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June is annually designated by the National Center for Post-Traumatic Stress as PTSD awareness month. Just as anyone can experience a traumatic event, PTSD is an outcome for many who do. About one in eleven Americans will develop symptoms of PTSD at some point in their lives.
Post-Traumatic Stress Disorder (PTSD) is a common, treatable, but often misunderstood behavioral health condition that can occur after someone experiences a traumatizing event. Talking to employees about mental health issues, like PTSD is not always easy or comfortable. It is also a condition that has the potential to impact job performance, organizational productivity, and workplace morale. Most managers want to help, but many are not sure of the best way to go about it. Here is some guidance for those who supervise and manage others as it pertains to PTSD.
A Brief History of PTSD
Let’s briefly look at the history of what we now call PTSD. The term PTSD itself was unknown until only a few decades ago. But in fact, people have probably long experienced the condition since people have always been exposed to extraordinary and traumatic events.
Throughout history symptoms that are now classified as PTSD were called by various other names related to the events that caused the symptoms. The early history of trauma related stress is tied to combat in the military and dangerous working conditions associated with the industrial revolution. The significant emotional and behavioral symptoms that were experienced by some individuals after being involved in combat situations or traumatic incidents on the job, were given various names like shell shock, war neurosis, battle fatigue, and railway spine. The medical professionals of the time had little understanding of what caused these symptoms or how to treat them. In many cases they were dismissed as personal weakness, cowardice, or lack of discipline.
Even up through the Vietnam War era in the 1960s and 70s, PTSD was still largely disregarded. A significant number of veterans were severely affected after the Vietnam war, and only after many years of research, study, and suffering on the part of war veterans were the symptoms recognized as a legitimate condition– Post Traumatic Stress Disorder– and classified in the handbook of mental health diagnosis and classification, the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition (DSM III) in 1980.
Sources of Significant Trauma
As we learned, PTSD can occur after a person experiences a very traumatic event, like being in a life-threatening situation like combat. But many other events can trigger PTSD. The word trauma comes from the Greek word for “a wound”- in this context, psychological trauma- an emotional wound or shock that causes great distress or disruption. There are many sources of trauma today, all of which can create great distress for the person experiencing the event and also have the potential to lead to the development of PTSD. The commonality is that these experiences are all extraordinary and far outside our normal routines.
Here are some examples of events that have the potential to cause significant trauma:
- Military combat
- Violent personal assault or robbery
- Childhood physical or sexual abuse
- Being kidnapped
- Being taken hostage
- Terrorist attacks
- Being tortured
- Being a prisoner of war
- Severe natural or manmade disasters
- Motor Vehicle Accidents or other severe accidents
- Being diagnosed with a life-threatening illness
- Domestic Violence
- Any event in which a person feels extremely threatened
What is PTSD?
The DSM, written by the American Psychiatric Association and used by mental health professionals in the diagnosis of patients, defines PTSD as a psychological health injury that may occur after an extremely traumatic event. The event, directly experienced or witnessed happening to another person, involves actual or threatened death, serious injury or a threat to one’s personal safety. The person’s response to the event is one of intense fear or helplessness. In children the response may vary but can include agitation or unusual behaviors.
Remember that PTSD is often described as a normal set of reactions to an abnormal experience or situation. And it is a condition that can happen to anyone, since extraordinarily traumatic events can happen in any of our lives. More about that in a moment.
Signs and Symptoms of PTSD
People with PTSD persistently experience the traumatic event in the form of flashbacks (feeling or acting as if the event is actually happening again), intrusive thoughts and recollections of the event, nightmares, or intense reactions to reminders of the event (rapid breathing, heart pounding, sweating, etc.).
These intense reactions often lead people with PTSD to avoid anything that may “trigger” a recollection of the event. This might involve the person “numbing out,” or becoming nonresponsive. The person will make efforts to avoid thoughts, feelings or conversation associated with the event and might make efforts to avoid activities, places or people that could cause them to recollect the trauma. The person can become disinterested in activities and detached from their relationships. Some people may not even be able to remember certain parts of the event. The person’s range of feelings may become restricted (like not being able to have loving feelings or being unable to feel happy about something, which prior to the trauma, would have brought them great joy).
