“Law enforcement is a popular career among veterans returning to the civilian
workforce – nearly 19% of police officers are veterans.1 The connection between the two is not surprising, as both jobs entail similar ideals and skill sets. The relationship between military service and subsequent employment in law enforcement also carries with it the consequences of military-related post-traumatic stress disorder. With such a prevalence already found in veterans, it is unavoidable that police officers also experience higher rates of PTSD as well.
Written By Autumn Barnes, MD
Medically Reviewed
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01
What is PTSD?
PTSD is a chronic, multifactorial disorder that follows exposure to traumatic events. The term post-traumatic stress disorder was first coined in 1980, in the Diagnostic and Statistical Manual, 3rd Edition (also referred to as the DSM-3, the diagnostic publication used by medical professionals to diagnose mental health conditions). In 2013, the DSM-5, the current edition, developed a checklist to use for a PTSD diagnosis. According to the DSM-5, PTSD encompasses 20 symptoms that fall into four distinct clusters that occur after exposure to the trauma, including:2
Intrusion
Recurrent, involuntary distressing trauma memories and dreams
Dissociative reactions and flashbacks
Intense or prolonged psychological distress
Marked physiological reactions
Avoidance
Avoidance of internal and external trauma reminders (such as memories, thoughts, feelings, people, places, activities)
Negative cognition and mood
Amnesia related to trauma
Persistent, exaggerated negative beliefs and distorted cognitions lead to inappropriate blaming of self or others
A persistent, negative emotional state
Loss of interest or participation in significant activities
Detached or estranged feelings from others
Persistent loss of positive emotions
Hyperarousal
Irritability and angry outbursts with little/no provocation
Reckless or self-destructive behavior
Hypervigilance
Exaggerated startle
Concentration problems
Sleep disturbances
Additional symptoms include clinically significant distress or functioning impairment, as well as symptoms lasting for longer than a month that are not attributable to any other medical condition or substance.
The qualifying trauma exposure includes direct exposure to trauma, witnessing others’ traumas, learning of a close family member or friend being exposed to trauma, or repeated or extreme exposure to aversive details.
In PTSD, multiple structures in the brain are altered to induce a state of hyperactivity. The amygdala, the structure responsible for fear responses, is hyperexcitable and its ability to detect threats and expression of fear is amplified in those with PTSD.4 The periaqueductal grey (PAG) orchestrates the physiological responses, such as heart rate, that work in excess with PTSD.
02
PTSD and Violence in Police Officers
Police officer sitting with head down
Studies have shown that military police officers with combat experience were less likely to utilize positive coping skills than non-military police officers, despite a higher rate of life-threatening events in the latter. Other studies have found an association between a particular gene variant with increased risk for PTSD in previously traumatized police officers, suggesting veteran officers are at an increased risk of moral injury than their civilian counterparts.9
Those suffering from “moral injury,” a term used to describe the trauma of experiencing ethical dilemmas when on the job, are also associated with further lapses in ethical decision-making and exasperated PTSD symptoms such as irritability, aggression, engaging in risky behavior, hypervigilance, and compassion fatigue.10
Difficulties controlling one’s automatic defensive responses may impair split-second decisions under threat and can also increase the risk of PTSD symptoms, which has implications in high-risk professions such as law enforcement.
Studies have been conducted testing these responses, such as shooting tasks in which one of two opponents was presented to officers, one pointing a phone and the other pointing a gun. If the officer successfully inhibits shooting in response to an inappropriate stimulus, it is considered a positive response.11
Furthermore, independent of military history, PTSD is already a symptom of repeated exposure to traumatic circumstances encountered during police work.8
03
PTSD Prevalence in Veterans
There is a strong correlation between military service and rates of PTSD, which garnered public concern during military operations in Afghanistan and Iraq. The incidence rate of PTSD in veterans ranges from 5.4% to 16.8% – nearly double the rate found in the general population both nationally and abroad.2 One study found an association between serving in combat roles and the risk of committing violent offenses among UK military personnel (6.3% risk vs. 2.4%) and specifically, an increased risk of 8.6% in those with PTSD and hyperarousal symptoms.6
There is also an association between PTSD and impaired social functioning and emotional regulation, resulting in aggression and domestic violence in veterans.2 One study found connections between dissociative symptoms and an increased degree of functional impairment.
