PTSD Awareness Month

June 8, 2016
Post-traumatic stress disorder can occur after you have been through or have witnessed a traumatic event. A traumatic experience typically involves the potential for death or serious injury resulting in feeling of intense fear, helplessness, or horror.

In 2010 Congress named June 27th PTSD Awareness Day, and in 2014, the Senate designated the full month of June for National PTSD Awareness.  Have you kept up with your knowledge base not only for yourself, but also for your brothers and sisters?

Post-traumatic stress disorder can occur after you have been through or have witnessed a traumatic event. A traumatic experience typically involves the potential for death or serious injury resulting in feeling of intense fear, helplessness, or horror. It also includes learning that the traumatic event(s) occurred to a close family member, friend, or police partner. 

PTSD is no longer considered an Anxiety Disorder.  Posttraumatic stress disorder, along with Acute Stress Disorder, have been moved to the newly created DSM-V as Trauma and Stressor-Related Disorders. This change reaffirmed that the symptoms are significantly broader than anxiety alone.

Every law enforcement officer has been or will be involved with a traumatic event, often a multitude of traumatic events by the nature of the job. The details of these events would stagger the average citizen.  Living through a traumatic event is hard enough for an officer, admitting that you are having problems related to that event is even harder.

What Types of Trauma Can Lead to PTSD?

Anyone who has gone through or witnessed a life-threatening event can develop PTSD. These events can include: combat or military exposure, violent personal assault (rape, battery, robbery, mugging), being kidnapped or taken hostage, terrorist attacks, torture, incarceration (such as a prisoner of war), natural or manmade disasters, diagnosis of life threatening illness, childhood sexual or physical abuse, terrorist attacks, serious accidents, etc.

What Events Are Most Likely to Traumatize Law Enforcement Officers?

Nancy Davis, PhD identified the following eighteen events as being the most traumatic for law enforcement officers:

  1. Witnessing the death of a law enforcement officer or viewing their body at the scene.
  2. A reasonable belief that the officer's death or critical injury was imminent.
  3. Accidentally killing or wounding a bystander.
  4. The officer's inability to stop a suspect from injuring or killing another.
  5. Killing or wounding a child, teenager or mentally ill individual, even if the life of the officer had been threatened.
  6. Viewing the body of a child victim, particularly if the officer has children, or if the child had been assaulted, abused or tortured.
  7. When a dead victim becomes personalized, rather than just an unknown body.
  8. The terror of being caught in a violent riot.
  9. An officer is blamed or told he or she is responsible for the death of an innocent bystander, law enforcement officer, or a child victim.
  10. Exchanging shifts with another officer who is killed while working the exchanged shift.
  11. Responding to a call minutes after an officer is killed or critically injured.
  12. Particularly bloody or gruesome scenes that involve decay, dismemberment, or suffering.
  13. Observing an event involving violence or murder, but not being able to intervene.
  14. Feeling responsible for someone else’s life (hostage negotiators)
  15. Undercover assignments in which the officer is constantly "on-guard" because of the likelihood of being hurt, killed, or discovered.
  16. When an "informant" developed by an officer is murdered for providing information to law enforcement.
  17. Viable threats of violence by suspects towards an officer and/or his family.
  18. Being referred to as a "Hero" after being involved in an incident where other officers died or were critically wounded.

According to the United States Department of Veterans Affairs National Center for PTSD approximately 6.8% of Americans suffer from PTSD at some point during their lives and approximately 3.6% of U.S. adults have PTSD during the course of a given year.  However, according to the National Center for Biotechnology Information (NCBI), the incidence of current duty-related PTSD in police officers has been found to vary between 7% and 19%. The discrepancy in this range may be due to underreporting. Additionally, when there is exposure to multiple traumatic events, an officer is more vulnerable to developing more severe forms of PTSD, including cumulative and complex PTSD. Untreated PTSD can be disabling and/or deadly.


The components for the diagnosis of PTSD symptoms include: exposure to a traumatic incident with four resultant and specific symptoms: re-experiencing, avoidance, alterations in thoughts or mood, and hyper-arousal. PTSD symptoms usually start soon after the traumatic event, but they may not happen until months or years later. These symptoms may be terrifying, disrupt an individual’s life, work, and relationships. How disabling these symptoms are depends on several factors including: the person's life experiences before the trauma, their own natural ability to cope with stress, how serious the trauma was, and what kind of support a person gets immediately following the trauma. The symptoms may come and go over many years.

