Police Work, PTSD and Family Spill-Over
Is there a link between the negative stressors of police work and spilling over into the police family, potentially resulting in domestic violence? The effects of domestic violence can result in the development of PTSD and impairment of mental and physical health among victims. This article examines, explores, and presents the risk factors related to domestic violence within the police family. Police perpetrated domestic violence exacerbates additional problems for the victim when the batterer is a police officer. This literature review will provide an accurate view of the extent, nature of the problem, and provide an understanding for the purpose of developing intervention strategies to assist victims and officers in dealing with the unique challenges and stressors related to police work, personality traits, exposure to traumatic events, and violence.
Domestic violence by police officers poses barriers otherwise not found in the general public; evoked code of silence among officers, concerns with confidentiality, and the Lautenberg amendment to the Gun Control Act of 1968 (Family Violence act); which prohibits any person convicted of domestic violence from possessing firearms. Interventions and strategies to reduce domestic violence among police officers will be discussed. Education, routine psychiatric evaluations, family therapy, stress management, on-scene crisis intervention with follow up, and individual counseling are potential strategies to reduce family violence within the police family. The effects of and symptoms of police perpetrated domestic violence (PPDV) and PTSD can leave a person debilitated psychologically, physically, economically, socially, and spiritually.
Domestic Violence by Police Officers, police culture, police training and the administration of the police department, can influence and have a great impact on domestic violence within the police family. It is suggested that police training skills not only make effective officers but possibly contribute to domestic violence. “Police culture encourages authoritarianism, isolation, and a sense of entitlement. Domestic abusers have these same traits as well. Loyalty among police serves to protect the police batterer and further victimizes the victim” (Sgambelluri 2000).
The relationship between domestic violence and repeated exposure of violence on the job by police officers have been a subject that raises many questions, and researchers continue to investigate the link between the nature of police work and domestic violence. There are a number of variables that may affect police officers as a result of the nature of their work, how they cope with it, and potentially resulting in domestic violence within the police family.
According to the USDOJ Office on Violence Against Women domestic violence can be defined as; “a pattern of abusive behavior in any relationship that is used by one partner to gain or maintain power and control over another intimate partner. Domestic violence can be physical, sexual, emotional, economic, or psychological actions or threats of actions that influence another person; This includes any behaviors that intimidate, manipulate, humiliate, isolate, frighten, terrorize, coerce, threaten, blame, hurt, injure, or wound someone” (USDOJ, OVW, 2009).
The following are examples of types of abuse that often occur in a battering relationship, also known as domestic violence:
· Physical Abuse: Hitting, slapping, shoving, grabbing, pinching, biting, hair-pulling, biting, etc. Physical abuse also includes denying a partner medical care or forcing alcohol and/or drug use.
· Sexual Abuse: Coercing or attempting to coerce any sexual contact or behavior without consent. Sexual abuse includes but is certainly not limited to marital rape, attacks on sexual parts of the body, forcing sex after physical violence has occurred, or treating one in a sexually demeaning manner.
· Emotional Abuse: Undermining an individual's sense of self-worth and/or self-esteem. This may include, but is not limited to constant criticism, diminishing one's abilities, name-calling, or damaging one's relationship with his or her children.
· Economic Abuse: Making or attempting to make an individual financially dependent by maintaining total control over financial resources, withholding one's access to money or forbidding one's attendance at school or employment.
· Psychological Abuse: Causing fear by intimidation; threatening physical harm to self, partner, children, or partner's family or friends; destruction of pets and property; and forcing isolation from family, friends, or school and/or work.
Dynamics of Domestic Violence
Domestic violence does not discriminate, and it can happen to anyone at any time. Domestic violence occurs in heterosexual relationships, same-sex relationships, marital, and dating relationships, with siblings, with family members, in all occupations, and populations and cultures. The consequences can be devastating and is the leading cause of injury among women (NIH, 2009). Furthermore, “intimate partner violence can be life-threatening for some women, but more commonly results in injuries, immune disorders, difficulty in sleeping, gastrointestinal problems, and other illnesses. The mental health impairments associated with IPV include depression, low self-esteem, psychological distress, and PTSD” (DeJonghe, et al, p. 294, 2008).
There are three primary phases during the cycle of domestic violence:
Phase one-The tension building phase; phase two-the battering phase; and phase three- the honeymoon phase.
