The Nature of being a first responder is that you will be involved in numerous critical incidents, encompassing all sorts of trauma throughout your career. These may range from deaths, serious injuries, natural disasters, seeing people in great distress whilst being unable to help ease their suffering, all whilst having your own life and safety seriously threatened.
As a result of this unique part of the character of a first responder, many don’t seek out medical help until they have faced, in some cases, years of repeated exposure to traumas. Often this will leave them with a seemingly small or “regular” job that may be the final straw that causes the symptoms of Post traumatic stress disorder (PTSD) to become most prevalent. On the other hand in fact it may be just the very first trauma you experience that afflicts you with PTSD.
Many civilians with PTSD experience feelings of intense fear, helplessness or horror. But it is quite common for First responders to experience strong feelings of anger, guilt or shame as a part of their PTSD symptoms. Most first responders do not realise how ill the cumulative traumas they have experienced have already made them. Often due to the delayed onset on PTSD , many first responders may have co morbid mental health conditions such as depression, anxiety, alcohol or substance abuse conditions.
PTSD is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault.
People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.
A diagnosis of PTSD requires exposure to an upsetting traumatic event. However, exposure could be indirect rather than first hand. For example, PTSD could occur as a result of repeated exposure to horrible details of trauma such as police officers exposed to details of child abuse cases.
The Diagnostic and Statistical Manual of Mental Disorders (DSM), per the American Psychiatric Association states the critera to be diagnosed with PTSD as
A
CRITERION A
(one required)
The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):
- Direct exposure
- Witnessing the trauma
- Learning that a relative or close friend was exposed to a trauma
- Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)
B
CRITERION B
(one required)
The traumatic event is persistently re-experienced, in the following way(s):
- Unwanted upsetting memories
- Nightmares
- Flashbacks
- Emotional distress after exposure to traumatic reminders
- Physical reactivity after exposure to traumatic reminders
C
CRITERION C
(one required)
Avoidance of trauma-related stimuli after the trauma, in the following way(s):
- Trauma-related thoughts or feelings
- Trauma-related reminders
D
CRITERION D
(one required)
Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):
- Inability to recall key features of the trauma
- Overly negative thoughts and assumptions about oneself or the world
- Exaggerated blame of self or others for causing the trauma
- Negative affect
- Decreased interest in activities
- Feeling isolated
- Difficulty experiencing positive affect
E
CRITERION E
(two required)
The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):
- Direct exposure
- Witnessing the trauma
- Learning that a relative or close friend was exposed to a trauma
- Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)
F
CRITERION F
(Required)
Symptoms last for more than 1 month.
G
CRITERION G
(Required)
Symptoms create distress or functional impairment (e.g., social, occupational).
H
Criterion H (required)
Symptoms are not due to medication, substance use, or other illness.
Two specifications:
-
Dissociative Specification. In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:
-
Depersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not happening to me" or one were in a dream).
-
Derealization. Experience of unreality, distance, or distortion (e.g., "things are not real").
-
-
Delayed Specification. Full diagnostic criteria are not met until at least six months after the trauma(s), although onset of symptoms may occur immediately.
If you are seeking self diagnoses, please do not do this. Check below and if you believe that you are fulfilling the criteria, immediately seek clinical assistance.
Symptoms
- Intrusive thoughts such as repeated, involuntary memories; distressing dreams; or flashbacks of the traumatic event. Flashbacks may be so vivid that people feel they are re-living the traumatic experience or seeing it before their eyes.
- Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that bring on distressing memories. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it.
- Negative thoughts and feelings may include ongoing and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); ongoing fear, horror, anger, guilt or shame; much less interest in activities previously enjoyed; or feeling detached or estranged from others.
- Arousal and reactive symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being easily startled; or having problems concentrating or sleeping.
Treatment
Many people who are exposed to a traumatic event experience symptoms like those described above in the days following the event. For a person to be diagnosed with PTSD, however, symptoms last for more than a month and often persist for months and sometimes years. Many individuals develop symptoms within three months of the trauma, but symptoms may appear later. For people with PTSD the symptoms cause significant distress or problems functioning. PTSD often occurs with other related conditions, such as depression, substance use, memory problems and other physical and mental health problems.
Several effective treatment options are available including psychotherapies such as cognitive behavioural therapy (CBT), cognitive processing therapy (CPT), prolonged exposure therapy (PE), and eye movement desensitisation and reprocessing (EMDR); and medications, such as the antidepressants known as selective serotonin reuptake inhibitors (SSRIs). Often the combination of medication and psychotherapy is more effective than either form of treatment alone.