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 (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness, and sexuality) (Criterion C6).

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) (Criterion C7).

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 (Criterion Dl), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5).

Some individuals report irritability or outbursts of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3).

Specifiers

The following specifiers may be used to specify onset and duration of the symptoms of Posttraumatic Stress Disorder:

Acute: This specifier should be used when

Diminished interest means some officers won't bother to ask for help, or may cause others to withdraw from treatment, as being not worth the trouble.

Feeling detached: The isolation that results from unavoidable trauma can increase one's sense of being alone. Cause one to feel that NOTHING, not marriage, not the job, or even life is worth the trouble.

Sleep disturbance is an especially disturbing symptom for police officers.

Too, hypervigilance, can be troublesome for officer's as the line between being vigilant and "hyper" can get blurred.

Irritability, anger and lack of concentration: The symptoms are more frequently reported by supervisors or friend's of the officer with PTSD.

Onset and duration: Watch how your doctor interprets this--it affects your diagnosis, but also impacts other areas such as Workers Comp claims or other legal rights you may have. (Note: Just because you may be unaware that you are having symptoms DOES NOT MEAN you are symptom free.)

Example: You were in a shooting two years ago. A year later you get divorced. Now, two years later, your supervisor says clean up your act or else... You may have symptomology going back two years to the original shooting. Check it out.

Foreshortened future is a difficult symptom for many officers. One officer was sure that the department had failed him, so he quit, felt that his wife had failed him, so he got divorced, and when his church disagreed with that, he quit his church. He had lost the ability to distinguish between problems at work or in his marriage (problems that could be resolved) and having no future.

Anxiety and increased arousal, are important life saving skills for officers. The problem, then, for many officers is to be able to distinguish between what is "normal" officer survival skill and what is a symptom. One officer knew he had a problem when he woke up while running to the front door with his gun in his hand after hearing his dog step on a twig in his back yard in the middle of the night.

Hypervigilance can also be confused by officers as "normal" officer survival skill. One very good officer discovered there was a difference when he "killed a Christmas tree," during a building search one evening. Working for LAPD for several years, I knew several officers who had "killed" mirrors in the same set of circumstances.