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Home > Uncategorized > Part 2: What is Psychological Trauma? Diagnosing PTSD

Part 2: What is Psychological Trauma? Diagnosing PTSD

The following has been reprinted with permission from Correctional Oasis: Volume 13, Issue 4.

The examples presented below are based on actual corrections professionals’ experiences, with details changed to render them unidentifiable.

If you happen to get “triggered” (become emotionally upset) while reading this article, I strongly advise you to stop reading, and to contact the National Suicide Prevention Lifeline at 800-273-TALK (8255), and/or your agency’s EAP, and/or 911. For non-emergency situations you can also call Safe Call Now at 206-459-3020, and Serve & Protect at 615-373-8000. And you are welcome to contact me at 719-784-4727 or through our website. More general suggestions are also presented at the end of the article.

My special thanks are offered to Greg Morton, DWCO’s Training Manager, for his careful reading and compassionate edits of this article.

Those who work in corrections have most likely experienced at least one traumatic episode directly, and/or also encountered traumatic material indirectly, possibly repeatedly. You may still be bothered by these exposures, and might be experiencing some of the symptoms that are mentioned later on in this article. Remember, even the “toughest of the tough” show signs of wear-and-tear as the number and types of traumatic material to which they are exposed at work continue to accumulate. We should consider this wear-and-tear outcome to be an inherent and practically inescapable part of our profession, and therefore a subject worth acknowledging and validating by all involved. Peers and colleagues, support each other when you recognize signs of discomfort and strain in your coworkers. Administrators and supervisors, let your staff know that corrections workers, like police officers, fire-fighters and military veterans, do get affected more or less by what they experience at work, and that these effects have nothing to do with weakness. Not seeking help when help is needed is the actual weakness, just like not keeping one’s tools cleaned or one’s vehicles maintained reduces their utility.

That said, please read the following with care. We at Desert Waters are not implying that corrections staff as a general rule suffer from these symptoms at a diagnostic level. Rather, we want to note that these symptoms can exist on a continuum from mild to moderate to more severe. Just because you might recognize individual behaviors in the descriptions below, that does not indicate a diagnosable condition. However, it would also be a mistake to believe that the very real consequences of incidents that happen during a corrections employee’s career might never rise to a severe level of dysfunction. This information is provided so that the profession overall can begin to recognize the possible severity of these outcomes at their most extreme, both on and off duty.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5, APA, 2013)1, Post-traumatic Stress Disorder is comprised of four groupings of symptoms. These symptom clusters are intrusive remembering, avoidance, negative changes in thinking and mood, and increased arousal and reactivity.

If a certain number and combination of the four clusters of symptoms exist for more than one month following exposure to a traumatic stressor, a trauma-exposed individual can be diagnosed with PTSD. For such a diagnosis, however, experienced symptoms must also result in significant distress and impairments in functioning socially, occupationally, or otherwise.

Interestingly, it is possible that diagnostic criteria based on the above symptoms may not be met in full for six months or longer following exposure to traumatic stressors, in which case symptom expression is described as being delayed. That is, a person may show few if any symptoms at first, but months after the event they may start exhibiting enough symptoms to meet criteria for a PTSD diagnosis.

Again, please remember that PTSD, or any psychological condition, can only be diagnosed by a licensed clinician following direct contact, including a one-on-one interview with the person assessed, and perhaps also the administration of clinical tests. If you think that you are suffering from PTSD, please seek professional assistance. Your family and friends, not to mention all of us at Desert Waters Correctional Outreach, want only the best for you.

  1. Intrusive Distressing Memories

    This category of symptoms refers to repeated and unwelcome remembering of details of traumatic events. These details are based on our senses—such as, sights, sounds, smells, tastes, or textures related to the incident. It is as if sensory details are branded in one’s memory, popping up repeatedly in their raw format, unaltered, and like one hit the replay button. This involuntary remembering can be unexpected, “out of the blue.” Or it is cued (“triggered”) by reminders of the traumatic episode(s). Such reminders may be in the person’s external environment (for example, certain smells, sounds, sights, textures, people, locations, situations), or in the person’s internal environment (for example, their own thoughts and emotions). In the case of PTSD, intrusive memories are accompanied by intense emotional distress and physiological arousal, such as increased heart rate, shaking, or sweating. Flashbacks are dissociative reactions, a particularly disturbing type of intrusive remembering, when the person re-lives the event vividly, as if it is happening all over again. Intrusive memories can be experienced both while awake and while asleep (as in nightmares). Distressing dreams of traumatic events rob their victims of what is typically a refuge for all of us—peaceful sleep. Intrusive remembering can become so upsetting, that sufferers may resist falling asleep (trying to stay awake no matter what), as they do not want to re-experience their nightmares.

