decade, as I have worked with cops, firfighters,
abuse victims and children of addicts, I have learned that
there are many causes for PTSD. It has also affirmed my belief
that PTSD is real and harmful, not only to those who have it,
but also to those around them. It impacts the way we act,
react, our motivation and our capacity to feel–well, anything.
Terrifying experiences that shatter people’s sense of
predictability and invulnerability can profoundly alter their
coping skills, relationships and the way they perceive and
interact with the world. The criteria for Post Traumatic Stress
Disorder (PTSD) are 1) exposure to a traumatic event(s) in which
the person witnessed or experienced or were confronted with an
event or events that involved actual or threatened death or
serious injury, or a threat to the physical integrity of self
or others, and 2) the person’s response involved intense fear,
helplessness or horror DSM IV p. 427-28). Gradual Onset
Traumatic Stress Disorder can be caused by repeated exposure to
=ECsub-critical incidents=EE such as child abuse, traffic
fatalities, rapes and personal assaults.
Nevertheless, not all people exposed to trauma are
=ECtraumatized.=EE Why? In 1998, Pynoos and Nader proposed a theory
to assist in explaining why people have different reactions to
the same event. They asserted that people are at greater risk
of being negatively impacted by traumatic events if any of the
following are present: 1) they have experienced other traumatic
events within the preceding 6 months, 2) they were already
stressed out or depressed at the time of the event, 3) the
situation occurred close to their home or somewhere they
considered safe, 4) the victims bear a similarity to a family
member or friend and 5) they have little social support.
It has been argued that officers, emergency service personnel,
children of addicts and abuse victims experience traumatic
events or threats to their safety on an almost daily basis.
Being abused, not knowing when or if your parents will come
home, repeatedly seeing children murdered, people burned in car
fires and devastated victims starts to take its toll. People
like idealistic officers who joined the force to change the
world and protect the innocent begin to feel like nothing they
do makes a difference, they cannot even keep their zone safe
(criteria 3). This is especially problematic for officers who
live in or near their work zone and often leads to frustration
and burnout (criteria 2). Children start to feel that the whole
world is uncontrollable and unsafe.
It is still not totally accepted within the law enforcement
community for officers to discuss the impact of situations on
them. Anger, humor and sarcasm are but a brief outlet for what
many officers dream about at night. As their condition worsens,
many officers withdraw, because they are fearful of seeking help
or support for fear it is a one way ticket to a fitness for duty
evaluation or will get out and be an obstacle for future
promotions. Several studies in recent years have shown that
Post Traumatic Stress Disorder (PTSD) is among the most common
of psychiatric disorders.
Another thing that distinguishes people who develop PTSD from
those who are just temporarily overwhelmed is that people who
develop PTSD become “stuck” on the trauma, keep re-living it in
thoughts, feelings, or images. It is this intrusive reliving,
rather than the trauma itself that many believe is responsible
for what we call PTSD. For example, I have worked with officers
who have responded to child abuse calls and had a child of their
own who was a similar age (criteria 4). In the course of daily
life children get hurt and have bad dreams. As parents they
have seen looks of pain and fright on their kids faces. This
makes it just that much easier to envision the looks of terror
and agony on the face of the child as their parent beat them.
Sometimes this visualization gets corrupted and officers
suddenly they start to see their child in their mental
re-enactment of the trauma, obviously a much more powerful
memory. These officers are much more likely to be =ECtraumatized=EE
by the incident and potentially get =ECstuck.=EE
Traumatized individuals begin organizing their lives around
avoiding the trauma. Avoidance may take many different forms:
keeping away from reminders, calling in sick to work, or
ingesting drugs or alcohol that numb awareness of distress. The
sense of futility, hyperarousal, and other trauma-related
changes may permanently change how people deal with stress,
alter thier self-concept and interfere with their view of the
world as a basically safe and predictable place. In the example
above, these people often became even more overprotective of
their children, suspicious of others, and had difficulty
sleeping, because every time they close their eyes they see the
child.
One of the core issues in trauma is the fact that memories of
what has happened cannot be integrated into one’s general
experience. The lack of people’s ability to make this =ECfit=EE
into their expectations or the way they think about the world
in a way that makes sense keeps the experience stored in the
mind on a sensory level. When people encounter smells, sounds
or other sensory stimuli that remind them of the event, it may
trigger a similar response to what the person originally had:
physical sensations (such as panic attacks), visual images
(such as flashbacks and nightmares), obsessive ruminations, or
behavioral reenactments of elements of the trauma. In the
example above, sensory triggers that triggered some of the
officers memories were certain cries, hearing or seeing a
parent spank their child, returning to the same neighborhood
for other calls and, of course, television shows or news
reports that involved descriptions of abuse.
The goal of treatment is find a way in which people can
acknowledge the reality of what has happened and somehow
integrate it into their understanding of the world without
having to re-experience the trauma all over again. To be able
to tell their story, if you will.
The Symptoms of PTSD
Regardless of the origin of the terror, the brain reacts to
overwhelming, threatening, and uncontrollable experiences with
conditioned emotional responses. For example, rape victims may
respond to conditioned stimuli, such as the approach by an
unknown man, as if they were about to be raped again, and
experience panic.
