Anxiety Disorders and Posttraumatic Stress Disorder (PTSD) Nicole Duranceaux, Ph.D. Albuquerque Police Department Behavioral Sciences Division 505-764-1600

What is Anxiety? Anxiety is worry or stress at levels which are beyond what is considered “normal” or acceptable given the situation. It is worry that interferes with a person’s ability to function in life in one way or another.

Symptoms of Anxiety Intense fear, helplessness, or horror. Physical pains, rapid heart rate, sweating, chills, etc. Intense emotional distress. Avoidance efforts and tendencies. Flat affect. Hypervigilance. Concentration problems and irritability. Difficulty falling asleep or staying asleep.

Anxiety Disorders Panic Disorder Social Phobia Other Phobias Discrete period of intense fear or discomfort usually accompanied by some of the following; sweating, pounding heart, trembling, shortness of breath, choking sensation, dizziness, chills, and nausea. Social Phobia Intense fear of social interactions or performance which creates severe anxiety Other Phobias Examples: agoraphobia, flying, height, spiders, etc. Obsessive Compulsive Disorder Recurrent and persistent thoughts, impulses, or images which are beyond normal worry levels which often result in repetitive behaviors designed to decrease the anxiety Generalized Anxiety Disorder Excessive anxiety and worry in most aspects or facets of a person’s life, lasting at least six months

Anxiety Disorders Trauma Normal Stress Response vs. Disorder Person confronted with an event involving: Actual or threatened death or serious injury, Threat to the physical integrity of self or others  Response involved intense fear, helplessness, or horror Too much, too fast, too similar, too different Normal Stress Response vs. Disorder All persons will have some reaction during and following trauma Different events will affect different people differently

Acute Stress Disorder Increased anxiety related directly to a recent trauma Symptoms Sense of numbing, detachment, or absence of emotional responsiveness Reduction in awareness of surroundings (‘being in a daze’) Feeling like things aren’t real Feeling like one is outside of one’s body Inability to recall important aspects of the trauma 2-4 weeks duration

Posttraumatic Stress Disorder: Historical Perspective Erichsen (England),1880 - railroad spine Oppenheim (Germany), 1890 - soldier’s heart Myers (England), 1915 - shell shock Kardiner (U.S.) , 1941 - combat neurosis In WW II, over 200 British soldiers were executed for cowardice, most of whom were suffering from PTSD

PTSD Defined Symptoms (longer than 1 month) Intense anxiety and stress after exposure to a trauma Symptoms (longer than 1 month) Reexperiencing Avoidance Hyperarousal Acute (less than 3 months) or Chronic (greater than 3 months) January-February 2010

Reexperiencing Remembering the event “over and over” Repeatedly dreaming about the event Feeling as if the event is occurring again Intense emotional stress when see/feel/experience things that stimulate recall of the event Intense physical stress when see/feel/experience things that stimulate recall of the event

Avoidance Symptoms Avoiding anything that is associated with the event Avoiding anyone/anything that may stimulate recall of the event Difficulty remembering important aspects of the event Lack of interest in life Decrease in ability to feel all feelings Sense of isolation from others

Hyperarousal Symptoms Difficulty sleeping Irritable/easily angered Difficulty concentrating Hypervigilance Exaggerated startle response

PTSD Myths Trauma always leads to PTSD Only happens to “weak” or “damaged” people Developing PTSD means you’re “crazy” PTSD is untreatable PTSD dooms the person to a life of anger, sadness, divorce, alcoholism, homelessness and/or suicide

Treatments for PTSD Talk Therapy Exposure Treatments Medications Prolonged Exposure, Cognitive Processing, EMDR Medications Support Groups Stress Management Prevention Debriefings Continued self care

Stress and Coping in Law Enforcement Every time we dial 911, we expect that our emergency will be taken seriously and handled competently. Law Enforcement Officers are routinely exposed to special kinds of traumatic events and daily pressures that require a certain adaptively defensive toughness of attitude, temperament, and training.

Stress and Coping in Law Enforcement Sometimes, however, the stress is just too much, and the very toughness that facilitates smooth functioning in your daily duties now becomes an impediment when needing help for yourself. This is vicarious trauma.

Vicarious Trauma Defined as the process of taking on the trauma of someone else. In some ways it can be compared to emotional fatigue. Every little bit contributes. Rescue dogs during 9-11

Critical Incidents-What Are They? Tragedies, deaths, serious injuries, hostage situations, threatening situations Sometimes an event is so traumatic or overwhelming that emergency responders may experience significant stress reactions. People who respond to emergencies encounter highly stressful events almost every day.

Physical Reactions Chills Fainting Twitches Headaches Elevated BP Rapid heart rate Muscle tremors Shock symptoms Thirst Fatigue Nausea Vomiting Twitches Dizziness Weakness Grinding of teeth

Cognitive Reactions Nightmares Uncertainty Hypervigilence Suspiciousness Intrusive Images Blaming Poor Abstraction Poor Memory Disorientation Confusion Poor concentration Difficulty identifying objects or people Heightened or lowered alertness, Increased or decreased awareness of surroundings

Emotional Reactions Guilt Grief Panic Denial Anxiety Agitation Irritability Depression Rage Fear Apprehension Emotional shock Emotional outbursts Feeling overwhelmed Loss of emotional control Inappropriate emotional response

Behavioral Reactions Antisocial acts Withdrawal Inability to rest Intensified pacing Erratic movements Change in social activity Change in speech Withdrawal Change in appetite Hyper alert to environment Increased alcohol consumption Change in usual communications January-February 2010

Some Stress Relieving Habits Exercise Communication with support network Hobbies Leave work at work Mindless activity Vacations Fun

Concluding Issues The key to taking care of others is first taking care of yourself. Don’t be afraid to ask for help or to get a tune-up. Take time away. Be honest with yourself about your stress.