How well do you understand PTSD?

Post-Traumatic Stress Disorder (PTSD) first appeared in the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, back in 1980 (DSM-III).  The symptoms of PTSD are caused by exposure to specific types of traumatic incidents; however, the vast majority of people who experience trauma do not experience symptoms in a way that would result in a legitimate diagnosis.  “What is a legitimate diagnosis?” you ask.  A legitimate diagnosis is:

  • One that is reached following objective evaluation by a licensed clinician
  • When the precipitating factor is one of the limited kind of traumatic experiences specified in the current edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5
  • When the required number of symptoms from each of 5 categories of symptoms listed in the DSM-5 are present for a period longer than 30 days
  • And when there is significant impairment of function in some area of the individual’s life who is suffering from those symptoms

According to the National Center for PTSD, about 7-8% of adults experiencing a traumatic event will end up with a diagnosis of PTSD, roughly the same percentage of the adult population in the United States that have a diagnosis of depression.  That, in a nutshell, is why we continue to refer to PTSD as a disorder – because even though the majority of people who experience a traumatic event will have some stress-related symptoms for a relatively short period of time afterward, only a relatively small percentage will go on to qualify for a diagnosis of PTSD.

Despite this truth, efforts have intensified over the last decade to remove the “D” from PTSD and simply call it PTS or PTSI (for Post-Traumatic Stress Injury).  There are professionals, like Frank Ochberg, a professor of psychiatry at Michigan State University, who think the only way to reduce the stigma associated with seeking help for PTSD is to change the name and stop calling it a disorder.  There are others, like Bessel van der Kolk, professor of psychiatry at Boston University, who firmly believe that the way to end the stigma is to call it what it is, and confront it head on.

PTSD is more prevalent in the military and among first responders than in the general population.  Studies have shown that the percentage of military veterans and emergency services personnel that meet the diagnostic criteria for PTSD at any given time to be approximately 15%.  There is also a significant stigma associated with that diagnosis, especially for first responders, because many times the department or agency they work for assume that such a diagnosis disqualifies them from doing their job.  Nothing could be further from the truth!  Indeed, personnel are typically able to continue to perform their normal duties while receiving one of the many treatment options available, including:

  • One of several forms of psychotherapy such as Cognitive Behavioral Therapy, Cognitive Processing Therapy, or Prolonged Exposure Therapy
  • One of several different types of medication, including anti-anxiety medications, anti-depressants, and in some cases even anti-seizure medications
  • Eye Movement Desensitization and Reprocessing (EMDR) Therapy

The comments in this article are not intended to be a substitute for medical advice or treatment.  If you are suffering from stress-related symptoms, seek help.  The best way to overcome the stigma is to put your own mental and emotional wellness at the top of the priority list and focus on getting better.  If you’re not sure where to turn, feel free to reach out to us at m.me/callforbackup.org and we can help point you in the right direction.  If you are struggling with stress-related symptoms or just have questions that you’d like to have answered, it’s time to call for backup.

 

Have you heard about Police Identity Disorder?

By guest author Dr. Stephanie M. Conn

Do you remember what you were like when you became a police officer?  How does this person compare to who you are today?  Chances are, if it was just last year that you joined, you are not a drastically different person but I would bet you are different.  Police work changes people. It changes the people around you too- your family, friends, and sometimes it even changes your neighbors. I saw this when I joined and even noticed it when I was a kid because my family wasn’t like non-police families.  For some reason, unbeknownst to me at the time, my dad needed to know my friends’ last names and their parents’ names. But I digress.

Research confirms that police work changes people and it doesn’t take long before the changes begin.  Studies of new police officers show that personality changes begin at the recruitment phase, are more pronounced after two years on the job, and substantially more pronounced at the four-year mark. Researchers found that officers rated higher for depression and vulnerability to addictive behaviors. The results suggested that the officers were at heightened risk for stress-related physical complaints and substance abuse after a mere four years of service.

One of the most troubling changes is the tendency for police officers to begin narrowing how they define themselves. On entering policing, officers typically possess multiple identity roles – they are not just a police officer but they also identify as parents, partners, friends, community members, members of sporting teams, etc.  As they spend more time in policing, these other roles tend to fade behind the ever-strengthening police role.  Police work is not “what you do”, it is who you are.  This trend is troubling for a number of reasons.  First, when you narrow how you identify yourself, you also narrow your problem-solving skills.  For instance, when an officer encounters a personal dispute with a spouse or partner, he or she will likely call upon the police role to resolve the conflict.  Most spouses / partners would not be particularly receptive to this kind of interaction.  In fact, a colleague of mine conducted a study of police partners who complained of feeling that the family was being “policed” at times.

