1. Post-Traumatic Stress Disorder Presented to LCPD Class 42 by Peter DiVasto Ph.D. Police psychologist nmcopdoc@aol.com

2. Post Traumatic Stress Disorder Considerations: The person with PTSD may have been symptom-free prior to experiencing the stressor however, the presence of psychological symptoms beforehand increases the likelihood of PTSD The events that cause PTSD range from the commonplace (auto accidents, hurricanes) to the unusual (torture,war), but events caused by man will cause more psychological trauma than those caused by nature

3. Incidence of PTSD In a survey of Manhattan residents done one month after 9/11: 7.5% of sample met the criteria for PTSD 17.4% met the criteria for sub clinical levels of PTSD After six months, rates dropped by 80% Galea, Ahern, et al. 2002

4. Incidence of PTSD, cont. Among hospitalized motor vehicle accident victims, 79% did not experience PTSD Among those exposed to the 1992 L.A. riots, 78% did not experience PTSD Among Gulf War veterans interviewed within one year of their return to the U.S., 63% did not experience PTSD Quoted in Bonanno, 2004

5. Incidence of PTSD, con’t. In a study of 6201 service members, Hoge (2004) found that among active duty combat troops, the rate of reported PTSD symptoms after combat in Iraq was 12%. Prior to experiencing combat, the rate was 5%, which is the same as the U.S. general population.

6. Incidence of PTSD, con’t. The most recent (2010) data on returning veterans from the wars in the Middle East indicates that 1 in 5 will develop PTSD symptoms. The figures are slightly higher for reservists.

7. How long have we known about PTSD?

8. 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

9. Treatment principles developed by the U.S. military in 1941 Proximity - treat the soldier as close to the front lines (and his home unit) as possible Immediacy - provide treatment as soon as feasible, practical and safe Expectancy - expect (and behave as if) the soldier will get well and return to his unit

10. What we learned prior to WW II is still true today. Treat the problem quickly, as close to the scene as possible and with the expectation of recovery.

11. PTSD Gender Differences Men are most likely to experience PTSD as result of combat and manifest the symptoms outwardly Women are most likely to experience PTSD as a result of rape or chronic domestic violence and internalize the symptoms

12. Diagnosis of Post Traumatic Stress Disorder The symptoms fall into three categories: Arousal (anxiety) symptoms Re-experiencing the event Avoidant symptoms

13. Post Traumatic Stress Response Arousal –Difficulty sleeping –Irritable/easily angered –Difficulty concentrating –Hypervigilance –Exaggerated startle response

14. Post Traumatic Stress Response Re-experiencing the trauma –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

15. Post Traumatic Stress Response Avoidance and Numbing –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

16. PTSD: Why Person A not B Resilience Support –Family –Spiritual –Economic Inherent personality Environment Information processing - verbal vs. visual

17. PTSD: Treatment Medications –Antidepressants –Anti-anxiety agents Therapy –Behavioral therapy –Expressive therapy –E.M.D.R.