Common Symptoms Arising from Job-Related Trauma and Post Traumatic Stress Disorder (PTSD)
Photos by Jim Macmillan, Philadelphia Daily News
"The only real mistake is the one from which we learn nothing." - John Powell
Law Enforcement Officers, Fire, Rescue and EMS professionals commonly become traumatized by job experiences, often incidents that occur when seeking to help others. Problems and symptoms can arise immediately following a critical incident or may appear slowly. Symptoms may also appear suddenly, weeks or months after a traumatic incident.
1. Job-Related trauma commonly causes sleep problems.
Sleep problems may take many forms…you may not be able to make yourself go to bed, you may lie in bed for hours before falling asleep, you may go to sleep immediately after getting in bed, but wake up two to four hours later and find yourself unable to go back to sleep. You may wake up a hundred times a night. As you sleep, you may be very restless, throwing yourself around during sleep. You may find that you are experiencing less than four hours of deep and restful sleep each night. If sleep problems continue for more than a few days, the sleep-deprivation that results will negatively impact all other areas of your personal and professional life.
"He had lots of trouble sleeping. The first month, he had a lot of nightmares; since then, he yelled out and was frantic in bed, about once a month and he jerked in his sleep, especially in his legs. If I tried to wake him up to stop the nightmare, or bumped him in his sleep, he was instantly and loudly awake. If he fell asleep on the floor, I could not wake him up gradually...he startled awake."
2. You may have one or more flashbacks of job-related incidents.
Flashbacks are often so vivid it may seem like you’re back at the scene. Flashbacks may be so frequent that they occur a hundred times a day or as little as once a month. Although many flashbacks consist of visual pictures of a critical incident, they may also take the form of a smell, taste, sounds and/or body sensation. Flashbacks may occur as you sleep and are experienced as nightmares or night terrors. Occasionally someone will act out a nightmare.
"I was standing there when the building collapsed. I knew how many people were in there. Half the guys in my station were in the building. I keep seeing the building come down and imagining what they must have thought. It happens all day."
"When we arrived, the townhouse was totally involved in the fire. I could hear a child screaming from inside the townhouse, but I couldn’t get to him. I tried, but the fire was too advanced. Then the cries stopped. After the fire was out, I saw his body; I can’t get it out of my mind. I keep thinking that it was my job to help him and I didn’t save him. I hear his screams all day and night…they keep me awake."
"I saw a woman’s hair sticking up. I ran and pulled it up. It was attached to the front of her face; everything else was gone. I still see it every time I shut my eyes."
"It's like I get the feeling that I did then. Pictures come in my mind. It feels like it just happened this morning. I have no control over it."
"Whenever I take a shower, it reminds me of everything in the event. I hate how it makes me feel. It colors everything I do and say and feel and think."
"I try not to think about it, but I can't. It never leaves my thoughts."
"He's shooting at me and I'm trying to get away, but I can't move. I try to fire my weapon, but it won’t fire. I wake up with sweat all over my body."
"I have a reoccurring dream that a child is calling for my help and I can’t get to him and the monster that has him murders him. I have it again and again. I’m screaming and it always wakes up my wife. She tries to comfort me, but I don’t want to go back to sleep because I don’t want to have the dream again."
3. You many have flashbacks that interfere with job performance.
"When I’m giving my lecture on accident reconstruction, I focus on a particular part of the slide and my mind goes blank. The slides that make my mind go blank are of accidents that really bothered me. I have to cover it up and continue to talk. I don’t know if anyone notices or not."
"When we drive by a crowd, the incident flashes in my head again and again. I get the sweats. I don’t pay attention. I do anything to avoid going out on calls where there are crowds of people. I’m calling in sick to avoid coming to work. I can’t get the attack out of my head."
4. You may have difficulty concentrating, reading, writing or doing anything that requires that you pay attention. Your mind may seem to be racing.
"I do anything to avoid writing my reports. I take long lunches, make phone calls, and do anything that requires physical activity and moving. I just can’t make myself write them."
"I couldn’t concentrate or read. I wasn’t interested in anything. I just sat in the dark and smoked."
"My mind was always racing and on a thousand things; I would be hearing someone’s voice, but I would be thinking about all kinds of other things."
