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There was a year or two spent in the bargaining stage when Mom passed away. Then came the depression. The depression lasted years. Then, more friends and fellow cancer warriors passed away. It felt like everyone was dying around me when I was supposed to be the one gone.

I begged to take their place, slipping back into bargaining. Then hubby got diagnosed with tuberculosis and I was afraid I was going to lose him too.

The guilt for surviving has been a heavy weight. "Why am I still here?" Then, I ended up on college campus when I realized that my journey here was going to be extended. Something needed to be done while I was "waiting to see" like the doctors said. So, while we were waiting I figured some classes to gain a little knowledge made sense.

Entering the PierceWorks! program, I was lost, depressed, angry and bitter. I was frustrated that I couldn't just jump into a UNIX class. Then, as someone shared about their family values and the history behind their values, out of the blue I started crying. Not weeping. Full on crying.

It was as if the losses, all of the losses that had been experienced came flooding through. I finally broke.

Then, I slowly began the path of navigating back to who I needed to be because, obviously, I was still here. After I graduated the PierceWorks! program, the desire for an education was fueled. It turned from taking a UNIX class into getting a degree. What if I can cross that stage for once in my life? What if all of those years of disappointing mother with failing to graduate can be my tribute and a patch over the wound of not living up to her expectations? What if this can be the one last thing that I can check off my bucket list?

There are no guarantees in life. We never really know what tomorrow will bring. As I journeyed back to myself, I watched several family members and spouses grieve for their losses. I was without the words to express how sorry I was and the guilt for being alive was immeasurable.

After realizing that I was more than passing my Algebra classes and getting 4.0 grades and making the President's list, I realized that I was capable of much more than I ever gave myself credit for. The professor of PierceWorks! knew. As did several of my cohorts in PierceWorks!. They saw something I did not and by the time I finished with my second degree, it dawned on me what they were trying to convey.

It took college for me to finally find myself. Every day presents something to be grateful for. Acceptance is where I am at now because, not only did I lose loved ones. I also lost myself. The grieving process does not have a timeline and parts of me died with every single person that lost their battle. It chipped away at my heart and my soul until I felt like nothing was left.

Standing in line to cross that stage, it was surreal. Is this really happening? At the bottom of the stage after I crossed was a lovely veteran by the name of Vicki who has spent hours talking with me about the challenges of veterans. She reached out to me and gave me her hand to hold onto. There she was, one last time, as if to say, "I got you. You got this." She smiled that beautiful smile of hers and walking with degree in hand, I saw all of the faces of the professors who were a part of my journey. Their smiles and clapping was bitter sweet.

That milestone moment was the pomp and circumstance of reclamation. I entered college expecting for my calling to happen before I would finish. It was the moment of letting go of the depression and accepting that it was time to move on.

There is light at the end of the tunnel. I spent a year getting rejection letter after rejection letter seeking a position. That year was grueling but the final 'yes' was the result of holding on to that moment knowing that the right organization with the right culture would call to ask me if my next chapter would be with them.

I am still here and here I am with the organization that was a top contender of my list because they had the values that fit the most.

It has been a very long and arduous journey through the grieving process. I wasn't grieving just for the losses of others, I was grieving the loss of myself and there are days, still, that I question whether this is all real. It is and I have accepted the loss of who I used to be and discovering a new me and looking forward to who I will become.

I'm not done yet. Neither are you. You're still here aren't you? It isn't without the pain and that pain is normal. You're not alone in this journey. When you decide to take that step, no matter how small, there are those of us who have been down that path that are willing to reach our hand out even if it's just for comfort. You are not alone.

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There's no manual on how to cope with loss and certainly no right or wrong way to go through the stages of grief that might come from it.

Mourning is an intimate and unique experience for each of us. If you or someone you love are going through a loss, the new emotions may feel overwhelming and confusing.

There are at least five emotions associated with grief. Feeling this way is natural and even necessary.

These emotions are forward steps in the healing journey, even when it doesn't feel like it at the moment.

Healing from a loss is possible, but it does take time and patience. Even if you're having a particularly hard time with it, resources like counseling and support groups can help you cope when you're going through five stages of grief.

In an effort to better understand the grieving process, many mental health experts and researchers have dedicated years to studying loss and the emotions that come with it.

One of these experts was Elisabeth Kübler-Ross, a Swiss American psychiatrist. She created the Kübler-Ross model, the theory of the five stages of grief and loss.

In her 1969 book, " On Death and Dying," Kübler-Ross examined the five most common emotional reactions to loss:

Originally, Kübler-Ross referred to them as the "five stages of death." This was because she was working with terminally ill patients at the time, and these were the common emotions they had regarding their own mortality.

Years after her first book, Kübler-Ross adapted and extended her model to include other kinds of loss. The five stages of death became the five stages of grief.

This grief can come in many forms and for different reasons. Everyone, from all walks of life and across cultures, experiences loss and grief at some point.

Mourning doesn't come only from dealing with your own death or the death of a loved one. Mourning can also come as a result of an illness, the end of a close relationship, or even the end of a project or dream.

Grief can similarly come from a perceived or real change in your life. For example, moving to a new city, school, or job, transitioning into a new age group, or staying in isolation because of a pandemic.

In other words, there's no written-in-stone list of "valid" reasons to grieve.

What matters is how you feel. And there are no right or wrong feelings regarding a loss.

Exploring the five stages of grief and loss could help you understand and put into context where you are in your own grieving process and what you feel.

Similarly, if you're concerned or want to understand someone else's grieving process, remember that there's no one way of going through it. Everyone mourns differently.

You could go through many intense emotions, or you could seemingly not react at all. Both responses are valid and not uncommon.

How much time you spend navigating the stages of grief also varies from person to person. It might take you hours, months, or longer to process a loss and heal from it.

You might not experience all these stages of grief or in the order listed above. You could go back and forth from one stage to another.

You may even skip all these emotions and process your loss differently altogether. The five stages of grief are supposed to serve you as a reference, not as a rule.

For some people, this may be the first response to loss.

Denial is a common defense mechanism. It may help you buffer the immediate shock of the hurtful situation.

As an immediate reaction, you might doubt the reality of the loss at first.

A few examples of this type of denial are:

If you're facing the death of a loved one, you might find yourself fantasizing someone will call to say there's been a mistake and nothing really happened.

If you're dealing with a breakup, you might convince yourself your partner will soon regret leaving and come back to you.

If you lost your job, you might feel your former boss will offer you the position back after they realize they've made a mistake.

After this first reaction of shock and denial, you may go numb for a while.

At some point, you could feel like nothing matters to you anymore. Life as you once knew it has changed. It might be difficult to feel you can move on.

The first stage of grief is a natural reaction that helps you process the loss in your own time. By going numb, you're giving yourself time to explore at your own pace the changes you're going through.

Denial is a temporary response that carries you through the first wave of pain. Eventually, when you're ready, the feelings and emotions you have denied will resurface, and your healing journey will continue.

Sometimes pain takes other forms. According to Kübler-Ross, pain from a loss is often redirected and expressed as anger.

Feeling intensely angry might surprise you or your loved ones, but it's not uncommon. This anger serves a purpose.

It might be particularly overwhelming for some people to feel anger because, in many cultures, anger is a feared or rejected emotion. You might be more used to avoiding it than confronting it.

During the anger stage of grief, you might start asking questions like "Why me?" or "What did I do to deserve this?"

You could also feel suddenly angry at inanimate objects, strangers, friends, or family members. You might feel angry at life itself.

It's not rare to also feel anger toward the situation or person you lost. Rationally, you might understand the person isn't to blame. Emotionally, however, you may resent them for causing you pain or for leaving you.

At some point, you might also feel guilty for being angry. This could make you angrier.

Try reminding yourself that underneath your anger is pain. And even if it might not feel like it, this anger is necessary for healing.

Anger might also be a way to reconnect to the world after isolating yourself from it during the denial stage. When you're numb, you disconnect from everyone. When you're angry, you connect, even if through this emotion.

But anger isn't the only emotion you might experience during this stage. Irritability, bitterness, anxiety, rage, and impatience are just some other ways you might cope with your loss. It's all part of the same process.

Bargaining is a stage of grief that helps you hold on to hope in a situation of intense pain.

You might think to yourself that you're willing to do anything and sacrifice everything if your life is restored to how it was before the loss.

During this internal negotiation, you could find yourself thinking in terms of "what if" or "if only": what if I did XYZ, then everything will go back to normal; if only I had done something differently to prevent the loss.

Guilt might be an accompanying emotion during this stage as you inadvertently might be trying to regain some control, even if at your own expense.

All these emotions and thoughts aren't uncommon. As hard as it might feel, this helps you heal as you confront the reality of your loss.

Just as in all the other stages of grief, depression is experienced in different ways. There's no right or wrong way to go about it, nor is there a deadline to overcome it.

In this instance, depression isn't a sign of a mental health condition. Instead, it's a natural and appropriate response to grief.

During the depression stage, you start facing your present reality and the inevitability of the loss you've experienced. Understandably, this realization may lead you to feel intense sadness and despair.

This intense sadness could cause you to feel different in other aspects too. You could feel:

fatigued

vulnerable

confused and distracted

not wanting to move on

not hungry or wanting to eat

not able or willing to get ready in the morning

not able to enjoy what you once did

This is all typically temporary and a direct response to your grieving process.

As overwhelming as it may feel at this point, this stage is a necessary part of your healing journey.

Reaching acceptance isn't necessarily about being OK with what happened. Depending on your experience, it might be understandable if you don't ever feel this way.

Acceptance is more about how you acknowledge the losses you've experienced, how you learn to live with them, and how you readjust your life accordingly.

You might feel more comfortable reaching out to friends and family during this stage, but it's also natural to feel you prefer to withdraw at times.

You may also feel like you accept the loss at times and then move to another stage of grief again. This back-and-forth between stages is natural and a part of the healing process.

In time, you may eventually find yourself stationed at this stage for long periods of time.

That doesn't mean you'll never feel sadness or anger again toward your loss, but your long-term perspective about it and how you live with this reality will be different.

The five stages of grief proposed by Kübler-Ross have served as a framework for many mental health professionals working with the grief process.

Some of these professionals, such as British psychiatrist John Bowlby, have developed their own work around the emotional responses to loss. Others, including Kübler-Ross herself, have adapted and extended the original five-stage model.

This adaptation is usually known as the Kübler-Ross Change Curve. It extends the five core stages of grief to seven overlapping stages:

1. Shock. Intense and sometimes paralyzing surprise at the loss.

2. Denial. Disbelief and the need to look for evidence to confirm the loss.

3. Anger and frustration. A mix between acknowledgment that some things have changed and anger toward this change.

4. Depression. Lack of energy and intense sadness.

5. Testing. Experimenting with the new situation to discover what it actually means in your life.

6. Decision. A rising optimism about learning how to manage the new situation.

7. Integration. Acceptance of the new reality, reflection on what you learned, and stepping out in the world as a renewed person.