The Tension Building Phase: The tension-building phase; also known as the escalation or build-up phase. During this phase, there is an increase in, anger, blaming and arguing in the relationship. This phase may last days, weeks, or months. This phase typically becomes more frequent as the cycle is repeated. During this time the batterer may increase in verbal and minor physical abuse. Examples include: Berating the victim, especially in front of others, calling the victim names, putting down the victim's friends and family, the batterer may throw things, threaten, and other actions that may frighten the victim into submission. The victim knows what will happen if he/she does not comply. At this point, the victim may be amenable to sources of help.
During this phase there may be battering-hitting, slapping, kicking, choking, use of objects or weapons; Sexual abuse; Verbal threats and abuse. During this phase, the batterer loses the desire or ability to control his/her anger and violence.
This stage may decrease over time. The batterer may deny the violence. He or she may make excuses for his/her behavior. For example, they may blame it on drinking, they were drunk; they may apologize and promise that it will never happen again. The batterer may buy the victim gifts and engage in loving behavior and actions. The victim is least likely to comply or take advice from others during this time, especially if they try to tell her/him to leave.
The victim is often hopeful that the violence will stop, and most often believes that the batterer “really means it” this time. However, the batterer may be most open to help at the start of this phase because he/she is remorseful, presents as remorseful, and wishes to please the partner in an attempt to manipulate and hold onto the relationship. At the peak of this stage, both parties may deny or distort what has occurred. This phase reinforces the battering cycle.
Traumatic Bonding and the Power Imbalance in Domestic Violence
Domestic violence is about power and control. “Social psychologists have found that unequal power in abusive relationships can become more imbalanced over time. As the power imbalance magnifies, the victim feels more negative in her self-appraisal, more incapable of fending for herself, and more dependent on the abuser. This cycle of dependency and lowered self-esteem repeats itself over and over and eventually creates a strong affective (emotional) bond to the abuser” (VJC, 2003). This is why many women stay. When a battered woman says she stays because she loves him, she is basically describing Stockholm syndrome the best way she can.
Stockholm syndrome and Traumatic Bonding
Stockholm syndrome was first recognized in Stockholm, Sweden during a hostage incident. “On August 23rd, 1973 two criminals with machine-guns entered a bank in Stockholm, Sweden. Blasting their guns, one prison escapee announced to the bank employees "The party has just begun!" The two bank robbers held four hostages, three women, and one man, for the next 131 hours. The hostages were strapped with dynamite and held in a bank vault until finally rescued on August 28th” (Carver, 2009). The authorities were amazed at the hostage’s behavior that occurred even after they were threatened, abused, and feared for their lives for five days. The hostages refused to cooperate with law enforcement and actually viewed them as the bad guys.
What was occurring was the hostage’s identification with the hostage-taker. The hostages supported their captors and bonded with them emotionally. While hostages may bond after a matter of hours, batterers usually have many years with the victims without any interference or intervention” (VJS, 2003). Therefore, when the victim knows she/he has very strong feelings for the abuser and can only attribute those feelings to love because of a lack of information; thus the victim does not have the information they need to accurately describe the dynamics involved in the bonding process that occurs with abuse and trauma; therefore attribute their intense feelings the best way that they can, as love.
Meanwhile, the abuser will develop an over-generalized sense of his own power which masks the extent to which he is dependent on the victim to maintain his self-image. This sense of power rests on his ability to maintain absolute control in the relationship. If the roles that maintain the sense of power are disturbed, the masked dependency of the abuser on the victim is suddenly made obvious. For example: “the sudden reversal of power is the desperate control attempts made by the abandoned battering husband to bring his wife back into the relationship through threats, intimidation, and or manipulation-begging her to come back. This is typical (“oh baby, I love you, I am so sorry, it will never happen again, I want you to have my babies, and grow old with you, I will quit drinking/drugging, I will die without you OR the use of guilt-I will kill myself if you don’t come back, on and on. This is the beginning of the honeymoon phase, only to repeat itself again. This is one reason why battered women tend to choose the same kind of man because they did not modify their behavior from previous experiences. It’s more complex, than simply “why don’t you just leave?”
Domestic violence occurs in all occupations and populations. When the batterer is a police officer, victims have many other obstacles and circumstances which affect their safety and overall situation. For example, safety planning is not the same for a victim of domestic violence by a civilian, as it is for a victim of PPDV. Everything that advocates, law enforcement and other professionals tell victims of domestic violence does not apply to the PPDV victim.
When a crime is committed, we tell victims to call the police, but what if the perpetrator is a law enforcement officer? Victims of police perpetrated domestic violence face many challenges including:
Police officers are trained to control individuals and crowds in order to protect the public and themselves. Other training tactics and skills that officers use in their job are often used to control the victim of domestic violence by the officer. These skills include, coercion, manipulation, frighten and intimidate in an attempt to produce a confession from a criminal suspect to confess; this is also used as a tactic on the victim. In addition, officers are trained to use surveillance in investigations; patrol the streets, making it easy to stalk his victim, and knowing her whereabouts at all times. The police batter may frequently “drop-in” to check up on her, accusing her of having an affair-jealousy are examples.