People who suffer from PTSD also experience symptoms of increased arousal, including problems with sleep, being irritable, having angry outbursts, problems concentrating, hypervigilance and having an exaggerated startle response. The intensity and duration of symptoms can wax and wane over time.
Symptoms of PTSD
- Re-experiencing the traumatic event
o Recurrent memories and intrusive thoughts
o Intense reactions to reminders of the event
- Avoiding things that may trigger memories of the event.
o “Numbing out.”
o Withdrawal and detachment from relationships
o Disinterest in activities
o Inability to recollect certain aspects of the event.
o Restricted range of emotions
- Symptoms of increased arousal following the event.
o Difficulty falling or staying asleep.
o Irritability or angry outbursts
o Problems with concentration
o Hypervigilance- Feeling on edge and hyper alert to any danger or possible threat.
o Exaggerated startle response- Feeling jumpy or easily startled.
Other Mental Health Conditions Associated with PTSD
It is very common for other conditions to occur along with PTSD. Depression, anxiety, and substance abuse are often seen in conjunction with PTSD. More than half of men with PTSD also have problems with alcohol. In women, the most common co-occurring disorder is depression—just under half of women with PTSD also experience significant depression.
People with PTSD also have problems with daily functioning. In general, people with PTSD have more unemployment, divorce or separation, spousal abuse, and a greater chance of being fired than do people without PTSD. (Source: National Center for PTSD)
People with PTSD may also experience a wide variety of physical and medical symptoms. Some evidence suggests that PTSD is associated with increased likelihood of developing certain medical disorders, but research in this area is ongoing and it is too soon to draw firm conclusions about which disorders are associated with PTSD. There are a number of neurobiological and physiological changes associated with PTSD, including changes in brain wave activity, as well as changes in parts of the brain called the hippocampus.
The Course of PTSD
In order to be formally diagnosed with PTSD a person has to experience most or all of the symptoms mentioned earlier, for at least 1 month after the traumatic event. The symptoms also have to be causing significant distress and interfere with one’s ability to function socially, on the job, in relationships or in other important areas of life.
PTSD can develop immediately following the traumatic event, or it may also take weeks, months or even years to develop. Also, the symptoms may arise suddenly or have a more gradual course. Often symptoms will come and go over time. People who have PTSD will have good days and bad days. There may be periods of no symptoms followed later by intense symptoms due to exposure to certain triggers or because of anniversaries of the event.
As you can see, the course of the condition over time may vary greatly from person to person.
PTSD is Relatively Common
Most people exposed to traumatic events will not develop PTSD, however the number of people who do have the disorder is significant.
An estimated 8% of the adult population meet the criteria for PTSD at any one time.
PTSD and Women
Women (10.4%) are more than twice as likely as men (5%) to have PTSD at some point in their lives. According to the National Center for PTSD, there are a few reasons why women might develop PTSD more than men. Women are more likely to experience sexual assault (1 in 3 women will experience a sexual assault or child sexual abuse in their lifetime), and sexual assault is more likely to cause PTSD than many other events. Women are also more likely to be abused or neglected in childhood and to experience domestic violence. They may also be more likely to blame themselves for trauma experiences than men.
PTSD in veterans is an ongoing problem. An estimated 30% of Vietnam War veterans had or have the disorder. An estimated 1 in 5 service members who return from military operations in Afghanistan and Iraq have symptoms of posttraumatic stress or depression.
For any mental health condition, there are risk factors that create a higher likelihood that a person will develop the condition, and protective or resilience factors that reduce risks. Since we know that most people do not get PTSD after a traumatic event, you are probably wondering why some people develop the disorder and some people don’t. Researchers have identified several factors that make people more susceptible to PTSD (risk factors) as well as factors that make people less likely to develop it (known as resiliency factors).
