Chronic: This specifier should be used when the symptoms last 3 months or longer.

With Delayed Onset: This specifier indicates that at least 6 months have passed between the traumatic event and the onset of the symptoms.

Associated Features and Disorders

Associated descriptive features and mental disorders.

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.

The following associated constellation of symptoms may occur and are more commonly seen in association with an interpersonal stressor (e.g., childhood sexual or physical abuse, domestic battering, being taken hostage, incarceration as a prisoner of war or in a concentration camp, torture); impaired affect modulation; self-destructive and impulsive behavior; dissociative symptoms; somatic complaints; feelings of ineffectiveness, shame, despair, or hopelessness; feeling permanently damaged; a loss of previously sustained beliefs; hostility; social withdrawal; feeling constantly threatened, impaired relationships with others; or a change from the individual's previous personality characteristics.

Guilt: Because of the nature of police work--always being called AFTER something happens--I've dealt with few officer's that don't have at least some guilt. Guilt about what we should have known, or what we should have done--could have done,
to prevent a tragedy.

Somatic complaints: A leading cause of police officer retirement is lower-back pain, and a large number of these complaints appear to have no direct connection with any physical symptoms.
Phobic avoidance: Avoidance of this kind is a major factor in loss of job and divorce--these are two of the main reasons officers come in to therapy. Trying to avoid any emotionally charged situation, officer's discover, is a major contributor to the problems they are having. Frequently, by the time these behaviors are recognized it is too late. Early recognition and treatment of symptomology helps significantly in saving the situation.

Self-destructive behavior: As already stated, 3 to 5 times more officers commit suicide than are killed in the line of duty. If left unchecked, symptoms can conspire to cause officers to take "the easy way out."

RELATED DISORDERS

Feeling constantly threatened: Here is another area where officer's need to understand the difference between "officer survival" tactics (who hasn't been uncomfortable in a restaurant when their back isn't against the wall) and the kind of feelings you experience with symptomology.

An officer recalled that during a family disturbance, he was confronted by a local high school football star. "The kid was not going to back down," he related, "and the only thing I could think of was "'if he hits me, I'm going to shoot him.'" To avoid killing the kid, the officer let his backup deal with him--the officer went and did something else. This officer knew when enough is enough--he came in for help for his symptoms.

Note: To compound the problem of self-destructive behavior in officers, many clinicians are not trained to recognize suicidal behavior in police officers. Further, officers are use to being 'in charge' and often deny feelings they think will cause them more trouble than they've already got.