    Examples of Intrusive Distressing Memories

    A corrections case manager still has nightmares about violent incidents she witnessed during the course of her corrections career. The nightmares are like a movie playing or a slide show of still photos of the event. The images remain unaltered, identical to those on the day of the incident. Sometimes she hears sounds and smells odors related to the events. Invariably, she wakes up with a start, sweating, heart racing. To avoid her haunting nightmares that seem to strike unexpectedly, “out of nowhere,” and for no apparent reason, she tries to stay awake as long as she can. Or she has several stiff drinks before going to sleep.

    A corrections educator, who had been assaulted by an offender a couple of months prior, has a flashback of the attack while he’s driving. He “sees” the offender on his left side lunging at him, shank in hand. Overtaken by the vividness of the experience, and forgetting that he is in fact driving, he ducks and swerves to avoid the offender in his mind’s eye, driving his vehicle into the ditch. As the flashback subsides, he sits in his car shaking until he can compose himself enough to drive to his destination.

  2. Avoidance

    Avoidance is an attempt of trauma survivors to “insulate” themselves, to protect themselves from reminders of traumatic events (“trauma triggers”) in order to avoid or reduce the jarring distress they can cause. Trauma triggers may exist either in the outer world (that is, they are external), and/or they may be birthed in one’s own mind (that is, they are internal). Such trauma-related avoidance is persistent, active, effortful, and intentional. External re-minders that are studiously avoided may include people, places, activities, conversations, situations, and things. Internal reminders may be one’s own thoughts, emotions, or memories associated with traumatic events. It would seem relatively easy to avoid at least some of the external reminders. The harder part may be insulating oneself from internal reminders—from one’s own mind—that is, from oneself. How does a person escape their own haunting feelings, thoughts and memories? There is considerable research that suggests that substance abuse and other compulsive and addictive behaviors may be one method of attempting to avoid/block one’s own memories, thoughts and emotions that are associated with traumatic events.

    Examples of Avoidance

    Since he retired on disability due to work-related PTSD, a corrections officer avoids driving in the vicinity of the prison where he used to work, and he absolutely refuses to drive down the road that leads to the prison. When he needs to go to the next town, he takes a 40-minute detour in order to avoid driving by his old place of employment. He says that just thinking about the gate causes him to start having feelings of panic. He’s also told his wife he no longer wants her to fix spaghetti with spaghetti sauce for him to eat. What he did not tell her was the real reason for that. The sight of spaghetti sauce has now become a strong trauma trigger, a reminder of what he saw on the concrete floor of a cell following an inmate-on-inmate assault that involved serious brain injuries. He’s also quit deer hunting, which he used to love doing annually.

    Since an attempted sexual assault in her office by a mentally ill parolee she supervised, a Parole Office has been postponing reading parolee files, especially when they contain details of sexual violence. She has also been having an increasingly harder time coming into her office every day. Just looking at the desk behind which the parolee had pinned her while she was screaming for help, causes her to start sweating. Lately she has been seriously contemplating a move, either to a different parole office, or to an entirely different profession unrelated to criminal justice.

  3. Negative Changes in Thinking and Mood

    This grouping of symptoms involves negative changes in one’s thinking and emotions that start after exposure to traumatic events, and that become entrenched, habitual. They involve negative changes in one’s thinking patterns, expectations, and beliefs about oneself and/or others; the persistent experiencing of distressing emotions; and an inability to recall key details about traumatic incidents. Examples include persistent negative judgments of self or others; exaggerated or unfounded self-blame and/or blame of others regarding perceived causes or consequences of traumatic events; hopelessness; pervasive anger, fear, sadness, guilt, or shame; loss of interest in important activities or activities that were previously enjoyed; feelings of emotional detachment from others; difficulty experiencing positive emotions, such as affection, and not remembering incident details or having said or done things during a traumatic event that are on tape or that coworkers state they witnessed them saying or doing.

    Examples of Negative Changes in Thinking and Mood

    A corrections lieutenant feels like life has lost its flavor. Even pleasant family activities that he used to enjoy now feel to him to be empty, meaningless. He cannot feel affection for his own children like he used to, or compassion toward them when they get physically hurt or when they are otherwise in distress.

    A Probation Officer cannot stop feeling angry about how an incident was handled by her supervisor over a year ago. She is convinced that had her suggestion been taken, a probation-er she supervised would not have had the opportunity to rob and murder his elderly grandmother.

