The Mental Health Of First Responders
The public has ignored for far too long the mental health of those who care for and rescue them. We have overlooked the fact that they are people first, people who can become depressed and stressed like anyone else.
First responders have an image in public, and among each other that they are tough, rugged, and ready for any emergency. But, what if that paramedic, fireman, or nurse is also a survivor of childhood trauma and lives with the effects of complex post-traumatic stress disorder?
The sturdy and unbreakable façade that many of those who are on the front lines of defending our lives leave them open for ridicule should they need to admit and seek help. They need to seek advice for stress, depression, or any of the myriad other mental health problems they may face.
Development Of The Ptsd Diagnosis
In 1952, the American Psychiatric Association produced the first Diagnostic and Statistical Manual of Mental Disorders , which included “gross stress reaction.” This diagnosis was proposed for people who were relatively normal, but had symptoms from traumatic events such as disaster or combat. A problem was that this diagnosis assumed that reactions to trauma would resolve relatively quickly. If symptoms were still present after six months, another diagnosis had to be made.
Despite growing evidence that trauma exposure was associated with psychiatric problems, this diagnosis was eliminated in the second edition of DSM . DSM-II included “adjustment reaction to adult life” which was clearly insufficient to capture a PTSD-like condition. This diagnosis was limited to three examples of trauma: unwanted pregnancy with suicidal thoughts, fear linked to military combat, and Ganser syndrome in prisoners who face a death sentence.
In 1980, APA added PTSD to DSM-III, which stemmed from research involving returning Vietnam War Veterans, Holocaust survivors, sexual trauma victims, and others. Links between the trauma of war and post-military civilian life were established.
Nostalgia Soldiers Heart And Railway Spine
Several alternative names have been used to describe trauma-linked stress disorders before the term post-traumatic stress disorder was coined. Swiss physician Dr. Johannes Hofer used the term nostalgia in the late 17th century to characterize soldiers who suffered from post-war symptoms such as anxiety, insomnia and homesickness.
TheIndustrial Revolution and the invention of the steam engine produced some of the first major human-made disasters. Physicians, confused by psychological symptoms displayed by survivors of major railway disasters, believed that the signs were caused by microscopic lesions on the spine or brain. This belief gave rise to the term railway spine. The term soldiers heart was coined after the Civil War by a doctor in Philadelphia, Dr. Jacob Mendes Da Costa, after mistaking post-combat psychological symptoms for a cardiac condition.
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Diagnostic And Statistical Manual
PTSD was classified as an anxiety disorder in the DSM-IV, but has since been reclassified as a “trauma- and stressor-related disorder” in the DSM-5. The DSM-5 diagnostic criteria for PTSD include four symptom clusters: re-experiencing, avoidance, negative alterations in cognition/mood, and alterations in arousal and reactivity.
War And Emotional Trauma
Although PTSD can arise after a variety of traumatic events, war trauma made a substantial contribution to the current conceptualization of PTSD. While the terminology for PTSD only appeared in the psychiatricclassification system in 1980, knowledge of battle-related psychological problems goes back to antiquity. Mythical Greek heroes Ajax and Hercules both succumbed to their emotional wounds, not injuries of combat. In 1688, Swiss physician Johannes Hoferwrote about an unusual grouping of symptoms in Swiss mercenaries fighting in France or Italy, which he termed nostalgia. Irritable heart, also called soldiers heart or Da Costas syndrome, was described in soldiersof the American Civil War by Jacob Mendes Da Costa, an American physician.The syndrome, a forerunner of PTSD, included unexplained cardiac symptoms, such as palpitations,chest pain and shortness of breath .
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Vietnam War Years: 1955
What Does The Research Say
Research from 2016 reviewed multiple studies exploring the link between bipolar disorder and childhood trauma. Researchers concluded that trauma didnt just increase bipolar disorder risk. It also seemed to lead to more severe symptoms, including suicidal thoughts or attempts.
In a nationwide study from 2016 , researchers used the Danish Civil Registration System to explore potential links between bipolar disorder, schizophrenia spectrum disorders, and a diagnosis of PTSD or acute stress reaction.
Their findings suggest that people diagnosed with traumatic stress had a higher risk of developing bipolar disorder or schizophrenia spectrum disorders. This risk seemed to be highest during the first year following a traumatic stress diagnosis, but it stayed high for over 5 years. Researchers also noted that the link didnt relate to a family history of either condition.
