Screening for post-traumatic stress disorder (PTSD) in law enforcement and treating the related symptoms are important for a number of reasons. First, several of the symptoms prevalent in those who suffer from PTSD can impair a police officer’s response time and/or judgment and prevent him or her from performing the job in a safe manner. In order to meet full DSM-5 criteria, a person needs to have personally witnessed, experienced, or learned about a traumatic event and then exhibit several symptoms for a prolonged period of time of at least a month. Some officers might meet partial criteria, such as experiencing a number of symptoms for less than one month, or might experience one but not two symptoms from the various categories. Regardless, the fact that safety might be compromised in someone experiencing one or more untreated PTSD symptoms can be disastrous for law enforcement professionals, especially when combined with easy access to firearms.
Why are law officers at a higher risk to develop PTSD? Frankly, police officers are generally exposed to traumatic situations quite a bit more often than the general public and are at higher risk for developing this disorder, yet these same officers might not seek or receive treatment for a variety of reasons which we will explore further below. Traumas might include accidents, shooting incidents, witnessing a death, and even hearing about something traumatic on the job such as a case of sexual or physical child abuse. Additionally, some research has been conducted to explore a potential link between chronic occupational exposures such as fire and smoke and sleep deprivation as these might also contribute to an inflammatory reaction that could put first responders such as police officers at a higher risk of developing PTSD. The number of other stressors a law enforcement official is already juggling can also make one more susceptible than the next.
In the general population, it is estimated that approximately 8% of people have PTSD, with women more likely than men to develop it. In contrast, if there are approximately 900,000 police officers in the United States, it is thought that nearly one-fifth of these might have PTSD with over one-third of them meeting partial criteria. However, post-traumatic stress disorder is often under-diagnosed. A study conducted in 2017 in the United Kingdom worked with a sample of people in the general population who already had at least one mental health diagnosis and found that more than 13% of the people in the study met criteria but did not yet have their PTSD diagnosed. It is likely that the rate of undiagnosed PTSD is even higher among police officers. Another study showed that 80% of first responders reported experiencing something traumatic while working; but only 10% to 15% were diagnosed with PTSD. It has been concluded that using routine screening questionnaires is quite helpful in identifying PTSD and only takes a short time during the screening paperwork before confirmation with clinical assessment and a structured interview.
In order to meet full criteria for a PTSD diagnosis, a number of symptoms need to be present in a few different categories, many of which could impair a police officer on duty; however, many people meet partial criteria which would still warrant a close eye as law enforcement professionals are often carrying firearms and may be at an increased risk for accidents if they are struggling with things such as irritable, self-destructive, reckless, and/or aggressive behaviors, hyper-vigilance, and poor sleep. At the time of a traumatic event, a person generally experiences a flood of neurochemical reactions and hormones related to stress which can impair memory among other things. Additional PTSD-related symptoms across the different categories include things such as feeling irritable, angry, jumpy, distressed, and having difficulty with concentration, experiencing flashbacks and/or nightmares, and feeling numb and avoiding people, places, and situations that remind him or her of the trauma.
There are some special considerations when working with law enforcement suffering from PTSD. First, it’s not always easy to spot who does or does not experience PTSD symptoms, especially in those who might exhibit a resilient exterior. Self-administered screening questionnaires and clinical assessment are effective and helpful for identifying PTSD when used in tandem. Second, police officers may choose to not seek help as they may fear they would be looked at as unable to perform well in their job or, worse, fear that they would lose their job if they admit they are struggling with symptoms. Third, the presence of these symptoms might be a factor that drives some police officers to substance abuse as a form of self-medication. Lastly, the suicide rate in first responders such as police officers and firemen is significantly higher than the general public. The symptoms of PTSD might aggravate thoughts of suicide such as when someone struggles with distorted view of oneself with exaggerated memories of the traumatic event(s), especially when coupled with depression. Job-related traumatic stress as well as non-traumatic stress all can contribute to a higher rate of suicidal ideation. This in itself is a huge concern as it is statistically more probable that a law officer will die by suicide than in the line of duty.
It is recommended to encourage law enforcement individuals with PTSD symptoms to seek treatment with an organization that is familiar with working with first responders such as Deer Hollow’s Trauma Program. Deer Hollow provides confidential services and therapies known to be effective in helping PTSD such as cognitive behavioral therapy (CBT), eye-movement desensitization and reprocessing (EMDR), and a form of biofeedback/music therapy known as Bio-sound. For those who cannot attend a residential or outpatient program, online support can also be effective. Additional screening for PTSD and offering a range of treatment options for law enforcement officials who are diagnosed continues to be an ongoing need if we want to reduce the risks associated with symptoms that meet either full or partial criteria of post-secondary stress disorder if we want to see a positive change in the lives of the law enforcement officials who have encountered trauma and other stresses in their line of work.
Chopko, B. A., Palmieri, P. A., & Facemire, V. C. (2014). Prevalence and predictors of suicidal ideation among U.S. law enforcement officers. Journal of Police and Criminal Psychology, 29(1), 1-9.
Cops and PTSD. Posted Jun 26, 2017. Accessed at https://www.psychologytoday.com/us/blog/cop-doc/201706/cops-and-ptsd-0
How to Not Miss a PTSD Diagnosis: The benefits of screening for PTSD outweigh the risks of upsetting clients. https://www.psychologytoday.com/us/blog/stress-relief/201811/how-not-miss-ptsd-diagnosis
- Klimley, Kristin & B. Van Hasselt, Vincent & M. Stripling, Ashley. (2018). Posttraumatic stress disorder in police, firefighters, and emergency dispatchers. Aggression and Violent Behavior. 43. 10.1016/j.avb.2018.08.005.
Lewis C, Raisanen L, Bisson J I, Jones I, Zammit S. Trauma exposure and undetected posttraumatic stress disorder among adults with a mental disorder. Depress Anxiety. 2018;35:178–184. https://doi.org/10.1002/da22707
Silence can be deadly’: 46 officers were fatally shot last year. More than triple that — 140 — committed suicide. Accessed at https://www.usatoday.com/story/news/2018/04/11/officers-firefighters-suicides-study/503735002/
Walker A, McKune A, Ferguson S, Pyne DB, Rattray B. Chronic occupational exposures can influence the rate of PTSD and depressive disorders in first responders and military personnel. Extrem Physiol Med. 2016;5:8. Published 2016 Jul 15. Accessed at https://www.ncbi.nlm.nih.gov/pubmed/27429749
ABOUT THE AUTHOR
Mark Lamplugh is a fourth-generation firefighter and former captain with the Lower Chichester (PA) Fire Company. He was the Chief Marketing Officer of 360 Wellness Inc and currently is Director of Media & Communications with Institute for Responder Wellness and Deer Hollow Recovery. Lamplugh is also nationally recognized in Crisis Stress Intervention through the American Academy of Experts in Traumatic Stress. Lamplugh hosts his own talk show called “Firefighter Wellness Radio” with Fire Engineering. Mark also published his first book “Marketing Playbook for Social Media” to basically help companies and non-profits learn how to spread their message on social media. He has helped thousands of firefighters, police officers, veterans, EMS personnel, and civilians nationwide find help for addiction, alcoholism, PTSD, and mental health support. Mark has been chosen as one of the Board of Directors at One World For Life (To head up Communication and the Health & Safety section). He can be reached for comment firstname.lastname@example.org