PTSD the Nature of Police

PTSD

The nature of police work increases the probability of developing Posttraumatic Stress disorder

Police Work

The nature of police work increases the probability of developing Posttraumatic Stress disorder (PTSD)

There is a general consensus that there are a very high number of police officers that suffer from PTSD, which has a decidedly negative impact on the individual and the functioning of the police force. As one study notes; "All too many police officers are victims of Post Traumatic Stress Disorder" (Police and PTSD, 2005, para.1). Post traumatic stress disorder is understood as a response to traumatic stress, such as having to kill someone in the line of duty.

Another area of concern that emerges from the literature is that there is a relative paucity of research and data on this serious issue. As one study notes, "Studies of police officers with post-traumatic stress disorder (PTSD) are relatively rare" (Green, 2004, p.1). The present study is intended as a contribution towards filling this gap in research.

There has been an emphasis in the literature on the relationship between PTSD and military personnel. However, as the definition and understanding of post traumatic stress disorder becomes more inclusive and wide-ranging, other sectors of society are being analyzed, and there is an increasing interest in groups that are prone to high levels of stress and trauma. This includes fire-fighters and the police. Studies have found that there is a PTSD prevalence rate of more than thirteen percent among police officer in some instances (Green, 2004, p.1). This is a matter of concern as it relates to issues such as low morale, absenteeism and poor functionality (Green, 2004, p.1).

This study is intended to make a contribution to the debate and investigation of post traumatic stress disorder among the police. It will provide an overview of the development of the diagnostic definition of post traumatic stress disorder and the way that this disorder affects and impacts the police officer. The central question that will be investigated will focus on the reasons why police officers are so prone to this disorder.

2. Thesis Statement

The central thesis that will be explored in present study is as follows: the nature of police work increases the probability of developing post traumatic stress disorder (PTSD). This refers to the daily experiences and life context of the police officer and how this context increases the probability of developing post traumatic stress disorder.

In investigating this central assertion a number of variables and factors have to be considered. One aspect that is discussed in the process of developing this thesis is the affect that post traumatic stress disorder has on the police officer. There are also a number of contributing factors that will be considered; for example, the fact that police officers experience stress and trauma over very long periods of time. Another aspect that has a bearing on this thesis is that there is often a severe discontinuity between the life experiences of the police officer during his working day and his normal social and family life. There is also the view to consider that post traumatic stress disorder affects relationships with others, which in turn increases the negative symptoms and outcomes of this disorder. These aspects can be seen to increase the propensity for post traumatic stress disorder in this group.

3. Research Methods

The research methodology of this study is focused mainly on research and analysis of the available literature on the topic. This included extensive research not only of the subject of post-traumatic stress disorder as it directly affects the police officer, but also took into account the more general literature on post-traumatic stress disorder that surrounds and indirectly impacts this issue. The intention was to provide as broad a view as possible in order to understand the way that post-traumatic stress disorder affects the police force.

To this end material and data for various sources were accessed. This included books, journals, reports as well as valid online databases. A number of Government and official sites were also found to be extremely useful in accumulating data and this subject. While a certain discretion must be exercised in using online sources, it was found that the Internet provided a valid and valuable means of accessing the latest and most up-to-date data on the subject. Online databases such as Questia and Highbeam were found to be a valuable source of information on this topic.

The process in the research process was basically as follows. Books, journals and magazines, as well as online and electronic sources, were scoured for information and data on post-traumatic stress disorder. This data was entered into as database for reference. A search was also undertaken for more specific studies, reports and commentaries on the relationship between police work and post-traumatic stress disorder. This was also entered into a database and the data was sorted according to the central hypothesis of this study. This provided the background and source material for the present discussion.

4. PTSD and the Police

4.1. Background: Overview of PTSD

In order to provide a comprehensive response to the central thesis of the present study it is essential to firstly establish the definition and meaning of post traumatic stress disorder in both a diagnostic as well as experiential sense. PTSD or post traumatic stress disorder has become an accepted medical condition since its inclusion as a diagnostic category in the third edition (1980) of the Diagnostic and Statistical Manual of the American Psychiatric Association (Williams and Sommer, 1994, p.3). This was not always the case and post traumatic stress disorder was previously not recognized as an integrated and cohesive medical condition. The official medical recognition and categorization of Post Traumatic Stress Disorder is a fairly recent event. It was first introduced with the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). This has increased the awareness and the formalization of the disorder. "…as a formal disorder, critical issues such as predictors of failure to recover from a trauma and the development and evaluation of effective treatments have just begun to be addressed in research using rigorous methodology" (Foa & Meadows, 1997, p.449).