Of course, as other research points out, the link could run in the other direction, too. People often feel more impulsive than usual during manic episodes. This impulsivity can lead you to take risks that might put you in danger or cause other harm, such as:
- driving too fast
- trying an extreme sport with taking safety precautions
- getting in a fight with your boss
These experiences can cause lasting trauma when they have a negative outcome, for you or anyone else.
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First Responders Complex Post
As Americans, we have grown accustomed to calling 911 when we are in trouble. We pick up the phone, talk to an operator, and fully expect first responders to appear as if by magic and save us. However, there is a darker side to this privilege. The hidden problem of what happens to the mental health of first responders when they answer calls for accidents involving kids or, god forbid, a school shooting.
The constant exposure to death and destruction takes an enormous toll on the mental health of first responders. Yet, many of them will not acknowledge their pain. If a first responder has a history of child abuse, the effects on their mental health by responding to calls for help can lead to many complications, including death by suicide.
This article will examine complex post-traumatic stress disorder in first responders and how their vital work harms these brave souls.
How Canada Is Helping
Canada is committed to addressing PTSD. We passed the Federal Framework on Post-Traumatic Stress Disorder Act in June 2018. The Act recognizes that all Canadians can be at risk for PTSD and that a great number face higher risks because of the nature of their work.
The Act led to a National Conference on PTSD in April 2019. Experts from across the country, including people with lived experience, shared their knowledge and views. With their involvement, we have developed Canadas first Federal Framework on Posttraumatic Stress Disorder.
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Diagnosis Of Complex Ptsd
While the concept of C-PTSD is longstanding, it is not in the fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders” , and therefore isn’t officially recognized by the American Psychiatric Association .
Although C-PTSD comes with its own set of symptoms, there are some who believe the condition is too similar to PTSD to warrant a separate diagnosis. As a result, the DSM-5 lumps symptoms of C-PTSD together with PTSD.
There are mental health professionals who do recognize C-PTSD as a separate condition because the traditional symptoms of PTSD do not fully capture some of the unique characteristics shown in people who experienced repeat trauma.
In 2018, the World Health Organization made the decision to include C-PTSD as its own separate diagnosis in the 11th revision of the “International Statistical Classification of Diseases and Related Health Problems” .
Because the condition is relatively new and not recognized in the DSM-5, doctors may make a diagnosis of PTSD instead of complex PTSD. Since there is not a specific test to determine the difference between PTSD and C-PTSD, you should keep track of the symptoms you have experienced so that you can describe them to your doctor.
Treatment for the two conditions is similar, but you may want to discuss some of your additional symptoms of complex trauma that your doctor or therapist may also need to address.
Starting Jan 1 Provinces Workers Compensation Board Will Presume Condition Was Caused By Job
The Province of Manitoba will recognize post-traumatic stress disorder as a work-related disease starting Jan. 1.
It’s the first time that PTSD has been included as an occupational disease by a Workers Compensation Board in Canada.
“When a worker who has experienced a traumatic event on the job is diagnosed with PTSD, the Workers Compensation Board will presume his or her condition was caused by the job, making it much easier to access supports, treatment and compensation,” Premier Greg Selinger said in a release.
The new bill extends coverage and benefits to all workers who are eligible for workers compensation in Manitoba and who are diagnosed with PTSD by medical professional.
“This is compassionate, humane but smart legislation,” said Selinger. “It helps people suffering from PTSD — no matter what area of work they are in.”
Selinger said many people working in the province’s public service experience extreme stress, and the legislation will help get them support more quickly.
“It is a well-established fact that PTSD is an illness that worsens over time if left untreated,” said Michelle Gawronsky, the president of the Manitoba Government Employees Union — the province’s largest union.
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Causes Of Complex Ptsd
C-PTSD is believed to be caused by severe, repetitive abuse over a long period of time. The abuse often occurs at vulnerable times in a person’s lifesuch as early childhood or adolescenceand can create lifelong challenges.
Traumatic stress can have a number of effects on the brain. Research suggests that trauma is associated with lasting changes in key areas of the brain including the amygdala, hippocampus, and prefrontal cortex.
