The Real Post Traumatic Stress Symptoms
In my two different careers, I have observed a tremendous amount of stress on myself and those around me. When you are in the middle of dealing with public-created stress, and surrounded by those who are dealing with the same pressure, it is difficult to know what normal is anymore. The link between my careers came with a mentality shift that I would have laughed about as a rookie police officer.
I spent 15 years in a police uniform between the Lexington Police Department and the Kentucky State Police Commercial Vehicle Enforcement. During my time as an officer, I experienced many of the same emotions, challenges and learning curves many of you reading this article have encountered.
I thought I was invincible, dealt with horrible sights and began to lose faith in humanity. I started to take my work home, turn to ways to numb the pain and treat my own family like they were outsiders. Once I realized I had a problem separating my work from home, I tried to reach out for help. But I found none. This lack of assistance led me to seek out how I could professionally help those who are busy serving others.
With my determination to help other hurting officers, I completed my bachelor’s in criminal justice, a master’s in professional counseling and a Ph.D. in counselor education and supervision. I began my second career as a professional counselor and provide psychotherapy to those dealing with traumatic incidents.
I spent most of my law enforcement career in the same mindset as many hard-nosed rookies who think mental health therapy is for the weak minded. I wish I had known then what I know now about the helpfulness of professional counseling. I feared that seeking help would ruin my law enforcement career. I wish I had known about confidentiality laws that protect professional counseling. I wish I had known how learning healthy emotional-regulation skills could have kept me from bringing home my frustrations.
I wish I had known that learning to deal with my thoughts in a healthy way could save my family years of stress. I wish I had known that post-traumatic stress disorder (PTSD) is a limbic system problem, not a weakness.
If I were to write a letter about psychotherapy to my rookie self, I would explain how it works. I would explain that therapy is not laying on a couch and talking about the past, or telling some stranger every life detail. I would explain that emotional-regulation skills are not some head-shrink telling me to count to 10 or to take deep breaths when dealing with a disrespectful citizen.
Instead of listing medical terminology defining PTSD criteria, I speak about what PTSD looks like in my clients and friends at public safety conferences. Anyone with internet access can read the list of symptoms required to diagnose PTSD, but I find it far more important to recognize changes that occur in first responders who are dealing with the disorder.
Need for Treatment
There is certainly a need for direct treatment for PTSD in law enforcement.
In 2009, researchers compared statistics from new police cadets with results from the same subjects one year into their careers. In that short year, 22 percent of officers showed PTSD-related symptoms, according to the article, “Routine work-environment stress and PTSD symptoms in police officers,” published in the Journal of Nervous and Mental Disease.
In 2013, the U.S. Department of Justice registered approximately 120,000 uniformed police officers. If the percentage of observable symptoms from the study is factored into the number of U.S. officers, then approximately 26,400 current members of law enforcement suffer from PTSD symptoms within their first year of public safety.
In Kentucky, this statistic would translate to about 1,700 of the state’s estimated 7,800 law enforcement officers who would experience PTSD symptoms within their first year of employment.
Public safety members who suffer from PTSD symptoms need mental health care specifically designed for their difficult jobs.
How PTSD Presents in Therapy
I continually find that those with PTSD seek psychotherapy for reasons not described in a psychological handbook for a specific disorder. While PTSD has become a more recognized term today, very few people come to my office and shake my hand while exclaiming that they have, “witnessed a traumatic event that is connected to their dissociative reactions and persistent effortful avoidance of trauma-related stimuli and a negative alteration of cognition and arousal of activity causing a functional impairment,” the American Psychological Association’s PTSD definition.
Never fear, if that run-on sentence of technical symptoms made your eyes cross, I took out a lot of student loans to help me interpret it professionally. I could bore you with the long, technical names of issues that might make you stop reading. But what is most important when watching for specific PTSD symptoms in one another is to understand what PTSD looks like.
What I find public safety members seeking therapy for is marital problems, anger issues, sleep disturbances, loss of interest in activities, memory loss, depression or an inability to feel emotions at all. In my years of mental health practice, I have yet to have a member of public safety identify their own PTSD. Some personality changes come from the overwhelming amount of trauma officers see or the distrust of the public we learn along the way. Some changes may be an attempt at healthy coping mechanisms. But an increasing amount of these symptoms could be the signal of a problem.
Although public safety members will naturally have a stressful or sad reaction when dealing with an initial traumatic incident, healing and recovery begin soon after. When the defense mechanisms begin to become unhealthy is when responders can no longer heal after the difficult observation.
Most members of society have lost someone they cared for at some point in their lives. Reminding ourselves of the natural healing process that happens afterward is a great example of how we should heal after a traumatic work event. What we should look for is when we see in ourselves, or in our co-workers, that the healing process is not occurring the way it should.
Strict vigilance is taught in the academy, but lasting hypervigilance following a trauma can cause a lifetime of exhaustion. A distrust of suspects on the roadside can be helpful, but a hatred for all humankind can be detrimental in the long term. It is the traumatic-thought events that linger in our own lives that cause the problem. Even if your difficult thoughts do not meet the level of PTSD, it is the off-duty intrusion of the sights and sounds we observe that require action.