Narrowing one’s identity to the singular police role can be even more troubling when police officers lose their status as police officers.  This could happen through retirement, injury, or involuntary resignation.  If all you are is a police officer and that’s taken away, what is left?  Cops have relayed to me that they couldn’t bear to leave policing because they would go from “hero to zero”.  No one wants to feel like a zero.  This contributes to the heightened suicide risk and rapidly declining health for officers who have recently retired.

So, what do we do with this information?  Are all officers doomed to feel like zeros?  Absolutely not!  Awareness precedes change.  I encourage you to take stock of the roles you currently play in your daily life.  Compare this to when you first became a police officer.  Do you notice that you have stopped doing hobbies you enjoyed or have withdrawn from non-police activities or people? If so, make the commitment to return to these activities.  It might be that you join a baseball league or running club.  It might mean reconnecting with an old friend or returning to the relationship rituals you shared with your partner that have fallen to the wayside.  Sometimes it helps to ask those close to you how you have changed since becoming a police officer.  Ask them if there is anything they miss about the “old” you, or the way the relationship was when you first started as a police officer.  Armed with this information, you can reconnect with all the other parts of who you are.  I encourage you to be vigilant in maintaining all of your life roles by taking stock annually of how you spend your time.  Having a well-rounded life, filled with multiple roles, will promote your resilience and overall quality of life.

Dr. Stephanie Conn is a licensed psychologist in private practice: First Responder Psychology.  Check out her excellent book, Increasing Resilience in Police and Emergency Personnel.

A “little bit” of PTSD?

Telling people they have “a little bit of PTSD” is like telling people with a sunburn that they have “a little bit of a third degree burn.” Like they say in the insurance commercial, “That’s not how this works. That’s not how any of this works.”

Post-traumatic Stress Disorder (PTSD) is probably one of the most misunderstood maladies of our time, and it is certainly one of the most serious problems facing first responders. PTSD consists of a complex set of symptoms that are brought on by a traumatic event, and it can cause a person to suffer significant impairment in the ability to function in one or more areas of daily living. The problem is that, while most emergency services personnel who experience a traumatic event will never develop PTSD, most of them have either diagnosed themselves or have been led to believe that they do have PTSD.

It is true that traumatic events (in the emergency services world we call them “critical incidents”) happen, and many first responders are exposed to them frequently. It is also true that the majority of individuals exposed to a critical incident will experience at least some symptoms of critical incident stress. Another term used to identify this type of stress is post-traumatic stress. That’s where a lot of the confusion comes in, because people tend to confuse common symptoms of post-traumatic stress with PTSD; hence, someone with a few symptoms or even mild symptoms is often told that they have “a little bit of PTSD” when, in fact, they do not.

After a critical incident, people may suffer a variety of symptoms that can be classified as:

• Critical incident stress (post-traumatic stress). These symptoms may include confusion or difficulty concentrating, memory problems, gastro-intestinal issues, difficulty controlling emotions, change in eating or sleeping habits, mood swings, social withdrawal, etc. The good news is that these symptoms are usually not particularly severe, and the vast majority of people find these symptoms are gone within a week to 10 days.

• Acute Stress Disorder. Those whose symptoms do not go away within that shorter time frame should be evaluated for what is known as Acute Stress Disorder. This disorder is possible, and typically is indicated by not only the duration of symptoms, but the intensity of the symptoms. The good news is here is that “acute” means the problem is only short-term, and the symptoms are gone within 30 days.

• Post-Traumatic Stress Disorder. This is obviously the most serious of the 3 stress-related disorders listed here. A legitimate diagnosis of PTSD cannot be made until at least 30 days have passed since the onset of symptoms. Beyond that, the type of event that leads to a diagnosis of PTSD is very specific, and the type and intensity level of symptoms associated with PTSD are also very specific and are found in the Diagnostical and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The good news here is that research shows that even though all emergency services personnel are exposed to the kinds of incidents that may lead to the development of PTSD, the percentage who actually can be diagnosed with this disorder is around 12-15%, according to the National Center for PTSD.

If you are suffering from stress-related symptoms and want more information, please feel free to reach out to us by sending a message to our social media page, or through our website at callforbackup.org. Now is the time to understand what is really going on. It’s time to call for backup.

Can it be this simple?

I grew up in Motown, listening to Motown music, and I still remember hearing Michael Jackson and the Jackson 5 singing “ABC.” It has me asking the question today, “Can making a difference in the phenomenon of law enforcement suicide be that simple? I didn’t say “easy,” I said “simple.” And the answer is, there are 3 simple steps to bringing down the number of police suicides (and suicides of other first responders as well).

