Post-Traumatic Stress Disorder (PTSD)

Definition of Post-Traumatic Stress Disorder (PTSD) PTSD

is a psychological reaction that occurs after experiencing a highly stressful event that is outside the range of a normal human experience. It can be caused by wartime combat, physical violence or a natural disaster. It is characterized by:

  • Depression
  • Anxiety
  • Flashbacks
  • Recurrent nightmares
  • Avoidance of reminders of the event

Examples of Triggering Events


There are a variety of events both personal and professional that can happen to an individual which can cause PTSD symptoms and result in a diagnosis of it. Although we commonly think of trauma as a reaction to a terrible accident or a disturbing violent event, we now know that there are some people who also experience emotional trauma after they have been diagnosed with a personal illness or they have been physically injured.

The following are examples of first-responder incidents that fall into this category:

  • Part of an officer-involved shooting (OIS)
    • – as a shooter
    • – as a witness officer
    • – as a dispatcher on the radio
    • – whether the suspect dies or survives
  • Unsuccessful rescue attempt
  • Responding to a fire call where there are fatalities or injuries due to a fire
  • Distressing 9-1-1 calls (dispatchers)
  • Responding to a car accident with multiple casualties
  • First responder being involved in a vehicle accident (i.e., engine, unit, personal vehicle)
  • Witnessing a fatality
  • Responding to an incident where there is a child fatality (i.e., accident, drowning, SIDS death)
  • Crimes against children
  • Death of his/her own child
  • Natural disasters
  • Being personally involved in a domestic violence situation
  • Being the victim of physical/sexual assault
  • Serious injury to self or co-worker
  • Experiencing a terrorist attack

This list in not all inclusive. For additional examples, refer to the Examples of Critical Incidents in the Critical Incident Stress Management section of this app.

Factors That May Reduce the Impact of PTSD

There are certain factors that may reduce the impact of PTSD:

  • Support from other people
  • Being in a support group after the traumatic event
  • Perception is an important factor following a traumatic event
  • Having a coping strategy

    • If the individual feels helpless and vulnerable in the aftermath of the event, it will be beneficial to examine the individual’s belief system and help him/her to find a way to reframe his/her perception.

  • For example, an individual badly wounded focusing on the scars of the wound, as opposed to celebrating the fact that he/she lived through the event

Coping Strategies

  • Utilizing family and friends for support
  • Being active in the recovery
  • Seeking professional help
  • Following a medication prescription from a physician
  • Familiarity with signs and symptoms
  • Processing through vs. avoiding memories
  • Healthy lifestyle

Frequently Asked Questions

Is there a cure for PTSD?
Not at this time. However, the different treatments for PTSD can reduce and even eliminate many of the symptoms.

Can treatment help a person forget that the event ever occurred?
No. Treatment can never take away the fact that a traumatic event has occurred but it can help the memory fade and make the incident more manageable.

Once a person gets treatment and the reactions are eliminated can they return?
Yes. Hopefully with treatment the reactions are never at the same intensity they once were.

Are there any medications that can help a person with PTSD?
Yes. It can be part of a treatment program. Refer to the Medications section of this app.

What should I do if I think someone has partial or full PTSD?
Refer to a mental health professional.

Does having PTSD mean I can not be a police officer or firefighter?
No. However, the more severe cases may preclude you from being fit for duty.

How long do PTSD symptoms last?
Symptoms and the reactions vary, depending on the unique circumstances of the event. The symptoms a person may experience depend on the treatment and circumstances.

PTSD in Children


Children can also suffer from PTSD. Symptoms may look different in children.

Some of the more common signs are:

  • Bed wetting
  • Forgetting how or being unable to talk
  • Acting out the scary event at playtime
  • Being unusually clingy with a parent or other adult

Post-Traumatic Growth

Post-Traumatic growth is developed through the experience of a traumatic event. It enables a person to give meaning to the trauma. A person takes his/her experience and uses it to benefit himself/herself and others, many times by telling his/her story.

What is Post-Traumatic Growth?

  • It is both a process and an outcome
  • It is derived from the cognitive process initiated to cope with stress.
  • It can change:
    • – How you view yourself
    • – Your relationship with others
    • – Your philosophy on life
    • – Foster social change (i.e., MADD, Concerns of Police Survivors COPS)
  • If refers to how adversity can develop into a new and more meaningful life:
    • – Re-evaluate priorities
    • – Deepen relationships
    • – Find new understandings of self

    • It is the power to tell a new story, not what happened to us, but the meaning we make of it.

    Six Stages of Thriving:

    1. Taking stock: make sure all of your basic needs are being met (you are safe, you are sleeping, you are eating well and you have received medical attention).
    2. Harvesting hope: be hopeful about the future
    3. Re-authoring: listen to the stories you tell yourself and open up to new ways of looking at things.
    4. Identifying change: monitor the change as it begins to appear.
    5. Valuing change: nurture the positive changes you are experiencing.
    6. Expressing change in action: begin to put the changes you experience into action and make them part of your life.

    Survivors and Thrivers

    • When adversity strikes, people often feel that at least part of them has been smashed.
    • Understanding the significance of our experience and rebuilding anew, will help us to become survivors.
    • This will help establish hopefulness and lead towards growth.

    What can someone experience from post-traumatic growth?
    Individuals who have suffered through a traumatic event were later able to report:

    • An increase in self-confidence
    • More focus and enjoying life in the present moment
    • An increase of acceptance of morality
    • An increase on the emphasis of family
    • A greater appreciation for life
    • Increase in feeling more open and concerned with spirituality and religion
    • 30-70% of survivors of life-threatening events say they have experienced positive changes of one form or another following the traumatic event.

