Reliving the event – Recurring, involuntary, and intrusive memories of the traumatic experience can last long after the event has ended. Recurrent distressing dreams that are related to the traumatic event. Dissociative reactions (flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring.
 

Avoidance – Avoiding situations or people that remind them of the traumatic event. For example, combat veterans may avoid crowded places because it feels dangerous to be around so many people. People may stay busy, so they do not have to talk or think about the experience.
 

Negative thoughts – Feeling sad or detached from other people; loss of interest in things that used to be enjoyable. Difficulty expressing happiness or other positive emotions. Feeling the world is dangerous and you cannot trust anyone.
 

Hyperarousal – Irritable behavior or aggressive behavior toward people or objects. Feeling “on edge,” or having difficulty sleeping or concentrating. Exaggerated startle response to ordinary stimuli such as a loud noise or an accidental touch. Reckless or destructive behavior, e.g., abusing drugs and alcohol or driving aggressively.
 

Depersonalization or Derealization – Persistent or recurring experiences of feeling detached from one’s mental processes or body, in “a dreamlike state;” or feeling a sense that one’s surroundings are unreal or distorted.