• Sometimes, unexpectedly, it feels like the event is happening over again.
• I have nightmares and bad memories of the terrifying event.
• I stay away from places that remind me of the event.
• I jump and feel very upset when something happens without warning.
• I have a hard time trusting or feeling close to other people.
• I get mad very easily.
• I feel guilty because others died and I lived.
• I have trouble sleeping and my muscles are tense.

If you are experiencing some of these problems, you may have Post-Traumatic Stress Disorder (PTSD).

PTSD is a real illness that needs to be treated. Many people who have been through a frightening experience. It’s not your fault and you don’t have to suffer. You can feel better and get your life back!

What is Post-Traumatic Stress Disorder (PTSD)?
PTSD is a real illness. People may get PTSD after living through a disturbing or frightening experience. It can be treated with medicine and therapy. You can get PTSD after you have been:
• Raped or sexually abused
• Hit or harmed by someone in your family
• A victim of a violent crime
• In an airplane or car crash
• In a hurricane, tornado, or fire
• In a war,
• In an event where you thought you might be killed, or
• After you have seen any of these events.

If you have PTSD, you often have nightmares or scary thoughts about the experience you went through. You try to stay away from anything that reminds you of your experience. You may feel angry and unable to trust or care about other people. You may always be on the lookout for danger. You can feel very upset when something happens suddenly or without warning.

When does PTSD start and how long does it last?
For most people, PTSD starts within about three months of the event. For some people, signs of PTSD don’t show up until years later. PTSD can happen to anyone at any age. Even children can have it. Some people get better within six months, while others may have the illness for much longer.

A Great Video Summary

Am I the only person with this illness?
No. You are not alone. In any year, 5.2 million Americans have PTSD.

What can I do to help myself?
Talk to a qualified specialist about the experience that upset you. Tell them if you have scary memories, if you feel sad, if you have trouble sleeping, or if you are angry all the time. Tell the specialist if these problems keep you from doing everyday things and living your life. Ask your doctor for a checkup to make sure you don’t have some other illness.

Ask your specialist if he or she has helped people with PTSD. Special training helps doctors treat people with PTSD. If your doctor doesn’t have special training, ask for the name of a doctor or counselor who does. You can feel better.

What can a doctor or counselor do to help me?
Doctor may give you medicine to help you feel less afraid and tense. It may take a few weeks for the medicine to work. Talking to a specially trained doctor or counselors helps many people with PTSD. This is called “therapy.” Therapy can help you work through your terrible experience.

Here is one person’s story:
“After I was attacked, I felt afraid, depressed, and angry all the time. I couldn’t sleep or eat much. Even when I tried to stop thinking about it, I still had awful nightmares and memories. “I was confused and didn’t know where to go for help. A friend told me to call the doctor. My doctor helped me find a special doctor who knows about PTSD. “I had to work hard, but after some helpful medication and therapy, I am starting to feel like myself again. I’m glad I made that first call to my doctor.”

What can I do if I think I have PTSD?
If you think you have PTSD, it’s important to get treatment. Treatment can work, and early treatment may help reduce long-term symptoms.

If you think you have PTSD:
1. Talk to your family doctor.
2. Talk to a mental health professional, such as a therapist.
3. If you’re a veteran, contact your local VA hospital or Vet Center.
4. Talk to a close friend or family member. He or she may be able to support you and find you help.
5. Talk to a religious leader.
6. Fill out a PTSD screen and take it with you to the doctor. An online PTSD screen is available for PTSD related to stressful military experiences, but you can also answer the questions as they would apply to any other traumatic event.

Many people who might need assistance with something like the symptoms of PTSD are afraid to go for help. 1 out of 5 people say they might not get help because of what other people might think. 1 out of 3 people say they would not want anyone else to know they were in therapy. A study that’s been done of soldiers coming home from Iraq found that only 4 in 10 service members with mental health problems said they would get help. Some of the most common reasons they gave were: Worried about what others would think. Thought it might hurt their military career. Might be seen as weak.