The police uniform, weapons, stance, and tone of voice all offer a commanding authoritative presence used to gain control over society. These are tactics they learn in training and are often carried over into their personal lives. In addition, they are also trained to constrain, use physical force when necessary in the course of their duties. Officers are trained to use physical force without leaving any evidence of injury; however, the learned tactics do inflict pain in order for the suspect to become submissive to the officer’s command. These tactics have also been used in intimate partner violence perpetrated by police officers.
Lautenberg Amendment Gun Control Act
When a police officer is convicted of domestic violence the consequences not only affect the officer, victim and their family, it also affects the officer’s job. “A Legal factor concerns a federal law; the 1997 Lautenberg amendment to the Gun Control Act of 1968 (Family Violence Act) prohibits any person convicted of domestic violence from possessing firearms. A law enforcement officer with such a conviction cannot carry a gun”.( Allen, Hibler, & Miller 2000). This poses a significant problem for the officer because carrying and using firearms is part of the tools needed to do the job of a police officer.
These unique issues that involve police officers as batterers are often under reported due to potential loss of employment, the victim may rely on the batterer’s income, and most importantly the victim has very few resources for seeking help without lethal consequences from the batterer. For example, the police department often sides with the officer to protect the image of the department. Charges are rarely filed, and the officer is given a verbal warning. This often leads to an escalation of violence for the victim because he feels she got him in trouble at work.
Empirical Based Study
A study conducted by Johnson (1991) “discovered a high incidence of violence by police officers. The survey and follow-up interviews indicated that 10 percent of police spouses reported actual physical abuse and 20-30 percent reported verbal and emotional abuse. When officers were asked if in the previous six months they had “lost control and behaved violently” toward a spouse or a child, approximately 40 percent indicated a positive response. (Neidig, et al. (1992) In another survey officers and their spouses included specific descriptions of behaviors which were categorized as “minor violence” (thrown an object at a spouse, slapped, kicked, hit, bit, pushed) and “severe violence” (choked, strangled, beat up, threatened or used a knife or gun). All of these behaviors constitute criminal conduct, which, by current federal law, would bar the perpetrator from owning or possessing a firearm. The study revealed:
· 25 percent of police officers perpetrate “minor violence “and 3 percent engaged in severe violent behavior. Interestingly, greater numbers of officer’s wives; 33 percent self-disclosed violent behavior.
· Among male officers, 41 percent indicated their relationship at home experienced some physical violence. Although these findings appear to be alarming rates of violence, the actual numbers may be higher due to not accurately reporting the frequency and severity of abuse” (Neidig, et al. (1992).
The Journal of Family Violence (2005) conducted a study on work-family spillover. The authors researched data from police officers in two large eastern U.S police departments to test their hypothesis that there is a relationship between violence exposure and domestic violence among police officers. They examined four variables including violence exposure and its effects relating to PTSD, burnout, authoritarianism, and alcohol use as factors that lead to a negative impact on police families. They based their study from other empirical studies of work-family spillover studies included: “empirical police studies on violence exposure by Robinson, et al. (1997), Kopel and Friedman (1997), Stratton et al. (1984), and Martin et al. (1986).
In the Robinson et al., study of 100 suburban police officers, significant correlations were found between duty-related stress and symptoms of Post-traumatic stress disorder (PTSD), with exposure to death, and life threats being the best predictors for the diagnosis of PTSD” (Robinson et, al.1997). “Unexpected events and exposure to life-threatening events (e.g., assaults, shootings, and accidents) are expected in police work. Because some officers find it difficult to turn off the job when at home, the authors suspect that higher rates of negative family outcomes exist for those most exposed to work-related violence” ( Johnson, Todd, Subramanian, 2005). This study was a modification of previous studies on police job-related stress and family conflict.
A study conducted by Young, Fuller, & Riley researched the helpfulness of on-scene mental health services provided to both victims and police officers during crises such as domestic violence, homicides, suicides, and sexual assaults. The crisis team included volunteers with mental health backgrounds including clergymen. The purpose of their study was to implement crisis intervention to emergency workers to help reduce symptoms of PTSD, and to determine if crisis intervention teams would be helpful within the scope of police work. Their expectations were met with evidence by data collected from surveys from both police officers and victims. “The literature about crisis intervention is primarily concerned with reducing anxiety and posttraumatic stress symptoms through critical incident stress debriefing (CISD).
