By Dr. Marla Friedman, Psy.D. PC, Police Psychologist
Although the official medical term is post-traumatic stress disorder (PTSD), within the police psychological community we prefer to use the term post-traumatic stress injury (PTSI). As retired General Peter Chiarelli stated, “many service men and women hate the term ‘disorder’ and suffer in silence rather than endure the label.”
The same is true in the law enforcement community because labeling something as a “disorder” can suggest something negative about a person’s character or something that can’t be changed. Calling it an “injury” clarifies that the person has unfortunately experienced something horrifying or traumatic, but can recover from it. Breaking the stigma about seeking mental health treatment is our goal as mental health professionals.
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PTSI is not a personality flaw or weakness. Anyone may develop it following a tragedy, cumulative trauma or vicarious trauma. Due to the nature of their work, law enforcement officers are particularly vulnerable to experiencing PTSI. If you or someone you know is facing PTSI, do not despair; it can be treated and healed.
The Difference Between Signs and Symptoms of PTSI
Most people have heard about PTSD or PTSI, but may not know the signs and symptoms. First, there is a difference between a sign and a symptom. In any psychological or physical diagnosis there are both. Signs of an injury are objective and observable. For example, when assessing a patient, some signs a therapist might observe are crying, shaking, trembling, wringing their hands, or rapid breathing.
Symptoms, on the other hand, are subjective and are reported by the person experiencing them. Common symptoms include nightmares, intrusive thoughts, checking the perimeters of their home, and feeling depressed or suicidal. When all is said and done, it’s the combination of signs and symptoms that the therapist uses to make the diagnosis.
Here are some common signs and symptoms of PTSI, in accordance with the Diagnostic and Statistical Manual of Mental Disorders (5th Edition: DSM-5):
- Feelings of fear, horror, guilt, shame, anger, irritability and self-blame.
- Avoidance of sights, sounds, smells, people, places, and activities that trigger memories of the original trauma.
- Depressed feelings and behaviors.
- Thoughts, plans, intentions and having the means of committing suicide.
- Poor concentration and memory problems. Inability to remember aspects of the trauma.
- Increased use of drugs and or alcohol.
- Panic attacks, agitation and increased generalized anxiety.
- Negative beliefs about the world at large and feelings that no one can be trusted.
- Reckless and self-destructive behavior.
- Sleeping too much or too little. Nightmares.
- Eating too much or too little.
- Isolation and detachment from others.
- Inability to feel pleasure.
- Flashbacks and frightening intrusive thoughts.
- Direct exposure, or indirect exposure to a horrifying event.
- Witnessing trauma or learning a friend or relative was exposed to trauma.
Taking Steps Toward Treatment
When a first responder recognizes these signs or symptoms, it’s time to seek help. Even for those who don’t believe they are suffering from PTSI, first responders and police officers need to take responsibility for their own psychological wellness.
It is a good idea to get to know a mental health specialist even before a problem occurs. When stress or trauma does occur, and it will, you will already be acquainted with a specialist you know and trust. Think of it as a safety net or a vaccine. Your mental health specialist will also be able to identify symptoms early and provide treatment, which reduces distress and avoids years of unnecessary suffering.
The key to effective treatment is to take the time to develop a positive relationship with a mental health professional. Establishing a healthy patient-practitioner relationship promotes an open back-and-forth discussion that assists in revealing the reason for the initial visit. It also encourages both parts of a therapy team to work together to identify signs and symptoms, define what the problem is in detail, and then decide and agree on a treatment protocol. The more input from both sides, the greater the chance of an efficient and successful outcome.
It is normal for an officer, or anyone for that matter, to be a little nervous before their first visit to see a mental health professional. Many fear being misdiagnosed, or being stigmatized as “crazy” or “paranoid” by others. It is important to know that those who specialize in working with law enforcement will understand these fears and focus on normalizing the therapy experience. Our hope is that one day, therapy will be as routine as going to the dentist or having the oil in your car changed. It will just be ongoing wellness maintenance.
Choosing the Right Therapist for You
There are many important variables to consider before selecting the therapist that fits your individual needs. While there are many psychologists, social workers and counselors offering treatment, the one you choose must be licensed in the state where you are receiving the treatment.
Look for individuals with many years of experience who have specialized training in working with trauma survivors. It can be very beneficial to find a therapist who has worked in a psychiatric hospital because they have been exposed to the most extreme forms of mental illness and are comfortable working with all levels of distress.
