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PTSD: The Hidden Injury

PTSD:  The Hidden Injury

Posttraumatic stress disorder (PTSD) is often called an “injury” because it actually causes dysfunction in parts of the brain that control memory (the hippocampus) and fear (the amygdala).  This causes them to operate at cross-purposes, leading to a host of often disabling symptoms.

Nonetheless, PTSD is a hidden injury because it leaves no visible scars, such as those left by a gun or knife attack.  There are no broken limbs from PTSD alone and the victim is not confined to a wheelchair.  They walk, they talk and often act in ways that seem “normal enough” yet, inside, they are a cauldron of disturbing thoughts, emotions and anxieties.

Where does PTSD even come from?

As the name implies, of course, it comes from that thing called trauma.  To understand this, however, one must recognize some simple definitions.  First, “stress” and “trauma” are two entirely different things—yet we tend to use them interchangeably as though they mean the same thing.  Stress alone does not cause PTSD—stress is a routine, daily part of life. It can even help you get that promotion you’ve been seeking, finish a marathon, or plan a vacation.  It’s “a state of mental or emotional strain or tension resulting from adverse or very demanding circumstances,” and can result in an abundance of stomach problems, headaches and ulcers. Over fifty percent of doctor’s visits are from stress related conditions and ailments.

“Trauma” is entirely different.  Put simply, trauma is “the result of a perceived threat that exceeds one’s ability to cope.”  It goes far beyond mere stress alone.  The person senses a life-threatening danger physically or emotionally from an event or events.  There is a sense of helplessness that goes with it, far exceeding that experienced from mere stress.  This is where PTSD comes from.

It’s important to remember that there are two types of trauma that result in PTSD, however—critical incident trauma (such as a gunfight or violent child death) and cumulative trauma (a series of events, such as accumulated screams, fights, or repeated exposure to disastrous scenes).

We’re all familiar with the trauma that results from a critical incident—it can be compared to a Mack truck running over you on the highway.  It’s a “headliner,” in which everyone in the office—and even the public—knows you’ve been involved in something traumatic.  Help is, in many cases, immediate.

Cumulative trauma is more insidious, however.  A good comparison is a bumblebee sting.  One is irritating, two or three are more painful, and too many stings require medical attention.  Cumulative trauma may show itself at any stage of a career and can build over the years, sometimes manifesting it just before—or after—retirement.  It can be just as destructive to the psyche as critical incident trauma.  Help is usually delayed or non-existent because the onset is unseen.

How do you know if you’re suffering from one of these injuries?  There are a few characteristics that are common to both.


Nightmares and night terrors

Uncharacteristic anger and displays of temper

Substance abuse




Scattered thinking

Suicidal thoughts

For law enforcement, there are two keys to avoiding the impacts of critical and cumulative trauma: prevention and treatment.  “Prevention” means doing something proactively for yourself.  One must first recognize that police work is one of the most toxic, caustic career fields in the world.  It is rife with potential trauma.  One must—and can—head off the trauma before it impacts you permanently.  This is why we at Badge of Life recommend a voluntary, annual “mental health check-in” with a licensed therapist of your choice. You do this with the same diligence as seeing your doctor once a year for a physical exam or your dentist for a cleaning and dental check.

To do this, you may want to choose your department’s psychologist, if there is one, or partake of the services of your employee assistance program.  Some officers are suspicious of these avenues, however, and if you fit that category we recommend you go “outside” a select a therapist on your own or as recommended by others.  Here, with a small co-pay, your confidentiality is absolute (unless you’re a danger to yourself of others).

Having a checkup like this is for “healthy” officers as well as those experiencing problems—it’s an opportunity to look at the past year, see what has worked well and examine what hasn’t.  It’s a chance to identify any trauma that has occurred or is in the process of catching up with you.  It’s an occasion to do something good for yourself and counter the unhealthy things you’re running into on the streets.

If you need help—if the anxiety, sleeplessness or other symptoms are catching up with you, don’t delay.  This is where “treatment” comes into it.  Get help for yourself as soon as possible.  Doing so can save your career.  Getting help can mean seeing that licensed therapist and, if they so recommend, getting the services of a good psychiatrist for medications.  PTSD and depression go hand-in-hand, and a simple anti-depressant combined with therapy can make the difference between a long, healthy career versus a disability retirement or discharge.

If you find yourself in immediate danger, such as contemplating suicide, call the National Suicide Prevention Lifeline.  They’re staffed by compassionate professionals who are local to you, will listen, and can direct you to appropriate assistance.

You owe these things to yourself.  Fifteen to eighteen percent of police officers in the United States are estimated to suffer the symptoms of PTSD.  You needn’t be one of them, but if you are, there are some things you can do about it.

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About The Author


Andy O’Hara is the founder and a board member of the Badge of Life organization. Andy has co-authored one book and has written numerous articles for publication. He is an advanced peer support officer, working with individuals to find appropriate help and ways to deal with law enforcement issues. Andy is a 24-year veteran of the California Highway Patrol, was suicidal and retired with PTSD.

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