Recurrent Intrusive Symptoms

Trauma survivors commonly re-experience their traumas. Re-experiencing symptoms involve a mental replay of the trauma accompanied by strong emotional, mental, and/or physical reactions. These symptoms are automatic and include: thinking about the trauma, seeing images of the event, feeling agitated, and having physical sensations like those that occurred during the trauma. This can happen when the person is awake or in nightmares during sleep. This feeling of being in the traumatic event again is called having flashbacks. Flashback symptoms are the most dramatic, and are the focus of most media attention. Flashbacks may consist of images, sounds, smells, or feelings, and are often triggered by ordinary occurrences; the slamming of a door, a news report, seeing an accident, or a car backfiring on the street. A person having a flashback may lose touch with reality and believe that the traumatic incident is indeed happening all over again. Re-experiencing symptoms are indicators that the individual is actively struggling to cope with the traumatic experience, even trying to make sense of what has happened.

Persistent Avoidance Symptoms

Avoidance symptoms are the most disabling and persistent; they fundamentally cause the most distress in an individual’s life. Avoidant symptoms are ways in which the person tries to avoid anything associated with the traumatic event; they are frequently exhibited by efforts to evade thoughts, activities, places, situations, or people that are reminders of the trauma. Additional avoidance symptoms include; not being able to recall important aspects of the traumatic event, having a sense of a shortened future, feeling emotionally dead, feeling disconnected from others, and losing interest in previously enjoyable activities. The individual may distance or detach himself from others and have difficulty experiencing any positive feeling. Symptoms may actually be physical: feelings of numbness or not feeling pain.

Negative Alterations in Cognitions and Mood

These symptoms include persistent and distorted personal blame or falsely holding others responsible for the traumatic event.  Additionally, the individual frequently is unable to recall key features of the event; as well as maintaining a persistent negative emotional state including: fear, horror, anger, guilt, or shame. The relentless inability to experience positive emotions fosters feelings of depression, isolation, and inactivity.

Marked Alterations in Arousal and Reactivity Symptoms 

Hyper-arousal symptoms are usually what bring an individual into treatment. The person seeks treatment for his disabling and relentless symptoms of anxiety or panic attacks. Hyper-arousal symptoms are the most bothersome symptoms for both the individual and the family. Increased arousal symptoms include the following: hypervigilance, agitation, difficulty concentrating, feeling sweaty and shaky, shortness of breath, heart pounding, watchfulness, wariness, irritability, outbursts of anger, insomnia, and being easily startled.

Treatment for PTSD

When you have PTSD, dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But treatment can help you get better. There are two main types of treatment, psychotherapy (sometimes called counseling) and medication. Sometimes people combine psychotherapy and medication.

Psychotherapy, or counseling, involves meeting with a clinical therapist. There are different types of associated psychotherapies:

  1. CBT - Cognitive behavioral therapy is the most effective treatment for PTSD. CBT focuses on exploring relationships among a person's thoughts, feelings and behaviors.
  2. CPT - Cognitive processing therapy (CPT) teaches the skills to understand how the traumatic event changed your thoughts and feelings.
  3. PE - Prolonged exposure therapy allows you to discuss the traumatic event repeatedly until the memories are no longer as unsettling. Tools to help you retreat to safe places are reinforced.
  4. EMDR - Eye Movement Desensitization and Reprocessing focuses on repeated sounds or hand movements while you talk about the trauma.

Medications can also be extremely effective in treating PTSD. Selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD. Another medication called Prazosin has been found to be helpful in decreasing nightmares related to the trauma.

IMPORTANT: Benzodiazepines and atypical antipsychotics should generally be avoided for PTSD treatment because they do not treat the core PTSD symptoms.

Finding a proficient provider can be a daunting, yet essential, experience.  Not all mental health providers are created equally.  It is essential to find a provider who uses proven treatment methods.  Get referrals from reliable resources.  Remember, you can find your providers, HPPA protection is important.  Look for certain words in the provider’s title: “licensed” or “board certified”; pretty much anyone can claim to be a therapist of some sort. Above all be very wary of easy fixes or sounds “too good to be true” remedies.  There is no scientific evidence for many of the purported alternative therapies promising treatment or a “cure” for PTSD; these include the use of life coaching, aqua therapy, equine therapy, neuro-linguistic programming, rapid resolution therapy, hyperbaric oxygen chamber therapy, etc.


Not every traumatized person develops full-blown or even minor PTSD. There is no definitive cure for PTSD. However, most people who develop PTSD do get better at some time. Debriefing after a traumatic event can promote a better prognosis.

Even if you never develop PTSD, someone you know, or someone on some call will. Recognize the symptoms and encourage them to seek treatment. Early identification of PTSD and treatment is essential for the individual’s total physical, psychological, and social well-being.

About the Author

Pamela Kulbarsh

Pamela Kulbarsh, RN, BSW has been a psychiatric nurse for over 25 years. She has worked with law enforcement in crisis intervention for the past ten years. She has worked in patrol with officers and deputies as a member of San Diego's Psychiatric Emergency Response Team (PERT) and at the Pima County Detention Center in Tucson. Pam has been a frequent guest speaker related to psychiatric emergencies and has published articles in both law enforcement and nursing magazines.

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