CISD is a group crisis intervention technique designed by Mitchell (1983) to ease the acute symptoms of distress associated with psychological crisis and trauma (Everly, Flannery, & Eyler, 2002). CISD was originally a way to allow emergency services personnel who had been exposed to traumatic events to emotionally process the event. Later, CISD was expanded to treat civilian victims of trauma (Pennebaker, 2001).
Monitoring stress on the job through routine psychiatric evaluations and family therapy can help reduce family violence significantly within the police family. Family violence remains a serious social problem throughout America. Law enforcement personnel face unique challenges that may be greater than that experienced by the general public (Blau, Super, Wells 200). Many stressors of life involve marriage, children, finances, work schedules, recreation, friends, and extended family. In addition to these stressors, police officers are often confronted with negative stressors on a daily basis. Considering the lethality of the profession, police culture, constant exposure to violence, substance abuse, dealing with crime and lack of appreciation can increase stress within the law enforcement community. Every call could be a potential threat to their lives, keeping them on guard and hyper-vigilant.
Many officers develop PTSD and turn to substance abuse as a way to cope. All of these factors impact and play a role in the behavior of a police officer. Domestic violence among police officers needs to be treated uniquely due to the nature of their work. Therefore examining potential risk factors related to police perpetrated domestic violence is a special population that needs continued research in order to develop prevention, interventions, and strategies to reduce domestic violence within the police family.
The relationship between domestic violence and violence on the job has been a subject that raises many questions and researchers continue to investigate the link between the nature of police work and domestic violence. The variables that may affect police officers as a result of the nature of their work, how they cope with it, and potentially resulting in domestic violence within the police family is vital to both the victim and the police family.
Variables Involved in Police Perpetrated Domestic Violence
• Work-family conflict
• Continuous exposure to violence
• Alcohol/substance abuse
• Authoritarianism and other personality traits
• Impact of Traumatic stress (symptoms of PTSD, depression, and anxiety
Some intervention strategies designed specifically related to domestic violence by police officers include; Routine psychiatric evaluations, therapy, on the job debriefing, on-scene mental health counseling, and crisis intervention have all proved successful in reducing the effects of domestic violence within the police family.
The law enforcement community “needs to increase its resources and direct its commitment toward prevention. Recommendations for research studies include: identifying contributing factors; evaluating intervention techniques and specific prevention strategies, such as lethality assessment, recognizing early warning signs, and initiating interventions. In addition, encouraging healthy coping strategies throughout an officer’s career provides the key to preventions. Agencies must dedicate resources to law enforcement personnel. (Quinn 2000).
The majority of research studies on domestic violence is related to the general public; data relating specifically to law enforcement remains sparse. McKay (1998) identifies the following correlates as risk factors associated with domestic violence:
1. Violence is a part of daily life in our society from TV, news and, in the case of law enforcement, work.
2. Gender-based socialization; men are tough, women are weak. Male entitlement, privilege, and dominance.
3. Economic factors/religious values supporting gender-based power differences.
4. Family of origin violence patterns.
5. Abusers hold traditional views about sex roles.
6. The abuser looks to his partner for all his emotional support, indicating a lack of self-esteem/self-worth. He looks to his spouse for reassurance. He finds it difficult to express any emotion other than anger.
7. Pathological jealousy.
8. Isolation of both partners fusing more dependency.
9. The use of violence as a tactic to get his needs met, which becomes reinforced as the method becomes a habit.
10. Drugs and alcohol; 80 percent of domestic violence incidents involved drug and alcohol use.
11. Military/law enforcement of indoctrination, specific training in the use of violence and combat skills to control situations, wok environment, and power hierarchy.
12. Irregular work hours may lead to feelings of powerlessness at work; may increase the need to control at home (Estimates of batterers with prior military experience range from 58 percent (Walker 1983) to 90 percent (Eisenberg-Miklow, 1979).
13. It is suggested the numbers 1, 2, 5, 8, 10, and 11 highly correlate with law enforcement.
Interventions for police officers who batter include the following:
· On scene mental health counseling- When an officer is faced with witnessing or experiencing traumatic events; on scene mental health counseling should be called to help debrief the situation. The counselor can help the officer in identifying feelings s/he may be feeling immediately after the event. In addition, on-scene mental health counselor also, help both officers and victims with witnessing and experiencing traumatic events such as fatal car accidents, suicides, and shootings.