Because everyone mourns differently and for different reasons, sometimes you might feel your own grieving process isn't going "according to the norm."

But remember, there's no such thing as a right or wrong way of coping with a loss.

These might be some of the thoughts that could cross your mind when looking at your own or someone else's way of grieving.

1. 'I am doing it wrong'

One of the most common misconceptions about grieving is that everyone goes through it in the same way.

When it comes to healing from a loss, there's no correct way of doing it. You might find it useful to remind yourself there's no "I should be feeling this way."

Grieving isn't about going over or following a set list of steps. It's a unique and multidimensional healing journey.

2. 'I should be feeling...'

Not everyone experiences all the above-mentioned stages or even goes through these emotions the same way.

For example, maybe the depression stage feels more like irritability than sadness for you. And denial could be more of a sense of shock and disbelief than an actual expectation that something out of the blue will fix the loss.

The emotions used to contextualize the stages of grief aren't the only ones you'll experience. You might not even experience them at all, and that's natural too.

This is no indication that your healing journey is faulty in some way. Your healing experience is unique to you and valid nonetheless.

3. 'This goes first'

Remember, there's no specific or linear order for the stages of grief.

You could move along the stages one by one, or you could go back and forth. Some days you might feel very sad, and the very next day you could wake up feeling hopeful. Then you could go back to feeling sad. Some days you might even feel both!

In the same way, denial isn't necessarily the first emotion you'll experience. Maybe your first emotional reaction is anger or depression.

This is natural and part of the healing process.

4. 'It's taking too long'

Coping with a loss is ultimately a deeply personal and singular experience. Many factors affect how long it takes.

Some people navigate through grief in a few days. Others take months or longer to process their loss.

You might find it useful to not set any deadlines to your process.

In grief, you'll experience some of these emotions in waves of intensity. In time, you'll notice this intensity decrease.

If you feel your emotions stay or increase in intensity and frequency, this might be a good time to seek professional support.

5. 'I'm depressed'

Going through the stages of grief, particularly the depression stage, isn't equivalent to clinical depression. There's a distinction between having clinical depression and grieving.

This means that even though some symptoms might be similar, there are still key differences between both.

For example, in grief, the intense sadness will lessen in intensity and frequency as time goes by. You might even experience this sadness at the same time you find temporary relief in happy memories from times before the loss.

In clinical depression, on the other hand, without the proper treatment, your mood would stay negative or worsen with time. It would likely affect your self-esteem. You may rarely experience feelings of pleasure or happiness.

This doesn't mean there isn't a possibility you could develop clinical depression during the grieving process. If your emotions progressively increase in intensity and frequency, reach out for support.

If you're experiencing intense grief and feel unsure about how to cope with it, reaching out for help can provide comfort and support.

Any reason that's valid to you is a good reason for reaching out for help.

Other instances in which you might want to seek help processing your loss include the following:

You need to go back to school or work and have a hard time going about your daily tasks. For example, you're having trouble concentrating.

You're the sole or main guardian or support source for someone else. For example, you're a single parent or someone else's caretaker.

You're experiencing physical discomfort or pain.

You're skipping meals or medications because you don't feel like getting up or doing anything.

Your emotions are increasing in intensity and frequency instead of coming in waves or lessening over time.

You've thought about hurting others or yourself.

If you or someone you know is considering self-harm, you're not alone. Help is available right now:

There are a few other ways to reach out for help, depending on what is available to you.

Friends and family

Talking with friends or relatives might give you a sense of relief.

Verbally expressing how you feel can sometimes release some of the inner turmoil you might be experiencing.

Sometimes you might not feel like talking but instead prefer to have silent company.

Expressing your needs to others can allow them to help you in the way you feel is best for your situation.

Support groups

Engaging in support groups can be helpful too. There are local support groups as well as online support groups.

You can connect to others in the group who have gone through or are going through similar losses. They can direct you to further resources as well.

Support groups can also become a safe space where you can express yourself without feeling judged or pressured if you feel that might be the case when talking to somebody else.

Mental health professionals

Grief counseling and therapy are two ways to work with a mental health professional who might support your own process.

If you have insurance, call your insurer to determine whether this grief counseling is covered under your policy and, if so, under which conditions.

If your insurance doesn't cover counseling sessions, your primary care doctor might be able to offer some support or guidance.

If you don't have health insurance or aren't covered for this service, you could try searching for a local organization that provides grief counseling at a low or no charge.

Many national mental health organizations, like the National Alliance on Mental Illness (NAMI), have local or regional chapters. Calling them directly might give you access to some of this information and their specific grief support services.

You've taken the first step by just wondering how you can help your loved one.

Here are some ways you can support them now and in the future.

1. Listen

Perhaps one of the main legacies from Elisabeth Kübler-Ross and her work is the importance of listening to the grieving person.

You might have the best intentions and want to provide comforting words. But in some instances, the best support comes from just being there and making it clear that you're available to listen to whatever - and whenever - they want to share.

It's also important to accept it if your loved one doesn't want to talk with you. Give them time and space.

2. Reach out

Not everyone knows how to comfort others. It might be intimidating or overwhelming seeing someone you care about have a rough time.

But don't let these fears stop you from offering help or from being there. Lead with empathy, and the rest will follow.

3. Be practical

Look for ways to ease the weight off your loved one's shoulders. Explore the areas they might need help managing while they process their loss.

This could mean helping with food preparation or grocery shopping, organizing their room or house, or picking up their children from school.

4. Don't assume

You might want to verbally offer your support and be attentive to whatever they tell you might help them feel better. But avoid assuming or guessing "which step" of the process they're going through at the moment.

A smiley face or no tears don't necessarily mean they're not grieving. A change in their physical appearance doesn't mean they're depressed.

Wait for them to express how they feel, if they're ready, and go from there.

5. Search for resources

You might have the clarity of mind and the energy to browse local support groups and organizations, call an insurance company, and find a mental health professional.

The decision of reaching out for this kind of help is, of course, entirely up to the grieving person. But having the information at hand might save time whenever they're prepared or willing to take it.

Some resources you might find helpful are:

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There's no manual on how to cope with loss and certainly no right or wrong way to go through the stages of grief that might come from it. Mourning is an intimate and unique experience for each of us. If you or someone you love are going through a loss, the new emotions may feel overwhelming and confusing.

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One of the many things the Afghans will miss when most American troops leave next year is the EOD (Explosive Ordnance Disposal) troops, who so expertly get rid of all the terrorist (and increasingly gangster) bombs and mines To deal with that the Afghan

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By Anna Raskin

Dr. Michelle Lilly published a groundbreaking study on 911 telecommunicators in the Journal of Traumatic Stress in April 2012 titled "Duty-Related Trauma Exposure in 911 Telecommunicators: Considering the Risk for Post-traumatic Stress." Bringing to light the PTSD symptomatology in telecommunicators, the study has been instrumental in showing that dispatchers are at risk for PTSD in a similar way as police officers. Dr. Lilly has been at Northern Illinois University since the fall of 2009 and is an Associate Professor of Clinical Psychology. She has a wealth of experience studying victims of intimate partner violence, survivors of sexual and physical assaults, and other survivors of traumatic stress.

What follows is a telephone interview of Dr. Lilly on June 12, 2015, in which she shares her insights and additional study data.

A: In 2010, I was having a conversation with an undergraduate research assistant in my lab, Heather Pierce. We were talking about research that I had done with police officers while I was in graduate school when she began describing her previous job as a telecommunicator. Heather had the idea of looking at mental health in telecommunicators, so we developed the first study focusing on telecommunicators. We had a cross-section of 170 telecommunicators from across the country. At first, we thought it would be an interesting one-time project, but after seeing the reactions and interest from the 911 community, I felt drawn in, and decided to do a follow-up study measuring PTSD symptomatology in a different way. In less than a year, my lab recruited over 800 participants for a second study. With support from NENA, the International Academies of Emergency Dispatch, the 911 Wellness Foundation, and APCO, I got connected with people and was able to publish a second paper in April 2015.

A: It does not look different from other forms of PTSD. Individuals who have been assaulted, in motor vehicular accidents, and in disasters all present the same symptoms as are present in telecommunicators. The rate of PTSD across telecommunicators is somewhere between 18 percent and 24 percent, as this percentage of individuals report enough symptoms of PTSD that they would likely receive a diagnosis if they were seen by a psychologist and were formally evaluated. The only sub-classification of PTSD is called delayed onset, which means that PTSD is not developed until after a subsequent event is experienced down the road. PTSD can develop when people have a lot of cumulative trauma exposure.

Secondary PTSD is a different construct. An example of secondary PTSD would be PTSD-like symptoms that develop from hearing about something bad that happened to somebody. According to the DSM (the "Diagnostic and Statistical Manual of Mental Disorders" published by the American Psychiatric Association), hearing about someone else's trauma has been removed as a potential traumatic event, unless that event is particularly violent in nature. Yet, the DSM has specifically stated that being continually exposed to graphic, traumatic details of events as part of one's job does fall into the definition of trauma, which of course fits for telecommunicators. In our recent study, we've been looking at PTSD symptoms, and it is very clear that even if it does not happen to the telecommunicator, just the fact that they have this recurrent exposure to very traumatic events can lead to PTSD.

Does the data show that repeated exposure to a high volume of 911 calls with trauma can lead to PTSD?

That is a stress response, and absolutely, when we are repeatedly confronted with stressful events, stress reactions occur. PTSD occurs when people handle calls that are particularly distressing or upsetting and that stick with them for a long period of time. The more of those types of calls a telecommunicator handles, the more they are put at risk for PTSD. PTSD is not a stress disorder; it is a distress disorder, so it is kind of mislabeled in that way. PTSD may develop because you have been exposed to events that are potentially traumatizing, distressing, and emotionally upsetting in some way. People will not develop PTSD simply from having a high-stress job.

A: I reviewed the study data prior to this interview and will explain the data regarding symptoms. PTSD has four symptom clusters: 1) avoidance (avoiding thoughts, memories, or feelings that bring back memories of a particularly upsetting call); 2) numbing (feeling detached, feeling as though the world has changed or that the world is a bad, malicious place); 3) hypervigilance (having a strong startle response, feeling on edge all the time, having trouble concentrating or sleeping); and 4) re-experiencing (flashbacks, unwanted thoughts, thoughts about the call that come up repeatedly).

So, when I looked at the data, the most commonly reported symptom by telecommunicators was hypervigilance: feeling keyed up or agitated; feeling on edge; trouble concentrating and sleeping. Some of that is related to the job-being on high alert all the time. I was surprised because I thought that avoidance would be necessary to do the job, as burying certain experiences could be helpful when having to handle similar calls. In fact, it turned out to be one of the lower symptom clusters. Hypervigilance really stuck out. Given that, telecommunicators who present as really keyed up and who can't calm down and may use alcohol and drugs to fall asleep stand out as having some of the bigger warning signs when looking for telecommunicators at risk for PTSD.