"Every since that incident, my husband would say, "You’re not listening to me—I just told you that." But he hadn’t just told me that. I think he must have been thinking the words in his head, and thought he said them to me, but he didn’t. If I wanted him to listen to me, I had to make direct eye contact with him to make sure he was listening, or he wouldn’t hear me. He was in his own world."
"I bought all these books because I know I will be home at least six months recovering from my wounds. But I can’t read; I’m a college graduate and I can’t read. I read the first sentence and I think of something else. I feel like my mind is racing. It’s the comprehension; I’m losing it."
5. You may feel as if you are falling apart.
"I over-react. I never feel calm. Things are bothering me. I feel on edge all the time."
"He used to be the first one to work; then he was brutally attacked by two thugs. Everyone said he was an agent’s agent. Now he comes in late, he looks sloppy; he doesn’t want to do anything. He keeps asking, ‘What’s wrong with me?’ "
6. You may have survivor guilt.
"All my life I wanted to be a policeman. I loved being a policeman, but since my partner was killed, I don’t care about the job anymore. I feel like it’s my fault. I should have been with him instead of at the dentist. He wouldn’t have died if I hadn’t taken sick leave."
"Ten of my friends died when the building collapsed. They all had families and kids. I’m single; I should have died in their place. They were fighting the fire; they were running up the stairs. I was working the fire, too, but they died and I didn’t. I’m glad I survived, but I feel guilty for being alive."
7. You may find that you are often angry and that this anger is causing problems for you.
"After I came home from working OKBomb, I didn’t talk about what I went through with any one. I wanted to forget it, but my mind wouldn’t let me forget. I kept getting pictures flashing in my mind that pulled me back there. One day when I was testifying in court, I got in a fight with a defense attorney. We were screaming at each other. I used to be so calm and let everything roll off my back. The judge wrote a letter to my supervisor. That’s why I’m here for treatment."
8. You may pull away from the people you care about and feel as if there is a wall around you that distances you from other people. When this happens, you may stop talking to family members, friends and peers. When others are talking to you, you may think of things to say to them, but find it’s too much trouble to communicate. You may feel numb, and find that you don’t feel any positive feelings, even love. You may lose your sense of humor and have little interest in activities that you used to find enjoyable.
"Since it happened, I don’t feel anything for anyone. I feel numb, except I do feel love for my daughter."
"I feel shut-down. I don't have anything to say. I can't join in conversations. I'm very uncomfortable."
"My partner will start talking to me....I'm hearing him, but it's like an echo. My mind's thinking a million other things."
"I didn't tell you this. I stopped eating. I stopped drinking. I stopped talking to my family and friends. I thought I could handle it alone, but what happened just kept going over and over in my head."
"In the morning, I pretend I’m asleep so I won’t have to talk to my wife. I just don’t feel like talking. I’ve turned to another woman on my squad; she listens to me and understands what I have been through. I love my wife, but I just feel like I’m pulling further and further away from her."
"I feel shut-down. I don't have anything to say. I can't join in conversations. I'm very uncomfortable."
"I felt as if there was a wall between me and everyone else and I wanted to stay behind it. I wouldn’t talk to my family. I would think of things to say, but it was too much trouble to say them. My husband would ask, ‘What’s wrong with you?’ and I would respond, ‘Leave me alone!’ I refused to go on vacations with my family, I stopped going out with friends. I didn’t return phone calls. I just couldn’t make myself do it. I stopped laughing. I didn’t realize how withdrawn I had become."
"I feel as if there is a wall around me. I think of things to tell people in my life that are significant, but I just don’t say them. I don’t return phone calls. I just can’t make myself do it."
9. You may have memory problems.
"I would start to tell a story and after the first sentence, I would forget what I was going to say. It happened all the time. I was afraid to talk to anyone."
"My partner would call for back-up. I would get in my car and start driving. Then, I’d forget where I was going and what I was supposed to do. I’d turn the car around and I’d go home. There was no one else to back him up and he could never depend on me."
"I miss appointments, I forget important events"
"I had to write a report on the incident but I couldn’t remember a lot of the details. I was sure of how many times I fired my weapon, but this wasn’t right either. I don’t know what’s wrong with me."
10. You may become obsessed with working while you neglect other activities that you used to enjoy.
"I’m down at the Firehouse every day. I stay long after my shift is over. I volunteer for anything and everything. I’m obsessed. I really don’t care about anything except working. It’s killing my marriage."