    What else should I keep in mind?

    • Life is uncertain and things can change.
    • One must be flexible in order to deal with life effectively.
    • The choices one makes in life have consequences.
    • The experience of trauma does not have to set us back or devastate us. You can experience positive changes of one form or another following the traumatic event.
    • Be aware of the stories you tell yourself. You have the power to tell new stories that will help you overcome adversity and move forward.
    • It is not WHAT happened to us that determines our reactions, but rather the meaning we make of what happened to us.

    Referral

    Someone who is suffering from symptoms of PTSD needs to be referred to a mental health professional or a family physician. Peer Supporters should understand that this is one example where they need to refer because it goes beyond a peer supporter’s role. This does not mean a peer supporter cannot help the individual while he/she is in treatment with a professional. There are a variety of treatment options available for PTSD including, but not limited to:

    • Cognitive Behavioral Therapy
    • Cognitive Processing Therapy
    • Prolonged Exposure Therapy
    • Narrative Therapy
    • Group Therapy
    • Stress Inoculation Training
    • Eye Movement Desensitization and Reprocessing (EMDR) (refer to EMDR section of this app and also example video and books in the Resources section)
    • Medications

    For more information on PTSD, refer to the PTSD Resource section of this app.

    Risk Factors

    It is important that peer supporters know that numerous factors could impact an individual’s ability to cope with a traumatic event. Not everybody’s coping skills are the same. The following are reasons why a person may be incapable of coping with the event:

    • Living through past dangerous events and traumas
    • Having a history of mental illness
    • Getting hurt during the traumatic event
    • Seeing people get hurt and/or killed
    • Feeling of horror, helplessness, or extreme fear
    • Having little or no social support after the event
    • Dealing with extra stress after the event
    • Proximity to the traumatic event • Past or current physical abuse and/or substance abuse

    Signs and Symptoms

    PTSD affects about 7.7 million American adults. Anyone can get PTSD at any age. Not everyone affected with PTSD has been through a traumatic event. It is possible for an individual to develop PTSD through vicarious traumatization (for example, a police officer’s wife develops symptoms as a result of her husband’s line-of-duty death). Experiencing any one symptom is not necessarily suggestive of a problem; however, multiple symptoms may warrant a professional referral. Here are some symptoms of PTSD:

    RE-EXPERIENCING SYMPTOMS

    • Flashbacks
    • Bad dreams
    • Frightening thoughts

    AVOIDANCE SYMPTOMS

    • Staying away from reminders of the experience
    • Feeling emotionally numb
    • Feelings of strong guilt, depression or worry
    • Loss of interest in activities that were enjoyable
    • Having trouble remembering the dangerous event

    HYPER-AROUSAL SYMPTOMS

    • Being easily startled
    • Feeling tense or “on-edge”
    • Difficulty sleeping
    • Angry outburst

    In order to be diagnosed with PTSD, a person must have all of the following symptoms for at least one month:

    • – At least one re-experiencing symptom
    • – At least three avoidance symptoms
    • – At least two hyper-arousal symptoms

    The PTSD Process (Suitcase Metaphor)

    Here is a suitcase metaphor for peer supporters to illustrate how the PTSD process works:

    • Thoughts and emotions have been hurriedly “packed away” in a mental suitcase from the scene of the trauma.
    • Since the suitcase is not well packed, it can burst open from time to time via nightmares, negative thoughts, and intrusive images.
    • Survivors must unpack and repack the emotional luggage (thoughts, beliefs, and assumptions).
    • Over time, there are things you can toss out of the suitcase and others you must keep in the suitcase.
    • Eventually, we rearrange the contents of the suitcase so it does not “burst open” as often.

    What Happens to Memories During Traumatic Events?

    Not everyone’s memory is the same after an event. For instance, you can have four deputies involved in the same shooting and their recall of the event will be different such as:

    • Parts of the event may lack detail while others may be vivid.
    • There is limited ability to weave the story together.
    • The memories remain “active” for up to a month. This is why people struggle to tell a coherent story about the trauma. Memories may be disorganized if victims have not taken the time to process the event.
    • PTSD is a disorder of information processing.

    There are times when the memories and feelings surrounding a traumatic event are just too painful for first responders to remember, so they may try to push away from their consciousness what took place. This can happen in varying degrees:

    • Emotional numbing: Memories remain fully intact, but there are no associated feelings with them.
    • Depersonalization: This is described as an out-of-body experience similar to watching what is taking place from above, almost like a movie.
    • Dissociative fugue: Where a person becomes confused and may not remember how he/she arrived at the location
    • Dissociative amnesia: It is the inability to remember information that goes beyond simple forgetting and often has to do with different details of the traumatic event.
    • Dissociative identity disorder: This is the most severe forms of dissociative disorders. It is extremely rare. It is when a person suddenly begins to behave as though he/she has several different personalities. This occurs after the person experiences an extremely stressful event (example: the movie “Sybil.” She developed 13 different personalities).

    Acute Stress Disorder

    According to Wikipedia, an “acute stress reaction (also called acute stress disorder, psychological shock, mental shock, or simply shock) is a psychological condition arising in response to a terrifying or traumatic event. It should not be confused with the unrelated circulatory condition of shock, or the concept of shock value.” Symptoms usually show up immediately after a critical incident. If help is provided right away when these reactions appear, it may prevent them from becoming worse.