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PTSD Among First Responders and Military Members

Coping with PTSD

Who is Typically Diagnosed with PTSD?

By Harold Cohen, Ph.D.,
There is no “typical” demographic profile for a person with PTSD. While military doctors first identified PTSD as “shell shock” or “battle fatigue,” today it is recognized as a disorder that affects people of all ages and from all social, economic, and ethnic backgrounds. For example, children who experience physical or sexual abuse, adolescents who witness drive-by shootings and adults who live through natural disasters may be diagnosed with PTSD.

Several recent studies have indicated that exposure to trauma is surprisingly common in the United States. One study notes that significant traumatic events occur for more than half of all persons during the course of their lifetimes. The events most commonly associated with PTSD in women are rape and sexual abuse. In men, the traumatic event most commonly associated with PTSD is combat exposure. Domestic violence is a common precipitant of PTSD, but is arguably not sufficiently recognized as extremely common. Impairments in personal adjustment, lack of supportive relationships, family history of PTSD, previous traumatic experiences and other existing mental disorders may also play a role in vulnerability to developing PTSD. Additional research is needed, however, to further clarify how different vulnerability and resilience factors interact in the development of PTSD.

As noted earlier, while PTSD is a common disorder, the majority of persons exposed to a traumatic event cope reasonably well. While many may develop symptoms (such as insomnia) for a short time, only a small percentage (less than 10 percent) go on to develop PTSD. Thus PTSD is not simply a “normal response” to an abnormal event; rather it is an anxiety disorder that involves specific kinds of physical and mental changes. Source:

911 Operators Vulnerable to PTSD Symptoms

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on March 30, 2012. 911 dispatchers deal with traumatic scenarios every day, but from a distance — and it turns out that combination can make them vulnerable to symptoms of post-traumatic stress disorder (PTSD).  New research, published in the Journal of Traumatic Stress, found that dispatchers who answer 911 and 999 emergency calls suffer emotional distress which can lead to PTSD symptoms. “Post-traumatic psychological disorders are usually associated with front line emergency workers, such as police officers, fire fighters or combat veterans,” said research leader Dr. Michelle Lilly, a psychologist at Northern Illinois University. “Usually research considers links between disorders and how much emotional distress is experienced on the scene of a traumatic event. However, this is the first study on emergency dispatchers, who experience the trauma indirectly.”

Investigators analyzed the responses of 171 currently serving emergency dispatchers from 24 U.S. states. The majority of the sample was female and Caucasian, with an average age of 38 and over 11 years of service. Researchers asked the dispatchers about the types of potentially traumatic calls they handle and the amount of emotional distress they experienced. They were also asked to rank the types of calls which caused the most distress and to remember the worst call they had dealt with during their career. Participants reported experiencing fear, helplessness or horror in reaction to nearly one-third of the different types of potentially traumatic calls.

 Over 16 percent of the dispatchers said the worst calls were associated with the unexpected injury or death of a child; nearly 13 percent of study participants said suicidal callers were next on the list of causing emotional distress; followed by shootings involving officers, and calls involving the unexpected death of an adult — with both of these scenarios reported by nearly 10 percent of the dispatchers. A further 3.5 percent of the sample reported symptoms severe enough to qualify for a diagnosis of PTSD. Investigators say these results are a valuable contribution to the ongoing debate on defining a traumatic event. Currently, the definition of a traumatic event is under review with official guidelines on the designation set to be published in 2013.

Researchers believe these findings support a broad definition as it shows dispatchers experience significant levels of emotional distress at work even though they are not physically present during a traumatic event, or even know the victim of a trauma. High levels of responsibility and little ability to actually influence the outcome can add up to extremely high stress. “Our research is the first to reveal the extent of emotional distress experienced by emergency dispatchers while on duty,” concluded researcher Heather Pierce, herself a former 911 dispatcher. “The results show the need to provide these workers with prevention and intervention support as is currently provided for their front-line colleagues. This includes briefings and training in ways to handle emotional distress.” Source:

Don't forget a fellow a First Responder after an injury

Sergeant Jon Brough and Officer Mike Kralicek, who were catastrophically shot — lives spared, but careers ended — teach us how we can help an injured officer. Work-related injuries can be devastating, especially for law enforcement officers — for whom even seemingly minor injuries can be career ending. Most officers think about the dangerousness of the job. They understand there is a chance they may not come home. This is a reality of police work, but statistically speaking, officers have a better chance of being injured or assaulted on the job. Are you prepared physically, emotionally, and psychologically to deal with a work-related injury? Are you prepared to deal with a catastrophic injury? How would your life change? How would an injury affect your family and your fellow officers? Are you really prepared for how your life may change? The truth: probably not.

Realities of the Profession
Most of us don’t want to deal with those what-if scenarios, because it is human nature to believe “It can’t happen to me.” But sadly, it can and does happen. Just ask former Sergeant Jon Brough (Belleville, Illinois) and former Officer Mike Kralicek (Coeur d’Alene, Idaho). Both officers were shot and catastrophically injured in the line of duty. Each sustained injuriesso severe that they nearly lost their lives. Their lives were spared, but sadly, their careers were cut short. Despite the tragedy, the injuries, and the pain, these men are some of the bravest, most courageous men I have ever met. But don’t think for a minute that they did it all by themselves. They were able to overcome many obstacles because they were trained to fight and to win. That is what warriors do. But warriors also need the support of family and friends. 

