Police Stress vs Trauma--a Difference? Badge of Life

Badge of Life Police Suicide Prevention

Is there a difference between “stress” and “trauma” in police work? Absolutely.

When we’re dealing with police mental health and suicide, it’s important that we understand and be able to communicate exactly what it is we’re talking about. One of the terms constantly, and casually, thrown around is the word "stress." In police suicide prevention programs and literature, "stress" means everything from your dog, Spot, getting loose in the neighborhood to the multiple fatality accident that happens before your eyes.

There are several reasons for this. "Stress" is a nice, polite term. No one chokes on their coffee when you say they might experience stress on their next shift. Everyone knows they won't commit suicide because of stress--only the other guy will.

So we can slide things by very smoothly. Be aware of the signs of stress and suicide--and watch for them in the other guy.

That's ok if that's all you want to do, but we suspect the truly well intentioned instructor and peer support officer really does want to get the true message of mental health across. And to do that, we have to speak clear english.

The key is this: “Stress happens.” Trauma “happens to you,” and can kill you.

STRESS: “Stress” is an everyday occurrence in every occupation and at every age. Stress happens in learning, in household work and hobbies, in negotiating traffic, and in our everyday work. Stress is inescapable. It happens at varying levels. The salesman, the pool sweeper, the cop and the candlestick maker all feel stress during their days. Eustress, we know, is “good stress” exhibited in preparation for an athletic event, positive activities or goal planning. Everyday negative stressors can be managed through a variety of well-known methods, such as good diet, moderation in habits, regular exercise, hobbies, a class in organization, or even self-help books. Kevin Gilmartin’s book, Emotional Survival for Law Enforcement, for example, contains good lessons on dealing with everyday stress and relax from their job by utilizing personal planning calendars for family activities, engaging in exercise programs and controlling spending patterns.

TRAUMA: Unlike stress, no amount of good dieting, exercise or planning calendars, however, will keep emotional trauma from playing havoc on your mind. The trauma that causes PTSD is not simply an injury to one’s “feelings.” It is physical as well as emotional—damage is actually done to the brain.

Stress does not lead to PTSD or suicide. Trauma leads to PTSD or suicide.* The trauma can be one incident or the incidents can be cumulative. The “critical incident” has distinct advantages, as a “headliner,” because everyone takes notice and CISM teams jump into action. The odds of swift therapy and recovery are enhanced. Cumulative or mixed trauma, on the other hand, takes place over years and is a “witch’s brew” that can lead to a lifetime of nightmares.

The only part that’s a little tricky to remember is that the DSM-IV draws a timeline on the length of the trauma, for purpose of diagnosis. According to 308.3 of the DSM-IV, if a person has been traumatized by an event and the symptoms last “a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the traumatic event,” it is called, “Acute Stress [sic] Disorder.” Simply put, it then becomes PTSD if the trauma (not stress) lasts longer (see below, 309.81 Posttraumatic Stress Disorder ).

CONCLUSION: We need to be clear in our terms. If we’re talking about stress, let’s talk about it: the patrol cars aren’t being serviced often enough, we don’t like a certain policy, or we’ve had to work three holidays in a row. We can certainly help an officer talk these things out. Perhaps we’re approached by an officer whose teenager is rebellious and staying out late. This is stress.

When we learn the officer’s teenager has been killed, however, we are dealing with a trauma.

If we, as educators and peer support officers, are careless in our terminology, we will only feed the confusion that has kept police mental health and suicide prevention a world of unnecessary mystery and confusion. Let’s make sure we’re clear on what we’re talking about.

*With any disorder is the possibility of co-occurring depression and other disorders.

Further reading on: Breaking the Mold.

Badge of Life Police Mental Health

____________________________

Diagnostic criteria for 308.3 Acute Stress Disorder
A. The person has been exposed to a traumatic event in which both of the following were present:

(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
(2) the person's response involved intense fear, helplessness, or horror

B. Either while experiencing or after experiencing the distressing event, the individual has three (or more) of the following dissociative symptoms:

(1) a subjective sense of numbing, detachment, or absence of emotional responsiveness
(2) a reduction in awareness of his or her surroundings (e.g., "being in a daze")
(3) derealization
(4) depersonalization
(5) dissociative amnesia (i.e., inability to recall an important aspect of the trauma)

C. The traumatic event is persistently reexperienced in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or distress on exposure to reminders of the traumatic event.

D. Marked avoidance of stimuli that arouse recollections of the trauma (e.g., thoughts, feelings, conversations, activities, places, people).

E. Marked symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness).

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience.

G. The disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the traumatic event.

H. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition, is not better accounted for by Brief Psychotic Disorder, and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.

Diagnostic criteria for 309.81 Posttraumatic Stress Disorder
A. The person has been exposed to a traumatic event in which both of the following were present:

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma
(2) efforts to avoid activities, places, or people that arouse recollections of the trauma
(3) inability to recall an important aspect of the trauma
(4) markedly diminished interest or participation in significant activities
(5) feeling of detachment or estrangement from others
(6) restricted range of affect (e.g., unable to have loving feelings)
(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hypervigilance
(5) exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more

Specify if:

With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

police stress managment police suicide police mental health police stress ptsd trauma badge of life mental health check law enforcement emotional self care statistics officer suicide police peer support training therapy counseling police suicides study studies NSOPS national numbers rate rates percent EAP employee assistance posttraumatic stress disorder danger stigma national memorial NLEOMF suicides among police officers deaths line of duty