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Desert Psychological

Associates

Cathie O’Connell, PhD.

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Post Traumatic Stress in The

Workplace

Cathie O’Connell, Ph.D.

Enter Slide Title

Posttraumatic Stress Disorder

(PTSD) did not exist as a

diagnosis until 1980 with the

publication of DSM III

Current Diagnostic Criteria

DSM IV

A. Experience of a Traumatic Event

B. Symptoms 1. Re-experiencing the event

2. Avoidance of reminders of the event

3. Heightened arousal

Current Diagnostic Criteria

DSM IV

Duration of at least one month

Impairment in Social or Occupational

Functioning

PTSD Often Accompanied By

Depression

Anxiety

Substance Abuse

Various Physical Complaints

Guilt

Non Specific Signs of PTSD

Vague Physical Symptoms

Interpersonal conflict at work

Impaired Work Performance

Social withdrawal

Increased Alcohol use

What Constitutes Trauma

The person must have directly

experienced the event, witnessed it, or

learned about it indirectly; the event must

have been life-threatening, involved

serious injury, or threatened physical

integrity; and it must have triggered an

intense emotional response of fear, horror,

or helplessness.

High Risk Occupational Settings

Military

Emergency services

Acute Care Medical Settings

Bank Officers

Train and Truck Drivers

Mining

Agriculture

Construction

PTSD is a relevant issue for all

employers since violence and

accidents are possible in most

occupational settings

Biological changes with PTSD

Changes in the regulation of the

Autonomic Nervous system

Changes in Immune Function

Endogenous Opioid Regulation

Startle Response

Higher Cortical Functions involving

Memory, Attention and expressive

language

Assessment of PTSD

Several Psychological Tests Specific to

PTSD

Impact of Events Scale

Posttraumatic Stress Diagnostic

PTSD Checklist

Incidence of PTSD in the

Workplace

Multiscale Personality

Inventories

MMPI_2

Personality Assessment Inventory (PAI)

Structured Interviews

Clinician Administered PTSD Scale

(CAPS)

PTSD Symptom Scale–Interview (PSS-I)

What I Use

CAPS

MMPI-2

Validity of the Worker’s Claim

PTSD is Easy to Fake

Assessing for Malingering

Avoid Scales that are too obvious

MMPI-2 Validity scales

Open ended interview questions

Causes of PTSD in the

Workplace

Robberies

Motor Vehicle Accident

Airplane Crashes

Construction Injuries

Machine Injuries

Rape and Sexual Assault

Factors That Increase the

Likelihood or Severity of PTSD

after a Traumatic Event

Multiple Occurrences

Prior Traumatic Experiences

Pre-existing psychiatric Disorders

Pre-trauma Catastrophic Thinking

Factors That Increase the

Likelihood or Severity of PTSD

after a Traumatic Event

Continued exposure to the distress of

Victims

Legal investigations of an event, especially

where blame is involved

Factors That are Protective

Post incident support of employers,

colleagues, family and Friends

Timely Intervention

There is a critical period following

Trauma during which irreversible

neuronal changes can occur in

those who develop PTSD

Barriers to Return to Work

Related to the Worker

Threat Appraisal

Severity of anxiety

Comorbid Depression, anger and Pain

Barriers to Return to Work

Related to the Workplace

Strong Potential for Repeat Traumatic

Events

Workplace Conflict