Features
Police post traumatic stress injuries

Understanding potential causes and treatments

Police officers are often the first on the scene to respond to events that involve highly stressful and sometimes dangerous situations. These duties place them at an increased risk of developing posttraumatic stress disorder (PTSD).

PTSD – for first responders, it’s often conceptualized as traumatic stress injury – is a mental health condition that some people develop after being exposed to a traumatic event. Mental health professionals define an event as traumatic when it involves “actual or threatened death, or serious injury, or sexual violence” (American Psychiatric Association, 2013). The exposure can occur through directly experiencing the event, witnessing it happening to someone else, learning that the event has occurred to a close person, or through repeated or extreme indirect exposure to traumatic events in the course of professional duties. Examples relevant for policing include exposure to scenes of gruesome accidents, homicides or suicides; dealing with victims of physical or sexual violence; involvement in shootings or other life-threatening situations; not being able to protect a colleague or member of the public from injury or death; causing injury or death to someone else; dealing with human remains or body parts; or reviewing video footage of childhood abuse.

Police stress reactions

Traumatic events can affect a person’s psychological health in several ways. In the initial days and weeks following the event, many people will experience at least some signs of distress. They may have upsetting memories of the incident, have difficulty sleeping, or feel shaken and on edge. These are normal reactions following a traumatic stressor, but humans are resilient, and most people will start to feel better after a few days or weeks.

However, police officers face a number of challenges to their recovery due to the nature of their job. For example, cumulative traumatic experiences are the norm rather than the exception. In a survey of the Canadian general population, participants reported exposure to an average of two potentially traumatic events in their lives (Van Ameringen et al., 2008). In contrast, Canadian police officers reported exposure to an average of 11 different types of traumatic events (Carleton et al., 2019). These accumulative experiences lead to frequent surges in stress hormones and sometimes don’t leave the officer enough space for recovery. In addition, they change the way the officer views their work, to the point that what was once considered traumatic is now perceived as a normal part of their daily duties. The stress resulting from such events can be exacerbated by chronic stressors such as working in a high crime/high-risk area where they have to be in a state of constant high alert; organizational stress (understaffing, working overtime, shift work); negative media coverage; politics within the department, and so forth.

Further, police officers are trained to remain calm in stressful situations and let their analytical mind ignore or supress most of their natural emotional responses at the time of a call. The emotional detachment and stoicism are valuable for making rational safety-critical decisions and getting the job done, but may later result in them being unable or unwilling to access and describe their emotions, even when they are off duty.

Many police officers are reluctant to admit that they are not coping with their traumatic experiences, because they see themselves as tough and able to deal with all challenges.

Many police officers also struggle with the impact of morally challenging experiences. For example, they frequently report a sense of failure to protect members of the public, or to have acted against their own values in order to protect someone, and their moral outlook might be shattered by the repeated witnessing of cruel acts by others. It’s often after an event that strong emotional responses such as fear, horror, anger, sadness, grief, guilt or shame come to the surface. Such feelings can be quite overwhelming if the officer hasn’t learned any techniques to cope with them and allow the natural flow of emotions to take place. However, police officers are typically focused on the external world (a victim, a potential threat, etc.) and may not be used to turning their attention to their inner experiences. Individuals who struggle with this tend to restrict and avoid their inner experiences, resulting in a hyper-aroused state that makes them prone to emotional lability or intense emotional reactions to seemingly minor events (e.g., angry outbursts in traffic, becoming tearful while watching a movie), which can further exacerbate their stress. And even though talking about a trauma and the associated feelings is helpful for recovery, an officer might avoid doing this in a police culture where emotional expression and sharing of traumatic experiences are not considered acceptable. If an officer struggles severely for more than a month after a stressful call, they may have PTSD.

What is PTSD?

PTSD can affect an officer’s emotions, thinking, physical sensations and behaviour, and significantly impact their daily functioning and relationships. PTSD involves a set of persistent symptoms and reactions in four areas:

• Re-experiencing or being “haunted” by the trauma in various ways, for example through frequent nightmares, or vivid disturbing and unwanted memories of the event during the daytime; or having intense physical or emotional reactions when confronted with reminders of the event (e.g., people, places, situations, objects, sounds, smells, etc.).
• Avoiding reminders of the trauma, either by pushing away memories, thoughts, feelings and conversations related to the trauma; or by staying away from people, places, situations and activities that are associated with the trauma.
• Hypervigilance, for example being constantly on guard and on the edge; being hypersensitive to noise; feeling jumpy or easily startled; difficult to concentrate, relax and sleep; feeling very irritable; or engaging in reckless behaviours.
• Negative changes in a person’s feeling and thinking, for example feeling numb and detached from positive feelings such as love and happiness; feeling frequently overwhelmed by negative feelings such as fear, sadness, anger, guilt or shame; inability to enjoy previously enjoyed activities; feeling detached from other people, even friends and family; and being preoccupied with self-blame or strong negative beliefs and appraisals of oneself, other people, and the world.