What was very interesting was data that seemed to link job longevity with positive beliefs about the world. Assumptions about the benevolence of the world and people seem to be more positive in veteran dispatchers than in new hires. That said, veteran dispatchers also have the highest rate of PTSD and the lowest job satisfaction. It might suggest that they hold onto those assumptions in order to stay in the job. It also might suggest that people who don't have compassion or feel that the world is a terrible place cannot survive in the job because their assumptions are attacked on a daily basis.

A: Every participant in the study was asked how many telecommunicators were in their communication center. Across the board, the data showed that there were no differences in mental health, physical health, job satisfaction, and coping as a function of agency size. There were very small differences between urban and rural centers. People in urban centers had slightly higher job satisfaction and world assumptions. People in rural settings reported worse mental health (depression). When people were asked if they would quit their job, the No. 1 reason they wouldn't was pinned to the job benefits and the role of the telecommunicator as the family financial breadwinner.

A: Definitely kid calls. When asked, "What is the worst call you have ever taken?" nearly a quarter of the participants reported an incident involving a child, regardless of whether it was the death of a child, child-related injuries, sexual assault of a child, etc. Those telecommunicators are at the highest risk for adverse mental health and functioning. Certainly, those calls involving kids would be the types of calls where follow-up with the telecommunicator is warranted. The next-highest incident cited was officer-involved shootings or line-of-duty deaths. The third-highest was "other":Some other type of call that was particularly unique, hard to classify, but also conferred higher risk for poorer outcomes.

A: Obesity is incredibly high. About 83 percent of telecommunicators in the study were obese or overweight. Fifty-three percent alone fell into the obese category. The U.S. is an obese place, but the U.S. general population has an obesity percentage in the low 30s, so this is 20 percent higher than the general population. On average, there were 17 different health complaints with an occurrence at least once a month, all the way up to once a week. In addition to obesity, the most common complaints were headaches, backaches, insomnia, heartburn, and upset stomach.

Cortisol dysregulation may be a major factor in some of these symptoms. My plans for next steps in studying the 911 field include cortisol functioning as one topic of interest. Looking into cortisol functioning with a telecommunicator sampling in Chicago could provide some hard data regarding why some of these health symptoms are occurring. It may specifically link cortisol to recurrent stress in this job.

The other piece is the shift work schedule, which can have a significant impact on physical health. Shift work interferes with sleep, specifically impacting metabolism and the hormone ghrelin that is released when the body does not get enough sleep. Ghrelin prompts hunger signals. So stress, poor sleep patterns, dysregulated cortisol, and the sedentary nature of the job can all impact the health of the telecommunicator.

Regarding ideas on how to handle some of these symptoms, there is a lot of interest all over the U.S. in installing treadmills and bikes at telecommunicator workstations. Incentivizing some of these habits might create interest in using these machines.

A: As a licensed clinical psychologist, I have seen a number of very well-supported treatment approaches for PTSD. Two of the approaches with the most support are prolonged exposure and cognitive processing therapy. Both treatments have been proven effective across a spectrum of cases: veterans, sexual assault victims, assault victims, vehicle accident survivors, etc. These treatments do not require long therapy but are specifically focused on helping the person alleviate their PTSD symptoms. If people could get access to those types of treatments, they would be in a good position to recover from their PTSD.

A: Any way to get people on board would be a start. For example, a communication center finding an online PTSD screener quiz and telling employees, "Hey, if you go online and take this quiz, you can have an extra break." By having telecommunicators actually do some of the online quizzes and engage in wellness checks online, the results could provide telecommunicators with some feedback on their functioning. It may provide some feedback such as, "Hey, you might be at risk for depression." Incentivizing people to get involved might at least show them that they may have an issue. Extra days off would be a great incentive, although communication centers are chronically understaffed. That would be the first step. I have suggested offering continuing education credits through some of the major 911 organizations to telecommunicators who participate in online interventions. That would be one way of ensuring they would continue being taken care of. Peer support programs have promise: Leaders within the call center who are more informed front-line people and know about the resources, but are not supervisors, might be a less threatening way to bring support to employees.
Dr. Lilly published a new study titled "Psychological Inflexibility and Psychopathology in 9-1-1 Telecommunicators" in the April 2015 issue of the Journal of Traumatic Stress. The interview was by Anne Raskin.

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PTSD AND EMERGENCY TELECOMMUNICATORS - The Journal of Emergency Dispatch

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By Anna Raskin Dr. Michelle Lilly published a groundbreaking study on 911 telecommunicators in the Journal of Traumatic Stress in April 2012 titled "Duty-Related Trauma Exposure in 911 Telecommunicators: Considering the Risk for Post-traumatic Stress." Bringing to light the PTSD symptomatology in telecommunicators, the study has been instrumental in showing that dispatchers are at risk for PTSD in a similar way as police officers.

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Some heartfelt advice from writer Bill Bernat, who's been there

When I lived with severe depression and social anxiety, I found it extremely difficult to talk to strangers. Yet the one conversation that uplifted me more than any other occurred in the dining hall of the mental health wing of a mountain-town hospital. I met a woman who told me that a few days earlier, she'd driven her Jeep Wrangler to the edge of the Grand Canyon. She sat there, revving the engine and thinking about driving over.

She described what had been going on in her life in the days and months leading up, what her thoughts were at that exact moment, why she wanted to die, and why she didn't do it. We nodded and half-smiled, and then it was my turn to talk about my journey to our table in that fine dining establishment. I had taken too many sleeping pills. After the doctors treated me, they were like, "Hey, we'd love it if you would be our guest in the psych ward!"

That day, she and I talked shop. She allowed me to be deeply depressed and simultaneously have a genuine connection to another person. For the first time, I identified as someone living with depression and I felt, oddly, good about it - or rather, like I wasn't a bad person for having it.

Now, imagine one of the people at that table was a member of your family or a close friend who told you they were really depressed. Would you be comfortable talking to them?

Depression doesn't diminish a person's desire to connect with other people, just their ability.

The World Health Organization says that depression is the leading cause of ill health and disability worldwide, affecting more than 300 million people. In the United States, the National Institute of Mental Health reports 7 percent of Americans experience depression in a year. But while depression is super common, in my experience most folks don't want to talk to depressed people unless we pretend to be happy. So we learn to put on a cheerful façade for casual interactions, like buying a pumpkin spice latte. The average barista doesn't want to know that a customer is trapped in the infinite darkness of their soul.

Depression doesn't diminish a person's desire to connect with other people, just their ability. And despite what you might think, talking to friends and family living with depression can be easy and maybe fun. Not like Facebook-selfie-with-Lady-Gaga-at-an-underground-party fun - instead, I'm talking about the kind of fun where people enjoy each other's company effortlessly, no one feels awkward, and no one accuses the sad person of ruining the holidays.

There's a chasm that exists. On one side are people with depression, and on the other side is everyone else and they're asking, "Why you gotta be so depressed?"

I've noticed there's a chasm that exists. On the one side are those people living with depression, who may act in off-putting or confusing ways because they're fighting a war in their head that nobody else can see. On the other side is everyone else, and they're looking across the divide, shaking their heads, and asking, 'Why you gotta be so depressed?'

I began battling depression when I was eight, and decades later, to my surprise, I started winning that battle. I shifted from being miserable much of the time to enjoying life. Today I live pretty well with bipolar disorder, and I've overcome some other mental health conditions, like overeating, addiction and social anxiety. As someone who lives on both sides of this chasm, I want to offer you some guidance based on my experiences to help you build a bridge across. I've also talked to a lot of people who've lived with depression to refine these suggestions.

Please don't let our lack of bubbly happiness freak you out. Sadness doesn't need to be treated with the urgency of a shark attack.

Before I get to the dos, here are the don'ts - some things you might want to avoid when talking to someone who's depressed.

Don't say "Just get over it." That's a great idea - we love it - but there's just one problem: we already thought of that. The inability to "just get over it" is depression. Depression is an illness, so it's no different from telling someone with a broken ankle or cancer to "just get over it." Try not to fix us - your pressure to be "normal" can make us depressed people feel like we're disappointing you.

Don't insist that the things which make other people feel better will work for us. For example, you cannot cure clinical depression by eating ice cream, which is unfortunate because that would be living the dream.

Don't take it personally if we respond negatively to your advice. I have a friend who, about a year ago, messaged me saying he was feeling really isolated and depressed. I suggested some things for him to do, and he was like, "No, no, and no." I got mad, like, "How dare he not embrace my brilliant wisdom!" Then I remembered the times I've been depressed and how I thought I was doomed in all possible futures and everybody hated me. It didn't matter how many people told me otherwise; I didn't believe them. So I let my friend know I cared, and I didn't take his response personally.

Don't think that being sad and being OK are incompatible. Please don't let our lack of bubbly happiness freak you out. Sadness does not need to be treated with the urgency of a shark attack. Yes, we can be sad and OK at the exact same time. TV, movies, popular songs and even people tell us if we're not happy, there's something wrong. We're taught that sadness is unnatural, and we must resist it. In truth, it's natural and it's healthy to accept sadness and know it won't last forever.

Talk to a depressed person as if their life is just as valuable, intense and beautiful as yours.

And here are some dos.

Do talk to us in your natural voice. You don't need to put on a sad voice because we're depressed; do you sneeze when you're talking to somebody with a cold? It's not rude for you to be upbeat around us.

Do absolve yourself of responsibility for the depressed person. You might be afraid that if you talk to them, you're responsible for their well-being, that you need to "fix" them and solve their problems. You're not expected to be Dr. Phil - just be friendly, more like Ellen. You may worry that you won't know what to say, but words are not the most important thing - your presence is.

Do be clear about what you can and cannot do for us. I've told people, "Hey, call or text me anytime, but I might not be able to get back to you that same day." It's totally cool for you to make a narrow offer with really clear boundaries. Give us a sense of control by getting our consent about what you're planning to do. A while back when I was having a depressive episode, a friend reached out and said, "Hey, I want to check in with you. Can I call you every day? Or, maybe text you every day and call you later in the week? What works for you?" By asking for my permission, she earned my confidence and remains one of my best friends today.

Do interact with us about normal stuff or ask us for help. When people were worried about a friend of mine, they'd call him and ask if he wanted to go shopping or help them clean out their garage. This was a great way to reach out. They were engaging with him without calling attention to his depression. He knew they cared, but he didn't feel embarrassed or like a burden. (Yes, your depressed friends could be a good source of free labor!) Invite them to contribute to your life in some way, even if it's as small as asking you to go see a movie that you wanted to see in the theater.