Risk Factors for the Development of PTSD
- Being injured during the event
- Seeing others hurt or killed.
- Feelings of horror, helplessness, or extreme fear
- Having little or no social support after the event
- Presence of extra stress after the event, (loss of a loved one, pain, injury, loss of job or home)
- History of mental illness
Resilience Factors that Reduce Risk of Development of PTSD
- Having a strong social support network before the event
- Seeking out support from family and friends
- Finding a support group after the event
- Feeling good about one’s own actions in the face of danger.
- Having a coping strategy
- Being able to act and respond effectively despite feeling fear.
PTSD Treatment Options
The good news is that treatment for PTSD is available and is effective. The main treatments for people with PTSD are psychotherapy (or “talk therapy’ or counseling), medications, or both. Everyone is different, so a treatment that works for one person may not work for another. It is important for anyone with PTSD to be treated by a mental health care provider who is experienced with PTSD. Some people with PTSD may need to try different treatments to find what works best for their symptoms. VA Healthcare facilities provide specialized PTSD treatment for qualifying veterans.
Myths about PTSD
Unfounded stigma based on misinformation often accompanies conditions like PTSD—especially in the workplace. Let’s separate myth from fact.
PTSD is a new condition that is exclusive to Veterans– This is a Myth. The fact is that while PTSD is getting a great deal of attention recently, the condition is not “new” nor is it unique to military veterans.
All employees with PTSD will have violent outbursts that disrupt the workplace– Myth. PTSD develops differently in different people. Having a diagnosed PTSD condition does not mean a person poses a direct threat to themselves or others. Employees who manage their symptoms (often through medication and/or counseling) are very unlikely to pose a threat. Employers may help reduce the overall stress in the work environment or mitigate known vulnerabilities of stress by providing an environment that is open, supportive and provides job accommodations as needed. Remember most symptoms will decrease over time.
All employees with PTSD will need extensive and expensive job accommodations–This is a Myth. Not every employee with PTSD will need accommodations. In fact, most don’t need any. But when they are necessary, employers should know that workplace supports are generally low cost or no cost, and simple to implement.
PTSD and the Workplace
Although their injuries may not be visible, people with PTSD may face difficulties with employment. As mentioned earlier, these individuals may experience sleep disturbances, anxiety, and poor concentration among other symptoms. All of these have the potential to interfere with everyday activities in and out of the workplace. However, keep in mind that not all cases of PTSD are the same, nor are all severe. Again, be mindful that most people who experience a traumatic event, will not develop PTSD. Plus, man of the people who do develop PTSD will not experience any noticeable problems at work.
Employment can play a very positive role in the recovery of a person with PTSD or any behavioral health condition. After all, employment enables many people with physical and emotional disabilities to fully participate in society. For example, employment provides income that is key to the individual and family’s fundamental economic well-being and independence. Employment also builds skills for future wellbeing. It provides greater social interaction and connections that can reduce feelings of isolation. Finally, employment provides a valued social role in our society and helps to improve self-esteem that further contributes to life satisfaction.
According to the National Council on Disability, people who regain employment following the onset of a disability report greater life satisfaction and better adjustment than do people who are not employed. For these reasons, gainful employment can be one important component in the recovery and rehabilitation of people who have experienced PTSD as a result of a seriously traumatic event.
Suggestions for Managers
Let’s now discuss a few simple things managers can do to support the success of employees who have PTSD. First, employees with PTSD may experience stress differently than others and may be overwhelmed and fatigued a bit more easily than others.
Being overwhelmed by stress and fatigue can be alleviated with some simple considerations:
- Scheduled rest breaks
- Flexible schedules
- Scheduling more difficult or challenging tasks at the beginning of the day
- White noise or environmental sound machines
Concentration and Time Management are common workplace difficulties for people with PSTD. Consider the following techniques to assist employees who are having difficulties with Concentration and Time Management:
- Schedule reminders
- Checklists for tasks
- Provide clear written and verbal instructions.