It is estimated that almost 15 per cent of police personnel worldwide have current PTSD (Syed et al., 2020). However, each person has their own way to respond to trauma, and the only way to know for sure if one has PTSD is to talk to a mental health professional. The symptoms and reactions can make it difficult for the individual to function in their personal and occupational life and can result in poor decision-making, frequent interpersonal conflict, social isolation, marital problems, difficulties in parenting, substance use and even suicidality.

Many police officers are reluctant to admit that they are not coping with their traumatic experiences, because they see themselves as tough and able to deal with all challenges, and they are used to being the ones that solve problems rather than having them. They may try to conceal stress reactions because of the stigma associated with mental health problems, fearing it will jeopardize their jobs or they will be perceived as “weak” by their colleagues or superiors. However, everyone who works in a high-stress environment is susceptible to traumatic stress injuries, just like professional athletes who can be injured at the peak of their fitness. Recognizing the signs of operational stress injuries in oneself or a fellow officer and taking steps to address them are very important.

What does PTSD treatment look like?

Police officers often think the symptoms will just go away over time, or it’s not the right time for them to seek treatment. However, when symptoms have persisted for a while, it’s unlikely that they will go away on their own (and in fact there is a risk that they might get worse), and when an officer is struggling and having symptoms, it’s the right time to start treatment. The good news is: PTSD is an injury, not a life sentence and several effective treatment options are available. Some police officers fully recover from PTSD after participating in treatment, some people even say that they have grown through the experience in significant ways. Others experience considerable improvements of their symptoms and their quality of life. Treatment can help even if the trauma happened years ago.

Medications, which mostly include prescription antidepressants, can help alleviate the symptoms. Before starting to take medication for PTSD, the officer will talk to a psychiatrist (a medical doctor who specializes in mental health).

Trauma-focused psychotherapies, such as prolonged exposure, cognitive processing therapy, cognitive therapy for PTSD, or eye movement desensitization and reprocessing, are the most highly recommended treatments for PTSD because they have the strongest scientific evidence showing that they work. First, police officers learn tools to better manage their symptoms and “turn down the volume” on their threat system. The therapist will also help them to re-engage in activities they used to enjoy but have given up, and to start doing things again that they have been avoiding because it reminds them of the trauma. In addition, the therapist will help the officer to talk about their memories of the traumatic event, work through the thoughts and feelings associated with it, and make meaning of the experience. This might sound difficult – and it is – but contrary to popular beliefs, talking about traumatic memories in this way does not make PTSD symptoms worse, and when it is done with the support of a skilled therapist, the symptoms will improve. Treatment usually involves weekly sessions with a psychologist or counsellor. If a police officer is off work due to traumatic stress, participating in a more intensive, interdisciplinary treatment program may be advisable.

Police officers can start to navigate the complex issues that result from critical events they are exposed to, by finding someone they trust – like a friend, colleague or family member – and talk about what they are thinking, feeling and experiencing. This might be hard initially but can be the first step to getting better. Finding a peer support member in their department is another step. The peer support worker can help the officer understand their extended health benefits and connect them to a therapist with whom they can develop a long-term relationship, ideally before the development of full-blown PTSD. An officer who works with a therapist they trust and offers trauma-focused psychotherapy has very good chances to get better.

References

• American Psychiatric Association. (2013). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric Publishing, Arlington, VA
• Carleton, R. N., et al. (2019). Exposures to potentially traumatic events among public safety personnel in Canada. Canadian Journal of Behavioural Science, 51(1), 37–52.
• Syed, S., et al. (2020). Global prevalence and risk factors for mental health problems in police personnel: A systematic review and meta-analysis. Occupational and Environmental Medicine, 77(11), 737–747.
• Van Ameringen, M., et al. (2008). Post-traumatic stress disorder in Canada. CNS Neuroscience & Therapeutics, 14(3), 171–181.

Iris Torchalla is a clinical psychologist and director of the West Coast Resiliency Centre in Vancouver. She works with emergency services personnel, serving firefighters, police officers and paramedics, as well as various other workers and civilian populations exposed to trauma.