· Implementing Crisis Intervention on the job can help to relieve work-family spillover; thus potentially reducing domestic violence in the police family. The use of crisis intervention may help reduce the impact of traumatic stress in police work, and reduce the possibility of developing PTSD, and other related problems such as substance abuse, anxiety, and depression.
· Routine psychiatric evaluations should be done on all officers, not only on officers who are referred for a fitness for duty exam. The unique nature of police work described is evidence of why making psychiatric evaluations mandatory and on a routine basis. Stress management should be a regular part of an officer’s career.
Many officers feel as if they need to uphold the reputation of being "tough or strong” and feel they cannot share their feelings with others, due to feeling vulnerable or less masculine. The authoritative figure rarely displays these feelings in public. Individual and family therapy can help families cope with the many negative stressors that police work can bring. These interventions can improve the psychological well being in the individual officer, intimate partner, and children; in addition to the law enforcement community and help reduce domestic violence by police officers.
It should be noted that if a couple is engaging in therapy due to domestic violence, it is not recommended that the batterer and victim begin therapy together. The power imbalance will often discourage any progress in therapy. The abuser will often manipulate, sabotage and control the therapy session. It is suggested that couples should attend therapy separately first, and then when the therapist believes it is time for couples therapy, then it should begin at that time.
Domestic violence prevention and intervention programs
These programs offer information on the cycle of abuse; officers are very aware of the cycle of violence, making this a difficult topic to introduce to them, since they already have had the training. They need this training in order to identify signs of domestic violence when they are called to a scene of a domestic. Trained officers understand how victims will react to trauma related to domestic violence. Abusive officers will utilize that information to their advantage to abuse their intimate partner.
If officers and their families understand the unique nature of police work and the fact that it can spill over into the family; they will understand the potential for maladaptive behaviors potentially leading to the development of domestic violence. PLEASE NOTE: Domestic violence is about power and control. We are not saying that police work is the reason for domestic violence perpetrated by police officers. However, we are saying that the research in this article reveals that negative experiences related to police work can spill over into the officer's intimate relationships. Some officers with maladaptive coping will lash out at family members. For example, if the officer has never engaged in domestic violence before, and it is a completely new behavior for the couple, it may be due to critical incidents or situations on the job where the officer needs help in managing symptoms. Police families should be educated on these topics and special interventions and services need to be available for this special population of abuse.
Resources -Resources should be available to officers before the problem begins, so that they are aware of the potential for family violence. PTSD in law enforcement is a real problem and can spill over into the officer's family life creating a negative environment for everyone involved. There is help out there for police families. Please reach out and do not ignore it.
Consequences of Domestic Violence and PTSD
Physical and psychological abuse has been shown to be associated with
PTSD symptoms (Jones et al., 2001), and both were expected to significantly predict trauma symptoms (Arias & Pape, 1999; Basile, Arias, & Desai, 2004; Taft et al., 2005) According to the
DSM-IV-TR “the essential feature of Post-traumatic Stress Disorder is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity, or witnessing an event that involves death, injury, or a threat to the physical integrity of another person (Criterion A1). The person’s response to the event must involve intense fear, helplessness, or horror (Criterion A2) (DSM-IV-TR). “All people with PTSD have lived through a traumatic event that caused them to fear for their lives, see horrible things and feel helpless. Strong emotions caused by the event create changes in the brain that may result in PTSD” (National Center for Post-Traumatic Stress Disorder 2009).
The DSM-IV-TR also gives the following traumatic examples “traumatic events that are experienced directly may include violent personal assault (such as sexual assault, physical attack, robbery, mugging, etc.), being kidnapped or taken hostage, terrorist attack, torture, natural or man-made disasters, or automobile crashes. Witnessed events include observing the serious injury or death of another person due to violent assault, accident, or disaster, or unexpectedly witnessing a dead body or body parts. This makes our children “the silent victims” when they witness domestic violence within the home. The disorder may be especially severe or long-lasting when the act is committed by another person, especially in domestic violence.
Symptoms of PTSD
A major symptom that is presented in PTSD is persistent avoidance of anything that is associated with the trauma or crime. “Most of the persistent avoidance of stimuli and diminished responsiveness to the outside world usually, begin soon after the traumatic event and are referred to as psychic numbing. This is an automatic reflex reaction in which the mind virtually shuts down to protect the survivor's psyche from further trauma, allowing the victim to do what is necessary in order to function” (NCVC 2009). Some examples of avoidance include: “Efforts to avoid thoughts, feelings or conversations associated with the trauma; Efforts to avoid activities, places or people that arouse recollections of the trauma; this is one reason why many victims will not leave their homes. However, when the traumatic events are occurring within in the home, the victim may quickly develop depression, helplessness, and hopelessness as a result.
