Nancy Davis PHD - Common Symptoms of Job-Related Trauma and PTSD

Photos by Jim MacMillan, Philadelphia Daily News

"The only real mistake is the one from which we learn nothing."

John Powell

If you develop Post Traumatic Stress Disorder/Job Related Trauma, you may find that problems and symptoms appear immediately following a traumatic incident or these symptoms may appear weeks or months after a traumatic incident. Symptoms can also be cumulative, in that they slowly increase in intensity as each additional job-related traumatic incident is experienced.

Although each individual may experience PTSD differently, the following are the most commonly reported symptoms and descriptions from individuals describing them:

Job-related trauma commonly causes sleep problems. Sleep difficulties which result in chronic sleep deprivation are a defining symptom of PTSD (NCPTSD; 2002, Ross, et al., 1989). Problems sleeping take many forms. You may not be able to make yourself go to bed, you may lay in bed for hours before falling asleep, you may go to sleep immediately after getting in bed, but wake up two to four hours later and find yourself unable to go back to sleep. You may wake up a dozen or more times a night. As you sleep, you may be very restless, throwing yourself around during sleep. You may find that you are experiencing less than four hours of deep and restful sleep each night. If sleep problems continue for more than a few days, the sleep-deprivation that results will negatively impact virtually all other areas of your personal and professional life.

“He had lots of trouble sleeping. The first month, he had a lot of nightmares; then, about once a month, he would yell out and became frantic in bed. He also jerked in his sleep, especially in his legs. If I tried to wake him up to stop the nightmare, or bumped him in his sleep, he was instantly and loudly awake. If he fell asleep on the floor, I could not wake him up gradually … he startled awake.”
"During my tour in Irag, I slept like a baby. I was exhausted every night. After I got back to the States, I started having problems sleeping. Now I wake up at three or four in the morning and can't get back to sleep. I'm only getting 3-4 hours of sleep a night and it's killing me."

You may have one or more flashbacks of job-related incidents. The flashbacks are often so vivid it may seem like you’re back at the scene. Flashbacks may be so frequent that they occur a hundred times a day or as few as once a month. Although many flashbacks consist of visual images of a traumatic incident, they may also take the form of a particular smell, taste, sound and/or body sensation related to the incident. Flashbacks may occur as you sleep and be experienced as nightmares or night terrors. Occasionally someone will act out a nightmare.

“I was standing there when the Twin Tower buildings collapsed. I knew how many people were in there. Half the guys in my station were in the buildings. I keep seeing the buildings come down and imagining what they must have thought. It happens all day.”
“When we arrived, the townhouse was totally involved in the fire. I could hear a child screaming form inside the townhouse, but I couldn’t get to him. I tried, but the fire was too advanced. Then the cries stopped. After the fire was out, I saw his body; I can’t get it out of my mind. I keep thinking that it was my job to help him and I didn’t save him. I hear his screams all day and night … they keep me awake.”
"Whenever I take a shower, I have to see the scars on y chest and arms where he shot me. It reminds me of everything; I see my wife on the floor, her blood eerywhere. I see my daughter screaming. I hate how it makes me feel. It colors everyting I do and say and feel and think."
"Two of my friends were in the truck when the RPG exploded and tore them apart. Pieces of their bodies were blown everywhere. I had to clean this up. Now, I get the feeling that I had then. Pictures of the explosion, the blood, their body parts come into my mind. It feels like it just happened this morning. I have no control over it."
“I saw a woman’s hair sticking up. I ran and pulled it up. It was attached to the front of her face; everything else was gone. I still see it every time I shut my eyes.”
“It’s like I get the feeling that I did then. Pictures come in my mind. It feels like it just happened this morning. I have no control over it.”
“Whenever I take a shower, it reminds me of everything in the event. I hat how it makes me feel. It colors everything I do and say and feel and think.”
“I try not to think about it, but I can’t. It never leaves my thoughts.”
“He’s shooting at me and I’m trying to get away, but I can’t move. I try to fire my weapon, but it won’t fire. I wake up with seat all over my body.”
“I have a reoccurring dream that a child is calling for my help and I can’t get to him and the monster that has him murders him. I have it again and again. I’m screaming and it always wakes up my wife. She tries to comfort me, but I don’t want to go back to sleep because I don’t want to have the dream again.”
“I can be walking down the street and suddenly I hear a loud noise and hit the ground. I don’t think I just react; if I hadn’t dropped like this in Iraq, I would be dead. When I realize the noise was from a dumpster dropped by a garbage truck I’m embarrassed."