This is, by no means, a definitive list. All of these suggestions are grounded in one guiding principle: speaking to someone like they belong and can contribute. That's what allowed the woman in the Jeep Wrangler to start me on my path to recovery without even trying: She spoke to me like I was OK and had something to offer exactly as I was at that moment. Talk to a depressed person as if their life is just as valuable, intense and beautiful as yours. If you focus on that, it might just be the most uplifting conversation of their life.
This piece was adapted from a talk given at TEDxSnoIsleLibraries2017.

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How you can connect to friends who are depressed

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When I lived with severe depression and social anxiety, I found it extremely difficult to talk to strangers. Yet the one conversation that uplifted me more than any other occurred in the dining hall of the mental health wing of a mountain-town hospital.

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How to Increase Mental Toughness: 4 Secrets of Navy SEALs and Olympians

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These techniques are all about good preparation and hard work

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Excessive alcohol use can lead to increased risk of health problems such as injuries, violence, liver diseases, and cancer.The CDC Alcohol Program works to strengthen the scientific foundation for preventing excessive alcohol use.

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Characteristics and Personalities of Adults Who Grew Up with Alcoholism in the Home

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Are You an Alcoholic? 10 Warning Signs of Addiction

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Problem drinkers don't have a full-fledged addiction to alcohol, but their drinking may be taking a toll and increasing the risk of addiction. Warning signs, learn more

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The intense emotional crisis of abandonment can create a trauma severe enough to leave an emotional imprint on individuals' psychobiological functioning, affecting their future choices and responses to rejection, loss, or disconnection. Following an abandonment experience in childhood or adulthood, some people develop a sequela of post traumatic symptoms which share sufficient features with post traumatic stress disorder to be considered a subtype of this diagnostic category.

As with other types of post trauma, the symptoms of post traumatic stress disorder of abandonment range from mild to severe. PTSD of abandonment is a psychobiological condition in which earlier separation traumas interfere with current life. An earmark of this interference is intrusive anxiety which often manifests as a pervasive feeling of insecurity - a primary source of self sabotage in our primary relationships and in achieving long range goals. Another earmark is a tendency to compulsively reenact our abandonment scenarios through repetitive patterns, i.e., abandoholism - being attracted to the unavailable.

Another factor of abandonment post trauma is for victims to be plagued with diminished self esteem and heightened vulnerability within social contexts (including the workplace) which intensifies their need to buttress their flagging ego strength with defense mechanisms which can be automatically discharged and whose intention is to protect the narcissistically injured self from further rejection, criticism, or abandonment. These habituated defenses are often maladaptive to their purpose in that they can create emotional tension and jeopardize our emotional connections.

Victims of abandonment trauma can have emotional flashbacks that flood us with feelings ranging from mild anxiety to intense panic in response to triggers that we may or may not be conscious of. Once our abandonment fear is triggered, it can lead to what Daniel Goleman calls emotional hijacking. During an emotional hijacking, the emotional brain has taken over, leaving its victims feeling a complete loss of control over their own lives, at least momentarily. If emotional hijacking occurs frequently enough, its chronic emotional excesses can lead to self-depreciation and isolation within relationships, as well as give rise to secondary conditions such as chronic depression, anxiety, obsessive thinking, negative narcissism, and addiction.

Post Traumatic stress disorder (PTSD) is a so called "disease" of the amygdala - the emotional center of the brain responsible for initiating the Fight Flee Freeze response. In PTSD, the amygdala is set on overdrive to keep us in a perpetual state of hyper-vigilance - action-ready to declare a state of emergency should it perceive any threat even vaguely reminiscent of the original trauma. The amygdala, acting as the brain's warning system, is constantly working to protect (overprotect) us from any possibility of further injury. In the post trauma sequelae related specifically to abandonment, the amygdala scans the environment for potential threats to our attachments or to our sense of self worth.

People with PTSD of abandonment can have heightened emotional responses to abandonment triggers that are often considered insignificant by others. For instance, depending on circumstances, when we feel slighted, criticized, or excluded, it can instigate an emotional hijacking and interfere in, and even jeopardize your personal or professional life.

Below, I'll identify some of the other issues related to post traumatic stress disorder of abandonment:
36 Characteristics of post traumatic stress disorder of abandonment This list is meant to be descriptive, rather than exhaustive of the many issues related to the abandonment syndrome.

1. An intense fear of abandonment that interferes in forming primary relationships in adulthood.

2. Intrusive insecurity that interferes in your social life and goal achievement.

3. Anxiety with authority figures.

4. Tendency toward self defeating behavior patterns that sabotage your love life, goals, or career.

5. A tendency to repeatedly subject yourself to people or experiences that lead to another loss, another rejection, and another trauma.

6. Intrusive reawakening of old losses; echoes of old feelings of vulnerability and fear which interfere in current experience.

7. Heightened memories of traumatic separations and other events.

8. Conversely, partial or complete memory blocks of childhood traumas.

9. Low self-esteem, low sense of entitlement, performance anxiety.

10. Feelings of emotional detachment, i.e. feeling numb to past losses.

11. Conversely, difficulty letting go of the painful feelings of old rejections and losses.

12. Difficulty letting go, even when we know the relationship cannot meet our basic needs

13. Episodes of self-neglectful or self destructive behavior.

14. Difficulty withstanding (and overreacting to) the customary emotional ups and downs of your adult relationships.

15. Difficulty working through the ordinary levels of conflict and disappointment within your adult relationships.

16. Extreme sensitivity to perceived rejections, exclusions or criticisms.

17. Emotional pendulum swing between fear of engulfment and fear of abandonment; you can alternate between 'feeling the walls close in' if someone gets too close and feeling insecure, love starved - on a precipice of abandonment - if you are not sure of the person's love.

18. Difficulty feeling the affection and other physical comforts offered by a willing partner - "keeping them out" or "pushing them away; evidence of emotional anorexia or emotional bulimia.

19. Tendency to 'get turned off' and 'lose the connection' by involuntarily shutting down romantically and/or sexually on a willing partner.

20. Conversely, tendency to feel hopelessly hooked on a partner who is emotionally distancing.

21. Tendency to have emotional hangovers 'the morning after' you have had contact with an ex or someone over whom you have felt pain.

22. Difficulty naming your feelings or sorting through an emotional fog.

23. Abandophobism - a tendency to avoid close relationships altogether to avoid risk of abandonment.

24. Conversely, a tendency to rush into relationships and clamp on too quickly.

25. Difficulty letting go because you have attached with emotional epoxy, even when you know your partner is no longer able to fulfill your needs, or even when you know your partner is not good for you.

26. An excessive need for control, whether it's about the need to control the other's behavior and thoughts, or about being excessively self-controlled; a need to have everything perfect and done your way.

27. Conversely, a tendency to create chaos by avoiding responsibility, procrastinating, giving up control to others, and feeling out of control.

28. A heightened sense of responsibility to others, rescuing, attending to people's needs, even when they have not voiced them.

29. Tendency to have unrealistic expectations and heightened reactivity toward others such that it creates conflict and burns bridges to your social connections.

30. People-pleasing - excessive need for acceptance or approval.

31. Self-judgment; unrealistic expectations toward yourself.

32. Fear response to people's anger, which unwittingly sets you up to being "controlled" by them.

33. Co-dependency issues in which you give too much of yourself to others and feel you don't get enough back.

34. Tendency to act impulsively without being able to put the brakes on, even when you are aware of the negative consequences.

35. Tendency toward unpredictable outbursts of anger.

36. Conversely, tendency to under-react to anger out of fear of breaking the connection and also out of your extreme aversion to 'not being liked'.

The impact of abandonment trauma can be mitigated by abandonment recovery - a program of therapy techniques designed to help you overcome abandonment and its aftermath of self sabotaging patterns.
Please see additional articles that help you explore whether you are on the abandonment trauma spectrum, offer practical help, explain why some people are more prone to getting post traumatic stress disorder of abandonment than others, and the Five Phases of Abandonment and Recovery which provides hands-on help for people across the abandonment spectrum-those with post trauma and those without. The workbook is helpful in guiding you through the abandonment therapy techniques step by step, teaching you self help tools for each of the five phases specific to abandonment grief and trauma. See also:
Are You on the Abandonment Spectrum? Do you have Symptoms of PTSD of Abandonment?
What is the Abandonment Syndrome? How Is PTSD of Abandonment Different from Borderline? (BPD)
PTSD of Abandonment: Why some people are More Prone to Developing it than Others
The Five Stages of Abandonment and Recovery
Abandonment versus Borderline: 12 Tasks for Coping with Emotional Hijacking

Fear of Abandomnent: 10 Ways to Turn it Around
Abandonment Recovery: How it Overcomes Abandonment Trauma and its Aftermath of Self Sabotaging Patterns
© Susan Anderson November 12 2013, updated and revised Sept 28 2016

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Post Traumatic Stress Disorder of Abandonment, Part I: An Overview

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The intense emotional crisis of abandonment can create a trauma severe enough to leave an emotional imprint on individuals' psychobiological functioning, affecting their future choices and responses to rejection, loss, or disconnection. Following an abandonment experience in childhood or adulthood, some people develop a sequela of post traumatic symptoms which share sufficient features with post traumatic stress disorder to be considered a subtype of this diagnostic category.

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We all have come in contact with the flamboyant narcissist. Their self-absorption can't be mistaken. But there is also the covert narcissist, who is not so easy to decipher. They are equally as self-absorbed as the outward version and equally as destructive in relationships.

Narcissistic personality disorder is created in one of two ways in childhood. Either the child is given too much attention or not enough. This leaves a large void as they enter adulthood. Their never-satisfied "taker" stance becomes the perfect magnet for the unknowing "giver" personality. Narcissists will attempt to find someone who will give them the attention they either had or lacked as children, putting others at an emotional deficit.

Narcissists will exhibit these five signs:

1. False Humility

This is actually a form of pride but will be shown in a self-deprecating way. Narcissists will play the victim and put themselves down so that they bait you into complimenting them. They will say they are doing things because they want to, but they are approval-seeking. They are concerned about themselves and are not truly humble.

Their goal is to let you know they are important and seek high status positions. Yet they disguise themselves in humility - which isn't anything like an inner humble character of one who puts others before themselves. Their goal is to make sure they are stroked for their efforts.

2. Lack of Empathy

Narcissists will ignore any valid concerns you may have. They will choose to follow their agenda in every circumstance because they are selfish. They don't want to learn compassion and want to stay isolated and withdrawn. They will ignore you when you aren't feeling well but want to be doted on when they are not well. There is no meeting halfway since they only want to be served, not to serve.

3. Immature Responses

Narcissists are highly sensitive and take offense at simple criticisms. They magnify a perceived or real offense more than it deserves. They are not able to dialogue but deflect blame onto others for their reactions.

They attempt to cover their anger by pretending things don't bother them, yet their nonverbal body language shows anger even though they don't admit it. They can become passive-aggressive in their responses and not follow through with actions.