A basic definition of PTSD is a "… mental health issue among many different cross-sections of society" (Martz, Birks & Blackwell, 2005, p.56). A fundamental description of this condition is; "… an individual's exposure to one or more events that involve death, threat to life or limb, or serious injury and a cluster of psychological responses to the memories of those events, consisting of intrusive, avoidant, and hyperarousal symptoms" (Martz, Birks & Blackwell, 2005, p.56). A similar definition is: " Post-traumatic stress disorder & #8230;is an intense physical and emotional response to thoughts and reminders of the event that last for many weeks or months after the traumatic event" (Coping With a Traumatic Event). It is also important to note that post-traumatic stress disorder has also been linked to patient with other psychiatric disorders such as depression, as well as substance abuse.

There are more comprehensive and inclusive definitions. The following definition for example includes PTSD as it related to various personality types.

Exposure to extremely traumatic events -- including situations where one witnesses death or serious injury to somebody else, or where someone is in fear for their own life -- is actually fairly common. Many people get through these events without many residual effects. But some people who have such an experience later go on to develop post-traumatic stress disorder. They can either develop it immediately after the event, or in some cases they may develop it months or years after the event occurred. (Haran C. 2010)

The symptoms of PTSD are usually classified in terms of different types. This refers to symptoms of re-living traumatic experiences, which includes flashbacks and "…extreme emotional and physical reactions to reminders of the event" (Coping With a Traumatic Event ) There are also symptoms of avoidance as well as symptoms of increased arousal which refers to irritability or outbursts of anger, and lack of concentration.

In the DSM-III formulation of this disorder a traumatic event is viewed as, "…a catastrophic stressor that was outside the range of usual human experience" (Friedman, 2007, para. 3). PTSD was initially conceptualized in terms of war, rape and extreme event such as nuclear holocausts; as well as in reference to devastating natural disasters such as earthquakes. In other words this initial formulation of PTSD and trauma was seen in the context of extreme events that were seen "…to be clearly different from the very painful stressors that constitute the normal vicissitudes of life such as divorce, failure, rejection, serious illness, financial reverses, and the like" (Friedman., 2007, para. 3).

For the purposes of this study and the focus on the police force, it is important to note that the diagnostic view of PTSD was altered with the revision of the DSM-III diagnostic criteria for PTSD, and in the formulation of the DSM-IV (1994), and DSM-IV-TR (2000), a number of new criteria were added to the view of PTSD. One important aspect was that research findings suggested that PTSD was more common than was thought to be the case when the DSM-III diagnostic criteria were formulated. (Friedman, 2007, para.3) the DSM-IV diagnosis of PTSD further extends the formalization of criteria as well as the methodological consistency for PTSD and now includes six main criteria. The first of these criteria qualifies the meaning of trauma. A traumatic event is defined as "…one in which: (a) the person experienced, witnessed, or was confronted with an event that involved actual or perceived threat to life or physical integrity; and (b) the person's emotional response to this event included horror, helplessness, or intense fear." (Foa & Meadows, 1997. p449) This also relates to the psychological symptoms which are categorized into three main groupings; namely the re-experiencing of symptoms, such as nightmares and flashbacks; secondly symptoms of avoidance of trauma and related stimuli and thirdly, symptoms of increased arousal, which manifest as the inability to sleep and irritability. (Foa & Meadows, 1997. p449)

4.2. The Effect of PTSD on the Police

One study on this subject makes the important point that "Rates of PTSD in police forces are therefore likely to be four to six times higher than in the general public" (Green, 2004, p.1). Taking the above account of the revision of the diagnostic category of PTSD, we are in a better position to understand the way in which this applies to the possible experiences of the police officer and why this profession is more prone to the effects of PTSD than many other professions.

The following is an actual documented experienced from a police offer and provides an example of the way that post traumatic stress disorder can affect an individual in this profession.

