Dr Ravi Gill discusses the factors contributing to the heightened susceptibility of individuals in high-risk occupations – such as emergency services and the armed forces – to Post-Traumatic Stress Disorder (PTSD)
Q: What factors can contribute to the susceptibility of those working in high-risk occupations, like emergency services or the armed forces, to PTSD?
Post-Traumatic Stress Disorder (PTSD) is a trauma-and- stress-related disorder characterised by symptoms such as persistent re-experiencing of a traumatic event (e.g., intrusive memories, nightmares), avoidance of reminders, negative alterations in cognition and mood, and marked physiological arousal (e.g., hypervigilance, exaggerated startle).
In high-risk occupations such as emergency services and the armed forces, workers are routinely exposed to potentially traumatic incidents, life-threatening situations, witnessing serious injury or death, moral/ ethical dilemmas, and sustained operational stress; all of which significantly elevate their risk for developing PTSD.
Within these professions, it’s not only a single traumatic event but the cumulative exposure, the organisational context (shift work, sleep deprivation, high responsibility), and the cultural norms around help- seeking that can all contribute to elevated vulnerability.
Several interrelated factors can contribute to the heightened susceptibility of individuals working in high-risk occupations to developing post-traumatic stress disorder (PTSD).
- Repeated exposure to trauma – Unlike single-incident trauma, those in high-risk roles are frequently exposed to distressing or life-threatening situations, even on an hour-by-hour basis. This cumulative exposure can erode the nervous system’s capacity to recover between events, leading to chronic hyperarousal
and emotional exhaustion. - Occupational culture and stigma – Many high-risk professions operate within cultures that prize resilience, stoicism, and ‘mental toughness.’ While these values can foster performance under pressure, they may also discourage emotional expression or help-seeking. Over time, suppression of distress can reinforce avoidance, a key feature of PTSD.
- Perceived responsibility and moral injury – Workers often face moral and ethical dilemmas, such as witnessing preventable deaths or being unable to save lives. The resulting moral injury, a sense of guilt, shame, or betrayal of one’s values, can complicate recovery and deepen psychological wounds beyond the trauma itself.
- Lack of recovery time and support – Long shifts, inadequate debriefing, and chronic sleep deprivation can impair emotional processing and memory consolidation, leaving traumatic experiences ‘stuck’ in the nervous system. Without structured psychological support or reflective supervision, distress can accumulate unnoticed.
- Personal and contextual factors – Pre-existing mental health vulnerabilities, previous trauma history, lack of social support, and personal coping styles also influence susceptibility. For example, individuals who rely heavily on avoidance or self-reliance may be more at risk of delayed or complex PTSD.
- Systemic and organisational pressures – High workloads, limited resources, and leadership dynamics can intensify feelings of helplessness or betrayal, which are known risk factors for trauma-related disorders. When the organisation itself is perceived as unsafe or unsupportive, recovery becomes even more difficult.
Q: What are some common symptoms associated with PTSD, and how can they impact a person’s daily life?
Post-Traumatic Stress Disorder (PTSD) can manifest through a range of psychological, emotional, and physical symptoms that significantly affect an individual’s ability to function in daily life. The Core Symptom Clusters (DSM-5 Framework) cover:
Intrusive symptoms:
- Recurrent, involuntary memories or flashbacks of the traumatic event
- Nightmares or distressing dreams
- Intense psychological or physiological reactions to reminders (sounds, smells, environments)
Impact:
These intrusions can make individuals feel as though the trauma is happening again, leading to hypervigilance and disrupted sleep. Many begin avoiding public places, crowds, or specific tasks that could trigger memories – often leading to social withdrawal or reduced work performance.
Avoidance:
- Avoiding thoughts, feelings, conversations, or reminders of the trauma
- Emotional numbing or detachment from others
Impact:
Avoidance can temporarily reduce distress, but it often reinforces PTSD by preventing emotional processing. Over time, this can lead to feelings of isolation, difficulties maintaining relationships, and emotional disengagement from family or work.
Negative alterations in cognition and mood:
- Persistent negative beliefs about oneself or the world (‘I’m unsafe,’ ‘It was my fault’)
- Guilt, shame, or loss of trust
- Diminished interest in activities once enjoyed
- Emotional flatness or inability to feel positive emotions
Impact:
These changes often erode self-esteem and hope. Individuals may struggle with motivation, decision- making, or maintaining concentration, which can impact their job performance and daily functioning. Depression and substance use can also co-occur as coping mechanisms.
