An Introduction to Posttraumatic Stress Disorder (PTSD) Ann
An Introduction to Posttraumatic Stress Disorder (PTSD) Ann Muczynski, LCSW Erie VA Medical Center Objectives Define PTSD as a psychiatric disorder Outline PTSD symptomatology Discuss potential behavioral impacts especially related to law enforcement/ criminal activity Brief look at overlap with Traumatic Brain Injury (TBI)
What is PTSD? As defined by the American Psychiatric Association, PTSD is an anxiety disorder. The essential feature is the development of characteristic symptoms following exposure to an extreme traumatic stressor in which the person experienced, witnessed, or was confronted with actual/threatened death or serious injury, or a threat to the physical integrity of self or others. The response must involve fear, helplessness, or horror.
What is PTSD? Some examples of traumatic events we see often with Veterans may include military combat, terrorist attacks, violent personal assaults (including physical and sexual), torture, incarceration as a POW, providing medical care to the seriously injured, and morgue duties. Witnessed events common with Veterans include witnessing the violent death/injury of others and witnessing dead bodies or body parts. PTSD Symptomatology
PTSD symptomatology falls into 3 clusters that include re-experiencing, avoidant behavior, and increased arousal. Re-experiencing symptomatology (one or more): Recurrent and intrusive recollections of the
event Recurrent distressing dreams Acting/feeling as if the event were reoccurring (flashbacks) Psychological distress on exposure to reminders Physiological reactivity on exposure to reminders PTSD Symptomatology Avoidant behaviors (3 or more): Avoid thoughts, feelings, & conversations associated with the trauma Avoid activities, places, & people associated with
the trauma Inability to recall aspects of the trauma Decreased interest in activities Feeling detached from others Restricted range of affect Sense of a foreshortened future PTSD Symptomatology Increased arousal (2 or more): Difficulty falling or staying asleep Irritability or outbursts of anger Difficulty concentrating Hypervigilance
Exaggerated startle response Do you see some of these behaviors in the Veterans you encounter in the criminal justice system? PTSD Symptomatology Common associated features can include: Depression Paranoia/mistrust Phobic avoidance
Emotional disinhibition Self-destructive and impulsive behavior Dissociative symptoms Hopelessness Loss of previously sustained beliefs Hostility Impaired relationships Social withdrawal Potential Legal Implications In reviewing the symptomatology and common
associated features, it becomes readily apparent that PTSD can lead to potential legal problems. Over a number of years working with Veterans suffering from PTSD, common legal problems patients encountered have included: Various MV violations: Speeding, reckless driving, accidents, road rage Hostility-related violations: A&B, domestic violence, resisting arrest, malicious wounding, attempted murder, murder, destruction of property Potential Legal Implications Substance abuse-related violations: DUI, DIP, various drug-related violations
Dissociative-related violation: Breaking & entering, trespassing, fighting Weapons-related violations Potential Legal Implications Thinking about PTSD symptomatology as the root cause: Chronic insomnia/fatigue, decreased concentration, anxiety, recklessness, selfdestructive behavior, and irritability/anger can all lead to MV violations. OEF/OIF Veterans: exposure to road side bombs and IEDs can generalize to unusual driving
behaviors. Dissociation/flashbacks, emotional liability, paranoia, exaggerated startle/wired up, anger/irritability, and impaired interpersonal relationships can all lead to hostility-related violations. Potential legal Implications Substance abuse is unfortunately a very common way in which Veterans attempt to cope with the myriad of PTSD symptomatology, although a poor coping mechanism. Substance abuse can lead to many significant legal violations. Dissociation/flashbacks can often lead to violations of being in the wrong place such as
breaking and entering, unlawful entry, trespassing. PTSD usually impacts a Veterans view of the people and the world and often shakes the foundation of their belief systemswhat is moral/ ethical, right and wrong, and acceptable human behavior. Potential Legal Implications Suspiciousness and paranoia, as well as reckless behavior, often lead to weapons-related violations. Survivors guilt, depression, emotional numbing, and just not caring can be a recipe for illegal behavior, as well as suicide.
Additional Thoughts on TBI/PTSD In recent survey indicates that of those who have experienced a TBI, from 37 to 44% also have overlapping PTSD or depression. Unfortunately, many of our returning Iraq/Afghanistan Veterans are experiencing these co-morbidities.
Due to overlapping symptoms, legal issues associated with PTSD are also relevant for TBI. TBI/PTSD PTSD TBI Insomnia Insomnia Poor concentration Poor Concentration Depression
Flashbacks nightmares hypervigilance avoidance Headaches dizziness fatigue noise/light sensitivity PTSD/TBI What about the overlap? Think about associated legal problems.
Insomnia , poor concentration, irritability, anxiety/depression Summary PTSD can be a devastating illness affecting thought, emotions, and behaviors. Veterans of the recent conflicts diagnosed with PTSD have a higher percentage of TBI, another debilitating disorder. Left untreated, Veterans suffering from PTSD have a greater probability of becoming involved in the legal system secondary to their symptomology. Fortunately, there are excellent treatments
offered for this disorder if Veterans choose to engage.
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