by: Nancy Ryba Panza, PhD, ABPP
At First Responder Wellness we specialize in the treatment of Posttraumatic Stress Disorder (PTSD).
PTSD is diagnosed when someone has been exposed to an incident (or incidents) that involve actual or threatened death, injury, or sexual violence and then develops impairing symptoms after that exposure. Given the high propensity for police officers to be exposed to such events, it is not surprising that we see a higher rate of PTSD in officers than in the general population (Lewis-Schroeder et al., 2018).
What is PTSD?
PTSD is found in the Trauma- and Stressor-Related Disorders section of the DSM-5-TR (Diagnostic & Statistical Manual for Mental Disorders, 5th Edition, Text Revision; American Psychiatric Association, 2022). PTSD is a unique mental health condition as it is one of the only disorders that specifically requires a precipitating event. As noted above, that event must be one that involves actual or threatened death, serious injury, or sexual violence by either directly experiencing or witnessing the event or by learning of a qualifying incident that happened to a close friend or relative. Recently, the DSM added a qualifier that PTSD may be diagnosed after indirect exposure to the details of a trauma through professional duties and specifically mentions first responders and medics in this capacity.
PTSD is only diagnosed if, after the qualifying event, the individual experiences a collection of impairing symptoms from each of four categories. The individual must have at least one re-experiencing symptom (i.e., upsetting memories, nightmares, flashbacks, etc.) and at least one avoidance symptom (i.e., avoidance of thoughts, feelings or reminders of the trauma or anything related to the trauma). The person must also have at least two symptoms involving negative thoughts and feelings (i.e., isolation, negative mood, self-blame) and at least two symptoms involving arousal and reactivity (i.e., irritability, aggression, self-destructive behavior, easily startled, difficulty sleeping).
It is important to understand that PTSD is only diagnosed if the symptoms are experienced for more than one month and are significantly impairing for the person. This can look very different from one person to the next and while the symptoms sound obvious, it is sometimes hard for the individual experiencing them to recognize what is happening or how impairing the symptoms have become.
PTSD and Police Officers
There are a few things that are important to know about PTSD and police officers:
- Police officers are more likely to experience PTSD than the general population.
- PTSD often goes undiagnosed in police officers.
- PTSD, when left untreated, can have a serious and harmful impact, not just on the officer, but on family members as well.
PTSD Prevalence in Police Officers. While prevalence rates are notoriously hard to pin down, it is generally accepted that the rates of PTSD in first responder groups are higher than in the general population. One survey found that 61% of officers screened positive for symptoms of PTSD (Jetelina et al., 2020) and prior research has shown that between 0% and 44% of officers across of wide range of studies had been diagnosed with the disorder (Wagner et al., 2020). While the exact number of officers impacted is hard to pin down, it is clear that the nature of the job contributes to the increased risks of developing PTSD.
Underdiagnosis of PTSD. If we know that officers experience higher rates of exposure to trauma and have higher rates of PTSD, why would PTSD be underdiagnosed? The culture of police work is one of controlled emotions, mental and physical toughness, and never displaying “weakness.” Historically, mental health concerns, like PTSD, have been seen as weakness and officers went to great lengths to deny, cover up, or minimize any symptoms they might be experiencing. The ‘tough it out’ standard of law enforcement has not left room for officers experiencing the negative impacts of trauma to acknowledge this and seek help.
PTSD Untreated. Obviously, if PTSD is underdiagnosed, it goes without saying that it is also often untreated. We need to recognize the problem before we can resolve it. PTSD, when left untreated, tends to lead to more problems as the individual will often become isolated (impacting relationships at home and at work), use substances (to help cope with the distress), or seek other distracting experiences to shift the mind and body away from the symptoms (work more, spend more, distract more). Untreated PTSD tends to become worse overtime and tends to bring about a decline in functioning both at work and at home.
The Good News: Treatment for PTSD
Of all the conditions commonly treated by mental health professionals, trauma treatment has evolved and evidenced more progress than any other area and a host of promising new treatments have emerged and are currently being studied. Since the 1990s, numerous, therapeutic approaches have been developed, tested, and found to be highly impactful in the treatment of PTSD.