You may have flashbacks that interfere with job performance.

“When I’m giving my lecture on accident reconstruction, I focus on a particular part of the slide and my mind goes blank. The slides that make my mind go blank are of accidents that really bothered me. I have to cover it up and continue to talk. I don’t know if anyone notices or not.”
“When we drive by a crowd, the incident flashes in my head again and again. I get the sweats. I don’t pay attention. I do anything to avoid going out on calls where there are crowds of people. I’m calling in sick to avoid coming to work. I can’t get the attack out of my head.”

You may have difficulty concentrating, reading, writing or doing anything that requires that you pay attention. Your mind may seem to be racing.

“I do anything to avoid writing my reports. I take long lunches, make phone calls, and do anything that requires physical activity and moving. I just can’t make myself write them.”
“I couldn’t concentrate or read. I wasn’t interested in anything. I just sat in the dark and smoked.”
“My mind was always racing and on a thousand things; I would be hearing someone’s voice, but I would be thinking about all kinds of other things.”
“Ever since that incident, my husband would say, “You’re not listening to me—I just told you that.” But he hadn’t just told me that. I think he must have been thinking the words in his head, and thought he said them to me, but he didn’t. If I wanted him to listen to me, I had to make direct eye contact with him to make sure he was listening, or he wouldn’t hear me. He was in his own world.”
“I bought all these books because I know I will be home at least six months recovering from my wounds. But I can’t read; I’m a college graduate and I can’t read. I read the first sentence and I think of something else. I feel like my mind is racing. It’s the comprehension; I’m losing it.”
"I left the Marines after my tour in Afghanistan and decided to take more college courses. It's not the same; I'm not the same. I have trouble concentrating on the assignments. Reports are the worst. Writing papers used to be easy for me, but I can't seem to get myself together when I write now. My husband edits my papers and tells me, 'This is a disorganized mess.'"

You may feel as if you are falling apart.

“I over-react. I never feel calm. Things are bothering me. I feel on edge all the time.”
“He used to be the first one to work; then he was brutally attacked by two thugs. Everyone said he was an agent’s agent. Now he comes in late, he looks sloppy; he doesn’t want to do anything. He keeps asking, “What’s wrong with me?’”
"People ask me, 'How was it in Iraq? What did you see?' I tell them 'nothing.' I feel like I am holding myself together with rubber bands and if I tell them what I saw over there, I will lose control. It takes everything I have to hold myself together."
"I am in a dark world and I can't find my way out."

You may have survivor guilt.

“Ten of my friends died when the building collapsed. They all had families and kids. I’m single; I should have died in their place. They were fighting the fire; they were running up the stairs. I was working the fire, too, but they died and I didn’t. I’m glad I survived, but I feel guilty for being alive.”
“I hate it when people call me a “hero.” I’m not a hero; my partner died at the scene. I should have shot the b…… before he shot my partner; I should have done something to save Chris. He died in my arms. I keep running the scene of the shooting and Chris dying over and over. I see his wife and kids falling apart at his funeral. I keep getting reminded of what happened. I don’t want to go to memorial services and I am not a hero. I should have been the one who died.”
"All I ever wanted to do was be a police officer. I loved my job; my partner and I were best friends. I trusted him; he trusted me. Since that asshole killed him, I just want to quit. On the day he was shot, I was at the dentist, on sick leave. It's my fault he's dead. If I hadn't taken sick leave I would have been there for him. He wouldn't have died. It's my fault he's dead."

You may find you are often angry and that this anger is causing problems for you.

“After I came home from working OK Bomb, (the bombing of the Federal Building in Oklahoma) I didn’t talk about what I went through with anyone. I wanted to forget it, but my mind wouldn’t let me forget. I kept getting pictures flashing in may mind that pulled me back there. One day when I was testifying in court, I got in a fight with a defense attorney. We were screaming at each other. I used to be so calm and let everything roll off my back. The judge wrote a letter to my supervisor. That’s why I’m here for treatment.”

You may pull away from the people you care about and feel as if there is a wall around you that distances you from other people. When this happens, you may stop talking to family members, friends and peers. When others are talking to you, you may think of things to say to them, but find it’s too much trouble to communicate. You may feel numb, and find that you don’t feel any positive feelings, even love. You may lose your sense of humor and have little interest in activities that you used to find enjoyable.

