Post-traumatic stress disorder (PTSD) is a disorder that occurs in response to the direct experience of, witnessing others being involved in, or hearing of others being involved in a extremely traumatic or stressful event, such as a natural disaster, assault, kidnapping, etc.
 
PTSD is a psychological/psychiatric disorder that requires a fulfillment of certain diagnostic criteria. It is not associated with just being sad, anxious, or upset over experiencing, witnessing, or hearing about these events.

The disorder can develop immediately after experiencing or witnessing the event, or it can develop some months, and in some cases even years, after the event. The person diagnosed with the disorder must either be directly involved in the aspects of the event or indirectly witness or hear of someone close to them being involved in the event.

Certain professions are associated with a high risk for the development of stress and trauma disorders such as PTSD. Some professions, such as retail clerks who may be assaulted, have varying rates of PTSD, but they are not considered to be high-risk professions when the overall rate of individuals employed in these professions is compared to the rate of individuals who actually develop PTSD. High-risk professions are generally designated as professions that have significant proportions of individuals developing trauma-related disorders such as PTSD.

Traumatic Events

comorbidTraumatic or stressful events are not really well defined. This is because these experiences are subjective in nature and elicit different responses in different individuals. The types of traumatic or stressful events that are commonly associated with the development of PTSD include:

  • Physical or sexual assault, either completed or attempted
  • Experiences in combat
  • Being involved in accidents, such as automobile accidents or accidents occurring in mass transportation
  • Being a victim of or witnessing acts of terrorism
  • Being a victim of or witnessing other serious crimes
  • Being diagnosed with a serious and/or life-threatening illness, or having a relative diagnosed with one of these

People do not have to be directly involved in these events as stated above. One can witness, hear about, read about, or learn about such events happening to others who are close to the individual.

According to The Handbook of PTSD: Science and Practice, it is estimated that well over half of the population in the US experiences some stressful event during their lifetime, whereas the prevalence of PTSD is generally considered to be 10 percent of women and 5 percent of men. The overall prevalence of PTSD in the US is considered to be 7-8 percent. Women may have several inherent risk factors making them more vulnerable to the development of PTSD, such as being at higher risk for assaults, kidnappings, etc.

Nonetheless, the proportion of individuals experiencing some potentially traumatic event and the prevalence of PTSD in the US indicate that the vast majority of individuals do not experience PTSD as a result of their exposure to these types of events.

High-Risk Professions

Several professions are associated with a higher risk for the development of PTSD. These include:

  1. Military occupations: The experience of combat is a high risk factor for the development of PTSD. Combat veterans appear to develop PTSD at different rates depending on the conflict. For instance:
    1. Veterans involved in operations Iraqi freedom and enduring freedom are reported to have rates of PTSD of 11-20 percent.
    2. Gulf War veterans have rates of PTSD around 12 percent.
    3. The rates of PTSD in Vietnam veterans are reported to be between 15 and 20 percent; however, the lifetime prevalence of PTSD in Vietnam veterans may be as high as 30 percent.
    4. A large number of individuals in the military also report experiencing sexual harassment and sexual abuse. The rates of PTSD as a result of these experiences are not well defined but would be expected to be relatively high compared to the overall rate of PTSD in the general population.
  2. Police officers: Law enforcement officers are exposed to a number of serious direct threats and stressful conditions. In addition, they experience and witness the devastating effects of assaults, robberies, kidnappings, and other events. Individuals in this profession have surprisingly lower-than-expected overall rates of PTSD, estimated to be about 10 percent overall (although some estimates are lower than this). This lower-than-expected rate is most likely due to the number of opportunities for individuals in this profession to engage in counseling and directly expressing their feelings to others once they are involved in these situations, as well as rigorous pre-employment screenings.
  3. Firefighters: This profession also includes paramedic work and being first responders to natural disasters in many countries. It is considered to be an extremely hazardous profession. Firefighters are exposed to a number of stressful conditions and traumatic events, ranging from threats to their own safety to experiencing the devastating effects of these catastrophes. The prevalence of PTSD has been described as high as 20 percent in this group of individuals. Volunteer firefighters may have even higher rates of PTSD.
  4. Emergency medical and ambulance personal: People in these professions are routinely exposed to critical incidents and have a higher number of health problems than individuals in other professions. Prevalence rates of PTSD in this group have been reported as high as 20 percent; however, these figures can be variable depending on the samples used. When staff members undergo pre-employment screening and are informed about how to access support and counseling services, these rates are much lower. Best estimates of the prevalence of PTSD in this profession indicate that these prevalences are comparable with the prevalence of PTSD that occurs in police officers.
  5. Other healthcare workers: Healthcare workers are as a group at a higher risk to develop PTSD than individuals in the general population, especially healthcare workers in emergency rooms or in intensive care units. However, there are a number of qualifying variables associated with this group of workers. For instance, nurses working in critical care units are more likely to develop PTSD than nurses on other units; senior-level nurses report fewer PTSD symptoms than junior-level nurses (but also report higher rates of burnout); and healthcare workers directly exposed to violence, such as an assault, are more likely to develop PTSD than surgeons who treat assault victims.
  6. Journalists: Some journalists, such as journalists who work as war correspondents, are exposed to increased risks of being injured, killed, or kidnapped. This particular group has a high lifetime prevalence of PTSD that is close to 30 percent. This figure may be in part explained by a lack of support and available treatment options for these individuals.
  7. First responders to disasters: Rescue workers, medical workers, and volunteers who are first responders to disasters witness the aftermath and can even become involved in severe traumatic events. The prevalence of PTSD in these individuals has been estimated to be between 15 and 30 percent depending on the sample.

While the above occupations are associated with a higher risk for the development of PTSD than many other occupations, this association should not be interpreted as causal. Being a firefighter, police officer, or combat veteran does not cause one to develop PTSD any more than being involved in a natural disaster causes one to develop PTSD. Risk factors simply increase the probability that some illness or disorder may occur; they cannot be interpreted as causes. In addition, there are a number of other very salient risk factors associated with the development of PTSD. One of these is substance abuse.

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PTSD and Substance Abuse

Man tapering off drugsIndividuals who develop PTSD have high comorbidities with other psychological disorders, including substance use disorders. The general figures indicate that over one-fifth of individuals who seek treatment for issues with PTSD also have a diagnosable substance use disorder.

The relationship between PTSD and substance abuse is not quite as simple as many believe. Many treatment websites for addiction imply that this relationship is a result of individuals with PTSD attempting to self-medicate their symptoms of PTSD with drugs and alcohol; however, as it turns out, individuals with PTSD not only have high rates of substance abuse, but individuals who first develop substance use disorders are also at a high risk to develop PTSD. Thus, substance abuse appears to be both a consequence of having PTSD as well as a risk factor for the development of PTSD.  The relationship between these two disorders is not as simple as many believe it to be.

A large number of individuals who develop PTSD exhibit some form of substance abuse prior to being involved in a traumatic or stressful event.

Conclusions

There are several professions that are associated with a higher risk for the development of PTSD; however, in some of these professions, the risk for the development of PTSD has actually been reduced by adhering to policies regarding debriefing, making support and counseling available to individuals in these professions, and even pre-employment screening policies that can eliminate individuals who may be at high risk for adverse reactions to stressful conditions.

Because not everyone who is exposed to a traumatic or stressful event will develop PTSD, and not everyone in one of these professions develops PTSD, it would be a mistaken notion to assume that experiencing a traumatic or stressful event or being in one of these professions can cause PTSD to occur. In addition, the relationship between substance use disorders and PTSD is bidirectional and difficult to interpret and understand. In some cases, individuals may develop PTSD and use drugs or alcohol as coping mechanisms for their distress, whereas in other cases, individuals who have pre-existing substance abuse problems are at a higher risk to develop PTSD.