Tuesday, March 24, 2009

Frequently Asked Questions About Post-Traumatic Stress Disorder

Frequently Asked Questions About Post-Traumatic Stress Disorder (PTSD) & Employment

What is PTSD?

Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop in response to exposure to an extreme traumatic event. These traumatic events may include military combat, violent personal assaults (e.g., rape, mugging, robbery), terrorist attacks, natural or man-made disasters, or serious accidents. The trauma can be directly experienced or witnessed in another person, and involves actual or threatened death, serious injury or threat to one's physical integrity. The person's response to the event is one of intense fear or helplessness.

What are some possible behaviors associated with PTSD?

Many people with PTSD repeatedly re-experience their ordeal in the form of flashback episodes, intrusive recollections of the event and nightmares. A stress reaction may be provoked when individuals are exposed to events or situations that remind them of the traumatic event. Avoidance of those triggering cues is a very significant feature of PTSD. Symptoms of PTSD may also include feeling detached from others, emotional "numbing," difficulty sleeping, problems concentrating, irritability, being hyper-alert to danger, feeling "on edge," and an exaggerated startle response. PTSD symptoms usually emerge within a few months of the traumatic event; however symptoms may appear many months or even years following a traumatic event. It is normal for most people to experience some symptoms following a traumatic event. PTSD diagnoses are based on the intensity and duration of these symptoms. For many, PTSD symptoms will resolve completely while, for others, symptoms may persist for many years.

How prevalent is PTSD?

Studies suggest that about 8% of the U.S. population (approximately 24 million people) will develop PTSD at some point in their lives. Compared to men, women are about twice as vulnerable to developing PTSD following a traumatic event. Among military veterans, PTSD is quite common. Approximately 30% of Vietnam War veterans experience PTSD over the course of their lifetimes. Recent data compiled by the Rand Corporation suggest that approximately one in five service members who return from deployment operations in Afghanistan and Iraq have symptoms of PTSD or depression.

Is PTSD a disability under the Americans with Disabilities Act (ADA)?

The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet. Therefore, some people with PTSD will have a disability under the ADA and some will not. A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having such an impairment. For more information about how to determine whether a person has a disability under the ADA, visit www.eeoc.gov/policy/docs/902cm.html.

Are employees with PTSD required to disclose their disability to their employers?

No. Employees need only disclose their disability if/when they need an accommodation to perform the essential functions of the job. Applicants never have to disclose a disability on a job application, or in the job interview, unless they need an accommodation to assist them in the application or interview process.

Can an employer ask an employee with PTSD to submit to a medical examination?

Yes, if the need for the medical examination is job-related and consistent with business necessity. Typically, employers will ask an employee with PTSD to submit to a medical examination (also called a fitness-for-duty exam) after the employee has an incident on the job that leads the employer to believe that the employee is unable to perform the job, or to determine if the employee can safely return to work, and if any accommodations will be needed on the job.

Do employees with PTSD pose a direct threat to themselves or others?

In general, people do not pose a direct threat to themselves or others solely by virtue of having been diagnosed with PTSD. Employees who effectively manage their symptoms through medication or psychotherapy are very unlikely to pose a threat to themselves or others. Employers can also help reduce the overall stress in the work environment or mitigate known vulnerabilities to stress by providing a job accommodation.

How and when does a person with PTSD ask for an accommodation?

An employee with PTSD can ask for an accommodation at any time when he/she needs an accommodation to perform the essential functions of the job. The employee can make a request verbally or in writing and is responsible for providing documentation of a disability.

Can an employer discipline an employee with PTSD who violates conduct or performance standards?

Yes, an employer can discipline an employee with PTSD who violates conduct standards or fails to meet performance standards, even if the exhibited behavior is influenced by the employee's disability, as long as the employer imposes the same discipline on an employee without a disability who violates conduct or performance standards. However, an employer is obligated to consider reasonable accommodations to help the employee with PTSD meet the conduct or performance standards.

Why does employment play such an important role in the recovery of returning service members with PTSD?

Employment enables many people with disabilities and combat-related conditions, including those with PTSD, to fully participate in society. In fact, according to the National Council on Disability, people who regain employment following the onset of a disability report higher life satisfaction and better adjustment than do people who are not employed. At the most fundamental level, employment generates income that is vital to individual and family economic well-being. Given how closely our identities are tied to our occupation, employment plays a critical role in maintaining our self-concept. Further, employment affords opportunities to experience success and build self-esteem, which are critical elements toward psychological health. It facilitates social interaction and connections that can reduce the isolation that is commonly experienced through depression and PTSD. For these reasons, gainful employment can be an important component in the recovery and rehabilitation of people with PTSD.

What challenges might people with PTSD encounter in the workplace?

Although their condition may not be visible, service members with PTSD may face some difficulties-especially with respect to employment. These individuals may experience memory deficits, difficulty sustaining concentration, disorganization, and poor sleep patterns, among other challenges. All of these can interfere with everyday activities, inside and outside of the workplace.

How can employers help people with PTSD do their jobs more effectively?

A variety of promising practices can help people with PTSD succeed in the workplace. These include:

Flexible work schedules and/or job sharing with another employee.
Schedule-reminders (telephone, pagers, alarm clocks).
Scheduled rest breaks to prevent stimulus overload and fatigue.
Work task checklists, clipboards and tape recorders as memory aids.
Stop watches or timers for time management.
Job coaches who make frequent, scheduled site visits.
White noise or environmental sound machines (to help eliminate distractions).
Mentoring by a co-worker or retired worker.
Providing encouragement, moral support, and a listening ear.
Understanding that PTSD and symptoms of any psychological condition may ebb and flow, and that the person may experience good days and more challenging days.
Support for pursuing treatment and assistance, even during work hours. Employers should know that treatment is a process that can be effective in managing psychological symptoms and conditions. Supporting employees in their need to regularly follow up or comply with treatment recommendations is an important part of their recovery.

What resources are available to help employers meet
the needs of employees with PTSD?

The America's Heroes at Work Web site-www.AmericasHeroesAtWork.gov-features numerous tools and resources to help employers and workforce development professionals understand and address the needs of employees with PTSD. It offers additional fact sheets on PTSD-related job accommodations, as well as links to the Web sites of other agencies and organizations such as:

The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury
The National Center for PTSD
Employer Support of the Guard and Reserve
Hire Vets First
The Job Accommodation Network
Vocational Rehabilitation and Employment

This fact sheet was developed in cooperation with the U.S. Department of Labor's (DOL) Office of Disability Employment Policy, the Job Accommodation Network, the Veterans' Employment and Training Service, the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, and the Defense and Veterans Brain Injury Center.

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