I am a (10 plus) year police veteran and (30 plus) years of age. I have become seriously concerned with some of the events that have been taking place in my life for the past two years. I have started having nightmares frequently and have great difficulty going to sleep at night. There is always a feeling of uneasiness at night and I have started to develop some unnatural habits associated with these uneasy feelings. At the slightest sound, I have to get out of the bed and check every room in the house.

( Brown, 2006,para.2)

In another study Lieutenant Lori Beth Sanford (2003) points out that police officers respond to stress in different ways and according to the manner in which the individual internalizes this stress. She emphasizes that all officers experience at least a few crucial traumatic incidents in the course of their careers. However, while for some these incidents have a minimal effect on their daily routine, for others "…the stress of these events becomes debilitating and intervention is necessary" (Sanford, 2003, p. 2). This is an important feature of the experiences of police officers under stress and is a factor that should be taken into account in assessing this profession in relation to post traumatic stress disorder.

The psychological and emotional impact on the individual as well as on his or her family life and relationships is clearly expressed in the following personal experience.

Certain events that I have experienced cause me a great deal of emotion l distress when I think or communicate about them. My hands are shaking here at 1:06 AM as I write this letter. I have recently found myself to be very irritable, and my wife and I often argue because I don't want to go to social gatherings with her. I am not being anti-social, I just don't like to be around people. I just like being with my kids and taking care of them. I feel bad about some things that are happening to me.

( Brown, 2006, para.3)

These are only a few examples of the most common references to the way that post traumatic stress disorder affects the police officer. It is clear from the above that the symptoms and effects of PTSD range from extreme anxiety to depression and forms of serious dysfunctionality, which can impact not only the individual's personal life and career but also the functioning of the police force. These brief glimpses into the way in which PTSD impacts the lives of police officers highlights the central thesis that is being explored in the present study; namely that police officer is more prone to or has a greater propensity to suffer from post traumatic stress disorder than people in many other professions.

4.3. The Propensity for Post Traumatic Stress Disorder

The above discussion tends to support the view expressed in a number of studies that the nature of police work increases the probability of developing post traumatic stress disorder. For example, as one study states;

Some occupational groups are at increased risk of developing mental health problems due to the nature of their work, which can sometimes be extremely traumatic. Studies have shown that there is a high prevalence of PTSD and other psychiatric impairments in firefighters and police officers & #8230; (Ziegenbein and Kropp, 2012, para. 2)

A UK study also tends to confirm the general view that police work has much higher propensity for post traumatic stress disorder than many other professions. This study states that;

Causes of PTSD in police officers and civilians are broadly similar, such as motor vehicle accidents. Several cases of PTSD have occurred after high-speed car chases. However, police were very significantly more likely to acquire PTSD as a result of direct assault or from being threatened with death by guns, knives

(Green, 2004, p. 1)

The very nature of police work should therefore be examined in order to ascertain what creates the context or environment for post traumatic stress disorder in this profession. There are some statistics to back this assumption; for example, one study claims prevalence rates for PTSD in the general community are "…probably about 2 -- 3%" while rates of PTSD in police forces are "…likely to be four to six times higher than in the general public"(PTSD STATISTICS, para. 2). However, because of various internal factors and a possible reluctance on the part of the police officer to admit to having or being treated for post traumatic stress disorder, there is little in the way of available statistics. As one U.S. police officer states; "Living through a traumatic event is hard enough for an officer, admitting that you are having problems related to that event is even harder" (Post Traumatic Stress Disorder Statistics, para. 12).

Therefore, conclusive and verifiable data and statistics on post traumatic stress disorder in the police force are difficult to obtain. There are however estimates that put the common rate of officers suffering from post traumatic stress disorder at between four and fourteen percent (Post Traumatic Stress Disorder Statistics, para.18.)

An analysis of the nature of police work leaves little doubt that these estimated high rates are valid. In the first place the police officer is more prone to experiences of traumatic and stressful situations. This might be take the form of a confrontation with criminals or a stressful hostage situation -- or being shot at in the line of duty. The stressful and dangerous situations that form an integral part of police work are an obvious initial indicator of being prone to PTSD. "Police are likely to be subject to a variety of traumatic incidents throughout the course of their working lives -- physical assault, motor vehicle accidents while pursuing criminals, and viewing victims of sudden death" (Green, 2004, p. 3).