4. Simplification of Others' Needs

Narcissists will minimize the needs of the people around them. They will not explore the details of a particular situation because they don't deem it worthy of their time. They will label people and deflect blame onto them instead of taking responsibility for their own actions. They reduce complex issues to simple ones in order to brush them aside as stupid or useless. They don't want to be bothered with facts or logic, only their own limited scope of what is important so as not to invest their time or energy in anything contrary to their personal agenda.

5. Unable to Listen

Narcissists tend to "shoot from the hip" with quick advice and not ask questions during conversations, but instead shut down dialogue so they do the minimum amount. They do not want to expend any energy toward relationships. They don't care about what you have to say because they want to follow what is best for them regardless of what you are sharing. In the end, they don't care enough to listen to you.

Obviously, not all quiet or shy people are covert narcissists. But keep these signs in mind. Covert narcissists are not as benign as they seem and can cause you much distress.
Woman with crossed arms photo available from Shutterstock

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We all have come in contact with the flamboyant narcissist. Their self-absorption can't be mistaken. But there is also the covert narcissist, who is not so easy to decipher. They are equally as self-absorbed as the outward version and equally as destructive in relationships. Narcissistic personality disorder is created in one of two ways in childhood.

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Avoidant Personality Disorder DSM-5 301.82 (F60.6) - Therapedia

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They compared the cost of a toxic worker with the value of a superstar, which they define as a worker who is so productive that a firm would have to hire additional people or pay current employees more just to achieve the same output. They calculated that avoiding a toxic employee can save a company more than twice as much as bringing on a star performer – specifically, avoiding a toxic worker was worth about $12,500 in turnover costs, but even the top 1% of superstar employees only added about $5,300 to the bottom line.

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Superstar employees are the obsession of the corporate world. They're highly sought after, given the most attention and the best opportunities, generously rewarded, and expressly reassured after setbacks. And while some question whether such special treatment is appropriate, it's clear that this group has outsize influence: high-performers have been estimated to be four times as productive as average workers, and research has shown that they may generate 80% of a business's profits and attract other star employees. They can comprise the top 3% to 20% of a company's workforce.

But according to a recent working paper from Harvard Business School, there's another group that can have an even greater effect on organizations: toxic workers. These are talented and productive people who engage in behavior that is harmful to an organization, say authors Dylan Minor, a visiting assistant professor at HBS, and Michael Housman, Chief Analytics Officer at Cornerstone OnDemand. They looked at otherwise skilled employees who ended up doing real damage - employees who had been fired for egregious company policy violations, such as sexual harassment, workplace violence, or fraud - and found that avoiding such people can save companies even more money than finding and retaining superstars.

The high cost of bad hires

Their data came from a company that sells job-testing software to large employers, and it combined three things: 1) job assessment scores that captured applicant traits like confidence in their skills, whether they care about others people's needs more than their own, and their philosophy on following rules; 2) attrition data, which included hire dates, termination dates, reasons for termination, etc.; and 3) daily performance data. The dataset spanned 11 global companies and 58,542 hourly workers. Minor and Housman found that roughly 1 in 20 workers was ultimately fired for toxic behavior.

They compared the cost of a toxic worker with the value of a superstar, which they define as a worker who is so productive that a firm would have to hire additional people or pay current employees more just to achieve the same output. They calculated that avoiding a toxic employee can save a company more than twice as much as bringing on a star performer - specifically, avoiding a toxic worker was worth about $12,500 in turnover costs, but even the top 1% of superstar employees only added about $5,300 to the bottom line.

The real difference could be even bigger, if you factor in other potential costs, such as litigation fees, regulatory fines, lower employee morale, and upset customers. One 2012 CareerBuilder survey found that 41% of the nearly 2,700 employers surveyed estimated that a bad hire could cost $25,000, while a quarter believed it was much higher-$50,000 or more.

Who is likely to be toxic?

The study also uncovered certain personality and behavioral traits predictive of such behavior.

Overconfident, self-centered, productive, and rule-following employees were more likely to be toxic workers. One standard deviation in skills confidence meant an approximately 15% greater chance of being fired for toxic behavior, while employees who were found to be more self-regarding (and less concerned about others' needs) had a 22% greater likelihood. For workers who said that rules must always be followed, there was a 25% greater chance he or she would be terminated for actually breaking the rules. They also found that people exposed to other toxic workers on their teams had a 46% increased likelihood of similarly being fired for misconduct.

Overconfidence and narcissism have been associated with negative work outcomes before. What was more surprising was that people who believed rules should always be followed (compared to those who answered that you sometimes have to break the rules to accomplish something) were more likely to exhibit toxic behavior. The authors hypothesized that this may be due to applicants trying to tell recruiters what they want to hear. "It could be the case that those who claim the rules should be followed are more Machiavellian in nature, purporting to embrace whatever rules, characteristics, or beliefs that they believe are most likely to obtain them a job," they wrote. "There is strong evidence that Machiavellianism leads to deviant behavior."

The toxic employees in their sample were also more productive than the average worker, in that it took them less time to complete a task than it took their colleagues. The authors say this is consistent with other research that has found a potential trade-off when it comes to unethical workers - they may be corrupt, but they are high performers. And aside from performance, bad guys often win at work because they exhibit other valued traits, like charisma, curiosity, and high self-esteem. Still, they aren't likely to help the organization in the long term. Minor and Housman note that although toxic workers may be faster than average employees, they don't necessarily produce higher quality work.

Avoiding toxicity

"We often think of hiring and evaluation as one or two dimensions. We want someone who is highly productive in sales and has good customer service," Minor told me over email. "However, there is a third dimension: the person's corporate citizenship. If it is really poor, they are not going to be a good hire. Organizational productivity would likely even be greater if the manager hired the worker that was a bit less productive but had better corporate citizenship."

The idea that a negative has a stronger impact than a positive has been established in fields like finance ( losses have more of an impact than gains), psychology (people remember bad experiences more than good ones), and linguistics (we pay more attention to negative words than positive or neutral ones). If toxic workers have a stronger ( corrosive) effect on a firm than even the highest performing non-toxic ones, then it seems fair to say that managers should give the former more thought.

"The medical term primum non nocere (first do no harm) I think applies here," Minor told me. To follow his advice, managers may need a more holistic hiring approach-one that actively focuses on avoiding bad hires at least as much, if not more so, than on attracting superstars.

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It's Better to Avoid a Toxic Employee than Hire a Superstar

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Superstar employees are the obsession of the corporate world. They're highly sought after, given the most attention and the best opportunities, generously rewarded, and expressly reassured after setbacks.

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Neuroimaging in Posttraumatic Stress Disorder and Other Stress-related Disorders

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Neuroimaging in Posttraumatic Stress Disorder and Other Stress-related Disorders

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Nightmares and PTSD - PTSD_ National Center for PTSD

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Nightmare and PTSD Training - Alan Siegel, PH.D

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Cascading effects of stressors and inflammatory immune system activation_ implications for major depressive disorder

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My own father sold me for 5 dollars! | Bella Galhos | TEDxDili

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My own father sold me for 5 dollars! | Bella Galhos | TEDxDili

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My own father sold me for 5 dollars! | Bella Galhos | TEDxDili

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Bella Galhos talks passionately about the violence and abuse she suffered during her childhood and speaks out against violence against women in Timor-Leste. She believes that every child has a right to happiness and safety and has built Timor-Leste first green school, a safe haven where children learn about sustainable agriculture practices and good nutrition.

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https://www.whatnext.com/blog/posts/when-cancer-is-over-is-it-really-over

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Breaking my silence -- healing thrives in conversation | Jodie Ortega | TEDxRenfrewCollingwood

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This talk was given at a local TEDx event, produced independently of the TED Conferences. On a mission to foster dialogue and start a domino effect, an advocate for survivors of sexual abuse raps and shares her own story, how it is linked to shame, and the important role Hip Hop has played in her healing journey.

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FORT MEADE, Md. -- She was four days out before returning home to Dover Air Force Base, Del., from her deployment in Provincial Reconstruction Team, Farah, Afghanistan. Master Sgt. Jennifer Allara and her explosive ordinance team started the day off at 0330 for a routine combat mission patrol. Allara and her EOD teammates went outside the fence to sweep an ally they call 'IED alley' in Shewan, Afghanistan. Unfortunately, they didn't foresee what was about to happen next. Allara is a 436th Civil Engineer Squadron Explosive Ordinance Disposal team leader currently based out of Dover AFB, Del., who had her world turned upside down in a matter of minutes. "We are trained to accept a certain amount of danger with our job," Allara said. "And I always thought in terms of me, what if something happens to me? What if we get blown up? I wasn't thinking in terms of losing a team member in a turret. It was a very big wake-up call." It was on that fateful day in September 2009, Allara lost her good friend and co-worker, Staff Sgt. Bryan Berky, during an attack. Her team was involved in a firefight and as they tried to turn around to get out of the firefight their vehicle got stuck in the sand. She said as her team tried to get their vehicle out of the sand, a team of Afghan national soldiers flew 500 meters ahead of her team in trucks. She recalls them disappearing into a large cloud of smoke and hearing a detonation. "The only thing I could think of ... that was us ... that was going to be me," she said. "And they just took that." They were receiving indirect fire and mortars when another team member yelled out to their turret gunner, Berky, to see if he was Ok. Allara looked over to Berky and noticed he was hunched over in his harness and unresponsive. She pulled an emergency latch and pulled him into her lap. She yelled out for a medic, then noticed the small bullet hole in his head. Her team grabbed a medic, put him into their vehicle and they drove to a casualty evacuation point. As the fire fight continued a field surgeon did everything to save him. Unfortunately, Berky doesn't make it. With four days left before her team was heading home, Allara was allowed to fly back with Berky's remains back to the United States. As a result of her attack, Allara suffers from Traumatic Brain Injury and Post-Traumatic Stress Disorder, a condition she struggles with to this day. She credits her coworkers helping her to get where she is today. She thanks their constant check-ups and looking her in the eye and asking her ... how are you doing? Are you Ok? "Knowing what's wrong with me and working with the doctors to combat that, if I know what it is, I can overcome it," Allara said. "I'm looking forward to the holistic approach they take in treatment. That intrigues me." Allara hopes to be an example for others returning from a deployment. She hopes her story will help other to seek help. "There is no shame in getting help," she said. "There is no shame in recognizing what is going on with someone and being able to reach out and help. If you don't take care of yourself, you can't take care of your Airmen." She stresses that Airmen shouldn't feel ashamed if they are experiencing symptoms of PTSD. "PTSD is not what's wrong with you, it's what happened to you," Allara said. "It's a normal reaction to an abnormal situation. I'm looking forward to the holistic approach to their treatment and diagnosis."

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FORT MEADE, Md. -- She was four days out before returning home to Dover Air Force Base, Del., from her deployment in Provincial Reconstruction Team, Farah, Afghanistan. Master Sgt. Jennifer Allara and her explosive ordinance team started the day off at 0330 for a routine combat mission patrol.

