumatic Stress Disorder (PTSD) When pursuing a claim for post traumatic stress disorder (PTSD) it is important to understand the bureaucratic process toward your goal. PTSD is a psychological injury with political overtones. Due to the egregious injustices to Vietnam veterans during the 60s and 70s, the collective repair of mental health professionals today is to insure that all veterans are given the benefit of doubt. Veterans of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) are three times as likely to get a diagnosis of PTSD then veterans of the Persian Gulf War, Vietnam, Korea or World War II. Not because they actually have the disorder as understood in the Diagnostic and Statistical Manual for Mental Disorders (DSM), but due in part to mental health professionals wanting to “make up” with veterans from all war eras. Due in part to guilt from mental health professionals, the overwhelming numbers of veterans filing for PTSD claims, and a well crafted strategy, it is pretty easy to get diagnosed with PTSD. Here’s how. Keep in mind, real or imagined your experiences are your realities. Therefore, when visiting a psychiatrist or psychologist in the civilian sector or your local Veterans Affairs (VA), you need to make sure your story is “heard.” Mental health staff see many veterans and clients everyday, and inherent in this process is a tendency for mental health staff to go “intellectually numb.” That is, your story is a blur in a long line of very similar stories. The details get lost, and it is perceived with subtle indifference by mental health staff. So, it is very important to make your story stand out. This does not mean to lie or deviate from the truth, what it suggests is for you to inject some degree of hyperbole. The squeaky wheel gets the oil in any bureaucracy. Who To See For A Confirmed Diagnosis In order to get a diagnosis for PTSD, you must visit with a psychiatrist or a psychologist (PhD level). They will assess you for certain criteria which will qualify you for PTSD or rule you out. Typically, the psychiatrist or psychologist you visit with will be at your local VA or an outside contractor Getting An Appointment Calling the mental health department at your local VA and requesting an evaluation for PTSD is not good enough. You need to integrate yourself in the system. You do this by contacting the mental health department and inform them that you have a set of symptoms that might suggest PTSD. For instance, inform them you are having nightmares about war trauma, anxiety attacks when you are in crowded places, anger outbursts for minor issues, and that you are so depressed about issues from the war that you cannot sleep. Also, you may want to let the intake coordinator know that you are so immobilized by your depression that you have no energy. That should be enough to get you an appointment for an evaluation. How To Dress For Interview Those with PTSD are so psychologically fragile and emotionally upset by their trauma that personal hygiene takes a back seat. Understand, to set the tone that you are suffering from this intense psychological injury, you must dress the part. A disheveled appearance works best. Unshaven face (for men), uncombed hair, mismatched clothing, dirty nails, tattered clothing, and a few days without a bath or shower will make the impression you need. Also, deprive yourself of sleep. Red, bloodshot eyes project trouble to mental health professionals. Try to get an appointment for Monday. That way, you have the weekend to excuse away hygiene of any sort. Case in point. We know of a veteran who visited a psychologist at his local VA dressed in a beautifully tailored suit. As if going for a job interview. And another veteran who followed the prescription above. Needless to say, the veteran who followed our advice was given a diagnosis of PTSD and later awarded a service-connected rating of 100% for the psychological injury. The Interview During your intake assessment interview with the mental health professional you will be under a psychological microscope. Some mental health professionals make a concerted effort not to make you feel as though you are being scrutinized. Either way you look at it, you are being scrutinized. Their job is to rule you out for PTSD. Your job is to prove to them that you have PTSD. For instance, part of their assessment is to determine if you have good eye contact. If you do, in their clinical view, you are on the road to recovery, if not totally cured. One cagey veteran made it known to us that he always averts direct eye contact with his psychiatrist. In our opinion, this is a good strategy. Direct eye contact suggests a healthy self-image and good self-esteem. Veterans with PTSD do not have such attributes. Also, you want to give the impression of being distant and detached. In the mind of a mental health professional, this is a symptom of PTSD. At some point during your interview the mental health member will ask you about your sleep. Veterans with PTSD are bombarded with nightmares, restless sleep patterns, and very little sleep. You need to let the mental health member know who is interviewing you that you are afraid to go to bed for fear of dreaming about war trauma. You also want to let them know that your significant other is afraid to sleep near you because of your violent and abrupt sleepwalking events. Additionally, your night sweats has caused you to be alarmed by the intensity of your dreams as well. Your mental health professional will see these as definitive signs and symptoms of PTSD. You want to inform the psychologist that upon waking from your violent nightmares that you then conduct reconnaissance missions around your home. You check the windows, doors, under the bed, in all closets, and the perimeter. You inform the clinician you are looking for the enemy. Your mental health professional will see this as hypervigilance, a sure sign of PTSD. