The following case studies are related to incidents that resulted in PTSD. In each case the STOP D technique was used to assess the severity of the trauma and monitor improvement during the treatment phase.
The PTSD case studies have been anonymised to protect patient identity.
Five young men shared a common interest in surfing. One of them had a car and they set off together one Saturday to a surfing beach. The patient was the nearside rear passenger. They were approaching a fairly gentle right hand bend. A loaded car transporter was approaching on the other side of the road. The driver of the transporter misjudged the bend and moved to the right side of the road. There was a head on collision. The car transporter cut the car in half longitudinally. The driver and offside rear passenger were killed instantly and the middle rear passenger was cut in half longitudinally. The patient was dazed and when he fully regained his composure saw that the friend he was sitting next to was only half a body. The patient was deeply traumatised and developed PTSD. For the next 18 months he was unable to sleep, eat, concentrate or doing anything useful. He lost his job and emotionally was in a deeply distressed state. His family with whom he lived were very upset and did not know what to do with him.
His solicitor was very concerned and eventually referred him to me as I regularly assessed PTSD and used Eye Movement Desensitisation and Reprocessing (EMDR). The patient identified his reliving and over the next six weeks each reliving was removed or greatly reduced. The patient improved sufficiently to go surfing in Australia for a number of months.
At the time I was seeing patient’s hour on hour. I focused my attention on whoever I was with and for that reason did not have the opportunity to dwell on any particular case no matter how distressing it may have been. At this time I was preparing many reports on asylum seekers for the Home Office adjudication panels. Asylum seekers often had deeply distressing stories to tell.
It was these experiences that led me to the opinion that there needed to be a revision of assessment procedures for diagnosing, quantifying and monitoring PTSD. I judged the credibility of many paper tests to be limited because it was easy for patients to over or under play the severity of their condition.
The psychometric issues involved in this were complex and it has taken much time and effort for a satisfactory assessment procedure to evolve. STOP D is the culmination of my research.
A woman in her late 20’s was sent by her employer to give lectures all over the country. She was selling wigs to those who had lost their hair due to the cancer treatment they had received.
On one occasion she was driving at speed on a motorway. A car in the middle lane saw that a car in front of her had had a blow out. She suddenly moved to the right to avoid a collision. In moving right the patient hit the central reservation and was thrown across all three lanes. She hit the barrier on the left hand side of the road. She was thrown off this and she came to a halt facing oncoming traffic in the near side lane. She had the presence of mind to switch her engine off.
She was deeply traumatised and she developed severe acute PTSD. She required much treatment because her difficulties were being fuelled by anxiety. She had a fairly high level of dispositional anxiety that had a familial origin. She developed a high level of situational anxiety due to the accident.
As often happens in cases of this type her situational and dispositional anxiety had a multiplicative interaction leaving her in a deeply troubled state. This was exacerbated by her PTSD and kept her PTSD alive. Hence her relatively slow recovery.
A 63 year combat vetran had been a Royal Marine Commando in his early 20’s. He served in the Far East and was recruited to the Special Services. He was involved in hand to hand combat. The fact that he survived meant that he had witnessed dreadful wartime atrocities. Helped by the camaraderie of his brothers in arms he was able to assimilate the extreme traumas of which he had been part. He never spoke of what happened and to all intents and purposes his past was quiescent.
Now in retirement he was involved in a very frightening and potentially life-threatening incident. A high up window on a shop towards which he was walking was covered in a sheet of thick Perspex. For reasons unknown it came loose and hurtled through the air landing just behind the patient. It is a strange material and noisily shattered into a million pieces. Everybody in the vicinity including the patient thought a bomb had gone off. The patient said that while falling it sounded like a helicopter in the air. The sound of a helicopter and an explosion took him back to his war service and he relived the horrors he had experienced, the people he had killed with a knife, of advancing insurgent soldiers being cut in half by machine gunfire and other unspeakable horrors. He was suffering from severe PTSD. As a sequel to his relivings he developed a severe depressive illness of such severity that there was concern that he would commit suicide.
He was referred to me as I have had expertise in PTSD assessment and EMDR. Even with such an effective treatment it took several months of frequent treatment to free him of his difficulties.
A 54 year old man had retired 3 years earlier from a senior position in the Fire & Rescue Service. He had been in the service for 26 years. He was ill-prepared for retirement and missed being in command. Time hung heavily for him and his health problems became more apparent. He had a pacemaker and suffered from arterial fibrillations. He had osteoarthritis and angina. Probably because of his difficulties he began to relive horrific events he had encountered in his career. These included the 6 year old son of a murdered woman, the mutilated survivor of a road traffic accident, the shredded body of an engineer, the suicide of a 26 year old drug addicted prostitute, the traumatised children of a woman killed in a road traffic accident, the child victims of a car crash, the charred remains of an elderly woman whose house burnt down. None of these were recent but he no longer had the support of colleagues. The ethos of the Fire & Rescue Service is to assimilate horrors never admitting that they caused stress or anxiety. The cumulative effect of having no support, not knowing what to do with his time and deteriorating health reawakened past horrors so that he had inescapable and intrusive relivings.
It was found that he had a high level of anxiety, to which he had never been able to admit. Via cognitive therapy he acquired skills in how better to cope with his anxiety and his relivings began to fade.
A retired officer organised a continental holiday for a club. On a ferry on the way home the group realised they were on the wrong side of the ship for their cabins. They entered an empty part of a car deck with a view to crossing to the other side of the vessel. No sooner had they entered the car deck than they found that it was being raised hydraulically. The officer’s wife and several other passengers left by the door they had entered by jumping 4 feet down to the corridor below. One woman had had a recent hip replacement and could not jump down. Other members of the group had to help her. There was no evident way to raise the alarm. The wife witnessed her usually calm husband screaming and feared, as did he, that he would be crushed against the deck above.
The commotion caught the attention of crew members who raised the alarm in time to avert the impending disaster. The officer who by nature had a calm and collected disposition was rescued safely as were other members of the group who had been trapped with him. Nonetheless it had been a deeply traumatic incident that had the realistic appearance of being life threatening.
There should have been no access to the car deck while the deck was being raised or indeed at anytime during the crossing.
A police officer who had served as a constable for 33 years encountered repeated traumas. The traumas included an IRA bombing, the death in his arms of a 9 year old girl and 6 separate urban riots. After 12 years he left the police and for the following 8 years he worked for charitable organisations delivering emergency aid to children in two active war zones. Both wars were notable for appalling atrocities. He rejoined the police in a different part of the country and was a traffic officer on a motorcycle. He had attended between 35 and 40 fatal accidents since rejoining the force. He was a notably compassionate man albeit that he had a formal role. Evidence for this was his work for children’s charities. An allegation of assault was made by a motorist who was stopped for speeding. The case was not resolved by the Courts for 14 months. The wait was very stressful. The motorist was found guilty of the offence with which he had been charged and the officer was found not guilty of assault.
He was asked to identify but not talk about what he relived of the six traumas he had experienced. He was given a list of the 21 symptoms in the 6 criteria used by DSM IV to define the nature of PTSD. In each of the traumas over a 30 year period he had many symptoms of PTSD but until the recent past he did not fulfil all of the criteria. By the strict criteria of DSM IV he was not suffering from PTSD until recently. The trend of the results was of increasing difficulty. He was no longer able to fulfil his duties. Trauma finally got the better of him.