Veteran-Related PTSD & Police Violence

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.

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

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.

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

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.

• 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