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event is another surefire sign of PTSD. Vietnamveterans with PTSD often recall certain smells that remind them of war trauma. For instance, oders closely related to Asian spices bring back intense traumatic memories for Vietnam veterans. For OIF/OEF veterans, a common environmental cue that reminds them of war trauma is the contour of geographical landscapes. Especially those veterans that live in the West (i.e., California, Nevada, New Mexico, Arizona, and West Texas). Also, many OIF/OEF veterans experience intense anger outbursts from traffic jams. We learned of several Iraqi veterans who informed doctors that driving around the Middle East meant driving as fast as they wanted, any time they wanted. Also, road rules of any sort did not exist. For obvious reason, following any such road etiquette could have gotten them injured or killed. When back in the states, these veterans perceived road rules and congestion on the road as a sign of imminent or immediate danger. Therefore, road rage is another probable indicator of PTSD. If you are an OIF/OEF veteran make sure and tell the clinician you cannot tolerate driving. Veterans of both Vietnam and OIF/OEF with PTSD show signs of detachment from loved ones and friends. Getting emotionally and psychologically attached to others in the combat zone can make veterans vulnerable. This defense mechanism helps veterans protect themselves from the pain of loss. It is important to let your psychologist know that you are afraid to connect with love ones. You find it difficult to establish meaningful relationships since you departed the war zone. This is another key marker of PTSD. Alcohol abuse is another characteristic of PTSD. Why? The pain, suffering, and psychological turmoil you are struggling with is often drowned in booze. Many veterans with PTSD consume alcohol to mask depression, reduce anxiety, or divert their feelings. Albeit, this is not a good way to fight against PTSD, but those with PTSD abuse alcohol often. Again, another symptom of PTSD. Those veterans diagnosed with PTSD who experienced multiple combat traumas often suffer with “survivors guilt.” They often ask themselves, “How did I survive when others did not?” Or, “Why I am alive? The other guys that died were so much more deserving of life.” Tree hugging mental health professionals will certainly sympathize with those veterans who show signs of survivor’s guilt. Lastly, during your interview it is important to note that all of your symptoms occurred after your tenure in the war zone. Before heading to war, you were happy, extroverted, and positive about your future. This suggests to mental health professionals that war trauma has changed you in dramatic fashion. Understanding Your GAF Score After your interview, the mental health professional who did your assessment will provide you with a GAF score. The Global Assessment of Functioning (GAF) is a measure of your immediate daily functioning. It is a score from 0-100. The higher the score the healthier you are, psychologically speaking. Veterans with PTSD generally have a GAF score of 40 – 49. Once your interview is completed you may want to ask your interviewer what GAF score they assigned you. If you receive a score over 60, you may want to injected a well rehearsed, “Oh, I forgot to tell you…” Developing A Documentation Trail So much of making the bureaucratic evaluation system work is to “play the game.” The mindset of VA mental health professionals is such, that if you are not actively working on helping your condition, then you do not have a condition. If a veteran is not involved in individual or group psychotherapy, then, according to VA personnel, that veteran does not have a condition. If PTSD has been previously diagnosed and the veteran refuses treatment or rarely attends treatment, then that veteran is in jeopardy of losing his or her benefits. When pursuing service-connected benefits a veteran must show that he or she is attending treatment programs offered by the VA. Vet Centers are great vehicles for developing documentation trails. Your local Vet Center will help you put together the documentation you need to show proof that you are interested in working on your PTSD. After several weeks of attending group or individual therapy, your therapist at your local Vet Center can provide you with a 2-3 page letter illustrating your involvement in the Vet Center program. Moreover, one of the side benefits of utilizing Vet Center programs is the education you get from other veterans about the benefits process. Vet Center environments are much more relaxed then VA run programs. Veterans are free to discuss issues related to benefits in an open forum. We know of many veterans who have attempted to secure PTSD benefit for years. Once engaged in the Vet Center program these veterans went from 0% rating, to 60% rating and more. PTSD Residential Treatment Programs Veterans who have been diagnosed with PTSD have great leverage in increasing their ratings. If you are less than 100% service-connected for PTSD, talk to your VA psychiatrist, psychologist or Vet Center therapist about PTSD residential programs. If you can get away from work or home for 6-7 weeks, one of many inpatient PTSD residential