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From Victim to Survivor: Find Your X…but First, Find Your (Wh)Y? | Lauren Book | TEDxOxford

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The childhood trauma Lauren Book suffered robbed her of her childhood, but forced her to learn how to find her voice and rebuild her life with purpose...through her TED Talk, she challenges viewers to do what she's been challenged to do through her journey from victim of physical, sexual and emotional abuse to struggling survivor and now thriver and internationally recognized advocate for change.

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Many people diagnosed with a form of cancer also experience post-traumatic stress disorder, and for some, this persists and sometimes worsens with time, even after successful cancer treatment.

People living with cancer sometimes develop post-traumatic stress disorder, and for some, the symptoms persist for years.

Post-traumatic stress disorder (PTSD) is a psychological condition that develops in the aftermath of a particularly distressing event. The condition can be debilitating for many; it can lead to avoidance of places and contexts reminiscent of the trauma and may result in social isolation and negative coping strategies, such as substance abuse.

It may come as no surprise, then, that many people diagnosed with cancer also develop PTSD. This is not just because the news always comes as a shock, but also because the aggressiveness of the treatment itself is often traumatic, as studies have confirmed.

New research from the National University of Malaysia in Bangi now shows that a large number of people who have experienced cancer develop PTSD and may continue to live with this condition even after successful cancer treatment. For some, the PTSD symptoms even worsen with time, explain the authors.

Lead author Caryn Mei Hsien Chan, Ph.D., and colleagues published their findings in a paper in the journal CANCER.

Cancer diagnosis often followed by PTSD

Chan and team worked with 469 adults who had been diagnosed with different types of cancer. These were all recruited within 1 month of their diagnosis, at the same oncology referral clinic.

They were evaluated for PTSD symptoms first after 6 months following their cancer diagnosis, and then again after 4 years.
The team found that nearly one fifth of the study participants were also facing PTSD within a few months of their cancer diagnosis, and many of these people continued to exhibit PTSD symptoms after 4 years.
Six months following the participants' cancer diagnoses, Chan and colleagues noted a 21.7 percent incidence of PTSD. The incidence fell to 6.1 percent at the 4-year follow-up, but approximately one third of the people earlier diagnosed with PTSD exhibited persistent or even worsening symptoms of the condition at this point.

Therefore, the researchers suggest that healthcare professionals should screen cancer patients for signs of PTSD early on and make sure they get the support and treatment that they need.

"Many cancer patients believe they need to adopt a 'warrior mentality,' and remain positive and optimistic from diagnosis through treatment to stand a better chance of beating their cancer. To these patients, seeking help for the emotional issues they face is akin to admitting weakness."

Caryn Mei Hsien Chan, Ph.D.

"There needs to be greater awareness," she adds, "that there is nothing wrong with getting help to manage the emotional upheaval - particularly depression, anxiety, and PTSD - post-cancer."

One reason why some may continue to live with PTSD even after successful cancer treatment is because they may fear a return of the disease, says Chan.

They may also be avoidant of hospital settings in general, and they might fail to seek treatment for unrelated diseases or conditions because this might trigger traumatic memories about cancer and cancer therapy.
They also noted that people diagnosed with breast cancer, in particular, were more exposed to PTSD. These people were 3.7 times less likely to be diagnosed with this condition within 6 months from receiving the cancer diagnosis. However, this was not the case at the 4-year follow-up.
This finding may be owed to the fact that all the participants attended the same oncology referral center, which offers a support program targeting people diagnosed with breast cancer.

The overall results of the study, the researchers emphasize, indicate the stringent need to offer psychological support from the initial cancer diagnosis through the whole process of cancer treatment.

"We need psychological evaluation and support services for patients with cancer at an initial stage and at continued follows-up because psychological well-being and mental health - and by extension, quality of life - are just as important as physical health," urges Chan.

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Many grapple with PTSD after a cancer diagnosis

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Many people diagnosed with a form of cancer also experience post-traumatic stress disorder, and for some, this persists and sometimes worsens with time, even after successful cancer treatment. People living with cancer sometimes develop post-traumatic stress disorder, and for some, the symptoms persist for years.

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The most immediate person affected by sexual violence is the victim/survivor, but the effects of sexual violence also go far beyond individual survivors, impacting their closest relationships as well as impacting communities and our society at large.

Impact on the survivor*

Each survivor reacts to sexual violence in their own unique way. Personal style, culture, and context of the survivor's life may affect these reactions. Some express their emotions while others prefer to keep their feelings inside. Some may tell others right away what happened, others will wait weeks, months, or even years before discussing the assault, if they ever choose to do so. It is important to respect each person's choices and style of coping with this traumatic event. Whether an assault was completed or attempted, and regardless of whether it happened recently or many years ago, it may impact daily functioning. A wide range of reactions can impact victims. Some common emotional, psychological and physical reactions follow.

Some health outcomes can be fatal such as suicide, homicide, maternal mortality and AIDS related deaths.

Impact on loved ones

When someone is a victim of sexual violence, it affects not only the survivor, but also all of the people around them. Sexual violence can affect many people in a victim/survivor's life: parents, friends, partners, children, spouses, classmates and/or co-workers.

Part of what makes it so difficult for loved ones is not knowing what to say or do, but there are ways to offer constructive help as well as for you to get support. In addition to the information below, RVA offers free confidential services to anyone who has been affected by sexual violence, including loved ones.

Let them know that you believe them

All too often, disclosure is met by skepticism or outright disbelief. Simply letting a survivor know that you believe them and that you stand behind them is meaningful. Remember that although you may be having a strong reaction to what happened, it's important to focus on the feelings and reactions of the survivor rather than your own.

Allow the survivor to make his or her own decisions

This point can be very difficult, it can be very tempting to "take over" for a while in an attempt to help the survivor deal with the rape. It is important to remember that because of the rape, the survivor felt a loss of control over their life. Reestablishing that control is very important. Try to defer to a survivor's decisions, even if they decide to let you make some decisions. Then at least that was their choice and not yours. If a survivor wants to talk, try to be an open listener. If they prefer not to talk about the assault, then try to be supportive in other ways, letting them know that you care about him/her and are willing to listen at a later time if so desired.

Educate yourself about the myths of rape

A great deal of harm is done, often unintentionally, to survivors because the people around them believe the myths that surround rape. Rape is never the fault of the survivor, but rather the fault of the rapist. Although this sounds like a simple, even obvious, fact, much of the misinformation that exists points to the victim as being responsible for the rape. Educating yourself allows you to provide informed, compassionate support. Learn more about the most common myths about sexual violence.

Be ready to listen

Being a willing listener, who acknowledges the feelings of a person, makes a significant positive impact. Sometimes it's very useful to simply be with a person and create a safe silence. Non-judgmental support helps survivors tremendously as they recover from this traumatic event. If the victim/survivor you care about or you are in need of support, RVA provides counseling services free of charge. You can also call the 24-hour Chicago Rape Crisis Hotline at any time at 1-888-293-2080.

Help Resilience to help others
Your tax deductible donation to Resilience will help to continue providing services to victims/survivors of sexual violence and their loved ones.

Impact on communities**

As with any form of violence, sexual violence tears at the fabric of community well-being. Schools, workplaces, neighborhoods, campuses, and cultural or religious communities may feel fear, anger, or disbelief if a sexual assault happened in their community.

Additionally, there are financial costs to communities. These costs can include medical and mental health services, legal expenses, lost work time and productivity, theft and damage to property, and the incalculable lost contributions of individuals affected by sexual violence.

Although the economic costs of rape and sexual assault are hard to quantify and the data is limited, the existing research indicates that the costs are great. Various research studies have examined the quantifiable cost per rape, accounting for such costs as medical and victim services, loss of productivity, and law enforcement resources. Researchers also generally agree that intangible costs, such as decreased quality of life, though difficult to monetize, are also a necessary part of the cost calculus for sexual assault. (Many researchers, in fact, believe the intangible costs are especially high in cases of sexual assault, due to the serious physical and mental health consequences for survivors.) Each of the studies examined in the White House Council on Women and Girls 2014 Report Rape and Sexual Assault: A Renewed Call to Action used a somewhat different methodology, but all found the costs to be significant -ranging from $87,000 to $240,776 per rape. ( Miller, T.R., Cohen ,M.A. & Wiersema, B.(1996). Victim costs and consequences: A new look. National Institute of Justice.)

According to the U.S. Department of Justice (1996) the cost of crime to victims is an estimated $450 billion per year. Rape is the most costly to its victims, totaling $127 billion annually. According to the 1995 U.S. Merit Systems Protection Board, sexual harassment alone cost the federal government an estimated $327 million in losses associated with job turnover, sick leave, and individual and group productivity among federal employees.

Fifty percent of rape victims lost or were forced to quit their jobs in the year following their rapes due to the severity of their reactions (Ellis, Atkeson & Calhoun, 1981). Scholars at Johns Hopkins University School of Public Health indicated that development of Post Traumatic Stress Disorder (PTSD) is likely in 50 to 95 percent of rape cases (1999). Lifetime income loss, due to sexual violence in adolescence, is estimated at $241,600 (MacMillan, 2000).

In another study, the National Crime Victimization Survey found that between 2005-2010, 58% of female sexual assault victims were injured, 35% of whom received medical treatment.

For women who are raped by an intimate partner, about 36.2% are physically injured and, of those, 31% receive some type of medical care. NCIPC (2003). Costs of Intimate Partner Violence Against Women in the United States. Department of Health and Human Services, Centers for Disease Control and Prevention, March 2003. The injuries for intimate-partner rapes range from scratches, bruises, or welts to lacerations, broken bones, dislocated joints, head or spinal cord injuries, chipped or broken teeth, or internal injuries. (NCIPC 2003) Nearly 80% of those who receive medical care are treated in a hospital, and 43.6% of those victims spend one or more nights there. (NCIPC 2003)

A 2003 CDC report on the costs of intimate partner violence found that the average medical cost for victims who received treatment was $2,084 per victimization. In half of these cases, private or group health insurers were the primary source of payment; survivors bore most of the financial burden one-fourth of the time. Many survivors incur at least some out-of-pocket costs for their medical care.

Also among intimate-partner rape survivors, more than one-fifth lose time from paid work, with an average loss of 8.1 days. Additionally, over one-eighth report losing time from household chores, with an average of 13.5 days lost. Nationally, rape survivors lose an estimated 1.1 million days of activity each year. (NCIPC 2003)

Together, we can help

A 2006 study found that when victims receive advocate assisted services following assaults, like the 24-hour crisis response RVA provides to 14 hospitals across Chicago, they receive more helpful information, referrals, and services and experience less secondary trauma or re-victimization by medical and legal systems (Campbell, 2006). Furthermore, the same study found that when advocates are present in the legal and medical proceedings following rape, victims fare better in both the short-and long-term, experiencing less psychological distress, physical health struggles, sexual risk-taking behaviors, self-blame, guilt, and depression. Rape survivors with advocates were 59% more likely to have police reports taken than survivors without advocates, whose reports were only taken 41% of the time.

