I have been participating in quite a few discussions lately about Post Traumatic Stress Disorder (PTSD), and the topic has come up in so many different circles that I thought that I should write a brief piece on it. I have been discussing this with Combat Veterans, Police Officers, Aid Workers and Journalists. I have also been interested in the movement to drop the “D”; many feel that calling it a Disorder and giving it a psychological classification stigmatizes it and makes those that suffer it feel like outcasts and thus, less likely to seek assistance. Others feel that treating it as a somewhat normal stress-response will downplay the impact it can have and lessen the attention and aid that those that suffer would receive. I know where I fall in this debate, but that isn’t the point of this article, so I will use the currently accepted terminology of PTSD as opposed to PTS.
Now, considering the potential for violence that is an inherent part of the Personal Security/Contractor fields and also considering the backgrounds of many people that choose to follow these fields, it is not an uncommon occurrence to encounter someone with a personal experience with PTSD. It is also a fairly safe bet that a decent percentage of operators will encounter a situation that will set the course of a repeated negative response, and such responses can have an impact on both professional performance as well as an operator’s personal life as well. Violence; passing or extended, brief or extreme, can leave an indelible mark on a person’s psyche.
The American Psychiatric Association’s publication Diagnostic and statistical manual of mental disorders (Revised 4th ed.) addresses PTSD as follows:
DSM-IV-TR criteria for PTSD
In 2000, the American Psychiatric Association revised the PTSD diagnostic criteria in the fourth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) 1*. The diagnostic criteria (A-F) are specified below.
Diagnostic criteria for PTSD include a history of exposure to a traumatic event meeting two criteria and symptoms from each of three symptom clusters: intrusive recollections, avoidant/numbing symptoms, and hyper-arousal symptoms. A fifth criterion concerns duration of symptoms and a sixth assesses functioning.
Criterion A: stressor
The person has been exposed to a traumatic event in which both of the following have been present:
1. The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.
2. The person’s response involved intense fear, helplessness, or horror. Note: in children, it may be expressed instead by disorganized or agitated behavior.
Criterion B: intrusive recollection
The traumatic event is persistently re-experienced in at least one of the following ways:
1. Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
2. Recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content
3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: in children, trauma-specific re-enactment may occur.
4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
5. Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
Criterion C: avoidant/numbing
Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:
1. Efforts to avoid thoughts, feelings, or conversations associated with the trauma
2. Efforts to avoid activities, places, or people that arouse recollections of the trauma
3. Inability to recall an important aspect of the trauma
4. Markedly diminished interest or participation in significant activities
5. Feeling of detachment or estrangement from others
6. Restricted range of affect (e.g., unable to have loving feelings)
7. Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
Criterion D: hyper-arousal
Persistent symptoms of increasing arousal (not present before the trauma), indicated by at least two of the following:
1. Difficulty falling or staying asleep
2. Irritability or outbursts of anger
3. Difficulty concentrating
5. Exaggerated startle response
Criterion E: duration
Duration of the disturbance (symptoms in B, C, and D) is more than one month.
Criterion F: functional significance
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Acute: if duration of symptoms is less than three months
Chronic: if duration of symptoms is three months or more
With or Without delay onset: Onset of symptoms at least six months after the stressor
As you read over this list, pay attention to how far removed you, or someone that you work with or train with, are from fitting into this category. It is easy to write it all off as stress or just a normal part of the day/hazards of the profession, but before long it can all add up and boil over. Once that happens, you have become a liability to your team, to your client and to the mission; not to mention how it will impact your wife/husband, children, friends, etc. If you have chosen this field as a career, it behooves you to pay attention to your daily stresses and to make sure that you’ve got an outlet. Too many divorces, too many drug overdoses, too many livers eaten up by alcoholism and too many suicides have haunted those that choose this profession. Do not allow yourself to add to the statistics.
It is far too easy to come home from a long day or from time on the road and to just drop from exhaustion, and then to slot ourselves right back in to our daily routines without ever addressing the ugly aspect of our work. It is for this reason that I highly suggest that every operator finds a way to decompress. Start a garden, ride a motorcycle, meditate or practice yoga, take up painting or photography (my chosen method), learn to make exotic meals or to rehab a house, speak to a therapist or find a church/temple/etc. It can be expansive and all encompassing, or it can be something as simple as a 30 min meditation session to clear your mind. Find something that takes you away from the aspects of your job (I don’t care how much shooting relaxes you; if you shoot people for a living, time on the range is practice and preparation for violence-not decompression from it. Learn gunsmithing instead) and learn how to have fun and to relax before you forget how altogether. Saying that you do not have the time is a poor excuse. Resting and re-centering your mind and your focus will go a long, long way to making you a better operator.
Do not think that it cannot happen to you; it is not a mark of shame or weakness. It is a biological response to working in a field that regularly experiences stressors that the average human was never meant to experience. Pay attention to yourself and your team and get things squared away before they become an issue, not as a response to something that could have been addressed long before it went to Hell. If you’d like to read up on this further, I’ve attached a few links that can be a starting point for further research. Stay safe out there!
1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th edition.). Washington, DC: Author.