The types of long-term traumatic events that can cause C-PTSD include:
In these types of events, a victim is under the control of another person and does not have the ability to easily escape.
Us Civil War Years: 1861
- Irritable heart is used to describe PTSD in civil war soldiers.
- 1865: Unrelated to war, writer Charles Dickens wrote of experiencing “railway shaking” and a phobia of train travel after being traumatized in a railway accident, and witnessing people dying :7
- 1870: Soldier’s Heart is described by Charles Samuel Myers, a British military psychiatrist. :20,
- 1871: Da Costa, an army surgeon in the U.S. civil war, states that Soldier’s Heart involves almost constant traumatic neurosis, with some experiencing sudden paralysis or loss of sensation – now known as Functional Neurological Symptom Disorder or Dissociative Conversion Disorder.:20, ,
- 1878: Psychic trauma is a term proposed by Eulenberg for emotional shock leading to concussion of the brain.:41
- 1879: Denial of PTSD:compensation neurosis is a term introduced by Rigler following an increase in disability after railway accidents that occurs with the introduction of compensation laws in Prussia .:20
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Understanding Ptsd In Your Life
If you or someone you love has experienced a trauma and would like to learn more about modern treatment and support, Black Bear Rehab can help. Our dedicated team of treatment experts can help you and those you love get back to feeling good again, despite past traumas. Now, more than ever, it is possible to heal from PTSD. Call us at to learn more.
1 National Institute of Health. Post-Traumatic Stress Disorder. 30 June 2018.
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What Year Was Ptsd Recognized By The American Psychiatric
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What Is A Diagnosis
A diagnosis is a formal label that describes a certain set of problems or symptoms. Official diagnostic criteria describe which symptoms are necessary for any particular diagnosis. A diagnosis should help the person experiencing symptoms and should always be used in the context of a wider understanding of the persons needs, challenges and strengths when developing care plans. In mental health, diagnoses often describe a group of shared thoughts, behaviours and symptoms. Identifying these groupings helps professionals communicate effectively and, more importantly, supports research to identify what works to help people experiencing difficulties.
In some cases, a persons particular profile of difficulties may not meet the threshold for a diagnosis, but they can still be very distressing and warrant treatment.
There are two similar but not identical, recognised sets of diagnostic criteria for mental health problems:
- The International Classification of Diseases 11th Revision produced by the World Health Organisation .
- The Diagnostic and Statistical Manual 5th Edition produced by the American Psychiatric Association .
People find different kinds of meaning in diagnosis. For some people it helps them explain or make sense of the experiences they have had and the impact it has had on their lives. For others it may feel stigmatising, reductive, meaningless or result in them feeling like they are being treated as a set of symptoms rather than a person.
What Is Complex Ptsd
Complex post-traumatic stress disorder , is an anxiety condition that involves many of the same symptoms of PTSD along with other symptoms.
First recognized as a condition that affects war veterans, post-traumatic stress disorder can be caused by any number of traumatic events, such as a car accident, natural disaster, near-death experience, or other isolated acts of violence or abuse.
When the underlying trauma is repeated and ongoing, however, some mental health professionals make a distinction between PTSD and its more intense sibling, complex PTSD .
Complex PTSD has gained attention in the years since it was first described in the late 1980s. However, it is important to note that it is not recognized as a distinct condition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition , the tool that mental health professionals use to diagnose mental health conditions.
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Ptsd And The Civil War
The Civil War occurred before the age of modern psychiatry. At that time, the general consensus was that only weak-willed soldiers or persons with underlying health conditions suffered from PTSD. The horrific hand-to-hand combat was not considered a possible cause. Thus,Civil War PTSD was neither recognized nor treated at the time. However, detailed accounts of flashbacks, panic attacks, insomnia and suicidal thoughts were commonly documented among Civil War veterans.
Trauma Related To Other Events
Although post traumatic stress disorder came into the public eye through war veterans, it was later realized that the condition was not solely experienced by those engaged in military battle. Events such as sexual assault, physical abuse, car accidents, plane crashes and natural disasters like an earthquake could result in post traumatic stress disorder.
Before the full impact of PTSD became known, this type of stress was often viewed as a weakness by others. Once it was understood that the symptoms of post traumatic stress disorder was the mindâs attempt to process the traumatic event, the reality of the disorder was gradually recognized. And the proper help and treatments could be given.
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