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