The exposure to traumatic and life-threatening situations serves to increase "… intrusive and avoidant symptoms, hostility, somatisation…" ( Ursano et al. 1995, p. 36). Furthermore, the risk of PTSD and related symptoms can persist for months. This in turn can lead to long-term symptoms such as acute hyperarousal, job dissatisfaction and problems with social interaction and family relationships.

In many ways the context of police work can be compared to military trauma and tension. This view is clearly summarised as follows.

Police officers are in many ways similar to military combatants, experiencing events in their work that involve treachery, violence, and death. It is argued here that police officers with long-term exposure to trauma may, like the soldier, experience the after-effects of trauma long after separation from the war. For some, symptomatology may be full-blown, for others, a residual condition may exist (Violanti, 1997, para.1).

An example of an actual case study of an officer who experienced PTSD serves to support the above views. This is quoted at length as it provides a practical insight, as opposed to the more theoretical assumptions, into the reasons why police officers are more prone to post traumatic stress disorder.

A 46-year-old policeman was called to a street where a stolen car had crashed into a shop front. As he and a colleague drove up, their vehicle was surrounded by an angry mob who were friends of the driver of the stolen car. They were shielding their associate whilst he made his escape. The police officer in question had got out of the car and was attempting to pacify the crowd. Instead, they turned on him and beat him to the ground….The policeman suffered multiple punches and kicks. He could not see his assailants because he instinctively curled up to try to protect his head. He suffered a broken jaw & #8230;the police officer required 3 months off as a result of his injuries and anxiety, and suffered for 14 months with recurrent nightmares and flashbacks. Irritability was a prominent feature and his marriage of 20 years almost broke down. (Green, 2004, p. 2)

The above quotation places into sharper focus the trauma and stress that are part and parcel of the life of the police officer. It is therefore clear that incident such as the above can lead to symptoms of post traumatic stress disorder.

However, in order to understand why the police officer is more likely to experience post traumatic stress disorder one must go further and analyse the elements of their entire working and life situation in greater depth. In this regard, one of the central reasons why police officers are more prone to post traumatic stress disorder than other professions is that many police officers experience an extended period of exposure to stress. In other words, they experience stress and trauma over years and this has a decidedly negative effect on psychological health. Their situation therefore differs from a typical military situation which is usually associated with post traumatic stress disorder. In a war or combat situation the exposure to trauma and violence that can lead to post traumatic stress disorder takes place by comparison over a relatively limited period of time. As one study on this issue elucidates:

The exposure of police officers to trauma, while generally not as intense as combat, may be for a period of twenty years or more. With such long-term exposure, officers who separate from policing are still likely to experience symptoms associated with Post Traumatic Stress Disorder (PTSD) (Violanti, 1997, para. 2).

Another factor to consider is that the police officer has to return to normal life while often not having worked through or internalized traumatic experiences. It is very often the strain between adhering to the norms and conventions of society and family and the traumatic experiences of a working police officer that exacerbate the symptoms associated with post traumatic stress disorder. This can lead to further distress in family and other relationships -- which in turn adds to the problem. "With return to civilian life, police officers take with them emotional baggage remaining from traumatic work experiences" (Violanti, 1997, para. 2).

Consequently, it is suggested in a number of studies that one of the central reasons why police officers involved in police work experience high levels of post traumatic stress disorder is because of unresolved stress and tension within the officer's working day. This can lead to problems outside work, where there may be a constriction of social activity and a decline in the individual's ability to function in normal society; which in turn adds greater stress to an already stressful working lifestyle. This is seen as "… a detrimental pattern of residual trauma carried over into the new environment of the separated police officer. The officer's family and close friends may also contribute to this problem by adapting themselves to this widened avoidance"(Violanti, 1997, para. 3).

Another factor that should be considered and which contributes to the reasons for the tendency towards post traumatic stress disorder in police work is the training and milieu in which the police officer works. Besides the actual encounters with criminal elements and violence outside the police station, the police officer is, of necessity, always in a state of tense preparedness for the worst. This in fact part of his or her training and leads to occupational 'socialization' and a state of mind that habituates stress and is prone to post traumatic stress disorder. Violanti ( 1997, para.7) makes the following cogent observation.