Free B0038M1ADS EBOK by Charles W. Hoge M.D.

occur. How to
do this will be explored later on in this book.
    Criterion C Symptoms
    Criterion C symptoms have to do with withdrawal, avoidance, and emotional detachment, and are often the most difficult to address and the
ones that can most seriously affect a warrior's life. In some ways, these
symptoms are reactions to criterion B symptoms-an effort to avoid any
situation where wartime memories may come flooding back.
    I don't talk much about my stress or personal matters. I don't like
to discuss them.
    -NCO, MARINE, POST-IRAQ
    To whom this may concern-my thoughts are my thoughts. I sometimes wish I would just forget things.
    -JUNIOR ENLISTED SOLDIER, POST-IRAQ
    If I'm having a bad day, I try to withdraw.
    -JUNIOR ENLISTED SOLDIER, POST-IRAQ
    I used to love to go to the beach, but after Iraq, I can't stand sand
and don't go anymore.
    -JUNIOR ENLISTED MARINE, POST-IRAQ

    When I came back from Iraq, I didn't care about anything, even
my wife's tears.
    -NCO, POST-IRAQ
    The desire to shut down, detach, and withdraw can be very strong after
combat. Warriors often want to be left alone. They may avoid going out
because it puts them in situations that trigger strong reactions or reminds
them of their deployment. Since many little things can cause reactions or
lead to confrontations, the natural tendency is to want to avoid going anywhere. They also don't want to explain to people who may not understand
why they react the way they do. This can mean not doing a lot of things
that the warrior used to enjoy doing, and can be extremely frustrating for
loved ones and friends.
    The most detrimental aspect of criterion C is emotional detachmenthaving difficulty feeling a full range of emotions; not being able to show
love or other feelings toward others.
    He was very distant after coming home-it seemed like he didn't care.
-MILITARY SPOUSE
    Shutting down emotions is a necessary skill in combat, and it can
sometimes be very difficult to turn them back on after coming home. Warriors often describe not being able to feel love, not caring about others,
and feeling numb or detached. This is also essential for survival in combat. Unfortunately, these problems are the hardest for loved ones to deal
with, and the ones that are most likely to end up in failed relationships,
breakups, and divorce. Another problem is that once the emotions start
to turn back on, it can feel like floodgates opening. Believe me, it's far
better to go through the process of connecting with your emotions than
keeping them bottled up forever, even though it can feel overwhelming at
first. The truth is that warriors are in some ways best prepared to handle
the most complex human emotions a person can endure, but it may take
a while to appreciate this.

    Criterion D Symptoms
    Criterion D symptoms, the final set of symptoms that define PTSD, have to
do with the body's physical (physiological) response to trauma or threat:
feeling constantly revved up, startling easily, getting angry easily, having
difficulty sleeping, and difficulty concentrating.
    I woke up at 0100 hrs today after going to sleep at 10 p.m. last
night. Do you think I really have an interest in doing anything but
sleeping right now? Too many long days. Too much stupid shit
going on at work. It makes me want to hurt someone sometimes;
thank God I have some control.
    -JUNIOR ENLISTED MARINE, POST-IRAQ
    I have found that I drink more, dream less, and have more mood
swings since my deployment. It is very hard to manage my anger
and irritability towards others. I have little patience for repetition
and get angry over menial things for no reason.
    -JUNIOR ENLISTED SOLDIER, POST-IRAQ
    I'm jumpy when I hear thunder, door slams, fireworks. Much like
in Iraq, when I heard incoming. I drink more than I should.
    -JUNIOR ENLISTED SOLDIER, POST-IRAQ
    Body physiology plays a huge role in criterion D symptoms. Criterion
D has to do with the body remaining on high alert to threat and able