Your support, too, makes a difference. How you respond to a victim/survivor can positively impact their healing process. In studies of sexual assault survivors, receiving social support has been associated with many positive outcomes, including positive life change and growth as well as reduced PTSD and depressive symptoms ( Borja, Callahan, & Long, 2006; Filipas & Ullman, 2001; Schumm, Briggs-Phillips, & Hobfoll, 2006). Some of these studies found that the greater the amount of support survivors reported receiving, the fewer PTSD symptoms they had.

*Taken from Impact of Sexual Violence Fact Sheet, 2010, National Sexual Violence Resource Center

**Adapted from Rape and Sexual Assault: A Renewed Call to Action, 2014, White House Council on Women and Girls Report, and Economic Costs of Sexual Assault, Illinois Coalition Against Sexual Assault

References

Borja SE, Callahan JL, Long PJ. Positive and negative adjustment and social support of sexual assault survivors. J Trauma Stress. 2006 Dec; 19(6):905-14.

Ellis, E.M., Atkeson, B.M., & Calhoun, K.S. (1981). An assessment of long-term reaction to rape, Journal of Abnormal Psychology, 90:3, 263-266.

Erdreich, B.L., Slavet, B.S., & Amador, A.C. (1995). Sexual harassment in the federal workplace: Trends, progress, continuing challenges. Washington, D.C.: U.S. Merit Systems Protection Board.

Filipas, HH, Ullman SE. Social reactions to sexual assault victims from various support sources. Violence Vict. 2001 Dec; 16(6):673-92

MacMillan, R. (2000). Adolescent victimization and income deficits in adulthood: Rethinking the costs of criminal violence from a life-course perspective. Criminology, 38, 553-577.

Miller, T.R., Cohen, M.A., & Wiersema, B. (1996). Victim costs and consequences: A new look. Washington, D.C.: National Institute of Justice

Population Information Program. (1999). Population reports: Ending violence against women. Baltimore, MD: The Johns Hopkins University School of Public Health.

Schumm, JA, Briggs-Phillips M, Hobfoll SE. Cumulative interpersonal traumas and social support as risk and resiliency factors in predicting PTSD and depression among inner-city women. J Trauma Stress. 2006 Dec; 19(6):825-36.

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The most immediate person affected by sexual violence is the victim/survivor, but the effects of sexual violence also go far beyond individual survivors, impacting their closest relationships as well as impacting communities and our society at large. Each survivor reacts to sexual violence in their own unique way.

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Public

This section is for Veterans, General Public, Family, & Friends

Sexual Assault Against Females

Although anyone - men, women, and children - can be assaulted, this fact sheet will focus on adult female victims of sexual assault.

What is sexual assault?

Sexual assault is defined as any sort of sexual activity between two or more people in which one of the people is involved against his or her will.

The sexual activity involved in an assault can include many different experiences. Women can be the victims of unwanted touching, grabbing, oral sex, anal sex, sexual penetration with an object, and/or sexual intercourse.

There are a lot of ways that women can be involved in sexual activity against their will. The force used by the aggressor can be either physical or non-physical. Some examples of how women are forced or pressured into having sex include being:

taken advantage of by someone who has some form of authority over them (for example doctor, teacher, boss)

bribed or manipulated into sexual activity against her will

unable to give her consent because she is under the influence of alcohol or drugs

threatened to be hurt or that people that she cares about will be hurt

physical forced or violently assaulted

Who commits sexual assaults?

Often, when we think about who commits sexual assault or rape, we imagine the aggressor is a stranger to the victim. Contrary to popular belief, sexual assault does not typically occur between strangers. The National Crime Victimization Survey, conducted by the U.S. Department of Justice, found that about four of every five sexually assaulted women were attacked by a current or former husband, cohabitating partner, friend, or date. Strangers committed only about one of every five of the assaults that were reported in this survey.

How often do sexual assaults happen?

Estimating rates of sexual violence against women is a difficult task. Many factors stop women from reporting these crimes to police and to interviewers collecting statistics on the rate of crime in our country. Women may not want to report that they were assaulted because it is such a personal experience, because they blame themselves, because they are afraid of how others may react, and because they do not think it is useful to make such a report. However, there are statistics that show sexual assault is a problem in our country. For example:

A large-scale study conducted on several college campuses found that one of every five women reported that they had been raped in their lifetime.

The National Crime Victimization Survey estimated that one half of a million (or 500,000) sexual assaults occurred in the U.S. in one year, from 1992 to 1993. Of those assaults, about three of ten were completed rapes and an additional three of ten were attempted rapes.

What happens to women after they are sexually assaulted?

After a sexual assault, women can experience a wide range of reactions. It is very important to note that there is no single pattern of response. Some women respond immediately, others may have delayed reactions. Some women are affected by the assault for a long time, but others appear to recover more quickly.

In the time just after a sexual assault, many women report feeling shock, confusion, anxiety, and/or numbness. Sometimes women will experience feelings of denial. In other words, they may not fully accept what has happened to them or they may downplay the intensity of the experience. This reaction may be more common among women who are assaulted by someone they know.

What are some early reactions to sexual assault?

In the first few days and weeks following the assault, it is very normal for a woman to experience intense and sometimes unpredictable emotions. She may have repeated strong memories of the event that are difficult to ignore, and nightmares are not uncommon. Women also report having difficulty concentrating and sleeping, and they may feel jumpy or on edge. While these initial reactions are normal and expected, some women may have severe, highly disruptive symptoms that make it very difficult to function in the first month following the assault. When these problems disrupt the woman's daily life, and prevent her from seeking assistance or telling friends and family members, the woman may have .

What are some other reactions that women have following a sexual assault?

Major Depressive Disorder (MDD)

Depression is a common reaction following sexual assault. Symptoms of MDD can include a depressed mood, an inability to enjoy things, difficulty sleeping, changes in patterns of sleeping and eating, problems in concentration and decision-making, feelings of guilt, hopelessness, and decreased self-esteem. Research suggests that almost one of every three rape victims have at least one period of MDD during their lives. And for many of these women, the depression can last for a long period of time. Thoughts about suicide are also common. Studies estimate that one in three women who are raped contemplate suicide, and about one in ten rape victims actually attempt suicide.

Anger

Many victims of sexual assault report struggling with anger after the assault. Although this is a natural reaction to such a violating event, there is some research that suggests that prolonged, intense anger can interfere with the recovery process and further disrupt a woman's life.

Shame and guilt

These feelings are common reactions to sexual assault. Some women blame themselves for what happened or feel shameful about being an assault victim. This reaction can be even stronger among women who are assaulted by someone that they know, or who do not receive support from their friends, family, or authorities following the incident. Shame and guilt can also get in the way of a woman's recovery by preventing her from telling others about what happened and getting assistance.

Social problems

Social problems can sometimes arise following a sexual assault. A woman can experience problems in her marital relationship or in her friendships. Sometimes an assault survivor will be too anxious or depressed to want to participate in social activities. Many women report difficulty trusting others after the assault, so it can be difficult to develop new relationships. Performance at work and school can also be affected.

Sexual problems

Sexual problems can be among the most long-standing problems experienced by women who are the victims of sexual assault. Women can be afraid of and try to avoid any sexual activity. Or, they may experience an overall decrease in sexual interest and desire.

Alcohol and drug use

Substance abuse can sometimes become problematic for women who are the victims of assault. A large-scale study found that compared to non-victims, rape survivors were three to four times more likely to use marijuana, six times more likely to use cocaine, and ten times more likely to use other major drugs. Often, women will report that they use these substances to control other symptoms related to their assault.

PTSD

Posttraumatic Stress Disorder (PTSD) involves a pattern of symptoms that some individuals develop after experiencing a traumatic event such as sexual assault. Symptoms of PTSD include repeated thoughts of the assault; memories and nightmares; avoidance of thoughts, feelings, and situations related to the assault; negative changes in thought and feelings; and increased arousal (for example difficulty sleeping and concentrating, jumpiness, irritability). One study that examined PTSD symptoms among women who were raped found that almost all (94 out of 100) women experienced these symptoms during the two weeks immediately following the rape. Nine months later, about 30 out of 100 of the women were still reporting this pattern of symptoms. The National Women's Study reported that almost one of every three all rape victims develop PTSD sometime during their lives.

What should I do if I have been sexually assaulted? Where can I go for help?

If you were sexually assaulted and are experiencing symptoms that are distressing to you, or symptoms that are interfering with your ability to live a full life, we urge you to talk to a health care provider or mental health professional. Depending on the type of problems you are having, a number of therapies may be helpful to you.

The treatment you receive will depend on the symptoms you are experiencing and will be tailored to your needs. Some therapies involve talking about and making sense of the assault in order to reduce the memories and pain associated with the assault. Attending therapy may also involve learning skills to cope with the symptoms associated with the assault. Finally, therapy can help survivors restore meaning to their lives.

Unfortunately, sexual assault is fairly common in our society today. Survivors of sexual assault can experience a wide variety of symptoms, but they do not have to suffer in silence. Mental health professionals can offer a number of effective treatments tailored to the individual woman's needs. We urge you to seek help today.

Sources

This fact sheet is based on a more detailed version, located in the "Professional" section of our website: Sexual Assault Against Females

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Public This section is for Veterans, General Public, Family, & Friends Although anyone - men, women, and children - can be assaulted, this fact sheet will focus on adult female victims of sexual assault. Sexual assault is defined as any sort of sexual activity between two or more people in which one of the people is involved against his or her will.

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Post-traumatic stress disorder (PTSD) is an anxiety disorder. A person may develop PTSD after experiencing an extremely frightening or life-threatening situation. PTSD is most often associated with traumatic events such as war, sexual and physical attacks, natural disasters, and serious accidents. But it can also affect people with a history of cancer. For example, a recent study found that nearly 1 in 4 women who were newly diagnosed with breast cancer experienced PTSD.

Some aspects of the cancer experience that might trigger PTSD include:

Being diagnosed with the disease

Diagnosis of an advanced cancer

Painful tests and treatments

Pain from the cancer itself or other physical issues

Test results

Long hospital stays or treatments

A cancer recurrence or the potential for recurrence

Signs and symptoms of PTSD

It is normal for a person with cancer or a cancer survivor to have feelings of anxiety, such as worry, fear, and dread. However, if these feelings do not go away over time, continue to get worse, or affect daily life, they could be a sign of PTSD.

Other symptoms of PTSD include:

Nightmares and flashbacks

Avoiding places, events, people, or things that bring back bad memories

Strong feelings of guilt, hopelessness, or shame

Trouble sleeping or concentrating

Continuous feelings of fear or anger

Loss of interest in activities and relationships that used to be enjoyable

Self-destructive behavior, such as drug or alcohol abuse

Frightening or unwanted thoughts

Difficulty feeling emotions

PTSD symptoms are different for each person and can come and go. The symptoms usually develop within 3 months of a traumatic even. But they can also occur several months or even years later. If you experience any of these symptoms and they last more than 1 month, talk with your doctor or a member of your health care team.

