Factors such as having a history of mental illness or substance abuse, having little emotional or social support after the traumatic event, seeing others hurt or killed, and being physically injured during an event can increase the risk of developing PTSD in some people.

“Women are more likely to develop it than men,” adds Bartlett. “It really depends on the event you are exposed to. People in medicine like an ER nurse, ambulance driver or EMT are constantly exposed to horrible things. Some people are resilient and others are really impacted. No one knows how someone will react.”

What does it look like?

“The disorder affects a person's memory, emotional responses, intellectual processing and nervous system because of a traumatic experience,” explains Bartlett. “For it to be PTSD, the person must have experienced, witnessed or confronted death or serious injury, meaning they saw it or felt it would happen to them.”

Individuals who suffer from PTSD may have trouble in their relationships with other people like co-workers or a spouse, or have difficulty parenting their children. “There are changes to the biology of the brain,” says Bartlett. “A PET scan and MRI will show these changes, and scientists are trying to figure out if this is ever reversible.”

There may also be flashbacks, dreams or other memories where the individual relives the event. Affected individuals may withdraw from activities they previously enjoyed like golf or going out with friends. And there may also be an increased emotional response to normal activities where the individual becomes angry or irritable and feels guilt or shame about the event. This may result in the person drinking more, taking drugs, being easily frightened by loud noises and even developing a degree of social anxiety.

Children may also suffer from PTSD and it exhibits differently depending on the age of a child. Symptoms may range from having trouble sleeping or not wanting to be away from their parents, to nightmares, acting out, depression or anxiety.

The NIMH states that symptoms usually begin within three months of a traumatic event, but onset may be much longer — even years afterwards. The symptoms must last for at least a month and interfere with a person's relationships, as mentioned earlier to be identified as PTSD. The disorder is usually diagnosed and treated by a psychiatrist or psychologist.

The impact for adjusters

Catastrophe adjusters are exposed to a lot of devastation for extended periods of time following a major event. Depending on the circumstances under which they are working, adjusters could experience some form of PTSD. Co-workers should be aware of the symptoms mentioned earlier, as well as responses such as being unable to go to work, developing chronic depression or a panic disorder.

Bartlett says that many of those in field after disaster are primarily male and tend to work these types of losses for a reason — they are retired policemen or firemen who have seen a lot of loss, and most would be described as “tough guys.”

Many individuals who work under these circumstances tend to stick to themselves, don't talk about what they've seen and don't want to talk about it. “Over time they've figured out how to deal with those issues,” explains Bartlett. “They put it on a shelf in a box and close the lid.” The problem is that no one is sure what will open that lid. Many responders are able to compartmentalize their response and just avoid the subject altogether.

“When you're a first responder and see it, you're in recovery mode,” says Bartlett. “When you experience something firsthand, the response is different.”

Even though they are unlikely to be used, Bartlett recommends that insurers and other vendors have employee assistance programs. She also encourages those working in stressful environments to be aware of good self-care techniques. “Go out and run 5 miles. Chat with co-workers. Others use meditation, yoga or mindfulness — it depends on the person.” The techniques will be whatever helps an individual and could be as simple as going out for drinks with the guys from work and just being in a normal environment.

Adjusters who receive a claim for PTSD should ensure that an evidence-based treatment approach is used, advises Bartlett. Open-ended talk therapy alone may not produce the best results. A targeted approach that encompasses cognitive behavioral therapy to help individuals remember and address key aspects of the incident can be effective. Exposure therapy could help someone who experienced a traumatic event at work or school and needs to be gradually exposed to the location where the event occurred. Drug therapy may also be an option.

Other therapies that can help individuals overcome PTSD include teaching them about trauma and its effects; utilizing various relaxation or anger control skills; improving sleep, diet and exercise habits; and learning to identify triggers of symptoms, and then developing the ability to manage them.

Bartlett also stressed that it's important for adjusters to be patient and sensitive as they speak with individuals who have experienced PTSD because it may take some time to gather information from them. Recalling the incident could stimulate difficult memories and unexpected responses.

PTSD is treatable once diagnosed. How an individual will respond to treatment is as individualized as the treatment, but many people can be relieved of their symptoms or see a significant improvement in how it affects them so it doesn't constantly impact their everyday lives.