Alterations in arousal and reactivity:
- Hypervigilance, exaggerated startle response
- Irritability, angry outbursts
- Difficulty concentrating
- Sleep disturbance
- Physical symptoms such as tension, racing heart, or gastrointestinal issues
Impact:
Chronic hyperarousal can lead to exhaustion and burnout. In the workplace, it may manifest as reduced tolerance for stress, interpersonal conflict, or errors in judgment. Over time, the nervous system remains in a prolonged state of ‘fight or flight,’ impairing emotional regulation and physical health.
Cumulative effects on daily life:
- Occupational: Difficulty focusing, absenteeism, or leaving high-stress jobs.
- Relational: Emotional disconnection, irritability, or avoidance can strain intimate relationships.
- Physical health: Chronic stress responses can contribute to cardiovascular issues, sleep disorders, and immune dysregulation.
- Self-identity: Many individuals describe a sense of ‘not being the same person’ after trauma, impacting confidence and self-concept.
Q: Can you outline some key challenges faced by military personnel and emergency service workers in navigating symptoms and seeking help?
In my professional practice as a psychologist working within blue light services, I have found that several barriers consistently prevent individuals from recognising symptoms early and accessing the support they need.
Cultural barriers and stigma – Many emergency and military cultures still value resilience, composure, and self-reliance. Admitting psychological distress can be perceived as weakness or failure, leading to fears of being judged, sidelined, or deemed unfit for duty. This culture often reinforces silence and avoidance of help.
Identity and role conflict – For those whose identity is built on being capable and in control, experiencing trauma symptoms, such as irritability, emotional numbness, or hypervigilance, can feel like a personal or professional failure. This identity conflict deepens shame and can delay acknowledgement of distress. Symptoms may also be a ‘loss of control’ for the individual.
Cumulative and repeated exposure – Unlike single- incident trauma, repeated exposure to distressing events, serious accidents, violence, or loss creates a cumulative impact. Without adequate recovery time, workers may develop chronic stress responses or complex trauma patterns that are harder to recognise and treat.
Organisational and systemic factors – Long hours, shift work, and operational demands leave little space for recovery, processing, or reflection. Many still fear that disclosing psychological distress could affect promotional prospects, job security, or team trust. Within hierarchical structures, confidentiality concerns can further discourage seeking help.
Family and relationship strain – PTSD often affects the whole system around the individual. Emotional withdrawal, irritability, or avoidance behaviours can strain family dynamics, leaving both the worker and their loved ones feeling isolated or misunderstood.
Limited access to trauma-informed support – Even when support is available, it may not be trauma-informed or sensitive to the unique pressures of emergency and military life. Workers may encounter professionals unfamiliar with the operational culture, which can lead to mistrust or disengagement from therapy.
Q: What treatment options are available for PTSD? Are there any recent research developments you would like to highlight?
Evidence-based treatment approaches include trauma-focused psychological therapies; these are considered first-line treatments and are recommended by NICE guidelines.
Trauma-focused Cognitive Behavioural Therapy (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR): Both therapies focus on integration, helping the trauma become a part of the past rather than a recurring present-day experience.
Pharmacological treatment – Medication may be used when psychological therapy is not accessible or if symptoms are severe. This can include SSRIs, particularly Sertraline and Paroxetine, which are recommended in the UK. Medication alone does not typically resolve trauma memories, but it can help reduce anxiety, arousal, and depressive symptoms enough for therapy to become manageable. For children and young people, medication is not recommended as first-line treatment.
PTSD often co-occurs with depression, anxiety, substance use difficulties, sleep problems, and chronic stress responses. Supportive approaches and integrated care may therefore include:
- Stabilisation and emotional regulation skills
- Treatment of insomnia or nightmares
- Support for reducing reliance on alcohol or other substances
- Psychoeducation for family members or caregivers
- Workplace adjustments and occupational-health support where relevant
These approaches help create the safety and stability necessary for trauma processing.
Recent developments in PTSD treatment research include neuromodulation; emerging evidence suggests that vagus nerve stimulation (VNS), when used alongside therapy, may improve emotional regulation and trauma memory processing in individuals with treatment- resistant PTSD. This remains a specialist intervention requiring further large-scale research.