Currently, the VA/DoD Clinical Practice Guidelines for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder (Version 4.0, 2023) recommend three treatment approaches: Prolonged Exposure therapy (PE), Cognitive Processing Therapy (CPT), and Eye Movement Desensitization and Reprocessing therapy (EMDR). Each of these therapeutic approaches has a long-standing history of success in treating PTSD within a wide array of client populations. Each has been successfully used with first responder and law enforcement clients.
One word of caution, however, there are numerous other therapeutic approaches that have also shown excellent promise in treating PTSD; however, they are either newer or have been studied less frequently and have not yet amassed the scientific backing of the three listed above. As evidence builds, many of these approaches, like Written Exposure Therapy (WET), Present-Centered Therapy (PCT) and Accelerated Resolution Therapy (ART) will likely be added to the list of recommended treatments.
At First Responder Wellness, we approach PTSD treatment in a multifaceted manner using approaches that span across traditional individual psychotherapy, group and family therapy, and holistic or alternative methods. It is our belief that not everything will work for everyone, but some combination of approaches will work for each of our clients.
Other Important Treatment Considerations
Inpatient v. Outpatient Treatment: Level of care is a confusing issue for many considering treatment. Inpatient treatment typically involves 24-hour care in a specialized setting and is right when lower levels of care have proven insufficient. Outpatient treatment can range from once-a-week sessions with a therapist to Intensive Outpatient Treatment that typically involves spending for a few hours each day in a therapeutic environment. It is important to discuss what level of care is the best fit. This is typically determined by the extent of one’s symptoms and the degree to which the symptoms are impairing daily functioning. The admissions team at First Responder Wellness can determine what is the best approach to treatment for you.
Culturally Competent Care: One of, if not the most, important aspects of treating first responders, is to ensure that care providers understand the world in which they work. Policing is a unique job that comes with very specialized working conditions. For a clinician to be able to understand an officer’s experiences, they need to be familiar with an officer’s world. A culturally competent clinician is one who has taken on the education, training, and experience required to gain insight into the world of law enforcement. While no one can truly understand the experiences without having gone through them, a culturally competent clinician can achieve a level of insight and understanding that is sufficient to support officers in treatment. All therapists at First Responder Wellness have achieved cultural competence.
Substance Use/Abuse. What if, as a means of coping with PTSD symptoms you find yourself heavily involved with alcohol, prescription medications, or other substances? We can still help. We offer treatment for PTSD alone, but also for those with co-occurring substance use issues. We can help you to find stabilization, stop using substances, and to recover from past and present traumas and their impacts on your live.
A Final Word
We know that taking the first step to seek treatment is the hardest step to take. First Responder Wellness is here for you. We offer you the best in PTSD care in a setting that is safe, confidential, and where you are surrounded only by other first responders who are experiencing the same struggles as you.
If you think you might need or want support for PTSD, please reach out. We can help you figure out what level of care is best for you and, if we can’t help you directly, we will make sure we connect you with someone who can.
Our entire mission is to support the behavioral health of first responders.
We are here when you are ready.
References:
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
Jetelina, K.K., Molsberry, R.J., Gonzalez, J.R., Beauchamp, A.M., & Hall, T. (2020). Prevalence of mental illness and mental health care use among police officers. JAMA Nework Open, 3(10), 1-12. doi:10.1001/jamanetworkopen.2020.19658
Lewis-Schroeder, N.F., Kieran, K., Murphy, B.L., Wolff, J.D., Robinson, M.A., Kaufman, M.L., (2018). Conceptualization, assessment, and treatment of traumatic stress in first responders: A review of critical issues. Harv Rev Psychiatry, 26(4), 216-227. https://doi.org/10.1097/hrp.0000000000000176
Wagner, S.L., et al., (2020). Systematic review of posttraumatic stress disorder in police officers following routine work-related critical incident exposure. American Journal of Industrial Medicine, 63(7), 600-615. doi: 10.1002/ajim.23120
VA/DoD Clinical Practice Guidelines (2023). Management of posttraumatic stress disorder and acute stress disorder: Provider summary. https://www.ptsd.va.gov/professional/treat/txessentials/cpg_ptsd_management.asp
Clinically Reviewed & Written By:
Dr. Nancy Panza, PhD, ABPP
Dr. Nancy Ryba Panza, a Board-Certified Police and Public Safety Psychologist, has over 20 years of experience working with first responders. She holds a PhD in Clinical Psychology with a concentration in Psychology and Law from the University of Alabama and now serves as Director of Clinical Research and Development for organizations supporting first responders.