programs may be of interest to you. Such programs reimburse you at 100% while you are in the program, and some will pay travel reimbursement. The programs are designed to provide you with additional strategies for living with PTSD. One might assume that such programs are emotionally and psychological intense. Nothing could be further from the truth. One veteran put it this way; “I loved my time in Little Rock. It was a 7-week respite. I had my own room, we had daily outings to local restaurants and movie theatres. I made some great arts and craft items. It was great! I want to go back.” MST Veterans Recently, the VA has recognized Military Sexual Trauma (MST) as a compensable condition. Due to the sensitive nature of this condition it is obvious as to why this issue does not require any documentation. Also, one might be surprised to learn that many men have been diagnosed with this compensable condition. Common trauma that arises from MST issues is rape and sexual harassment. Many women feared reporting such events while in uniform for fear of jeopardizing their careers. Years later, these stories are being reported to VA staff, and men and women are being compensated in large numbers. Many receive ratings of 70% and more in a matter of just a few months. We have learned that military men have reported rape, sexual harassment, and sexual abuse events. For instance, one young Marine reported that members in his unit attempted to insert carrots in his anus as part of some tacit hazing ritual. Of course, no one can prove or disprove this event. Nonetheless, he now receives 100% service-connected compensation. Bottom line, if you have been sexually abused or think you may have been sexually abused report it as soon as possible. Also, make sure and report to your Veteran Service Officer (VSO) that you are interested in a claim for MST. MST compensation is ridiculously easy to secure. No one will ever question you about your story. No one! Most Vet Centers have specially trained counselors who work with MST clients. They want to help you get compensated for your trauma. ou Be The Judge Based upon the insight you have just read, please read the two transcripts below. One veteran received a diagnosis for PTSD, the other did not. Below is a transcript from a recent PTSD evaluation. Psychologist: “How are you doing today Mr. Smith?” Mr. Smith: “I feel ok Doc.” Psychologist: “How’s your sleep been?” Mr. Smith: “I sleep pretty good Doc. About 7-8 hours a day.” Psychologist: “Any dreams.” Mr. Smith: “None that I can remember.” Psychologist: “You drinking?” Mr. Smith: “An occasional beer with my friends.” Psychologist: “What about driving? Any issues on the road?” Mr. Smith: “No.” Psychologist: “Are you ok with large crowds?” Mr. Smith: “No problem Doc. They excite me.” Note: This veteran did not get a diagnosis of PTSD. On the other hand, read the transcript below. This veteran received a diagnosis of PTSD. Psychologist: “How are you doing today Mr. Jones?” Mr. Jones: “I feel like crap. I’m tired. I can’t concentrate. I feel angry all of the time.” Psychologist: “How’s your sleep?” Mr. Jones: “What sleep? I can’t get any. I barely get two hours.” Psychologist: “Any dreams?” Mr. Jones: “When I do zonk out, I dream about firefights. I keep having similar dreams about different firefights I was in. It’s ridiculous.” Psychologist: “You drinking?” Mr. Jones: “It is the only way I can get some sleep. I’m not addicted, I just need a beer or two so I can take the edge off and fall asleep.” Psychologist: “What about driving? Any issues on the road?” Mr. Jones: “I only drive at night. At night I don’t have to deal with all of the idiots on the road.” Psychologist: “Are you ok with large crowds?” Mr. Jones: “Hate them. I get nervous. Can’t trust the people.” Note: Mr. Jones received a rating of 100% for service-connected PTSD. This is what the VA Will tell you after they rate you. Each time they will say, we gave you 50% but would have given you 70% if you had the following General Rating Formula for Mental Disorders: 100% Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name 70% Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsession rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships 50% Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships 30% Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events) 10% Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication What the VA thinks PTSD is: What is Posttraumatic Stress Disorder (PTSD)? Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others' lives are in danger. You may feel afraid or feel that you have no control over what is happening. Anyone who has gone through a life-threatening event can develop PTSD. These events can include: • Combat or military exposure • Child sexual or physical abuse • Terrorist attacks • Sexual or physical assault • Serious accidents, such as a car wreck. • Natural disasters, such as a fire, tornado, hurricane, flood, or earthquake. After the event, you may feel scared, confused, or angry. If these feelings don't go away or they get worse, you may have PTSD. These symptoms may disrupt your life, making it hard to continue with your daily activities. How does PTSD develop? All people with PTSD have lived through a traumatic event that caused them to fear for their lives, see horrible things, and feel helpless. Strong emotions caused by the event create changes in the brain that may result in PTSD. Most people who go through a traumatic event have some symptoms at the beginning. Yet only some will develop PTSD. It isn't clear why