A – Address the Issue. Suicide among first responders is the issue that “we are not supposed to talk about.” But until we address the fact that we lose more officers to suicide each year than in the line of duty, and that research shows that 41% of officers would consider suicide an option, we will never make a difference.

B – Build Trust. Trust comes from relationships, and there is no stronger bond that the one that exists between fellow police officers. They can talk to one another because they understand one another. That’s why officers tell us – by a 4 to 1 margin – that they would rather have voluntary participation in an effective peer-to-peer support program than to be forced to have mandatory annual meetings with a mental health professional hired by their department.

C – Change the Culture. The number one reason officers don’t reach out for help when they should is because of the stigma associated with mental wellness. Departments need to stop punishing officers who need to talk to someone about their struggles. The culture of shame because of some perceived “weakness” has to change!

This is the motivation behind our unique Call for Backup Suicide Awareness and Prevention Campaign. We are well on our way to reaching our goal of presenting this program in all 50 states within the first 5 years (we are now in our second year). If you’re interested in bringing this program to your department or agency, or interested in having the founder speak at an event, simply send us a message and we’ll respond as soon as possible.

Slaying the Stigma

by guest author Jonathan Hickory

I just want to be real with you.  I understand why cops are killing themselves.  I understand because I have been all the way to the end of that dark, desolate road.  The only difference, the only saving grace, the only thing that saved me in that moment—was a fellow officer who gave me a mission of hope.

The voices whispered into my thoughts, “just end it all…this life…there’s no point..there is no hope…with all the darkness you have seen…with the wretch of a person you have become..there is no hope for you.

Lies.  But I almost believed them.  And in that moment, I received a sneak preview of Hell itself.  Though I had begun to refuse to acknowledge the existence of a higher power, in my heart I still clung to a belief in a Creator..and Heaven…and Hell.

A grizzly, gruff Lieutenant in my department recognized my despair and heard my plea for help one day.  I was in the midst of an internal investigation and I was convinced my career was over, my wife would leave me, and my daughter would be taken from me.

Drowning in alcohol abuse, depression, rage, and darkness, I could see no hope—no way out.  I asked my Lieutenant, “How am I supposed to deal with this? I don’t know what to do.”  I was cautious not to let him see how much I was hurting inside—that I was crying out for help.  I didn’t want him to know the true pain in my heart, for I was so ashamed that I wasn’t tough like him.

Before I knew it, my Lieutenant had made a call to our department’s police psychologist and had given my name and number over to the “Cop Doc.”  Now, I felt like I had a directive from my leader—Go get help. 

Soon, I found made my first appointment with the Cop Doc.  I found myself sitting in a rickety chair in a small office in an old townhouse that had been converted for commercial use.  The soft noise from a noise making machine drowned any conversation in the tiny office from leaking through the paper thin hollow door.  Through heavy tears, I poured out my soul to this man who was supposed to be the enemy…this supposed “quack;” the police psychologist.

The Cop Doc let me finish, he listened and he acknowledged my pain.  He did not try to minimize it, and he did not brush it off or tell me to “tough it out, suck it up.”  The Cop Doc was the perfect balance of reality, compassion, and understanding.  He walked with me through the darkness and he pulled me out of the bottom of the deepest, darkest pit I have ever been in.  Slowly, I put my armor back on.

In the weeks that followed, the Cop Doc allowed me to text him directly and treated me as a friend and not a patient.  He never wrote anything down and he assured me that all we discussed was completely confidential.   He was my only friend at a time when I had none.

Soon afterwards, I began attending church and committed my life to God.  But I kept going to see the Cop Doc; I knew he could help me.  For the first time in so, so long, I felt hope.  To this day, I still have a relationship with my Cop Doc, and I am thankful for his friendship and for the simple fact that he will always stand by my side.

Today, I am a survivor.  My life is back on track, and I’m still a cop.  I love my job and I love helping people and making a difference every day.  I still face the darkness and the impossibilities of this job, but the new light shining from within me will never be extinguished.  My fellow brothers and sisters, we MUST DESTROY the STIGMA.  We are NOT weak if we ask for help.  We are all human and we are all broken.

Your badge is a shield, but it will not shield you from the trauma and the darkness we face.  We must seek help when we are hurting, and we must surround ourselves with a support network that will always uplift us and extend a lifeline of hope when we find ourselves in troubled waters.  Seeking help is the only weapon we have against the enemy of suicide.

To learn more information about this author, visit https://JonathanHickory.com