Here are some of the reasons why you may want to seek help. Seek help because:

• Early treatment is better
  Symptoms of PTSD may get worse. Dealing with them now might help stop them from getting worse in the future. Finding out more about what treatments work, where to look for help, and what kind of questions to ask can make it easier to get help and lead to better outcomes.
• PTSD symptoms can change family life
  PTSD symptoms can get in the way of your family life. You may find that you pull away from loved ones, are not able to get along with people, or that you are angry or even violent. Getting help for your PTSD can help improve your family life.
• PTSD can be related to other health problems
  PTSD symptoms can worsen physical health problems. For example, a few studies have shown a relationship between PTSD and heart trouble. By getting help for your PTSD you could also improve your physical health.
• It may not be PTSD
  Having symptoms of PTSD does not always mean you have PTSD. Some of the symptoms of PTSD are also symptoms for other mental health problems. For example, trouble concentrating or feeling less interested in things you used to enjoy can be symptoms of both depression and PTSD. And, different problems have different treatments.

While it may be tempting to identify PTSD for yourself or someone you know, the diagnosis generally is made by a mental-health professional. This will usually involve a formal evaluation by a psychiatrist, psychologist, or clinical social worker specifically trained to assess psychological problems.

If you have PTSD or PTSD symptoms you may feel helpless.

But, there are things you can do.

Here are ways you can help yourself:
• Learn more about PTSD from this website or from other places.
• Talk to your doctor or a chaplain or other religious leader
• Go for a PTSD evaluation by a mental health professional specifically trained to assess psychological problems.
• If you do not want to be evaluated but feel you have symptoms of PTSD you may choose “watchful waiting.” Watchful waiting means taking a wait-and-see approach.
• If you get better on your own, you won’t need treatment.
• If your symptoms do not get better after 3 months and they are either causing you distress or are getting in the way of your work or home life, talk with a health professional.
• In a few cases, your symptoms may be so severe that you need immediate help. Call 911 or other emergency services immediately if you think that you cannot keep from hurting yourself or someone else.

Today, there are good treatments available for PTSD. When you have PTSD dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But talking with a therapist can help you get better.

Cognitive-behavioral therapy (CBT) is one type of counseling. It appears to be the most effective type of counseling for PTSD. There are different types of cognitive behavioral therapies such as cognitive therapy and exposure therapy. There is also a similar kind of therapy called eye movement desensitization and reprocessing (EMDR) that is used for PTSD. Medications have also been shown to be effective. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD.

At Assault Prevention, we understand this well. Here is how we approach PTSD.

PTSD Defined

1. The person experienced, witnessed, or was confronted with actual or threatened death, or serious injury, or a threat to the physical integrity of self or others.

2. The person’s response involved intense fear, helplessness or horror.

Re-experienced Persistently
• Images, Thoughts, Perceptions
• Dreams
• Feeling as if it were recurring
• Psychological distress at exposure to symbolic cues
• Physiological reactivity on exposure to cues

Persistent Avoidance
• Thoughts, Feelings, Conversations associated with the event
• Activities, Places and People that arouse recollections
• Inability to recall an important aspect of the trauma
• Diminished interest or participation in significant activities
• Feelings of detachment or estrangement from others
• Restricted range of effect
• Sense of foreshortened future

Persistent Symptoms of Increased Arousal
• Difficulty falling or staying asleep
• Irritability or outbursts of anger
• Difficulty concentrating
• Hypervigilance
• Exaggerated startle response

1. Duration More Than One Month
2. Causes Significant Impairment in Social, Occupational, or Other Important Areas

How We Define a Critical Incident
1. Sudden and unexpected.
2. An event that is a threat to the person’s life or physical well-being
3. An event that may include some element of loss: work partner, physical ability, one’s position.
4. An event that might also result in an abrupt change in the a person’s values, confidence, or ideals.