    A youth counselor has been feeling guilty about the injury of a coworker, holding herself responsible for it, even though her supervisor and administrators have told her that she did everything she could have possibly done to help—and by the book. She keeps re-playing the incident in her head, remaining adamant that had she gotten there just a minute sooner, her coworker would not have been stomped by a group of juveniles in the dorm.

    A corrections sergeant, who has been assaulted on numerous occasions by members of a certain ethnic group, has developed deep-rooted and hate-filled prejudices against all people of that ethnic group. He has tried talking himself out of that type of thinking, but has not been able to get rid of his sweeping negative generalizations. He feels ashamed, as the logical part of him tells him he’s wrong to think that way.

  4. Increased Arousal and Reactivity

    This refers to being ready to go off—on yellow much of the time, and ready to explode onto red at the least perceived provocation. That is, to be chronically agitated, irritable, “on edge,” and at times unable to keep oneself from going “over the edge,” quickly progressing to a “fight or flight” mode (which most of the time is “fight”). Examples include snapping at people; anger outbursts; verbal or physical aggression; reckless or self-destructive behavior (including self-injury and suicide-related behaviors); heightened sensitivity to potential threats; an unusually strong startle response; difficulty concentrating; and restless sleep.

    Examples of Increased Arousal and Reactivity

    A corrections officer feels angry much of the time. In fact, if you asked his family members, they’d tell you that’s he’s mad all the time. At work he sometimes purposely provokes inmates by staring at them and by saying humiliating things to them in front of their “homies.” A couple of times recently he confronted men in public as well, because he thought that they had stared at him disrespectfully. His wife has told him that she no longer wants to go out with him, because she’s afraid he’ll get in a fight. After particularly intense shifts he drives home at 90mph in 65mph zones, at times riding other drivers’ bumpers, screaming at the top of his lungs, and cutting them off. At home, he can see fear in his children’s eyes when he approaches them. His wife has pleaded with him to not give her “the prison look” any-more. She has told him that when he gets enraged at her, she is afraid he is going to hit her.

    After 10 years of working at a metro jail, a detention officer feels safe only when he is inside his house. He avoids going to grocery stores (his wife does all the shopping now), malls, movie theaters, concerts or the state fair—all activities that he used to enjoy prior to starting his corrections career. He also worries greatly about his family’s safety. He has installed several security devices in his home, and motion-triggered lights all around his yard. And he has hidden fire-arms and knives in secret locations in his house. He cannot sleep for more than two hours at a stretch without waking up. He feels chronically wired and tired at the same time.

In addition to the above four clusters of PTSD symptoms (intrusive remembering, avoidance of trauma reminders, negative changes in thinking and emotions, and increased arousal and reactivity), PTSD sufferers may also experience the following two types of dissociative symptoms, persistently and repeatedly. These are:

  • Depersonalization: feeling detached from oneself, from both one’s own mental processes or one’s body, such as having a sense of time moving slowly, feeling as if one’s body is not real, or experiencing events as if they were dreams;

  • Derealization: feeling as if one’s surroundings are not real, or as if the surroundings are distant or distorted.

If you identify any of the above issues in yourself, here are some suggestions:

  • Acknowledge that you are still bothered by extremely stressful situations to which you were exposed;

  • Talk to significant others, peers, or spiritual advisors about this;
  • Seek help from knowledgeable medical and/or behavioral health professionals;
  • Engage in activities that are positive, health-promoting, body-calming, emotion-calming, and nurturing physically, socially and spiritually, such as physical exercise, outdoors activities, psychotherapy, journaling, hobbies, or attending support groups or faith-based gatherings; and
  • Abstain from substance abuse or other addictive behaviors.

Do not put it off any longer. Pursue your healing!

Yes, you can work through traumatic experiences. And you can even grow in self-awareness, compassion, and appreciation of life and of relationships as a result of doing so. As many wise people have said, the greatest challenges in life also present the greatest opportunities for growth and transformation. As corrections professionals, you have jobs that on certain days may cause you to encounter the worst in life. But every single one of you also has the capacity to grow stronger afterwards. And that is one of the many things to be proud of as corrections professionals!

Here are the resources mentioned earlier: National Suicide Prevention Lifeline at 800-273-TALK (8255); Safe Call Now at 206-459-3020; and Serve & Protect at 615-373-8000. Safe Call Now and Serve & Protect serve all U.S. first responders and public safety employees, including corrections staff and their families.

[1] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5) (Fifth Ed.). Washington D.C.: American Psychiatric Association.

Please note: This series on Psychological Trauma will be continued in future issues of the Correctional Oasis.

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