some people develop PTSD and others don't. How likely you are to get PTSD depends on many things. These include: • How intense the trauma was or how long it lasted • If you lost someone you were close to or were hurt • How close you were to the event • How strong your reaction was • How much you felt in control of events • How much help and support you got after the event Many people who develop PTSD get better at some time. But about 1 out of 3 people with PTSD may continue to have some symptoms. Even if you continue to have symptoms, treatment can help you cope. Your symptoms don't have to interfere with your everyday activities, work, and relationships. What are the symptoms of PTSD? Symptoms of posttraumatic stress disorder (PTSD) can be terrifying. They may disrupt your life and make it hard to continue with your daily activities. It may be hard just to get through the day. PTSD symptoms usually start soon after the traumatic event, but they may not happen until months or years later. They also may come and go over many years. If the symptoms last longer than 4 weeks, cause you great distress, or interfere with your work or home life, you probably have PTSD. There are four types of symptoms: reliving the event, avoidance, numbing, and feeling keyed up. Reliving the event (also called re-experiencing symptoms): Bad memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place. You may have nightmares. You even may feel like you're going through the event again. This is called a flashback. Sometimes there is a trigger: a sound or sight that causes you to relive the event. Triggers might include: • Hearing a car backfire, which can bring back memories of gunfire and war for a combat veteran • Seeing a car accident, which can remind a crash survivor of his or her own accident • Seeing a news report of a sexual assault, which may bring back memories of assault for a woman who was raped Avoiding situations that remind you of the event: You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event. • A person who was in an earthquake may avoid watching television shows or movies in which there are earthquakes • A person who was robbed at gunpoint while ordering at a hamburger drive-in may avoid fast-food restaurants • Some people may keep very busy or avoid seeking help. This keeps them from having to think or talk about the event. Feeling numb: You may find it hard to express your feelings. This is another way to avoid memories. • You may not have positive or loving feelings toward other people and may stay away from relationships • You may not be interested in activities you used to enjoy • You may forget about parts of the traumatic event or not be able to talk about them. Feeling keyed up (also called hyperarousal): You may be jittery, or always alert and on the lookout for danger. This is known as hyperarousal. It can cause you to: • Suddenly become angry or irritable • Have a hard time sleeping • Have trouble concentrating • Fear for your safety and always feel on guard • Be very startled when someone surprises you What are other common problems? People with PTSD may also have other problems. These include: • Drinking or drug problems • Feelings of hopelessness, shame, or despair • Employment problems • Relationships problems including divorce and violence • Physical symptoms What the VA thinks the symptons of PTSD are: The symptoms of PTSD include: * sleep problems including nightmares and waking early * flashbacks and replays which you are unable to switch off * impaired memory, forgetfulness, inability to recall names, facts and dates that are well known to you * impaired concentration * impaired learning ability (eg through poor memory and inability to concentrate) * hyper vigilance (feels like but is not paranoia) * exaggerated startle response * irritability, sudden intense anger, occasional violent outbursts * panic attacks * hypersensitivity, whereby every remark is perceived as critical * obsessive ness - the experience takes over your life, you can't get it out of your mind * joint and muscle pains which have no obvious cause * feelings of nervousness, anxiety * reactive depression (not endogenous depression) * excessive levels of shame, embarrassment * survivor guilt for having survived when others perished or for not having done more to help or save others * a feeling of having been given a second chance at life * undue fear * low self-esteem and shattered self-confidence * emotional numbness, anaerobia (inability to feel love or joy) * feelings of detachment * avoidance of anything that reminds you of the experience physical and mental paralysis at any reminder of the __________________________________ There are four main types of PTSD symptoms. A diagnosis of PTSD requires the presence of all categories of symptomatic responses: *re-experiencing the trauma: flashbacks, nightmares, intrusive memories and exaggerated emotional and physical reactions to triggers that remind the person of the trauma. *emotional numbing: feeling detached, lack of emotions (especially positive ones), loss of interest in activities *avoidance: avoiding activities, people, or places that remind the person of the trauma increased arousal: difficulty sleeping and concentrating, irritability, hypervigilance (being on guard), and exaggerated startle response. __________________________________ From the VA Do I have PTSD? A natural first question is whether symptoms experienced really are due to PTSD. Stress and trauma cause symptoms that are normal reactions and these symptoms may not be indicative of the full condition of