A 42-year-old male veteran presents for psychiatric evaluation. He was deployed twice and experienced multiple combat-related traumatic events during a single 12-month deployment. He reports flashbacks to a specific IED explosion, avoidance of fireworks and loud noises, severe startle response, and insomnia with recurrent nightmares about the explosion. He identifies a clear before-and-after distinction, stating he was a well-adjusted person with close friendships and a stable sense of self before deployment. He maintains his marriage and several close friendships, though he acknowledges being more withdrawn than before. His self-image is intact, describing himself as someone dealing with a difficult experience rather than a fundamentally flawed person. His affect is anxious but modulated, and he does not report dissociative episodes or chronic emotional dysregulation. His PCL-5 score is 52.