• At any given time 15-32% of Emergency Responders will deal with a reaction to Post Traumatic Stress. There is a 30-64% chance that they will have a reaction to it during their lifetime.
• For law enforcement in urban areas, 20-30% will develop a reaction during their lifetimes.
• This is in contrast to the general population which is 1-3%.
• Urban adolescents are 9-15%.
• Vietnam Vets are 15-20%.

How To Support Someone Who Has Just Experienced A Critical Incident

1. Initiate contact in the form of a phone call or note.
2. Offer to stay with the person the first day or two.
3. Let the person decide the amount of contact.
4. Don’t ask, but be willing to listen.
5. Ask questions that show support and acceptance.
6. Accept their reaction as normal.
7. Avoid suggesting how they should be feeling.
8. Practice non-judgmental listening.
9. Do not attempt to “relate” unless you can do so.
10. Do not encourage the use of alcohol or drugs.
11. Do not congratulate them or make jokes about it.
12. Offer positive statements.
13. Encourage them to take care of themselves.
14. Do not second guess the incident.
15. Gently confront them about negative emotional or behavioral changes that persist more than one month.
16. Encourage them to seek professional help.
17. Don’t refer to person’s experiencing problems in derogatory terms.
18. Educate yourself about trauma reactions.
19. Don’t pretend it did not happen.
20. If you don’t have anything nice to say, don’t say it.

If You Are Responsible For Investigating The Critical Incident: There are steps to maximize the accuracy of your investigation and minimize further traumatization to the person and their families.

1. When you first contact the person, tell them what the procedures are and what will be happening from that point on.

2. Ask the person if appropriate arrangements have been made to contact their families and or friends and facilitate if necessary.

3. If you have contacts with family support teams, find out if they have been contacted.

4. The person should have an uninvolved peer support person or friend of their choice available to them immediately after the incident.

5. It may be helpful for the person’s memories to view the scene and do a walk through.

6. Advise them to get an attorney if that would make them more comfortable.

7. Work out a process in advance to obtain important information on scene from the person without compromising their legal protection.

8. Do not confiscate the person’s personal property unless necessary or required by policy.

9. Remember uninvolved people who were present may be traumatized as well.

10. Affected people should not have to drive themselves anywhere after the incident.

11. Do not require the person to write a report immediately. It may be jumbled and poorly written.

12. Likewise for an interview. High Stress reactions can cause short-term memory loss. The information you will be given may be inaccurate.

13. Encourage exercise before going home to dissipate stress energy.

14. Provide an opportunity to shower and change clothes if necessary.

15. Remember when interviewing the person they may also be a crime victim.

16. Do not isolate the person from others.

17. It may be difficult for the person to sit still due to excess energy associated with an adrenaline surge.

18. Offer food and beverages.

19. Allow the person a “quiet room” if necessary.

20. If professional disagreements arise at the scene, they should be resolved as soon as possible.

21. Remember people can only report what they perceived, not what actually happened. You can facilitate honesty by being aware that perceptual, cognitive and memory distortions are a normal part of traumatic events.

22. People will “second guess” themselves after they get more information regarding the incident because of tunnel vision.

23. People’s reactions will vary widely in the hours following an incident.

24. Allow people to amend their statements. They may remember additional details days following the incident.

25. The interviewer / investigator needs to conduct a professional, accurate and thorough investigation while maintaining compassion and respect.

Copyright 2009 Assault Prevention

Sources: US Department of Health & Human Services, National Institutes of Health, Assault Prevention, US Department of Veteran Affairs, National Center for Posttraumatic Stress Disorder, FBI, 

Weathers, F.W., Huska, J.A., Keane, T.M. PCL-C for DSM-IV. Boston: National Center for PTSD – Behavioral Science Division, 1991. This is a Government document in the public domain.

PCL-M for DSM-IV (11/1/94) Weathers, Litz, Huska, & Keane National Center for PTSD – Behavioral Science Division. This is a Government document in the public domain.