“Since it happened, I don’t feel anything for anyone. I feel numb except I do feel love for my daughter.”
“I feel shut-down. I don’t have anything to say. I can’t join in conversations. It’s as if I am stuck in a dark hole that no one can see but me.”
“My partner will start talking to me … I’m hearing him, but it’s like an echo. My mind’s thinking a million other things.”
“I didn‘t tell you this. I stopped eating. I stopped drinking. I stopped talking to my family and friends. I thought I could handle it alone, but what happened just kept going over and over in my head.”
“In the morning, I pretend I’m asleep so I won’t have to talk to my wife. I just don’t feel like talking. I’ve turned to another woman on my squad; she really listens to me and she really understands what I have been through. I love my wife, but I just feel like I’m pulling further and further away from her.”
“I felt as if there was a wall between me and everyone else and I wanted to stay behind it. I wouldn’t talk to my family. I would think of things to say, but it was too much trouble to say them. My husband would ask, ‘What’s wrong with you?’ and I would respond, ‘Leave me along!’ I refused to go on vacations with my family, I stopped going out with friends. I didn’t return phone calls. I just couldn’t make myself do it. I stopped laughing. I didn’t realize how withdrawn I had become.”
“My friends and family call me, but it’s just too much trouble to call them back. I let the phone ring and don’t pick it up and sometimes I don’t even listen to my messages. It’s like the part of me that used to talk and joke with friends and family is dead. I just want to be left alone.”

You may have memory problems.

“I would start to tell a story and after the first sentence, I would forget what I was going to say. It happened all the time. I was afraid to talk to anyone.”
“My partner would call me to back him up. There were only two of us in that office, and it was me to back him up or no back up. First, I would get in my car and start driving. Then, I’d forget where I was going and what I was supposed to do. I’d turn the car around and I’d go home. He could never depend on me.”

You may become obsessed with working while you neglect other activities that you used to enjoy.

“I’m down at the Firehouse every day. I stay long after my shift is over. I volunteer for anything and everything. I’m obsessed. I really don’t care about anything except working. It’s killing my marriage.”
“I try to listen to my wife and kids talk about the problems they are having, but they talk about such trivial things. Day after day I deal with murder and torture of innocent victims by the most vile and evil people in the world. I can’t stop thinking about these victims and how I have to find ways to save future victims from having the same fate. I don’t want to talk about my cases to my family, so I withdraw and spend more and more time working and less and less time with them.”

You may find that you are too impatient to do the normal activities of everyday life, such as listening to your family talk about their day, standing in lines or paying bills.

“He lost patience. He couldn’t tolerate standing in line, being stuck in traffic, doing the normal things that make a family fun, like paying bills. We had shared the duties, but I had to take over all of them. He thought most things weren’t important enough for him to participate in. It was as if this event was so important that nothing else could compare, so he didn’t want to hear the normal every day problems of me and the children. I started having to handle them all.”
“When driving, he was more rigid, forceful and impatient. He drove faster and the safety zone between him and the car in front of him disappeared.”
" My wife planned a trip to Disney World to celebrate my return from Iraq. She doesn't understand that I'm different than I was before I was deployed there. The things that upset her and the kids seem so unimportant compared to what I have been through. We were standing in line for Space Mountain and my kids started complaining that the wait was too long. I lost it and yelled at them, 'This is nothing; have you ever seen someone dead? Have you seen pieces of a friend after a bomb exploded their body? You should be ashamed of yourselves acting this way over nothing.' They just looked at me. My wife got this strange look on her face. I feel like I am no longer a part of their world'; you have to have been there to get it."

You may find that you no longer feel safe and/or you are obsessed with the safety of your family. You may avoid activities that you enjoyed in the past because you no longer feel safe or become over-protective or controlling with family members.

“I don’t want to fly on an airplane; I don’t want to take the train or the subway. I’m afraid to let my family leave the house. I didn’t use to be afraid of anything, now I’m worried all the time.”
“Every night I wake up two or three times and check the locks on the doors and then my kids. The doors are always locked; my kids are always safe and asleep. I know it’s crazy but I can’t help myself.”
“My daughter says I am her prisoner. I know that my rules on when she can leave the house are unreasonable, but she doesn’t’ understand what can happen out there to a beautiful young girl. I keep seeing the bodies of teenager girls who had been raped and murdered in my head, cases that haunt me. I know what those girls went through before they died and I can’t bear the thought of my daughter dying in that way.”
“I saw the gas meter man and I thought it was someone trying to get in my house. I got my gun and barricaded the door. I positioned myself at the side of the window. When I realized who it was, I felt stupid.” (Law enforcement officer recovering form being shot.)

