Observations from a Disability Support Services Professional on Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder, as its name implies, is an anxiety disorder that manifests in individuals who have experienced a traumatic event at some point in their life. It’s important to distinguish between PTSD and Post-Traumatic Stress. Post-Traumatic Stress is a normal and even healthy part of the healing process in the wake of a traumatic event (note the lack of “disorder”). However; when that stress persists for longer periods of time (generally more than 6-12 months) and/or it severely impacts every day functioning, it can elevate to the level of a disorder. For many of the students we interact with during the academic year, these traumatic events may come in the form of an accident that seriously injured or maimed the student or took the life a close friend or family member. They may be survivors of a violent crime or sexual assault; or in today’s global climate of unrest, terrorism, and war – they may be returning from combat where those traumas are all the more common place.
According to the National Institute of Mental Health (NIMH), at some point in their life, 6.8% of the US population (which is approximately 322,000,000 people as of the last census) will develop PTSD. In any given year approximately 3.5% of the population will struggle with PTSD and 36% of those individuals, or 1.3% of the total population will suffer from “severe” PTSD (National Institute of Mental Health (NIMH), 2005). At a large state institution with a population of 30,000+ students we can, and probably should, expect that as many as 400 students may be dealing with some form of PTS or PTSD. PTSD will occur more frequently at 25-40 is than 18-25, and prevalence among combat veterans is much higher than in the general population. Some studies estimate that in veterans active from 2001-2005, at the height of the war in Iraq, rates of diagnosis were as high as 12% (Richardson, Frueh, & Acierno, 2010). So with that in mind, depending on the specific demographics at each college or university, this correlation/estimation will not be perfect or even remotely true; however, I think it behooves us to prepare for the worst case scenario; because when it rains – it pours. Say amen.
Thinking about the month of June and PTSD Awareness Month, I began reflecting on my experiences with students who have passed through my office and self-identified as having, or had, Post-Traumatic Stress Disorder. While every student is unique and presents with their own one-of-a-kind strengths and areas of personal growth, there are certain themes or patterns that I think DSS professionals and student affairs professionals will anecdotally agree are more likely in many of these students. To name a few, students with PTSD may feel isolated, scared, misunderstood, ashamed or embarrassed and anxious. Studies suggest that PTSD among combat veterans in particular, is comorbid (or co-exists) at a high rate with other mental health concerns. In 2010-2011 Trivedi et al,. found that, of the veterans with PTSD that they surveyed, roughly 22% were also diagnosed with a substance use disorder. Almost 50% had a diagnosis of depression, and 8.8% had a “serious mental illness like Bi-Polar or Schizophrenia (Trivedi et al,. 2015)… In brief this means that if we were betting people, we’d wager that a student will come to us with ill-considered and dangerous coping mechanisms, and/or deep and debilitating mental illness on top of their trauma related stress.
Getting through college is challenging enough as it is. At the college or university level it is often expected, and in some programs demanded, that students spend more time on their studies than some people do at a full-time job. As these demands and challenges compound for students, their concerns and issues in academia can become magnified and difficult to address. To make matters worse, because many of these individuals rather unexpectedly find themselves struggling with this 800 pound gorilla, they may not have arrived at the developmental point in their diagnosis where they’re comfortable talking to people about their inner strife or accept any kind of help – hence why addressing their academic woes can be an arduous task. It can be difficult for people with PTSD to even know where to begin. Individuals with learning disabilities, ADHD, visual or hearing impairments, by contrast, have often been adapting over longer periods of time in order to be successful. They know what they’re capable of independently and when they need to access services because they’ve had practice and coaching. Survivors or veterans who have gone through the bulk of their life as a fully able individual (to the extent that society/culture tells us we’re able) may have immense apprehension, shame, or guilt associated with admitting they need any kind of accommodation or assistance.
I recently had the opportunity to sit down with one of my colleagues in Veterans Affairs to discuss the obstacles that veterans with PTSD (sometimes un-diagnosed) face while transitioning back to civilian and student life. We both shared stories of students who, by all appearances were struggling or flat out failing in their classes, extracurricular organizations, personal lives and everything else, but were insistent that they were fine and just needed to “tweak some things” or “try harder.” Only through continued conversations, realizations, and sometimes fellowship with other students who have sought some assistance, are these students able to recognize that some problems are just bigger than a single person and require a team approach to accommodate.
To that end, if a student makes the leap to register with their institution’s disability support services, there are some accommodations that they will find more helpful than, say: having more time on tests and help with notes (I don’t know about you all but this is the lion share of what our LD and ADHD community are requesting). While all students will engage in the interactive and deliberative process, and some may find that they do, in fact, need help with notes and extra time– it’s also more likely that they may experience triggering events or flashbacks that render them almost completely incapacitated. At their very least, an episode or panic attack will compromise their mental faculties to the extent that they can’t navigate the social and intellectual nuances of classes or exams (or get out of bed for that matter). Testing accommodations provide little relief in that scenario. Students with PTSD will need to have ongoing conversations with their instructors, their disability services advisors, and potentially other medical/mental health professionals on the topic of attendance and deadlines if their symptoms impact their ability to make it to class or take exams. Anecdotally, when I meet with students suffering with anxiety disorders, and they ask me “…so what can you even do for me?, in an incredulous tone (almost as if to say “you can’t possibly do anything for me”) – they are surprised that I would even entertain the notion of talking with their instructors about attendance, deadlines, and make-up exams. Of course, it’s important that students recognize that there is, and always will be, a limit to how far these accommodations will go and that classes taught and assessed primarily through experiential activities or discussions will be much harder (if not impossible) to miss without serious consequence. To me, being willing to commit to these conversations and bring people to the table and engage in complex conversations is the right and empathetic thing to do. This enables us to educate our students and faculty while advocating for student success.
No matter the disability, access to accommodation can make or break a student’s ability to adapt to the rigors of college life and will be the cornerstone of their success.
Alex Ecklund is currently an Accessibility Coordinator in Student Accessibility Services at Ohio University in Athens, Ohio. He earned a Master of Arts in Counseling at Edinboro University of Pennsylvania. For questions about this month’s blog please contact Alex at: firstname.lastname@example.org
Richardson, L. K., Frueh, B. C., & Acierno, R. E. (2010). Prevalence estimates of combat-related post-traumatic stress disorder: Critical review. Australian and New Zealand Journal of Psychiatry, 44(1), 4-19. doi:http://dx.doi.org/10.3109/00048670903393597
National Institute of Mental Health (2005). Post-Traumatic Stress Disorder Among Adults. Retrieved from http://www.nimh.nih.gov/health/statistics/prevalence/post-traumatic-stress-disorder-among-adults.shtml
Trivedi, R. r., Post, E. P., Sun, H., Pomerantz, A., Saxon, A. J., Piette, J. D., & Nelson, K. (2015). Prevalence, Comorbidity, and Prognosis of Mental Health Among US Veterans. American Journal Of Public Health, 105(12), 2564-2569.