The nature of posttraumatic stress disorder in treatment-seeking first responders

Background: Approximately 10% of first responders report posttraumatic stress disorder (PTSD). Although reports within first responders suggest that they have distinct symptom presentations, there is a need to understand how the clinical profiles of first responders may differ from others seeking treatment for PTSD.

Objective: This study compared the PTSD symptom profiles of first responder and civilians seeking treatment for PTSD.

Method: Participants self-referred to the Traumatic Stress Clinic (University of New South Wales, Sydney) for enrolment in out-patient treatment trials for PTSD. Participants comprised people of mean age 41.72 years (SD = 10.71) who met DSM-IV criteria for PTSD. The sample was composed of 128 first responders and 182 civilians. Clinician-administered interviews of PTSD (Clinician-Administered PTSD Scale) and depression were conducted, as well as measures of self-report measures of depression, alcohol use, posttraumatic appraisals, and anger.

Results: First responders reported greater rates of dysphoric cluster of symptoms, including diminished interest, emotional numbing, and social detachment, and less psychological reactivity and avoidance of situations, than civilians with PTSD. Beyond PTSD symptoms, first responders also reported more severe levels of depression and suppressed anger.

Conclusions: These findings indicate that treatment-seeking first responders present with a distinct clinical profile that is characterized by dysphoric symptoms. These symptoms can predict poor treatment response and require specific attention in treating PTSD in first responders.

HIGHLIGHTS

• Treatment-seeking first responders report greater rates of emotional numbing, avoidance, depression and suppressed anger than civilians, suggesting that treatment of PTSD in first responders should accommodate their specific symptom profiles.