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Combat Control - Afghanistan

The criteria for a diagnosis of ASD (Acute Stress Disorder) or PTSD are similar but vary in duration and time of onset. Readers should not self-diagnose and if a reader feels symptoms may be present, should see a professional. The essntial criteria are:

A. The person has been exposed to a traumatic event in which both of the following were present:
1. Person experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
2. Person's response involved intense fear, helplessness, or horror (at the time, as in war, these emotions may seem controlled but arise later).

B. The traumatic event is persistently reexperienced in one or more of the following ways:
1. Recurrent/intrusive recollections, including images, thoughts, perceptions
2. Recurent distressing dreams
3. Acting/feeling like it is recurring
4. Intense psychological distress on exposure to stimuli reminding one of the event
5. Physiological reactivity on exposure

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness as in three or more of:
1. efforts to avoid thoughts, feelings, conversations associated
2. efforts to avoid activities, places, or people arosuing recollection
3. inability to recall an import part of the event
4. markedly diminished interest or participation in significant activities
5. feeling of detachment or estrangement from others
6. restricted range of affect (unable to have loving feelings)
7. sense of foreshortened future

D. Persistent symptoms of increased arousal as shown by 2 or more of:
1. difficulty falling or staying asleep
2. irritability or outbursts of anger
3. difficulty concentrating
4. hypervigilence
5. exaggerated startle response

Duration of symptoms must be for more than a month. The symptoms should be severe enough to interfere significantly in social, occupational, or other functioning areas (including education). It may be specified as acute, chronic or delayed onset. NOTE: The above criteria are attributed to the American Psychiatric Association's DSM-IV-TR - The Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revised. Much more information is available in the DSM-IV-TR and related materials and books. See a professional. The text is available in many book stores and on-line through the American Psychological Association.

In many cases of brain injury, the events leading to the brain injury are horribly traumatic. On the other hand, a common result of a traumatic brain injury is amnesia. Does the amnesia protect us from the symptoms of PTSD? The answer to this question is debatable. For military veterans, PTSD can be a complicated subject. On active duty, a serviceman may suffer from the symptoms of PTSD but not seek treatment because treatment may cause removal from assigned duties. Those most likely to suffer PTSD are the warriors or war-fighters of our services and they, as individuals, learn individual and unique ways to deal with the symptoms of PTSD. Some deny it exists, others suffer symptoms but deny any need for treatment, and others eventually collapse emotionally under the stress of PTSD and are treated. The horrific events seen, smelled, and felt in war can be destabilizing. The symptoms of brain injury and those of PTSD may be confused by some practitioners.

If a person (non-military) survives an event that reaches the level of intensity that may produce ASD or PTSD, ore often than not, the person is unrained in the emotional skills to deal with the symptoms and is more likely to need treatment. When our amygdala is activated for purposes of fight or flight, the senses imprint images on the long term memory part of the mind accepting them. These are what we recall when something suddenly comes to mind from long ago or when we work to remember an incident from decades before while writing a memoir. Researchers in PTSD believe that such sensory images lack verbal narrative and context. Writing about them drags them to the forefront.

My memorable experiences in Vietnam were 32 and 35 years ago. I recall some images that don't seem to have sound or voices and I recall others in which I remember men yelling or whispering, but the latter were not scenes of explosive impact. I was a police officer between 1974 and 1979. Some still pictures of terrible images are there, especially with the murders of the two police officers I knew, but with those and others, there is no sound attached. Before writing about the incident, I reviewed my copy of the police report and, particularly, my narrative report of what I saw and did. The report served to recover memories, but the photographs of the scene and of the two officers was much more stimulating for memories.

Our minds process the images and awareness of something awful happening (emotions), whether it is stroke or traumatic injury, and it records snap-shots of images we see. Even as our thinking processes and awareness fade, the picture taking continues. The fragmentary memory we recover later, absent amnesia, is like that: snap-shots for which we may have no narrative. The more pain and shock, the more the brain shuts down parts of our bodies to preserve life. When we decide to write a memoir, we often have trouble verbalizing these deeply embedded images, since the experiences to which they are connected are not verbally based. As a result, when my writing commingles with the emotions with recalled with images, healing occurs.