More examples include: Inability to recall an important aspect of the trauma; Diminished response to the external world, or “emotional amnesia." Markedly diminished interest or participation in significant activities; with children, they may regress developmentally and may begin bedwetting, or talking like a baby; Feelings of detachment or estrangement from others; Restricted range of affect or reduced ability to feel emotions such as feeling or giving love (NCPTSD 2009). When both the parent, and the child have PTSD, the family dynamics become more complex. In addition, if the law enforcement batterer is also exhibiting PTSD from the job, this only makes matters more complex.
Additional symptoms of PTSD may include depression, anxiety, agoraphobia, self-medication, substance abuse, trouble concentrating, anger outbursts, disturbed sleep pattern, such as insomnia, or excessive sleeping, nightmares, avoidance, triggers, flashbacks or reminders of the traumatic event. The intrusive memories can be especially frustrating, for the survivor. Many survivors state “it’s like a movie that keeps rewinding, and it won’t go away”. Triggers or flashbacks can occur at any time and the survivor may feel the same fear and horror they felt when the event took place. This is called a flashback” (NCPTSD 2009).
What is a trigger?
“A trigger is a sound or sight that causes the survivor to relive the event. Triggers might include: Hearing a car backfire, which can bring back memories of gunfire and war for a combat veteran; for the victim of domestic violence, it can be seeing a police car, because she was being stalked, my trigger a panic attack or trigger.
Family and Friends
Family and friends are often confused and do not understand the condition. They may feel helpless and frustrated and say things like “just get over it, or it’ll go away soon” further debilitating the survivor. The survivor may become more depressed, isolated, and possibly suicidal as a result of not understanding what it is that S/he is experiencing. They often feel alone, afraid, feel shame, and may feel like it’s their fault. Victims of crime often begin self- medication with drugs or alcohol in an attempt to psychologically numb or block out the memories. According to the National Center for Victims of Crime, rape victims are 13.4 times more likely to have two or more major alcohol problems; again further complicating the victim’s condition, finances, health, and overall well-being. In many battering relationships, sexual assault/battering is part of the violence in the relationship.
Other disabling symptoms such as: hyper-vigilance, hyper-startle response, disturbed eating pattern-cannot eat, or eating too much leading to weight loss or weight gain, panic attacks, looking out for danger, locking doors and windows and being afraid to be alone when leaving the house, and fear that something will happen to them further complicate the survivors condition. If PTSD is left untreated the client may further deteriorate. They may feel helpless, anxious, angry, frustrated, depressed and even suicidal. They may not want to leave the house (a form of agoraphobia) as a result feeling as if the world is an unsafe place. All of these symptoms can disrupt the activity of daily living for the client and their family. Many PTSD suffers have a high rate of absenteeism and often times lose their jobs, leading to economic deprivation, again further complicating the condition. Suffers may fail in their academic studies and goals. (Salvatore, R., 2009).
According to DeJonghe et. al., “The prevalence of PTSD among battered women is high, ranging from 45-84%. Numerous studies find a relationship between IPV and PTSD: the more types of IPV experienced (e.g., physical, sexual, or emotional abuse), the greater the number of the woman’s PTSD symptoms. Research also found that depressive symptoms, somatic complaints, and PTSD symptoms were higher in pregnant women, at a hospital in India, who reported a history of IPV and sexual coercion compared to those who did not. Similarly, in another study, both physically and psychologically abused women displayed higher rates of PTSD, depressive, and anxiety symptoms, as well as thoughts of suicide when compared to non-abused controls” (2008).
The mental health consequences of domestic violence have been studied extensively and include the significance of substance abuse and posttraumatic stress disorder (PTSD) among the more prominent sequelae (Breslau et al., 1991)”(Cougle, J.R., Resnick, H., Kilpatrick, D.G.”, (2009). The alarming statistics from the USDOJ Office of Violence Against Women “One woman is victimized by an intimate partner every 52 seconds. One man is victimized every 3.5 minutes”, makes this a major health issue for communities and the nation” (NCPTSD 2009). If PTSD is left untreated, the victim's life may become dominated by attempts to avoid situations that remind him or her of the event” (NCPTSD 2009). Victims who are still living in the abusive environment cannot avoid the abuser like someone who does not live with the batterer. Many times the victim’s only means of avoidance is self- medication of drugs and/or alcohol.
