The Reality of Cumulative PTSD

Cumulative post-traumatic stress disorder (PTSD) is more common than one would think, particularly among first responders like police officers.  Sometimes called “complex PTSD,” it’s hard to detect because it builds up subtly and insidiously, and can be harder to treat than critical incident trauma.

“Critical incident trauma” is the shock on the mind of a single incident that threatens the life and/or emotional safety of the individual, such as a shooting or watching helplessly as a person burns to death in a car.  Cumulative trauma, on the other hand, is a series of events, often spread over the years, which build up—examples can include a history of screams and violent accidents, dealing with dead and mutilated bodies, desperate fights and suicides.

It’s easy to spot the critical trauma—we call them “headliners.”  They’re like a Mack truck running over you, horn blaring.  Everyone knows you’ve been through this kind of an incident.  Often the media respond, supervisors come, peer support officers may show up, and it’s generally apparent to everyone that you’ve gone through an incident that can affect you emotionally.  In many departments, debriefings are held for those involved and follow-up, such as therapy, may be recommended for those who appear to have been impacted.  Often, these steps are sufficient to prevent a debilitating onset of PTSD.

Cumulative trauma, on the other hand, can actually be more difficult to treat than critical incident trauma because its origins span a greater length of time, involve more incidents and are much more deeply ingrained.  We often compare cumulative trauma to bumblebee stings—one or two are painful, four or five are highly disconcerting, and more than these can require a trip to the emergency room.  Similarly, the events involved in cumulative trauma build up until the mind is overwhelmed and help becomes essential.

A tree in the forest, strong as it might be, is not felled by one stroke of an axe.  It takes numerous swings and chops before it finally topples and falls.  So it is with cumulative trauma—the “strongest” officer can eventually fall prey and suffer emotional damage.

Again, this is common in law enforcement.  Make no mistake about it, however.  Both critical incident and cumulative trauma can take their toll, the latter often not until retirement or separation from the department.  This only makes it worse, particularly if the individual doesn’t know what to do with it.

What defense do we have against cumulative trauma, in particular?  If we wait too long in our career until the events catch up with us, the path can be difficult to navigate.  Post-traumatic stress disorder of either kind is, in fact, rarely “cured,” but it can be managed in such a way that one can again lead a quality life and continue to pursue a healthy career in law enforcement.  It need not result in a disability and the loss of one’s career if it’s treated effectively.

Instead of just “waiting for it to happen,” however, there’s a thing called, “prevention.”  This is a set of steps one can take during one’s career to keep the effects of cumulative (and even critical) trauma at bay and safeguard your career.  This gets into what we like to call “annual mental health checks” (MHC’s) for police officers.  Designed almost ten years ago by Badge of Life, these entail officers approaching mental wellness in the same way they do their physical exams with a doctor, once a year, and their periodic trips to the dentist to fix and prevent cavities.

It’s an individual thing, not mandated by your department or even known by them.  You do it on your own, once a year for as little as one hour.  The steps are simple—you schedule a visit with a licensed therapist and go in to look at the past year, see what has been working well and what hasn’t, and what can be improved upon. This is not just for officers “with problems,” it’s for all officers, regardless of rank (five police chiefs committed suicide in 2016). If your department has an employee assistance program with therapists, you may wish to pursue it there, at no cost.  You may elect to utilize the services of a departmental psychologist if your agency has one on contract.  If you’re leery of either because of confidentiality, go to the outside where confidentiality is more assured.  Your department need not know.  The key is, these visits are voluntary (departments should encourage but not mandate them) and they’re a chance to keep abreast of what’s going on with your mental health.

Granted, one visit may lead to more if you need them to defuse, but they may be necessary and you should accept them for the benefits you can derive.  Put aside the stigma of seeking help to contend with the psychological impacts of this job.  After all, your mental health is just as important as your physical health.

An average of eleven police officers commit suicide every month, and 15 to 18 percent of law enforcement personnel are thought to be suffering from symptoms of PTSD.  Much of this is preventable with a few easy steps, and you need not lose your career.

Make the jump to good health.

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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