• Repetitive nightmares. Even sleep offers little respite. Sometimes the victim’s nightmares replay the actual events of the crime. • Dissociation. During the traumatic event, and for some time afterward, the patient may experience episodes of depersonalization (feeling that the self is unreal) or derealization (feeling that the outside world is unreal). Patients describe the feeling to be like “it is happening in a dream” or that “it’s happening to someone else.” • Impaired concentration and memory. The crime victim has trouble remembering names, tends to misplace objects, loses the train of conversations, or can’t keep their mind focused on work, reading material, family activities, and so on. • Sexual inhibition. Over 90% of PTSD subjects report decreased sexual activity and interest; this may further strain an already-stressed marital relationship. In some cases, complete impotence or frigidity may occur, especially in cases where the traumatic event involved sexual assault. This may be associated with a general decline in enjoyment of life activities and may shade over into clinical depression. • Withdrawal and isolation. The crime victim shuns friends, neighbors, and family members and just wants to be left alone. They have no patience for the petty, trivial concerns of everyday life—bills, gossip, news events— and gets annoyed at being bothered with these piddling details. • Impulsivity and instability. More rarely, the crime victim may take sudden trips, move from place to place, walk away from their job, disappear from their family for prolonged periods of time, uncharacteristically engage in drunken binges, gambling sprees, or romantic trysts, make excessive purchases, or take dangerous physical or legal risks. It is as if the trauma has goaded the traumatized crime victim into a what-the-hell-life-is-short attitude that overcomes his usual good judgment and common sense. Far from taking such walks on the wild side, however, the majority of trauma survivors continue to suffer in mute, shattered silence. Training Module on the Right to Mental Health for the Security Sector day and frightening dreams at night. In the most extreme cases, the patient may experience flashbacks or reliving experiences in which they seem to be mentally transported back to the traumatic scene, sometimes losing touch with current reality. ACUTE STRESS DISORDER ASD is defined as a reaction to the traumatic stress that occurs within 4 weeks of the index trauma. Although ASD focuses more on dissociative symptoms than PTSD, it also includes symptoms of reexperiencing, avoidance, and hyperarousal. Preliminary prospective studies suggest that between 60% and 80% of individuals meeting criteria for ASD following a traumatic event will meet criteria for PTSD up to 2 years later. It recognizes that some patients may show 32