An Introduction - PowerPoint Presentation

Slide1

An Introduction to Posttraumatic Stress Disorder (PTSD)

Anthony Mancini, Ph.D., LCP

Local

Evidence Based Program

Coordinator

Erie VA Medical CenterSlide2

Define PTSD as a psychiatric disorderOutline PTSD symptomatologyDiscuss potential behavioral impacts especially related to law enforcement

/ criminal

activityBrief look at overlap with Traumatic Brain Injury (TBI)

ObjectivesSlide3

As defined by the American Psychiatric Association, PTSD is an anxiety disorder.The essential feature is the development of characteristic symptoms following exposure to an extreme traumatic stressor in which the person experienced, witnessed, or was confronted with actual/threatened death or serious injury, or a threat to the physical integrity of self or others.

The response must involve fear, helplessness, or horror.

What is PTSD?Slide4

Some examples of traumatic events we see often with Veterans may include military combat, terrorist attacks, violent personal assaults (including physical and sexual), torture, incarceration as a POW, providing medical care to the seriously injured, and morgue duties.Witnessed events common with

Veterans

include witnessing the violent death/injury of others and witnessing

dead bodies or body parts.

What is PTSD?Slide5

PTSD symptomatology falls into 3 clusters that include re-experiencing, avoidant behavior, and increased arousal.Re-experiencing symptomatology (one or more):

Recurrent and intrusive recollections of the event

Recurrent distressing dreams

Acting/feeling as if the event were reoccurring (flashbacks)

Psychological distress on exposure to reminders

Physiological reactivity on exposure to reminders

PTSD SymptomatologySlide6

Avoidant behaviors (3 or more):Avoid thoughts, feelings, & conversations associated with the traumaAvoid activities, places

, &

people associated with the traumaInability to recall aspects of the traumaDecreased interest in activities

Feeling detached from others

Restricted range of affect

Sense of a foreshortened future

PTSD SymptomatologySlide7

Increased arousal (2 or more):Difficulty falling or staying asleepIrritability or outbursts of angerDifficulty concentratingHypervigilance

Exaggerated startle response

Do you see some of these behaviors in the

V

eterans

you encounter in the criminal justice system?

PTSD SymptomatologySlide8

Common associated features can include: Depression Paranoia/mistrustPhobic avoidance

Emotional

disinhibitionSelf-destructive and impulsive behaviorDissociative symptoms

Hopelessness

Loss of previously sustained beliefs

Hostility

Impaired relationships

Social withdrawal

PTSD SymptomatologySlide9

In reviewing the symptomatology and common associated features, it becomes readily apparent that PTSD can lead to potential legal problems.

Over a number of years working with

Veterans suffering from PTSD, common legal problems patients encountered have included: Various MV violations: Speeding, reckless driving, accidents, road rage

Hostility-related violations: A&B, domestic violence, resisting arrest, malicious wounding,

attempted

murder, murder, destruction of property

Potential Legal ImplicationsSlide10

Substance abuse-related violations: DUI, DIP, various drug-related violationsDissociative-related violation: Breaking & entering, trespassing, fightingWeapons-related violations

Potential Legal ImplicationsSlide11

Thinking about PTSD symptomatology as the root cause:Chronic insomnia/fatigue, decreased concentration, anxiety, recklessness, self-destructive behavior, and irritability/anger can all lead to MV violations.

OEF/OIF Veterans

: exposure to road side bombs and IEDs can generalize to unusual driving behaviors.

Dissociation/flashbacks, emotional liability, paranoia, exaggerated startle/wired up, anger/irritability, and impaired interpersonal relationships can all lead to hostility-related violations.

Potential Legal ImplicationsSlide12

Substance abuse is unfortunately a very common way in which Veterans attempt to cope with the myriad of PTSD symptomatology, although a poor coping mechanism. Substance abuse can lead to many significant legal violations.

Dissociation/flashbacks can often lead to violations of ‘being in the wrong place’ such as breaking and entering, unlawful entry, trespassing.

PTSD usually impacts a Veteran’s

view of the people and the

world

and often shakes the foundation of their belief systems…what is moral/ethical, right and wrong, and acceptable human behavior.

Potential legal ImplicationsSlide13

Suspiciousness and paranoia, as well as reckless behavior, often lead to weapons-related violations.Survivor’s guilt, depression, emotional numbing, and ‘just not caring’ can be a recipe for illegal behavior, as well as suicide.

Potential Legal ImplicationsSlide14

In recent survey indicates that of those who have experienced a TBI, from 37 to 44% also have overlapping PTSD or depression. Unfortunately, many of our returning Iraq/Afghanistan Veterans

are experiencing these co-morbidities

.Due to overlapping symptoms, legal issues associated

with PTSD

are also

relevant for TBI.

Additional Thoughts on TBI/PTSDSlide15

PTSD TBI Insomnia Insomnia

Poor

concentration Poor Concentration

Depression

Depression

Anxiety

Anxiety

Irritability

Irritability

Emotional numbing Fatigue

Flashbacks/nightmares

Headache

Hypervigilance Dizziness

Avoidance Noise/light Intolerance

TBI/PTSDSlide16

TBI/PTSDSlide17

PTSD/TBIWhat about the overlap?

Think

about associated legal problems.

Insomnia ,

poor

concentration,

irritability

, anxiety/depressionSlide18

PTSD can be a devastating illness affecting thought, emotions, and behaviors. Veterans of the recent conflicts diagnosed with PTSD have a higher percentage of TBI, another debilitating disorder.

Left untreated,

Veterans suffering from PTSD have a greater probability of becoming involved in the legal system secondary to their

symptomology

.

Fortunately, there are excellent treatments offered for this disorder if

Veterans choose to engage.

Summary