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04
Treatment and Prevention of PTSD
Prevention of PTSD is a three-pronged approach that requires education and psychotherapy, training in coping and relaxation techniques, and pharmacological interventions (the most common are SSRIs). Possible psychological interventions include:2
Cognitive-behavioral therapy
Cognitive processing therapy
Cognitive therapy
Cognitive restructuring
Coping skills therapy
Stress inoculation therapy
Exposure-based therapy
Eye movement desensitization and reprocessing
Hypnosis and hypnotherapy
Brief eclectic psychotherapy
Mindfulness training is a newer therapy that has shown some success with police officers. In one study of Brazilian police, mindfulness training resulted in a reduction in the severity of anxiety and depression for up to six months after the training.7 Virtual treatment options have also helped veteran police officers obtain treatment in an accessible manner while addressing privacy concerns.3
05
Strength of Evidence
The available evidence indicates a finding that:
PTSD is associated with feelings of aggression and potential violent conduct
PTSD is highly prevalent among military veterans
Law enforcement is a common career path for military veterans
Less is known as to the data directly measuring the rates of PTSD-induced violence in the veteran and police populations but studies have shown associations between PTSD and later bouts of violence.
06
Legal Issues
Potential discrimination by police departments against their veteran officers with PTSD (See Cooling v. City of Torrington (Ct. Sup. Ct.))
Potential use of PTSD as a defense strategy in criminal cases against law enforcement
07
Works Cited
1.
Lewis GB, Pathak R. The Employment of Veterans in State and Local Government Service. :34.URL
2.
Miao X-R, Chen Q-B, Wei K, Tao K-M, Lu Z-J. Posttraumatic stress disorder: from diagnosis to prevention. Mil Med Res. 2018;5:32. URL
3.
Jones C, Miguel-Cruz A, Smith-MacDonald L, et al. Virtual Trauma-Focused Therapy for Military Members, Veterans, and Public Safety Personnel With Posttraumatic Stress Injury: Systematic Scoping Review. JMIR MHealth UHealth. 2020;8(9):e22079. URL
4.
Koch SBJ, Klumpers F, Zhang W, et al. The role of automatic defensive responses in the development of posttraumatic stress symptoms in police recruits: protocol of a prospective study. Eur J Psychotraumatology. 2017;8(1):1412226. URL
5.
MacManus D, Dean K, Jones M, et al. Violent offending by UK military personnel deployed to Iraq and Afghanistan: a data linkage cohort study. The Lancet. 2013;381(9870):907-917. URL
6.
Boyd JE, Protopopescu A, O’Connor C, et al. Dissociative symptoms mediate the relation between PTSD symptoms and functional impairment in a sample of military members, veterans, and first responders with PTSD. Eur J Psychotraumatology. 2018;9(1):1463794. URL
7.
Trombka M, Demarzo M, Campos D, et al. Mindfulness Training Improves Quality of Life and Reduces Depression and Anxiety Symptoms Among Police Officers: Results From the POLICE Study—A Multicenter Randomized Controlled Trial. Front Psychiatry. 2021;12:624876.URL
8.
Maguen, S., Metzler, T. J., McCaslin, S. E., Inslicht, S. S., Henn-Haase, C., Neylan, T. C., & Marmar, C. R. (2009). Routine Work Environment Stress and PTSD Symptoms in Police Officers. The Journal of Nervous and Mental Disease, 197(10), 754–760. URL
9.
Krzyzewska IM, Ensink JBM, Nawijn L, et al. Genetic variant in CACNA1C is associated with PTSD in traumatized police officers. Eur J Hum Genet. 2018;26(2):247-257. URL
10.
Koenig HG, Al Zaben F. Moral Injury: An Increasingly Recognized and Widespread Syndrome. J Relig Health. Published online July 10, 2021:1-23. URL
11.
Koch SBJ, Klumpers F, Zhang W, et al. The role of automatic defensive responses in the development of posttraumatic stress symptoms in police recruits: protocol of a prospective study. Eur Psychotraumatology. 2017;8(1):1412226. URL
ABOUT THE AUTHOR
Autumn Barnes, MD
Autumn Barnes, MD, is a seasoned medical professional with a keen focus on Women’s Health, underpinned by a rich background that spans various facets of the medical field. Beginning her academic career with a Bachelor of Science in Neuroscience from UCLA, Dr. Barnes developed a profound interest in patient care, further amplified during her tenure as a Care Extender at Ronald Reagan Hospital, where she was recognized for her exceptional service. Her journey through medicine led her to St. George’s University School of Medicine, culminating in a residency in Family Medicine at HCA Florida Oak Hill Hospital. Dr. Barnes’s experience is complemented by her roles in medical administration and data analysis, notably improving operational efficiencies and patient care processes.
Her professional narrative is characterized by a deep commitment to healthcare, especially in managing and understanding the complexities of Women’s Health. Dr. Barnes’s transition into Obstetrics and Gynecology, fueled by her clinical rotations and a foundational role at engage2Health, highlights her ability to bridge the gap between clinical practice and healthcare data management. This unique blend of skills ensures that her contributions to medical content are not only informed by firsthand clinical experience but also by a comprehensive understanding of healthcare’s broader implications, making her an invaluable asset to any medical platform seeking to enhance its content with expertise and insight.”
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