UNITED STATES DEPARTMENT OF EDUCATION

OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES

REHABILITATION SERVICES ADMINISTRATION

WASHINGTON, DC 20202

> INFORMATION MEMORANDUM
>
> RSA-IM-01-43
>
> DATE: September 25, 2001

ADDRESSEES: STATE VOCATIONAL REHABILITATION AGENCIES (GENERAL)

> STATE VOCATIONAL REHABILITATION AGENCIES (BLIND)
>
> STATE REHABILITATION COUNCILS
>
> CLIENT ASSISTANCE PROGRAMS
>
> PROTECTION & ADVOCACY OF INDIVIDUAL RIGHTS PROGRAMS
>
> REGIONAL REHABILITATION CONTINUING EDUCATION PROGRAMS
>
> AMERICAN INDIAN VOCATIONAL REHABILITATION PROGRAMS
>
> RSA SENIOR MANAGEMENT TEAM

SUBJECT: Basic Information and Resources Available Regarding Post
Traumatic Stress Disorder

CONTENT: This Information Memorandum is designed to provide Vocational
Rehabilitation providers and other interested parties with basic
guidance on Acute Stress Disorder (ASD) and Post Traumatic Stress
Disorder (PTSD), as well as a listing of resources available for those
seeking more detailed information. In light of the tragic events that
occurred on September 11, 2001, as a result of terrorist activities, the
Rehabilitation Services Administration (RSA) is hopeful that this
information will prove useful to rehabilitation professionals and
consumers.

> Please Note: This document is designed as background material and is
> not a substitute for medical advice. A more detailed resource list
> follows. The primary source of information regarding the causes and
> symptomology of PTSD and ASD used for this document is the Diagnostic
> and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV).
> The pages referred to are 424-432.
>
> **PTSD**
>
> **What It Is**

According to the DSM-IV, PTSD is a disorder that can occur following the
experience or witnessing of an event in which there is actual or
threatened death or serious injury or a threat to an individual's
physical integrity. The person's response to the event must involve
intense fear, helplessness, or horror (in children, disorganized or
agitated behavior). Symptoms of PTSD include: persistent reexperiencing
of the traumatic event, persistent avoidance of stimuli associated with
the trauma and numbing of general responsiveness, and persistent
symptoms of increased arousal. The symptoms must be present for more
than one month and the disorder must cause clinically significant
distress or impairment in social, occupational, or other important areas
of functioning.

> A partial list of traumatic events that are experienced directly can
> include: military combat, violent personal assault or kidnapping, or
> terrorist attack. Witnessed events include: observing the serious
> injury or unnatural death of another person due to violent assault,
> accident, war, or disaster. Events experienced by others that are
> learned about by the individual could include: violent assault,
> accident, or injury experienced by a family member or close friend.
>
> The DSM-IV states that PTSD may be especially severe and/or long
> lasting when the stressor is of human design, such as torture or rape.
> Also, the individual becomes more likely to develop PTSD as the
> intensity and physical proximity to the stressor increase.
>
> PTSD prompts the individual to reexperience the event through
> recurrent and intrusive recollection, recurrent dreams, or, in rare
> cases, dissociative states during which the individual behaves as if
> experiencing the event at that moment. Trigger events, such as
> anniversaries or similar crises, can cause intense psychological
> distress and physiological reactions.
>
> Behaviors often exhibited by individuals with PTSD include: avoidance
> of thoughts, feelings, or conversations about the trauma, as well as
> avoidance of activities, situations, or people who arouse recollection
> of it. Individuals with PTSD may experience amnesia related to certain
> aspects of the event and may complain of diminished interest in
> previously enjoyed activities. They may have a diminished capability
> to feel emotions (especially those associated with intimacy or
> tenderness).
>
> Individuals with PTSD may have persistent anxiety, difficulty falling
> or staying asleep, hypervigilance, exaggerated startle response, or,
> in some instances, irritability, outbursts of anger, or difficulty
> concentrating or completing tasks.
>
> Individuals with PTSD may experience survivors' guilt or phobias
> associated with things that symbolize or resemble the traumatic event.
> These phobias can interfere significantly with the individual's
> interpersonal relationships and lead to loss of job, marital conflict,
> or divorce, among other changes.
>
> For individuals with PTSD, there may be an increased risk of the onset
> of Panic Disorder, Agoraphobia, and Substance-Related Disorders, among
> others. It is unclear whether or not PTSD precedes these other
> disorders.

### How It Is Treated

> Like most psychiatric disorders, there is no cure, per se, for PTSD.
> It is treated through cognitive-behavioral therapy, group therapy, and
> exposure therapy, among other modalities. Medications used for
> treatment of depression can also be beneficial.

# **ASD** 

> ASD has the same causes as were stated above for PTSD. ASD has an
> immediate onset during or following the traumatic event. The
> individual will experience emotional numbness, detachment, or absence
> of responsiveness. The trauma is persistently reexperienced. ASD
> usually begins within two days of the event and lasts only four weeks.
> ASD could be referred to as a "precursor" to PTSD.

# **Resource List**

What follows is a partial list of possible web-based resources for
further information regarding PTSD and assistance in dealing with the
tragic events of September 11, 2001.

> <http://www.ed.gov/about/offices/list/os/september11/index.html>: The
> U.S. Department of Education's response to the events on September 11,
> 2001.
>
> http://www.apa.org/topics/topicptsd.html: The American Psychiatric
> Association's on-line information source.
>
> <http://www.ncptsd.org/what_is_new.html>: The National Council on
> Post-Traumatic Stress Disorder's Web site.
>
> http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml:
> The National Institute of Mental Health's on-line information
> regarding PTSD.
>
> <http://www.nami.org/helpline/traumaresources.html>: The web-based
> resources of the National Alliance for the Mentally Ill.

CONCLUSION: This document is designed to provide basic information on
PTSD, its effects, and the ways in which it can be treated. We at RSA
hope you will use the information included here as a starting point for
learning about the disorder. For more information regarding this IM,
please contact Jenn Rigger at 202-260-2179 or via e-mail at
<jenn.rigger@ed.gov>. For more information regarding PTSD, please refer
to the resources listed.

> Joanne M. Wilson
>
> Commissioner

cc: COUNCIL OF STATE ADMINISTRATORS OF VOCATIONAL REHABILITATION

> NATIONAL ORGANIZATION OF REHABILITATION PARTNERS
>
> NATIONAL COUNCIL ON INDEPENDENT LIVING
>
> NATIONAL ASSOCIATION OF PROTECTION AND ADVOCACY SYSTEMS
>
> NATIONAL REHABILITATION FACILITIES COALITION