Cumulative Posttraumatic Stress Disorder and Its Impact on Law Enforcement Personnel

– Robert J. Marcello, Ph.D., LCP, CCHP

Posttraumatic Stress Disorder (PTSD) can occur for law enforcement personnel in response to a single event such as an on-duty shooting, or to a series of seemingly “less traumatic” events that build-up gradually over time; for example, responding to auto accidents, domestic situations, robberies and other crime scenes that individually might be seen as “less traumatic” than a shooting situation.  This latter type of PTSD is referred to as Cumulative PTSD (1).

Per an article posted on WarriorsHeart.com: “In some ways, cumulative PTSD can be much more of a threat to the sufferer and those around them. Because the stress builds up in small amounts over time, it is easier to be ignored by the sufferer and their support structure” (1).  In addition: “Because cumulative PTSD is relatively gradual, it can make detection more difficult than PTSD from singular extreme events. Catching the symptoms of cumulative PTSD early is essential when trying to be proactive” (1).  These symptoms include irritable and aggressive behavior, sleep disturbance, difficulty concentrating, hypervigilance, exaggerated startle response, memory problems, and reckless or self-destructive behavior (2).

In a firsthand account, one police offer states that when he “began my law enforcement career in 1994, I had no idea the toll daily exposure to traumatic events would cause.  At that time, mental health was never talked about nor was it mentioned in the police academy; the attitude was to “suck it up”. He goes on to state that over time he became increasingly depressed, began self-medicating with alcohol, experienced suicidal thoughts, and was on the verge of attempting to hang himself when he was interrupted by his wife.  Further, he states that he resisted getting help due to “shame and stigma”, but ultimately did seek help, and is on the road to recovery.  He concludes by stating: “I’ve come to realize help is available and we are not alone, but at some point, we have to really take the personal step to get help. I’ve talked with friends who are struggling on the job, shared my story, but they’ve resisted taking those first few hard steps. If they do, I know there’s light and hope on the other side.  All I know to do is to continue to try, not as someone who’s arrived, but as a wounded brother just trying to lift up another wounded brother or sister” (3).

In a recent article, Dr. Michael Pittaro states: “As a nation, we are well aware of the dangers that come with policing. But we are largely unaware of the fact that our nation’s police officers are more likely to die by suicide than in the line of duty.  Let me repeat that: Police officers are more likely to die by their own hands than being killed on the job” (4).  He references an ABC News article by Luke Barr that reports: “A record number of current or former police officers died by suicide last year, according to Blue H.E.L.P., a nonprofit that works to reduce stigmas tied to mental health issues for those in law enforcement.”  And further, “In 2019, 228 current or former officers died by suicide, compared with 172 in 2018, the group announced on Thursday” (5).

On a more optimistic note, organizations such as Blue H.E.L.P., Save A Warrior (SAW), and Warriors Heart are leading efforts to reduce mental health stigma and provide resources to first responders including law enforcement personnel to get the necessary help to address symptoms of PTSD and Cumulative PTSD.  In addition to these resources, law enforcement agencies should be provided with the necessary funding to provide increased training and services for their personnel by qualified mental health professionals.  Such training and services should include preventive measures such as stress management, resilience, and increasing awareness of mental health signs and symptoms, as well as intervention resources including critical incident stress debriefing, employee assistance programs, and group and/or individual therapy when indicted.

As stated by the police officer in the firsthand account referenced previously, “Thankfully, mental health and wellness is slowly becoming a topic amongst law enforcement nationwide.  For that I’m thankful” (3).  While progress is being made, given the seriousness of these matters we need to have a greater sense of urgency regarding addressing the mental health needs of these critical first responders.

Citations

1. The Long-Term Effects of Cumulative PTSD – Warriors Heart
2. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013, pg. 272
3. “Cumulative Trauma” My Story – Blue H.E.L.P.
4. The Harmful Consequences of Labeling Police Officers | Psychology Today
5. Record number of US police officers died by suicide in 2019, advocacy group says – ABC News (go.com)