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Post-Traumatic Stress Disorder - A Case Study
by Mark Sichel, LCSW

"I was in the park talking with my friend and I had my dogs with me. I see Officer Breck and I feel worried because I've seen him harass people in the past, so I start to leave the park. Plus, I've had a long history of community activism, and I've had several verbal altercations with Officer Breck myself. As I'm leaving, Officer Breck is entering the park, and I say 'How are you?' He says, 'Better than you. I keep walking and he pushes me hard on the shoulder. I say, 'Is that legal?' I start to walk forward and he keeps pushing me back. He then says, 'I'm going to shoot your dogs, lady.'

"I became so frightened at that point that I peed in my pants. I was terror struck. I asked him please to stop. I told him I was pregnant and said I was sorry. He said he didn't care. I went into a panic when he reached for his walkie-talkie. I thought he was getting his gun because he keeps saying that he's going to shoot my dogs. He tries to handcuff me and I'm terrified that if I let the dogs go they'll bolt into the street and get hit by cars. When I resisted the handcuffs because of the danger to the dogs, he threw me on my stomach, stepped on my back, and handcuffed me. He then threw me into the police car and fortunately my friend had arrived and she took the dogs.

"I start to think I'm miscarrying because I didn't realize I had urinated in my pants and I thought I was bleeding profusely. My friend kept telling Breck to stop because I'm pregnant. I keep crying and saying I'm losing my baby. Suddenly there are four police cars and eight officers. They tell me they're going to tie my dogs to a pole on the street and Officer Breck keeps saying he's going to shoot the dogs. My friend has managed to reach my husband, Steve, who arrives in the park. When he gets there, Officer Breck says to him, 'I never laid a hand on her.' He then asks my husband if I've taken my medicines. He tells Breck that I'm pregnant, and not on medication. The police then gave me a ticket for disorderly conduct."

The narrator of the above story is a 34-year-old married woman with one child who we'll call Karen*. She has a history of provocative behavior, but has never been in trouble with the law. She's come to see me three weeks after this incident, complaining of overwhelming anxiety and fear. She feels hopeless and helpless, and is consumed with obsessive thoughts about what happened to her that day in the park three weeks ago.

"I have nightmares every night now. Last night, I dreamed that I was being shot, along with my dogs, executioner style. I was on my knees and facing away from the executioner with one dog on either side of me. The dogs were shot and then I turned around and saw Officer Breck and I woke up terror struck. I got no sleep for the rest of the night. I'm exhausted, scared, confused, and angry. I can't take care of my son, and I'm terribly worried about my pregnancy. Then I had another dream that I'm in the cop car and the cops are laughing at me. I'm peeing in my pants, thinking I've lost my baby and they're laughing."

This reliving and re-experiencing of the traumatic event is the central symptom of post traumatic stress disorder. Chronic and persistent dreams of the traumatic event, and difficulty sleeping are also core symptoms of this disorder.

Karen continued to tell me her ongoing difficulties as the session continued. "When I see a cop I get terrified. I start to feel like I'm in terrible danger, and my heart starts to beat rapidly, I sweat, shake, can't breathe. My stomach hurts and I'm nauseous a lot of the time. It's terrible because I'll be out with my son and I'll see a police car and my adrenaline starts pumping and I get a startled look on my face. I immediately go back to the house, and proceed to get sick in the bathroom."

Hypervigilance, exaggerated startle response, and physiological symptoms such as palpitations, abdominal distress, sweating, breathing difficulties, are all typical responses for people who are suffering a post-traumatic stress disorder.

As Karen continued her therapy with me, more symptoms of post-traumatic stress disorder continued to emerge. As she talked through the episode with Officer Breck and what happened to her that day, she slowly started to feel better.

The most helpful treatment for Post-Traumatic Stress Disorder (PTSD) is to talk about what happened during the event, and to share your feelings with another person. It's most helpful if this person is a trained and licensed therapist, but it's useful to discuss it with others as well.

As is the case with many emotional problems, the course of treatment is never a straight up hill progress, for there are often regressions that can follow progress. If you are experiencing PTSD, don't get frightened if your progress is sometimes slowed down by a return of symptoms. This is normal and to be expected, and will go away eventually if you continue to work on your problem.

Karen came in one day after ten weeks of therapy, and told me that she had stayed in bed all weekend, unable to mobilize herself and feeling dissociated and detached from her own experience. She was fortunate to have had her husband at home to take care of their son, but found it distressing that she had no interest in any of her usual activities. Feelings of detachment and estrangement and loss of interest in significant activities are also symptoms of PTSD. I reassured Karen that a regression or backslide in progress was not unusual, and asked her if something had happened that could have caused this.

"Oh yes, for sure something happened," she said. "I saw Officer Breck riding on bicycle patrol and yelling at a woman with a dog. I was terror struck. The whole horrible event with him came back to me. I instantly lost control and peed in my pants. My heart was pounding, I was shaking and couldn't breathe and then vomited and had diarrhea all weekend. I just lay in the bed the whole weekend, completely numb and frightened. I guess I couldn't even deal with this until I saw you in a session."

Karen's treatment progressed for another ten weeks, with progress followed by back-sliding. At one point she had a particularly bad day, and realized it was because she had run into Officer Breck in the supermarket. He was in civilian clothes, but as soon as she saw him, she freaked out. She continued to feel frightened of going out of her house, and most certainly avoided the park where the incident took place. Avoidance of activities, places or people that arouse recollection of the traumatic event is another central symptom of PTSD.

Karen eventually felt she had a good enough handle on her recovery to continue her treatment by going to a support group with other women who were experiencing similar post-traumatic fears.

If you are having symptoms of post-traumatic stress disorder, try some of the tools for anxiety reduction in our Panic Disorder lesson Relaxation Techniques. If you can't see a professional therapist, talk to your friends and family about the incident. Find a support group; they are plentiful both on-line and in the real world.

To learn more about PTSD, read Critical Incident Debriefing to find out how you can prevent a traumatic experience from coming back to haunt you in the form of PTSD.

*The names of all individuals have been changed to protect their identities.

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