11. You may find that you are too impatient to do the normal activities of everyday life, such as listening to your family talk about their day, standing in lines or paying bills.
"He lost patience. He couldn’t tolerate standing in line, being stuck in traffic, doing the normal things that make a family run, like paying bills. We had shared the duties, but I had to take over all of them. He thought most things weren’t important enough for him to participate in. It was as if this event was so important that nothing else could compare, so he didn’t want to hear the normal every day problems of me and the children. I started having to handle them all."
"When driving, he was more rigid, forceful and impatient. He drove faster and the safety zone between him and the car in front of him disappeared."
12. You may find that you no longer feel safe and/or you are obsessed with the safety of your family. You may avoid activities that you used to do because you do not feel safe or become over-protective or controlling with family members.
"I don’t want to fly on an airplane; I don’t want to take the train or the subway. I’m afraid to let my family leave the house. I didn’t use to be afraid of anything, now I’m worried all the time."
"Every night I wake up two or three times and check on the kids. They are always asleep and I know its crazy, but I can’t help myself."
"My daughter says I am her prisoner. I know that my rules on leaving the house are unreasonable, but I keep seeing the bodies of cases I worked where teenage girls were raped and murdered. I see my daughter’s face on those bodies and it terrifies me. I know what those girls went through before they died and I can’t bear the thought of my daughter dying in that way."
"I saw the gas meter man and I thought it was someone trying to get in the house. I got my gun and barricaded the door. I positioned myself at the side of the window. When I realized who it was, I felt stupid." (Law enforcement officer recovering from being shot).
13. You may believe management is against you, that everyone wants you to quit or thinks that there is something wrong with you.
"I thought everyone in the office was against me, talking about me, trying to get me fired or put on disability retirement."
14. You may not want anyone touching your personal property. You may make evaluations through emotions, rather than judgment and thinking things through.
"My brother came to visit me. I didn't want him there. I watched him all the time and I wouldn't tell him anything. He kept asking questions."
"Someone put their coffee cup on my desk and I went nuts. My partner wanted to put some of his papers in my filing cabinet and that really upset me. He's my best friend but I was upset about sharing my space."
15. You may find that you no longer think about the future and have problems making decisions, especially those involving personal matters.Your imagination and problem solving skills may seem to become frozen.
"I used to plan what I would do when I retire; I’d picture a cabin in the woods, and I’d be fishing. I don’t think about the future anymore. I don’t care about the future."
"My supervisor said that I can get out of this office and move to another one. This office reminds me of the shooting but I can’t decide what to do. I want to go, but I just stay here."
"It's like running on a treadmill and grasping for something to latch on to gain control, but I can't grasp anything and I can't get control. I feel like a gerbil running round and round on an exercise wheel...running as fast as I can but getting no where."
16. You may start drinking too much, because it numbs the symptoms you are experiencing. Research has shown that the workers who increase their alcohol intake following a critical incident are typically those who were most impacted by the incident and if this increase in alcohol use continues, it is predictive of the development of PTSD.
"Since that night, every night after work, I go out with my buddies and drink. I can’t go home without drinking. I’m drinking now on my days off. I have to drink to get to sleep."
17. You may begin to think about suicide or engage in dangerous and life-threatening behaviors.
"When we get to a fire, I rush in; I do things which I know can get me killed. I don’t care"
"Every time I’d put my weapon away, a voice in my head would say, ‘just do it’. I’d put the gun in my mouth, but I’d get a picture of my son finding my body and I couldn’t do that to him. I’d put my gun away, but the voice would talk to me the next evening and I’d have to fight it again."
"I know I’m taking chances and doing all kinds of dangerous things. It’s driving my Chief crazy. I figure if I die, I die. That way life takes care of it. I don’t really care if I die, but I’m not going to kill myself."
18. You may have physical problems as a result of being traumatized. These include high blood pressure, increased heart rate, pain (especially in back and head) and gastrointestinal problems. You may get sick a lot. These physical problems are the result of the high levels of hormones that occurred during and following the trauma. Elevated cholesterol, low-density lipoprotein, triglycerides and reduced high density lipoprotein have also been associated with chronic PTSD.
"I’m on blood pressure medication, my heart keeps skipping a beat, and I sleep so little that my wife won’t let me sleep in the same room with her. I’ve got headaches and I have to pop Tums all day."