A nurse is counseling a group of clients from a town that was affected by a hurricane 6 months ago. For which of the following clients should the nurse initiate a referral to assess for the presence of posttraumatic stress disorder? (Select all that apply.)

PTSD symptoms include emotional numbing and feeling detached from others (A), intrusive symptoms such as nightmares/flashbacks (D), and persistent negative mood states such as anger, guilt, or shame (E). Moving to higher ground is an adaptive coping strategy, not a PTSD symptom. Recognizing that life has changed is a normal grief response — it does not indicate PTSD without accompanying intrusive, avoidance, and hyperarousal symptoms.