- Tape recorders and note pads for memory aids.
Survivors of PTSD often have difficulty in managing the strong emotions that sometimes accompany PTSD. To assist those having difficulty dealing with the strong emotions that accompany PTSD consider the use of :
- Desktop or computer monitor mirrors to mitigate startle responses (small mirrors can be purchased to clip or tape to the computer monitor that the employee to see what is behind him/her. This can help prevent the employee being startled when someone approaches them from behind.
- Provide encouragement and moral support.
- Support the employee in pursuing treatment, even during work hours.
- Understand that the symptoms of PTSD will naturally ebb and flow.
Some Do’s and Don’ts for Managers
- Don’t assume some with PTSD needs assistance, many people with PTSD do not need any special assistance.
- Do your best to minimize high-pressure situations, as stress can sometimes affect a person’s behavior or work performance.
- People experience trauma differently and will have their own various coping and healing mechanisms. Treat each person as an individual and ask what will make him or her most comfortable and respect his or her needs.
- Be tolerant if the person repeats his or her stories and experiences and avoid interrupting.
- In a crisis, remain calm, be supportive and remember that the effects of PTSD are normal reactions to an abnormal situation. Ask how you can help the person and find out if there is person you can contact.
- Be mindful that symptoms may fluctuate and are influenced by many factors—there may be periods of ease and comfort as more challenging times. Support, patience and understanding go a long way. Be generous with these.
- Managers should also keep in mind that you may very well have another invaluable resource in situations like this- a behavioral health professional at your Employee Assistance Program (EAP). You may seek out their guidance and support for yourself as a manager through your EAP. Call your EAP to discuss your concerns and how to help an employee with PTSD and provide a supportive workplace. At Espyr we understand how valuable these consultations can be to managers, supervisors, and human resource professionals who many times are confronted with a novel and horrific event. That’s why we provide unlimited consultation to managers and to HR professionals to help them address most any kind of employee or workplace challenge. And it’s all provided by experienced, licensed mental health professionals attuned to issues around mental health and wellbeing in the workplace.
Espyr also provides other services that assist people who have experienced traumatic events. Annually, Espyr provides over 500 critical incident responses. Some may be as brief as an hour or two debriefing bank employees after a robbery; some may be a weeklong deployment as in responses after a hurricane. These psycho-educational services help to normalize reactions and provide tips about coping with personal responses to traumatic events. They also inform people about when and how to seek further assistance. Espyr’s mental health consultants also help guide, support, and provide resources to managers whose team has experienced a traumatic incident.
Espyr provides both Employee and Student Assistance Programs (EAPs and SAPs) that serve as a barrier-free means to get no cost professional assessments for PTSD. Espyr also provides screening and wellbeing assessments for law enforcement, first responders and healthcare professionals who are frequently exposed to traumatic events in their daily work. Another Espyr service related to PTSD is TalkNow, a 24/7 problem-solving and emotional support line staffed by mental health professionals that can also connect people with PTSD symptoms with resources, referrals, and assistance.
If you know someone who has experienced a traumatic event and might be experiencing PTSD symptoms, reach out. Just ask if they would like to talk. Help them start down a path to assessment and treatment that can improve their quality of life.
About the Author
Adrienne Moberg, LCSW, CEAP is the Customer Experience Manager at Espyr. Adrienne has over 15 years of behavioral health experience including in EAP, domestic violence, community mental health and substance abuse treatment settings.
For over 30 years Espyr has provided innovative mental health solutions – solutions like our AI powered chatbot, TESS – to organizations operating under some of the most challenging conditions. Espyr’s portfolio of customized counseling, coaching and consulting solutions help people and organizations achieve their full potential by providing mental health support and driving positive behavioral change. For more information on how Espyr can help your organization, call Espyr at 888-570-3479 or click here.
National Center For PTSD. https://www.ptsd.va.gov/
Veterans Employment Services. https://www.dol.gov/agencies/vets/veterans/veterans-employment-services