Victims will react differently depending upon the level of personal violation, their personality, experiences, and support systems, and their state of equilibrium at their victimization” (NCVC 2009). The longer the exposure the more complex the PTSD will become and treat. All people have a normal state of equilibrium called homeostasis and it is influenced by everyday stressors such as illness, moving, changes in employment, and family issues and so forth. If a person’s equilibrium is disrupted our bodies react, however they return to previous functioning levels. The combination of everyday stressors in addition to being victimized, a person’s equilibrium becomes overloaded making the person vulnerable to developing PTSD.
PTSD and Brain Chemistry
We are all born with an innate response to crisis called “the fight or flight response”. The fight and flight response is a natural response that is produced when our bodies are feeling threatened, or in a high state of stress. For example: If a tiger is chasing us, our brains tell us to run. “In stressful situations a variety of body changes occur. The changes associated with the "fight or flight" response are products of increased blood levels of the hormone, adrenaline (a.k.a. epinephrine). This chemical messenger produces several body changes including elevated blood pressure and increased pulse rate. These actions increase blood flow and, along with increased circulation to arms and legs, allow an animal to increase appropriate physical exertion capabilities” (PBS 2009). This is what allows us to run quickly in order to escape an attack from the tiger.
Researchers have found a connection between PTSD and brain chemistry. What happens to the brain during and immediately after the critical, traumatic event will determine how each unique individual will respond, develop, or recover from PTSD. “Essentially, the chemicals that flood the brain during the trauma do so in order to help the person to survive the event, either by running away, or fighting furiously. A third option, to submit to the trauma also has brain chemistry implications. In some individuals, once the brain goes through this chemical „rewiring‟ to survive the trauma, the wiring stays that way”. (Briere, J., 2009).
Everyone is unique and “depending on their unique brain chemistry, they may or may not have after effects of PTSD symptoms and behavioral signs. This means that two people can experience the same trauma, and one may come out with PTSD, and the other will not” (Briere, 2009). Research has also shown that parts of the brain that are most involved in PTSD are the amygdala, hippocampus, medial front cortex, thalamus, hypothalamus and the hypothalamic-pituitary-adrenal axis. Along with these, chemicals in the brain such as noradreneline, dopamine, serotonin, the opiod systems, insulin, and cortisol all play complex roles in the PTSD symptom producing process. This complexity is why there has not yet been developed an effective medication to help those who suffer from PTSD to gain relief from all of their symptoms” (Briere, 2009). Research has also suggested that the hippocampus may actually shrink and kill neurons, in addition to slowing down the growth of new neurons. This new finding has lead to understanding why individuals with PTSD have a hard time concentrating or remembering things. It is suggested that “the „wiring‟ of the brain’s neurochemical systems become over sensitized, and this results in the symptoms commonly seen in PTSD. The complex chemical-neurological reactivity affects parts of the brain that are all about learning, memory, and fear conditioning” (Briere, 2009).
Another neurochemical that plays a role in chronic stress is cortisol. “Cortisol is a hormone that is produced in the adrenal gland. It is sometimes called the „stress hormone‟ because it tends to increase blood pressure, blood sugar levels, and has an immunosuppressive effect” (Briere, 209). For people who do not have PTSD, it actually helps restore homeostasis (calmness) after stress. However, research has shown that “some individuals with PTSD, actually have a lower base level of cortisol production to begin with, and when cortisol is released, their bodies have a hyper-sensitive reaction to it; that is, the cortisol does not work in them like people without PTSD” (Briere, 2009).
When a person is under chronic stress or has experienced a traumatic event, the secretion of cortisol is prolonged; making high cortisol levels “normal” for that person. This begins a viscous cycle of symptoms. “In the average person, cortisol levels are highest in the morning and lowest a few hours after sleep begins” (Briere, 2009). These findings are essential “regarding behaviors like sleep, nightmares, getting a PTSD child up and out the door for school, or being calm enough or alert enough to carry out everyday tasks. Since cortisol acts to increase the blood sugar level, insulin production may increase as well, and go into an overdrive situation along with the other chemicals rushing into the PTSD victim’s body. The extra insulin can then crash the blood sugar, signaling the hypothalamus that glucose (the brain’s only source of energy) is being starved from the brain, which in turn triggers a message to the adrenal glands to increase adrenaline, and the cycle of high stress symptoms begins again. The whole bio-chemical process, once begun, travels at lightning speed” (Briere, 2009). This is a significant breakthrough for patients with PTSD. This evidence may help improve the quality of life for PTSD suffers.