Fortunately, if symptoms do not reach the diagnostic requirements for PTSD, and are not causing significant dysregulation in your personal life, then you may need to reach out no further than the circle of support already formed around you.
Peer support has a measured positive effect on law enforcement officers. Reaching out to those around you, whether in emotional distress or for personal support, should be your first line of defense when things are not going well after a traumatic event. In my life, having a like-minded police officer to share my stressors with helped me to process the manner in which my reactions were becoming more than general law enforcement career frustrations.
However, if the more severe symptoms discussed above sound like something you or your co-workers are dealing with, then it may be time to seek professional help.
Psychotherapy can take many forms, from individual behavioral sessions to large group critical-incident debriefings. My areas of expertise are Rational Emotive Behavior Therapy and Eye Movement Desensitization Reprocessing therapy, commonly called EMDR. What is important to understand about these therapy systems is that the final goal is to help change the core and intermediate beliefs that shape how we interpret the things that happen around us.
The reason these therapies work well for public-safety individuals is that they are designed with the understanding that we cannot always change the circumstances. While there are times in our lives that we need to take a step to change our surroundings, those of us in law enforcement cannot always control the circumstances in which we are working. While I enjoyed that about policing, appreciating the fact that some circumstances cannot be changed in public-safety responses fits well into these methods of psychotherapy.
Individual psychotherapy is often about changing the way we deal with circumstances that are already happening around us. We learned to deal with dangerous situations in the academy and through our experiences on-the-job. Psychotherapy does not need to change that type of response. However, the way we apply those experiences to the rest of our life can be both helpful and detrimental.
It is the personal understanding learned in psychotherapy that can assist in the detrimental life applications.
Police officers dealing with traumatic experiences in law enforcement often keep the public from having to understand the stress that comes with it, and in my likely-biased opinion, that makes law enforcement officers true heroes. True heroes can also admit when they are out of their league and need some help with a situation.
Police call in tactical units when a situation has reached the point that a specialized unit would be a better fit. It does not mean the patrol level was incapable of performing their duties, but that a specifically-trained unit might have more experience and ideas about how to successfully handle the situation.
If stress and the responses to it are causing difficulties in your personal life, I plead with you to seek out peers and professional counseling. I cannot write intelligently about what is available at your agency, but I can express that when I decided I needed to talk to someone professionally, my agency did not have many options available. If you are seeking professional help, understand that finding one you are comfortable with may be like working with your first field training officer. Some trainers you may have meshed well with, and some you may not have been able to agree with.
Every professional counselor comes from a differing background. Do not be afraid to keep looking for one with whom you can have a strong therapeutic relationship. With the added physical and psychological dangers that continue to grow in today’s society, being able to be a hero and ask for professional help may save your career, your family, your sanity or your life.
PTSD or PTS?
The acronym PTSD, short for Post-Traumatic Stress Disorder, is widely used in today’s vernacular when discussing trauma-related mental health. For some, however, the acronym carries a negative connotation pertaining to the word “disorder.” A disorder implies there is something wrong with you. But post-traumatic stress is a normal reaction to an abnormal event.
Additionally, post-traumatic stress is often experienced by first responders following a critical incident or culmination of multiple traumatic events. Not all post-traumatic stress rises to the level of disorder. That stress becomes diagnosable as PTSD when it becomes intrusive on an individual’s daily life.
As therapist Trevor Wilkins describes it, PTSD is a brain-perception problem. It’s fixable. The purpose of the word “disorder” lies in clinical application. Below are the criteria mental health professionals use to diagnose an individual with PTSD for treatment.
The following is adapted from brainline.org, a website devoted to brain injury and PTSD.
In 2013, the American Psychiatric Association revised the PTSD diagnostic criteria. All of the conditions included in this classification require exposure to a traumatic or stressful event as a diagnostic criterion.
Intrusion symptoms. The individual persistently re-experiences the trauma in nightmares, flashbacks and/or upsetting memories. Exposure to these traumatic reminders causes emotional distress and physical reactivity.
Avoidance. The individual avoids trauma-related stimuli, such as thoughts, feelings and/or external reminders of the event.
Negative alterations in cognition and mood. The individual experiences negative thoughts and/or feelings that began or worsened after the trauma. Some examples include negative thoughts and assumptions about oneself or the world, exaggerated blame of self or others for causing the trauma, decreased interest in activities, isolation feelings, difficulty experiencing positivity and the inability to recall key features of the trauma.
Alterations in arousal and reactivity. The individual experiences hypervigilance, including a heightened startle reaction, risky or destructive behavior, irritability or aggression, difficulty concentrating and/or sleeping.
These symptoms reach the diagnostic level for PTSD when they last more than one month, create distress and/or functional impairment and cannot be dismissed because of medication, substance use or other illnesses.