You may believe management is against you, that everyone wants you to quit or thinks that there is something wrong with you.

“I thought everyone in the office was against me, talking about me, trying to get me fired or put on disability retirement.” (Officer who indicated he had only been sleeping an average of 2-3 hours a night for 10 years.)

You may not want anyone touching your personal property. You may make evaluations through emotions, rather than judgment and thinking things through.

“My brother came to visit me. I didn’t’ want him there. I watched him all the time and I wouldn’t tell him anything. He kept asking questions.”
“Someone put their coffee cup on my desk and I went nuts. My partner wanted to put some of his papers in my filing cabinet and that really upset me. He’s my best friend, but I was upset about sharing my space.”

You may find that you no longer think about the future and have problems making decisions, especially those involving personal matters. Your imagination and problem solving skills may seem to become frozen.

“I used to plan what I would do when I retire; I’d picture a cabin in the woods, and I’d be fishing. I don’t think about the future anymore. I don’t care about the future.”
“My supervisor said that I can get out of this office and move to another one. This office reminds me of the shooting but I can’t decide what to do. I want to go, but I just stay here.”
“It’s like running on a treadmill and grasping for something to latch on to gain control, but I can’t grasp anything and I can’t get control. I feel like a gerbil running round and round on an exercise wheel --- running as fast as I can but getting nowhere.”
"On Thursdays, everyone is planning what they are doing for the weekend ... like fishing or bowling or getting together for a bar-b-que. They ask me, "Want to join us?' I tell them I have something planned, but I don't. I want to say I'll join them, but I don't."
"Even though my wounds have healed, I am not healed. I can do the things I used to do, but I can't do new things. A friend asked if I wanted to go shopping with her. She was pushing me to get new things. I couldn't make a decision. I didn't buy anything. How do you explain that you can't decide?"

You may start drinking too much, because it initially numbs the symptoms you are experiencing. Research has shown that the workers who increase their alcohol intake following a traumatic incident are typically those who were most impacted by the incident and if this increase in alcohol use continues, it is predictive of the development of PTSD.

“Since that night, every night after work, I go out with my buddies and drink. I can’t go home without drinking. I’m drinking now on my days off. I have to drink to get to sleep.”

You may begin to think about suicide or engage in dangerous and life-threatening behaviors.

“When we get to a fire, I rush in; I do things which I know can get me killed. I don’t care.”
“Every time I’d put my weapon away, a voice in my head would say, ‘just do it’. I’d put the gun in my mouth, but I’d get a picture of my son finding my body and I couldn’t do that to him. I’d put my gun away, but the voice would talk to me the next evening and I’d have to fight it again.”
“I know I’m taking chances and doing all kinds of dangerous things. It’s driving my Chief crazy. I figure if I die, I die. That way life takes care of it. I don’t really care if I die, but I’m not going to kill myself.”

You may have physical problems as a result of being traumatized. These include high blood pressure, increased heart rate, pain (especially in back and head) and gastrointestinal problems. You may get sick a lot. These physical problems are the result of high levels of hormones that occurred during and following the trauma. Elevated cholesterol, low-density lipoprotein, triglycerides and reduced high density lipoprotein have also been associated with chronic PTSD.

“I’m on blood pressure medication, my heart keeps skipping a beat, and I sleep so little that my wife won’t let me sleep in the same room with her. I’ve got headaches and I have to pop Tums all day.”
'I'm in great shape; I run for an hour five days a week. I work out at the gym. But when I went for a physical yesterday, the doctor said, 'Your pulse is really high.' (An increased pulse rate is one symptom of PTSD) physical problems.

PTSD can cause a profound negative impact on many systems of the body as a result of these biological changes:

The cardiovascular system.
Higher resting and sleep rates.
Higher diastolic and systolic blood pressure, blood pressure variability and long-term hyper-responsiveness of blood pressure.
Elevated cholesterol, low-density lipoprotein, triglycerides and reduced high density lipoprotein-when PTSD is chronic.
Nonspecific ECG abnormalities, atrioventricular conduction defects and infarctions.
A compromised immune system, leading to illness infections, tumor development, slow wound healing, and the tendency to get sick when stressed.
Chronic pain, back problems, headaches, gastrointestinal problems. 95% of fire fighters and paramedics indicated that they had a pain complaint in the week prior to the study (Beaton, Murphy & Pike, 1986). A survey of law enforcement officers not identified as experiencing PTSD found that in the month prior to the survey, 26% had headaches, 43% had backaches, and 22% had digestive difficulties (Richardson, 1994).