The recovery process begins with removing the victim from the unhealthy and dangerous environment. Safety planning is the first step and most important. A lethality or danger assessment should be performed and a safety plan developed. All victims should be given referrals for community resources including, but not limited to, counseling services and shelters (Babcock, et al., 2008). “Trauma robs the victim of a sense of power and control; the guiding principle of recovery is to restore power and control to the survivor” (Herman, 1992). After experiencing initial reactions to victimization, victim’s lives will never be the same. Many survivors say “they want the old me back”. What they are expressing is that they aren’t the same, and they are having difficulty identifying with and accepting “the new me”. However, as they begin to heal, they will regain control, empowerment and a sense of confidence. The recovery process can be long and difficult.
Crisis intervention should be implemented as soon as possible. In addition, individual psychotherapy is recommended. “A therapist or counselor can help the victim restructure the fragments of their lives; understand and accept some irreversible changes brought about by the trauma; reopen channels of feeling that may have been repressed; and learn to manage the impact of distressing, invasive thoughts or flashbacks” (NVPTSD 2009).
Therapists need to be honest with their clients. They need to inform survivors that although effects of a trauma can be alleviated, they may not always go away (Young, 1992). Therapists should also inform their clients that life’s events, holidays, anniversary dates of the crime, or other potential triggers may trigger memories and cause them to re-experience the stress reactions in the future, even after the client feels happy again, or has developed some normalcy back in their lives. With effective treatment, survivors can learn to cope with symptoms and help to control symptoms of anxiety and depression. Medication may be needed for some survivors. There are many quality medications that are proving to help survivors manage their symptoms; such as anti-anxiety medications, anti-depressants, beta blockers, and sleep aids for insomnia.
Another intervention that is being used in clients with PTSD, depression, and anxiety is EMDR-eye movement desensitization repossessing. This is a new therapy for patients who have suffered for years from anxiety or distressing memories, nightmares, insomnia, abuse or other traumatic events. “Research shows that EMDR is rapid, safe and effective. EMDR does not involve the use of drugs or hypnosis. It is a simple, non-invasive patient-therapist collaboration in which healing can happen effectively” (EMDR-Therapy, 2009).
Domestic Violence does not discriminate and it can happen to anyone at any time. The consequences are devastating and can lead to post-traumatic stress disorder. The circumstances become more difficult for the victim when the perpetrator is a police officer. Early intervention can help reduce the potential of developing PTSD and reduce symptoms. “Due to the high risk for victims and survivors of developing crime-related PTSD, mental health referrals and services for crime victims should be provided to all victims” (NCPTSD 2009).
We now know that there is a biological connection between PTSD and brain chemistry. With current extensive research on PTSD, suffers are being treated, and improving their quality of life. Psychotherapy, medication regimens, a healthy lifestyle, stress reduction, exercise, good nutrition, EMDR-eye movement desensitization reprocessing, and support systems are some interventions being used to help treat PTSD. Early intervention is vital and has resulted in a better success rate than those who do not seek treatment or seek treatment long after the event. The good news is that research on how PTSD works in the brain is moving forward, there is hope that the rewired biochemical system from trauma can also be rewired into healthier brain chemistry through a healthy lifestyle, nutrition, exercise, stress reduction, cognitive-behavioral therapy. This will help people regain the life they had before their traumatic event (Briere, 2009).
The prevailing argument and current research on PTSD has come a long way in identifying symptoms, diagnosis and the treatment of PTSD. The connection between PTSD, trauma, intimate partner violence, crime victimization, the development of secondary symptoms, such as depression, anxiety, and substance abuse disorders are recognized as key symptoms and factors related to the condition. We now know that there is a biological connection between PTSD and brain chemistry. With extensive research on PTSD, sufferers can be treated.
Psychotherapy, medication regimens, EMDR-eye movement desensitization reprocessing, and support systems are some interventions being used to help treat PTSD. Early intervention is vital and has resulted in a better success rate than those who do not seek treatment or seek treatment long after the event. “The good news is that research on how PTSD works in the brain is moving forward, there is hope that the rewired biochemical system can be rewired one more time through therapy to help people regain the life they had before their traumatic event”(Briere, 2009).
The literature shows that “women who experience intimate partner violence (IPV) are at considerable risk of developing PTSD. The effects of IPV on victims are profound. Factors such as victimization during childhood, sexual abuse by a partner, type of abuse (e.g., sexual, physical), and timing of abuse (chronic, recent) may increase the probability that women will develop PTSD. When considering the effects of IPV on women, practitioners must also be mindful of how the IPV and the victim’s experiences of it may affect families and children” (DeJonghe, et al., 2008). Domestic violence does not only affect the victim, but it also affects the victim’s children, family, and friends, therefore, intervention should be considered for all who witness or are exposed to domestic violence.
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