PTSD 101 - Secondary PTSD

February 12, 2019
Reading Time: 4 minutes

Content warning: descriptions of ptsd, and non-specific traumas


As we left on in the last article, PTSD is technically a contagion in the mental health realm. Constant exposure to person’s suffering trauma and distress causes the same physical trauma as we discussed in the previous article, especially if exposed, without significant break, for an extended period of time.

But why?

One of the most powerful, and utterly extraordinary components of the brain is the “mirror neuron” arrays in the front and prefrontal cortexes. These allow us to empathise with others and appreciate their feelings and experiences. They are essential to the mechanisms of the brain which make us social creatures, capable of emotional connection, compassion, appreciation and insight. They are, without doubt, some of the most extraordinary pieces of neural bioengineering in the human design.

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However, they achieve this by embodying what they observe. If you see some hit hard in arm, and you are sympathetic to the person it is happening to, then the parts of your brain the control the movement and sensation, and report the pain of your arm light up, as if your arm had been struck. This promotes an understanding of the other person’s experience that you then use as a base for empathetic feeling and communication.

This means that after constant exposure to this suffering, the brain is sometimes unable to differentiate between what is happening to someone you don’t know, what is happening to someone you love or care about, and what is happening to you.

This makes it very difficult to work with trauma for extended periods — the trauma becomes mirrored in our own minds and bodies.

Complexity

This is still an area of workplace health which is poorly understood by a lot of workplaces. It is usually all lumped under the concept of “burnout” and whilst this is a genuine workplace concern, is does not describe an accurate gradient of severity.

Burnout

Burnout is often born of severe fatigue, and is common in occupations involving repetition, long hours or shift work, and companies where workplaces practices and systems could use major improvement/overhaul. It is characterised by less focus, slightly erratic emotional responses, depression, and fatigue related illness. it is not a catchall term, it is a very specific impact of unreasonably demanding or unsustainable work.

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Compassion Fatigue

This lies just beyond burnout and, in terms of neurological and psychological damage, is about where major alarms should start sounding. This is a major risk for nurses, paramedics, emergency care doctors, GPs, counsellors, youth workers and disability workers especially, but is common in most community service industries.

Compassion Fatigue is greatly more destructive than burnout because it alters or diminishes your core emotional stability — sometimes permanently. Without proper debriefing and self-reflection systems, these workers are repeatedly bounced between emotional extremes, until the only way for the brain to cope and regulate is to not feel. “No matter what happens to this patient, I have to keep going for the next one” and “No matter what I witness at this crime scene, I have to be alert for the next job”

In this state, we lose empathy, compassion, interpersonal awareness, and divergent coping capacities. With repeated damage…. this can become the brain’s permanent operational state.

Secondary PTSD / Vicarious Trauma:

Exposure trauma, which is usually what professionals are referring to when they say burnout, is the most significant and dangerous impact for many professionals in law enforcement, social services, emergency services, and health care, both physical and mental health. After constant, repeated, untreated and un-debriefed exposure to vicarious trauma, the brain mimics, or mirrors the impacts and anticipations of major trauma, resulting in the neural degradation and psychological dysfunction discussed in our previous article.

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First and foremost, the capacity for effective emotional response is blunted or limited, and hyper-reactive or vacant and disengaged emotional processes take place in their stead. Far beyond the outcomes of compassion fatigue, the ability to empathise and connect interpersonally become permanently (at least without treatment) disconnected or limited. The explosively aggressive, impulsive or fearful behaviour discussed for PTSD victims become more and more evident in victims of vicarious trauma. Soon, the health impacts associated with direct trauma sufferers become a real risk for secondary (vicarious) victims.

The risk of permanent disablement, over long periods is very real — as real as if they had suffered the traumatising events of their patients / clients themselves.

Issues in Policy

Through out the social and medical services, there are many topics that HR departments and employers in general will need to consider in the future.

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Proper debriefing, constant demands of overtime, long shifts or otherwise excessive rostering, appropriate support after abuse/witnessing abuse, ergonomics and awareness of the emotional fatigue caused by physical pain, a full understanding of subconscious pain mirroring when witnessing injury or surgical procedures, and more could all contribute, if implemented correctly, in a massive reduction of the consequences and prevalence of Secondary PTSD in our caring, enforcement and military workspaces.

With this being such a pervasive risk to our community, it is fair to ask how we avoid these risks, or mitigate the impacts that are so profound and far-reaching.

Luckily, whilst there is more research to be done, and more hard work needed, there are treatments available and methods that do work; more importantly, there are things you can do to support loved ones, friends and colleagues that will genuinely make a huge difference, which we will discuss next time. ‘

https://www.ausmed.com/articles/burnout-fatigue-post-traumatic-stress/

https://news.yale.edu/2017/07/17/new-ptsd-study-identifies-potential-path-treatment

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181836/

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