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

2. 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.

3. 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.

4. 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

5. 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

6. 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

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

8. 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

9. 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

10. 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

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

12. 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

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

14. 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.

15. 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.

16. 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

17. 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.

18. 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

19. 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

20. 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

21. 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

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

23. 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.