Remember, therapists don’t have to be officers who have been retrained in psychology—that’s like saying dentists can only treat other dentists. When searching for a therapist, always look for the most talented and experienced professional, and then interview them to make sure they are the best match for you. Remember, you are building a team that has a difficult job to do—your opinions and feelings are important in this matter.
The Best Treatment Protocols
For those seeking out therapy, be cautious of treatments that claim to cure PTSI. According to the Department of Veterans Affairs there are only four evidence-based treatments that successfully resolve PTSI at this time:
Prolonged Exposure (PE) was originally developed to assist military personnel who were returning from combat with significant PTSI. PE therapy teaches patients how to gradually approach their trauma-related memories, feelings, and situations that are often avoided since the trauma. When individuals are able to talk about the details of the trauma in a safe environment, they can often relieve their symptoms.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is a method that examines faulty, distorted, and illogical thoughts that contribute to individuals displaying dysfunctional behavior. CBT focuses on the present rather than the past and is focused on current problems. With the help of a therapist, individuals identify their dysfunctional thinking and work towards modifying repetitious conduct and replace it with more productive and gratifying thoughts and behaviors.
Eye Movement Desensitization and Reprocessing
Eye Movement Desensitization and Reprocessing (EMDR) is a method of treatment that has the learner focus on a traumatic memory while the therapist passes their fingers in front of both eyes or taps on both knees at the same time. After this, the patient focuses on a more comfortable thought of their choosing.
This treatment is theorized to neurologically desensitize the patient to the traumatic memory and reduce the reactions to external triggers, whether they are visual or involve touch, sound, smell or taste. Currently, the mechanism of action is not fully understood in the scientific community, though some officers report finding some relief after exposure to this treatment method. Officers are sometimes reluctant to engage in this kind of therapy, as it doesn’t make sense to them, however, the desperation of living with PTSI pushes them into trying it.
New Serotonin Medications
Selective serotonin reuptake inhibitors (SSRI) and selective serotonin norepinephrine reuptake inhibitors (SSNI) are similar in that they selectively target specific neurotransmitters at the cellular level in the brain. These classes of medication were developed in response to the inefficiency and side effect profiles of previous medications that were born out of the need to treat mood and anxiety disorders. While the mechanism of action for both groups of drugs are not fully understood, they are heads and tails above their predecessors in terms of patient tolerance and the success of their main effects. The specific benefits and risks of these medications will be discussed in-depth in future articles.
Companion Practices for PTSI
While the above four methods are the only treatment techniques that have been statistically proven to reverse the signs and symptoms of PTSI thus far, they are frequently used in conjunction with other techniques. For example, there are many ways to reduce anxiety, increase attention, and build the ability to bounce back. Many patients find that family support; yoga, relaxation training, tactical breathing, mindfulness training, meditation, stress inoculation and empathic attunement are great companion practices to their treatment.
Companion practices can help patients develop hope, reduce feelings of helplessness, and regain a sense of normality. It’s important to note that when used by themselves these practices do not lead to the resolution of PTSI. However, they can be a wonderful addition to therapy and many officers find it helpful to continue using them throughout their lives.
For those considering therapy and treatment, rest assured that many patients who have gone through it report no longer having PTSI. With some professional guidance, you too can be healed from your injuries. Your life will always be changed by the traumas you have suffered, but you can rebuild and retool your life so you are healthier going forward. You can do this!
About the Author: Marla Friedman is a licensed psychologist in Illinois and Michigan. She develops mental health, trauma cessation, and suicide prevention programs for law enforcement and trains officers nationally. She is a writer and maintains a full-time therapy practice. She is a member of the Executive Board of Badge of Life and is the Chief Psychologist for Field Training Associates. She can be reached at IPSauthor@apus.edu.
- Foa, E, B., Davidson, J. R. T; & Frances, A. (1999). The expert consensus guideline series: Treatment of posttraumatic stress disorder. Journal of Clinical Psychiatry, 60, 4-76.
- Alford, B., & Beck, A.T. (1997). The integrative power of cognitive therapy. New York: Guilford Press.
- Ellis, A. (1994). Reason and emotion in psychotherapy. New York, NY: Citadel Press.
- Shapiro, F. & Forrest, M. (1997) EMDR: The breakthrough therapy for overcoming stress and trauma. New York, NY: Basic Books.