People with cancer and cancer survivors who have PTSD need have treatment because the disorder can keep them from getting needed tests, cancer treatments, or follow-up care. PTSD can also increase a person's risk of developing other mental, physical, and social problems. These can include depression, alcohol and drug abuse, eating disorders, and loss of relationships and employment.

Risk factors for PTSD

It is not clear why some people develop PTSD while others do not. Certain factors may make a person more likely to develop the disorder, including a younger age at diagnosis. One study found that survivors of childhood cancer-especially those who had longer and more intensive treatment plans-had an increased risk of developing PTSD. Another found that nearly 20% of infants and preschoolers with cancer experience PTSD.

PTSD also seems to be more common for:

People who have had PTSD or other mental health conditions before being diagnosed with cancer

Women from minority groups

People with high levels of overall stress

People who use avoidance strategies to cope with stress, such as drugs or alcohol

People with less formal education

People with low or no income

Single people

However, a person with cancer or a survivor is less likely to develop PTSD if they:

Receive strong support from family and friends

Are given correct information about the stage of the cancer

Have good relationships with members of the health care team

PTSD and caregivers

PTSD can also affect caregivers. Learning that a loved one has cancer, seeing a loved one in pain, and experiencing a medical emergency are traumatic events. And they may contribute to the development of PTSD symptoms during treatment or years after the person has survived the cancer. One study found that nearly 20% of families with teenaged survivors of childhood cancer had a parent who was experiencing PTSD. Research also shows that it is extremely common for parents of children receiving cancer treatment to develop stress-related symptoms.

Treatment of PTSD

PTSD is treatable. Which treatment works best depends on a person's specific symptoms and situation. Common treatments are listed here and are often combined.

Psychotherapy. This meanstalking with a mental health professional, like a counselor, who has experience treating PTSD. Some counselors specialize in helping people who have or have had cancer. Therapy can be done 1-on-1 or in a group setting. Some health insurance companies pay for a portion of the treatment. Read more about the benefits of counseling.

Medications. Antidepressants and anti-anxiety drugs can help manage PTSD symptoms, such as sadness, anxiety, and anger. Medication is often used in combination with psychotherapy.

Support groups. Support groups can help people cope with the emotional aspects of cancer. They provide a safe place to share experiences and learn from other people facing similar situations.Research shows that support groups can help people with cancer feel less depressed and anxious and become more hopeful. Learn more about support groups.

Find support for PTSD

Many PTSD resources are available. Talk with your doctor or another member of your health care team for help and recommendations. Your hospital's social work or discharge department may also be able to connect you with counseling services and support groups in your community. Here are some other tips for finding help:

More Information

Additional Resource

National Cancer Institute: Cancer-Related Post-Traumatic Stress

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Post-Traumatic Stress Disorder and Cancer

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Post-traumatic stress disorder (PTSD) is an anxiety disorder. A person may develop PTSD after experiencing an extremely frightening or life-threatening situation. PTSD is most often associated with traumatic events such as war, sexual and physical attacks, natural disasters, and serious accidents. But it can also affect people with a history of cancer.

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Caregivers suffering from PTSD is real and serious problem. Last week, we talked about the anguish involved with caregiver stress, but more research has shown that the stress remains long after the caregiving is done.

What is PTSD?

Post Traumatic Stress Disorder (PTSD) is an anxiety disorder brought on by a traumatic experience. Although this is most commonly tied to war veterans, PTSD also affects those who have undergone abuse, violence, accidents or survived a natural disaster. In short, anyone who has suffered a trauma is at risk of developing PTSD.

Does Caregiving Cause PTSD?

Yes, for many people. It's not simply physically exhausting, but emotionally, mentally, and financially draining as well. This is especially true for adult children who take care of parents with dementia or a severe disability. Many of them feel an extreme amount of pressure and guilt to provide care, but feel powerless to stop the debilitating condition of their parents.

What are the Symptoms of PTSD?

The symptoms of this anxiety disorder are manifold and some people may experience a few or all of them.

Increased Anxiety
If you've ever had a night terror then you'll understand what this is like. Post trauma stress can manifest in your psyche and put you on high alert - all night.

Relive the Experience
For caregivers this might mean you flashback to your loved one berating you during a time when they were sundowning. It may be feeling like you've lost them all over again. It could happen hand-in-hand with increased anxiety, where you're suddenly on high alert and worried your loved one is wandering around the house.

Physical Pain & Mental Anguish
Many caregivers suffering from PTSD report aches and pains that won't go away. Additionally, many experience headaches and thoughts of hopelessness. They feel unable to move forward.

Antisocial Behavior
Many caregivers detach from their families and friends, feeling numb, empty, and guilt-ridden. They may think about death and contemplate suicide.

The scary part about PTSD is that it can lead to suicide and that's why it's all the more important to be wary of what's happening to you or your loved one. Everyone handles death differently, but if someone appears to be suffering some of the symptoms of post traumatic stress, then it's time to get help.

How to Treat PTSD

In most cases, the best way to treat PTSD is with therapy. Depending on the caregivers situation, that might mean private, group or family therapy sessions. Some other helpful remedies include meditation, physical therapy (massages), and EMDR (or Eye Movement Desensitization and Reprocessing). Some doctors may also recommend alternative treatments like acupuncturists, chiropractors, and Reiki masters.

Ultimately though, the best way to treat PTSD is to recognize the symptoms and exercise self-awareness. You may not be okay and it's more than okay to reach out. Remember that "self-care" should always come first.

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Caregivers Suffering from PTSD (Post Traumatic Stress Disorder) - Concierge Care Advisors

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Caregivers suffering from PTSD is real and serious problem. Last week, we talked about the anguish involved with caregiver stress, but more research has shown that the stress remains long after the caregiving is done. Post Traumatic Stress Disorder (PTSD) is an anxiety disorder brought on by a traumatic experience.

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Post-traumatic stress disorder (PTSD): An anxiety disorder that can occur after an individual has undergone extreme emotional trauma. It is most commonly associated with soldiers returning from war or victims of violent crime, but some experts now believe it can also befall caregivers. In fact, when I saw my doctor shortly after my mother died, it was something she mentioned.
Emotional Upheaval

In a way it sounds crazy; how could the impact of caregiving compare to war or violent crime? Obviously, they are very different, and I don't think anyone is trying to imply they can be compared. But if you unravel what occurs in a caregiver's life over many years, it's reasonable to believe some form of PTSD is certainly within the realm of possibility - perhaps to varying degrees depending upon many factors.

Barry Jacobs is a clinical psychologist and author of The Emotional Survival Guide for Caregivers. Dr. Jacobs notes that many caregivers wrestle with uncontrollable disruptive, distressing thoughts months - and sometimes years - after a loved one has died.

It drives me nuts when well-meaning people say, "focus on the good memories." (And for the record, I'm certain I've said the same thing to others a million times over my 47 years on this earth.) We'd all like to remember only the good times, and I imagine most of us constantly work toward that goal. But when you've watched someone suffer through years and years of an agonizing chronic illness, it's tough to just flip it off like the light switch in the kitchen.

Dr. Jacobs says, "Many people find themselves unable to stop thinking about the suffering they witnessed, which is so powerfully seared into their brains that they cannot push it away."

Haunting Memories

My mom died almost 9 months ago, and try as I might there are certain moments that regularly haunt me. Some nights, when I lay down and close my eyes at bedtime, the images are more vivid than I can bear. I just can't shake it, and the only way sleep will come is with television to distract my thoughts and melatonin to help me drift off.

Sometimes, the images pop into my head without warning - no apparent trigger - but there they are. It's a vicious cycle; the mental pictures tend to bring forth more unpleasant memories, particularly of the last several weeks of her life. Those thoughts lead to unreasonable worry about things that I couldn't control at the time and certainly can't control now.

For instance, in her last few days before going into the hospice facility, I had to administer morphine. Of course I was doing so under the direction of hospice nurses, but it was horrible. She was in so much agony; the morphine was the only thing that brought her peace. I know that. Yet, I still struggle and wonder if there was something I should have done differently.

Defying Logic

An image that is burned into my psyche is that frail, almost unrecognizable woman who, for nine days, occupied the bed in room 16 at Kobacker House. Face sunken in and unresponsive; so thin that at one point, I touched the sheet, wondering what the pointy thing was under there - only to realize it was a hip bone jutting out of her tiny body. I can still see her like it was yesterday, and if that's not painful enough it's a visual that never fails evoke memories of the moment she took her last breath.

Something that has bothered me for the past nine months; was I holding her hand at the very moment she crossed over or had I let go? Now what a ridiculous thing to obsess over! Even if I knew the answer, I couldn't change it, yet I have to consciously remind myself how illogical it is to allow that thought to take up residence in my head!

I don't doubt some people will read this and wonder why in the world I would put myself through reliving such painful memories, but it's not a choice. I'll be honest; I wish I understood it. What I do know is that I watched my mother's gradual decline for almost a decade; it's nearly impossible to even remember her BA (before Alzheimer's).

PTSD or Not, Caregiving Takes Its Toll

Symptoms of post-traumatic stress disorder include flashbacks, feelings of anxiety, dread, guilt, apathy, numbness, and depression, but as Dr. Jacobs points out, each of those issues are common in caregivers. It's really up to a physician to determine whether what you're experiencing might be a form of PTSD.

Do I think I have it? Probably not. The thoughts and images I've described aren't constantly present; they come and go. But at the end of the day we have to realize that years of witnessing the unthinkable, being forced to make life's most troubling decisions, never being able to completely settle our racing minds, constantly facing wildly fluctuating ups and downs - all while confronting life's "normal" daily challenges... it takes a toll.

I remind caregivers all the time they must be gentle with themselves, but the truth is, it's still something I have to work at everyday. It's only since my mom's passing that I've realized the need extends well into life after caregiving...
I would love to hear your thoughts on caregiver PTSD, as well as how you've dealt with the unwelcome images and memories that come calling at the most unexpected moments.

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Post-traumatic stress disorder (PTSD): An anxiety disorder that can occur after an individual has undergone extreme emotional trauma. It is most commonly associated with soldiers returning from war or victims of violent crime, but some experts now believe it can also befall caregivers. In fact, when I saw my doctor shortly after my mother...

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Dyslexia symptoms and PTSD- is there a connection?

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Dyslexia symptoms and PTSD- is there a connection?

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Dyslexia and PTSD- the left brain connection Rape Crisis Information Pathfinder

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"Studies show that individuals with dyslexia process information in a different area of the brain than do non-dyslexics." International Dyslexia Association "Neurological research suggests that there may be some abnormality in the function of the left side of the brain which controls the lexical system"The Dyslexia Institute