Remembrance and intrusion of the trauma is expressed on many
different levels, ranging from flashbacks, feelings, physical
sensations, nightmares, and interpersonal re-enactments.
Interpersonal re-enactments can be especially problematic for
the officer leading to over-reaction in situations that remind
the officer of previous experiences in which she or he has felt
helpless. For example, in the child abuse example above,
officers may be much more physically and verbally aggressive
toward alleged perpetrators and their reports tend to be much
more negative and subjective.
Hyperarousal. While people with PTSD tend to deal with their
environment by reducing their range of emotions or numbing,
their bodies continue to react to certain physical and
emotional stimuli as if there were a continuing threat. This
arousal is supposed to alert the person to potential danger,
but seems to loose that function in traumatized people. This is
sort of like when rookie officers start and a hot call is toned
out, they usually have an adrenaline rush. After two or three
years, the tones hardly have any impact on them. Since
traumatized people are always =ECkeyed up=EE they often do not pay
any attention to that feeling which is supposed to warn them of
impending danger.
Numbing of responsiveness. Aware of their difficulties in
controlling their emotions, traumatized people seem to spend
their energies on avoiding distress. In addition, they lose
pleasure in things that previously gave them a sense of
satisfaction. They may feel “dead to the world”. This emotional
numbing may be expressed as depression, and lack of motivation,
or as physical reactions. After being traumatized, many people
stop feeling pleasure from involvement in activities, and they
feel that they just “go through the motions” of everyday
living. Emotional numbness also gets in the way of resolving
the trauma in therapy.
Intense emotional reactions and sleep problems. Traumatized
people go immediately from incident to reaction without being
able to first figure out what makes them so upset. They tend to
experience intense fear, anxiety, anger and panic in response to
even minor stimuli. This makes them either overreact and
intimidate others, or to shut down and freeze. Both adults and
children with such hyperarousal will experience sleep problems,
because they are unable to settle down enough to go to sleep,
and because they are afraid of having nightmares. Many
traumatized people report dream-interruption insomnia: they
wake themselves up as soon as they start having a dream, for
fear that this dream will turn into a trauma-related nightmare.
They also are liable to exhibit hypervigilance, exaggerated
startle response and restlessness.
Learning difficulties. Being =ECkeyed-up=EE interferes with the
capacity to concentrate and to learn from experience.
Traumatized people often have trouble remembering ordinary
events. It is helpful to always write things down for them.
Often =ECkeyed-up=EE and having difficulty paying attention, they
may display symptoms of attention deficit disorder.
After a trauma, people often regress to earlier modes of coping
with stress. In adults, it is expressed in excessive dependence
and in a loss of capacity to make thoughtful, independent
decisions. In officers, this is often noticed because they
suddenly begin making a lot of poor decisions, their reports
lose quality and detail and they are unable to focus. In
children they may begin wetting their bed, having fears of
monsters or having temper tantrums.
Aggression against self and others: Both adults and children
who have been traumatized are likely to turn their aggression
against others or themselves. Due to their persistent anxiety,
traumatized people are almost always =ECstressed out,=EE so it does
not take much to them set off. This aggression may take many
forms ranging from fighting to excessive exercise or obsession
about something—anything to keep them from thinking about the
trauma.
Psychosomatic reactions. Chronic anxiety and emotional numbing
also get in the way of learning to identify and discuss
internal states and wishes. May traumatized people report a
high frequency of headaches, back and neck aches,
gastro-intestinal problems etceteras. Since the stress is being
held inside, the body begins to become distressed.
Summary
After a trauma, people realize the limited scope of their
safety, power and control in the world, and life can never be
exactly the same. The traumatic experience becomes part of a
person’s life. Sorting out exactly what happened and sharing
one’s reactions with others can make a great deal of difference
a person’s recovery. Putting the reactions and thoughts related
to the trauma into words is essential in the resolution of post
traumatic reactions. This should, however, be done with a
professional specializing in PTSD due to the wide range of
reactions people have when they start confronting and
integrating the memories of the trauma.
Failure to approach trauma related material gradually is likely
to make things worse. Often, talking about the trauma is not
enough: trauma survivors need to take some action that
symbolizes triumph over helplessness and despair. The Holocaust
Memorial in Jerusalem and the Vietnam Memorial in Washington,
DC, are good examples of symbols for survivors to mourn the
dead and establish the historical and cultural meaning of the
traumatic events. There are several events for survivors of
traumas that officers can also take part in. These events
remind survivors of the fact that there are others who have
shared similar experiences. Other symbolic actions may take the
form of writing a book, taking political action or helping other
victims.
PTSD is real, and can be resolved with time, patience and
compassion.
About The Author: Dr. Snipes received her PhD in Counseling and
Education from the University of Florida. She has worked for 10
years in community mental health and is an ordained Christian
minister. Currently she runs an online private practice
http://www.dr-is-in.com and online continuing education site
http://www.allceus.com. Both sites are managed by her husband
at http://www.datatriangle.com
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