Psychological Health at Work

by Dr Christopher C Ridgeway

Post Traumatic Stress Disorder

Insurance claims for post traumatic stress disorder (PTSD) are rapidly increasing. The cost to insurance companies is escalating. Organisations are facing ever-increasing costs in terms of management time, external professional fees, staff absence and, in some cases, industrial relations issues and a decrease in employee confidence in the company.

PTSD is claimed in respect of accidents in organisations’ premises and on company business and road traffic accidents or other out-of-work activities involving employers.

Whatever its cause, PTSD will negatively influence organisational performance. This page, and the linked sub-pages, will

  • Define PTSD
  • Explain its symptoms and complications
  • Examine its causes
  • Review what management can do to prevent it.

It will also discuss how to

  • Deal with claims
  • Facilitate treatment
  • Reduce negative impact.

It is claimed that at any time 1.5 per cent of the population, about 900,000 people, will be experiencing PTSD. On that calculation, most companies with 1000 or more employees will have around ten experiencing some PTSD symptoms.

PTSD arises from incidents which, although not pleasant to consider, do happen regularly, such as

  • A plane crashing and killing a number of a company’s senior executives on an overseas sales trip
  • A car crash in which an employee and his family are injured
  • A warehouse accident where an employee falls to his death from a ladder
  • Employees, who are members of the Territorial Army and who return from overseas operations in psychological distress
  • A daughter of an employee who experiences trauma as a result of physical assault or rape
  • Employees in a bank or retail store who experience an armed robbery.

So you need to know the answers to certain questions. What will their symptoms be? How will the symptoms affect them? For how long? Who can help? How will it affect the organisation? What can and should you, as a manager, do?

My story

For a psychologist to admit that just over ten years ago PTSD was a topic I had seen in text books but of which I had no in-depth knowledge seems, on reflection, odd. I had only a little more knowledge than a layman.

In 1999, my eldest son was a victim of a major road traffic accident. He was, in turn, pronounced dead, at scale 3 on the IT020 Glasgow scale (very unlikely to recover), then likely to be PVS (persistent vegetative state) and, finally, to be unlikely to walk or talk again. He is now, ten years on, physically normal and, except for short-term memory issues, psychologically fine. However, he did, and does, experience PTSD symptoms. He re-experiences the crash and has experienced some personality changes.

What did I learn? A lot about neurology from neurologists and neurosurgeons. A great deal about PTSD from others who were in his hospital wards. A huge amount from my own resources about brain damage or PTSD.

Ten years on, I know how distressing PTSD can be. I have experience of how it affects the patient and carers and I have developed a skill and knowledge that enables me to assess its effects, diagnose the symptoms, provide treatment and make prognoses. I have become an expert witness to courts and have, as a consequence, gained considerable knowledge about legal processes, insurance and organisational influences, systems and procedures. It is this personal knowledge and its associated professional development that this PTSD information will provide to those many thousands of managers who will experience PTSD personally or organisationally.

What is PTSD?

The fourth edition of the American Psychiatric Association Diagnostic and Statistical Manual (DSM-IV) defined PTSD as not only, as in DSM-III, the result of a life-threatening event, but as a result of an emotionally-traumatic experience or a series of events which cause a resultant number of symptoms.

The focus in DMS-III on a single life-threatening event meant that many who had the symptoms were not defined as suffering from PTSD. DMS-IV’s definition has resulted in many more people being defined as experiencing PTSD and hence the very significant number of cases of those claiming mental health issues and citing PTSD as reason for damages claims.

PTSD can occur when a person experiences a traumatic event(s) in which both of the following are present

  1. They were witness to or personally experienced actual or threatened death or serious injury
  2. They experienced, as a result, intense fear, hopelessness or horror.
The mechanism

PTSD is linked to our natural human flight-or-flight response. In a life-threatening situation, we are wired-in to respond by fighting or running away. This response was created to give our ancestors a chance to survive in a world inhabited by dangerous predators. It causes mental agony, however, in circumstances where we can do nothing – neither run nor fight (nor even hide): the driver who sees that a dangerous accident is unavoidable; the woman who is helpless against her rapist; the people trapped in a fire; the police who are unable to help victims of crime; the soldier who sees fellow soldiers or civilians dying, but who cannot rescue them – all these will experience feelings of extreme stress and helplessness. In time, victims may be able to process these terrible memories, though telling and retelling the story, through recognising that although the event(s) was/were terrible, they survived and so on. If they do not or cannot have help with processing these memories, then the result may well be PTSD.

A military example illustrates the nature of the mechanism: soldiers in World War I experienced a high level of ‘shell shock’ and other effects that we would now recognise as PTSD. They were trapped in the trenches, unable to flee (those who tried were shot for desertion) and knowing that if and when they were ordered to fight, they had little chance of survival. Levels of PTSD in World War II were much lower because it was a much more flowing, active war in which soldiers could usually fight or manoeuvre (flee). Levels in Vietnam veterans, on the other hand, were again higher, because the soldiers were made to walk through jungle, never knowing exactly where the enemy was or when he would strike.

The symptoms of PTSD are these:

  1. The event is persistently re-experienced as
  2. Recurrent intrusive recollections
  3. Recurrent dreams
  4. Reliving the experience
  5. Intense psychological distress when experiencing cues that resemble or evoke the event
  6. Distressing physiological reactions when experiencing cues that resemble or evoke the event.
  7. Persistent avoidance of stimuli associated with the trauma, as indicated by
  8. Avoiding places, people, or activities associated with the event(s)
  9. Inability to recall important aspects of the trauma
  10. Feeling detached from others
  11. Unable to have loving feelings
  12. Avoiding thoughts, feelings or conversations associated with the event(s)
  13. Having a limited future perspective of life (for example, career, marriage and so on)
  14. The symptoms last for over one month
  15. The symptoms significantly distress important areas of life functioning (for example, career, social and so on).

The life-threatened could also be the secondary victims. In a commercial sense, let’s imagine the following scenario: the primary victim is a salesperson who is the driver of a car in which he is taking his sales manager and director, who are sitting in the passenger seats, to a new potential client when they are hit, head on, by another car. The sales manager and director, who see the collision (though they are not seriously) injured, and who then suffer psychological distress and PTSD symptoms, are the secondary victims.

Those who rescue the car driver and passengers (fire service and ambulance personnel) may also be PTSD sufferers. They cut out the driver who has been beheaded and rescue the passengers, who are screaming that they can smell petrol and who are consequently experiencing a fear of explosion. The rescuers can also smell the petrol and may also fear an explosion. They may therefore be potential PTSD sufferers. They have personal fear and may, empathetically, experience others’ fear of death. They can experience PTSD symptoms, which may not occur immediately, but months, even years, after the incident.

It is calculated that for every victim or primary PTSD sufferer, there will be three secondary sufferers.

Imagine an incident in your offices. A fire breaks out on the third floor and staff on the fourth and fifth floors are trapped. Those on the third floor are the primary PTSD candidates. They see one person die and experience the horror/fear of a flame which could kill them. Those on the fourth and fifth floor can hear screams, see smoke and feel fear as they are rescued by the Fire Service. All those involved are potential PTSD sufferers, as are those on the second and first floor, who escape down the stairs, but see the smoke, hear screams and see the rescue. Injured colleagues or friends may, potentially, have PTSD symptoms.

Managers need to be aware that they, their staff, families and/or friends may, through primary or secondary experiences of major psychological distress, become sufferers of PTSD.