PTSD. Similar symptoms may be due to conditions created by stressors other than trauma (for example, work or financial pressures), medical problems (such as heart conditions or diabetes), or other psychological conditions (such as depression or anxiety). What are the symptoms of PTSD? PTSD symptoms are divided into three categories. People who have been exposed to traumatic experiences may notice any number of symptoms in almost any combination. However, the diagnosis of PTSD means that someone has met very specific criteria. The symptoms for PTSD are listed below. * Intrusive Re-experiencing People with PTSD frequently feel as if the trauma is happening again. This is sometimes called a flashback, reliving experience or abreaction. The person may have intrusive pictures in his/her head about the trauma, have recurrent nightmares or may even experience hallucinations about the trauma. Intrusive symptoms sometimes cause people to lose touch with the "here and now" and react in ways that they did when the trauma originally occurred. For example, many years later a victim of child abuse may hide trembling in a closet when feeling threatened, even if the perceived threat is not abuse-related. * Avoidance People with PTSD work hard to avoid anything that might remind them of the traumatic experience. They may try to avoid people, places or things that are reminders, as well as numbing out emotions to avoid painful, overwhelming feelings. Numbing of thoughts and feelings in response to trauma is known as "dissociation" and is a hallmark of PTSD. Frequently, people with PTSD use drugs or alcohol to avoid trauma-related feelings and memories. * Arousal Symptoms of psychological and physiological arousal are very distinctive in people with PTSD. They may be very jumpy, easily startled, irritable and may have sleep disturbances like insomnia or nightmares. They may seem constantly on guard and may find it difficult to concentrate. Sometimes persons with PTSD will have panic attacks accompanied by shortness of breath and chest pain. Who gets PTSD? PTSD can affect anyone at any age who has been exposed to a traumatic event where he/she experienced terror, threat (or perceived threat) to life, limb or sanity and his/her ability to cope was overwhelmed. Conservative estimates show that nine-ten percent of the general population has PTSD. Among people who were victims of specific traumatic experiences (rape, child abuse, violent assaults, etc.), the rate of PTSD is 60-80 percent. Diagnosis Unfortunately, it is common for those with PTSD to avoid treatment. Also, it is common for those who do seek treatment to be misdiagnosed. Because PTSD often occurs at the same time as other physiological and mental health disorders, PTSD symptoms may be masked or difficult to identify. Examples of common co-occurring conditions are depression, substance use/dependence and bipolar disorder. Trauma survivors may also experience headaches, chest pain, digestive or gynecological problems as well. However, there is a growing number of clinicians who are skilled at recognizing PTSD and still others who are specializing in treatment of traumatic stress disorders. If you think you might have PTSD you should seek professional help for a thorough physical and mental health assessment. Can PTSD be treated? Yes. A person who has survived a traumatic event will probably never feel as if the event didn't happen, but the disruptive, distressing effects of PTSD are completely treatable. Depending on the source of the trauma (manmade vs. natural), the nature of the trauma (accidental vs. purposeful), and the age of the victim at the time of the trauma, treatment strategies may vary. Treatment involves both managing symptoms and working through the traumatic event. Most experts agree that psychotherapy is an important part of recovery. Medications can help reduce some symptoms allowing psychotherapy to be more effective. __________________________________ The following is a list of the main symptoms of PTSD: 1.Re-experiencing: *Invasive memories of the trauma -- pictures and thoughts related to the event, which come up again and again and cause great distress. *Frequent nightmares -- connected to the trauma and recurring over many nights. *Flashbacks -- a continuous and permanent feeling that the person has, that the traumatic event has not finished, and that he is caught in the middle of it. *Feelings of stress and anxiety -- when exposed to stimuli that are connected to or symbolize the trauma. 5.Avoidance: *Avoiding thoughts, conversations or feelings -- connected to the trauma. *Avoiding places, activities and people -- that are reminders of the trauma. *Loss of interest in activities -- that used to be considered fun. *Feeling foreign and alienated -- from other people. *Difficulty feeling and expressing positive emotion -- such as happiness or love. *Lack of desire to deal with the future- or talk about it. 6.Hyper-arousal: *Problems sleeping. *Short-tempered and fits of anger. *Difficulty concentrating and studying. *Constant feeling of alertness. *Heightened reaction to loud noises and sudden movements. 6.Repeated feelings of guilt: Connected to the results of the trauma or the behavior of the victim during the event. 7.Compulsive dealing with the traumatic event: Non-stop thoughts of the trauma; the fields of interest narrow to topics relating only to the trauma; and behaviors that recreate the traumatic event repeatedly. 8.Dissociation: *Forgetting significant portions of the event. *Feeling disconnected from the self. A feeling that "this isn't really me". |