Families are usually supportive; one thing Jon and Mike have in common is a caring, compassionate spouse who acts as his full-time caregiver. But bonds with friends and fellow officers often come to an end. Not abruptly, but phone calls and visits will eventually fade away. Jon has a great support system of family and friends who have never forgotten him, but many of his fellow officers fail to keep in touch. Some fail to keep in touch because they were not close before the incident and others because the incident brings up too many bad memories. Jon’s working relationships were close, but they were centered on police work. Very little time was spent off-duty with fellow officers, because Jon was going back to school to complete his bachelor’s degree in Administration of Justice, working overtime, and raising children. Jon misses the camaraderie of sharing stories with fellow officers about what was going on in town. It would mean so much if fellow officers would stop by and keep him in the loop — it would give him a big emotional boost. For more go to:

After a Tragedy, Remember The Living

Doug Wyllie, PoliceOne Editor in Chief, July 17, 2013. As remembrances of the 19 elite firefighters killed in the recent Yarnell fire in Arizona continue, one hero in particular deserves special support and attention. Brendan McDonough is the sole surviving member of the extremely-tight team.  Chances are  strong that at least to some degree, he is struggling with the phenomenon of survivor’s guilt — as unjustified as that guilt may be — and thinking of McDonough gives me impetus to address the need to support survivors of tragic events.

A Longtime Challenge
​Survivor’s guilt has haunted many law enforcement officers who have survived, while their brother and/or sister officers have fallen.  For example, in Killeen, Texas earlier this week, a suspect armed with an AK-47 fatally shot Officer Robert Hornsby. In the same gunfight, Officer Juan Obregon was also shot and injured, but Obregon survived the fight. In high-risk missions, personal survival is just one of two ultimate goals — the other goal of course is ensuring that to every degree humanly possible, you ALL survive as a team. Sometimes that just doesn’t happen. Sometimes some survive and others don’t, and there was nothing more that could have been done to prevent the tragedy. 

It’s terribly painful, but it’s true. Those who live to give firsthand testimony to the heroics of their brothers and sisters in arms, although physically alive, may sometimes feel like they’re dying inside. They may not admit this feeling, so even as you remember the fallen, be sure you’re also remembering and intensely supporting those who face the potentially-painful road of a survivor. Lt. Col. Dave Grossman — author of On Killing and On Combat — recommends in Chapter Six of On Combat that the right response to a survivor is to say simply, “I’m so glad you’re okay.” 

Grossman teaches — and I wholeheartedly agree — that it’s important to plainly state to a survivor that you’re happy they survived the ordeal and that they’re okay. The message should be: “I give a damn about you, and I’m glad you’re okay.” Calling this the “ready round,” Col. Grossman says this is the one that’s “in the chamber, ready to go when you do not know what to say or do.” Source:

Function of the Amygdala & PTSD in Military Personnel

Richard L. Levenson, Jr., Psy.D., CTS, Deputy Chairman, Badge of Life. There is a structure in the human brain called the Amygdala which is generally seen as the physiological structure and "center" of emotion. A recent study published in the Archives of General Psychiatry(Kuo, Kaloupek, & Woodward, 2012, 69(10), 1080-1086) looked at the size of the Amygdala in the brains of combat-exposed soldiers with and without diagnoses of Posttraumatic Stress Disorder (PTSD). The size of the sample was large enough to conclude that the results can likely be generalized to the greater population of combat-exposed personnel with PTSD. There were two groups compared in the study - those with and without the diagnosis of PTSD.

The soldiers used as participants were active-duty personnel during the Persian Gulf War. To quote from the article, "Analysis 1 indicated that combat-exposed individuals with PTSD exhibited larger total amygdala volume compared with their non-PTSD counterparts (99 individuals, P = .047). Analysis 2 indicated that greater severity of combat exposure (87 individuals, P = .02), as well as the interaction between the presence of early life trauma and the severity of combat exposure (87 individuals, P = .008), were significantly associated with smaller total amygdala volume. The PTSD diagnosis continued to explain larger amygdala volume (87 individuals, P = .006).

CONCLUSIONS: Posttraumatic stress disorder is associated with enlarged amygdala volume, above the variance accounted for by a history of early life trauma and severity of adult trauma exposure. The discrepancy between our and prior findings may be explained by variability in these trauma indices in previous investigations. These findings support additional study of amygdala structure in human stress disorders and further delineation of the role of early and adult trauma on associated neurologic changes." It also supports the conclusion that PTSD is a physical, as well as an emotional injury. Now, can you imagine if a study was undertaken using police officers as participants? Such changes (i.e., enlargements in structure) in the Amygdala's of police officers diagnosed as have PTSD might provide significant support for aberrant behavioral changes such as anger and depression - and the long-standing effects of exposure to job-related stressors. In addition, one might speculate that a change in the size of the Amygdala due to significant occupational stress may be proof-positive of the effects of stress on occupational functioning in police officers. Implications for treatment, self-care, and post-occupational disability status need to be examined empirically. From:

Helping Children Cope During A Military Deployment


Deployments can be challenging for the entire military family. Even with the best preparation children may experience stress when one or both parents deploy. The at-home parent or caregiver may also experience stress as they adjust to new family roles and responsibilities. Although deployment may be challenging, military families often make adjustments that lead to new sources of strength and support. This article focuses on tools and resources that can help military families decrease stress and strengthen family resilience during a deployment.

Recognizing Signs of Stress in Children. Deployment is a time of change and adjustment for children. It is normal for children to behave and react differently to protect their feelings, to gain reassurance that they are still loved and to assure themselves that the at-home parent or caregiver won't leave them. Although children will have different reactions to separation, it is important to recognize some common signs of stress by age group. In the table below, provides some helpful guidelines for behaviors and moods children may experience during a deployment. For more go to: