Guest Blog: When Trauma Doesn’t Resolve: Understanding PTSD at Work

Guest contributor: Dr Judith Bird | Head of Mental Health Services, Medigold Health

Foreword from Mates in Mind

By inviting guest authors to share their thoughts, it does not necessarily mean that we share their view, but we do share their commitment to improve the impact of work on workers’ mental health and are keen to find opportunities for collaboration that will benefit those most at risk of suicide. So, please enjoy Judith’s blog and the thinking it provokes, and, if you would like to share your professional perspective, please get in touch.

When Trauma Doesn’t Resolve: Understanding PTSD at Work

In last month’s blog, I wrote about psychological trauma  — what it is, how the brain processes it, and why most people recover. If you haven’t read it, it’s worth doing so alongside this piece.

The key point to bring into this discussion: trauma exposure does not automatically lead to Post-Traumatic Stress Disorder (PTSD). Of all people exposed to a potentially traumatic event, approximately 5.6% go on to develop PTSD. It is a specific clinical condition — not the inevitable consequence of a difficult experience — and it requires a specific response. Understanding what PTSD actually is, and what it isn’t, can be very helpful for a manager or HR professional dealing with these situations.

What PTSD actually is

I’ll start with something that often surprises people: in the days and weeks after a traumatic event, almost everyone experiences what look like PTSD symptoms. Intrusive memories. Hypervigilance. Disturbed sleep. Avoidance of reminders.

This is not pathology. The brain was not designed to make you feel good — it was designed to keep you alive. When something overwhelming happens, it responds accordingly: replaying the event to consolidate the lesson, keeping the nervous system on alert in case the threat isn’t over, and steering you away from reminders while the processing is still running.

In most people, after some weeks, the system reaches its conclusion. Danger has passed. Lesson learned. Safe now. The alarm stands down, the intrusions fade, and the experience settles into memory rather than staying live in the present.

PTSD is what happens when that completion doesn’t occur. The brain cannot reach the all-clear. The memory stays active rather than filed. The nervous system keeps running the threat-detection programme indefinitely — not because something is fundamentally broken, but because the processing has stalled. This is not weakness. It is an ancient survival system that has not been able to stand down.

PTSD is diagnosed when symptoms across four clusters are present, persistent beyond one month, and significantly impairing everyday functioning:

• Intrusion — involuntary, distressing memories; flashbacks in which the event feels as though it’s happening right now (not just being remembered); distressing nightmares; intense distress when triggered by reminders. This is the hallmark of PTSD and what distinguishes it from depression or generalised anxiety. Without significant intrusion symptoms, the diagnosis is unlikely to apply.
  
  
• Avoidance — active, persistent effort to avoid thoughts, feelings, people, places, or situations associated with the trauma. Avoidance is partly what maintains PTSD: the brain never gets the chance to complete its processing.
  
  
• Negative changes in cognition and mood — persistent negative beliefs (“I am permanently changed”, “nowhere is safe”), self-blame, emotional numbing, feeling detached from others, inability to experience positive emotions. This cluster can look like depression, which is why the two are often confused.
  
  
• Hyperarousal and reactivity — hypervigilance, exaggerated startle response, sleep disturbance, irritability, difficulty concentrating. The nervous system is stuck on high alert.

PTSD is not the only outcome — and that matters for how you respond

One of the most practically important things to understand is that most people who struggle after a traumatic event do not develop PTSD. More will experience:

• Depression — persistent low mood, loss of motivation, withdrawal, hopelessness. Trauma roughly doubles the risk of major depressive disorder, and depression is more common after trauma than PTSD.
  
  
• Generalised anxiety — ongoing worry and unease that has spread beyond reminders of the event itself.
  
  
• Substance use — alcohol or drug use that has escalated since the incident, often as self-medication for sleep problems or intrusive symptoms.

This matters because these conditions need different support pathways to PTSD. PTSD treatment — NICE-recommended Trauma-Focused Cognitive Behavioural Therapy and Eye-movement Desensitization Reprocessing (EMDR) — targets the specific re-experiencing and intrusion symptoms at the core of PTSD. It won’t treat depression, and it isn’t designed to. Someone with post-trauma depression needs depression treatment, delivered with a trauma-aware lens. Getting this right — matching the support to the actual presentation — requires skilled clinical triage. This is where a good occupational health provider can be most helpful.

Who is most likely to develop PTSD?

Risk varies significantly by trauma type. WHO World Mental Health Survey data shows the conditional PTSD risk is highest after interpersonal violence:

• Rape: 19%.
  
  
• Physical abuse by a partner: 11.7%.
  
  
• Occupational accident resulting in injury: 12–18% at 6–8 months.
  
  
• Life-threatening road traffic accident: ~ 4.6%.

Intentional harm — where someone has done this to you deliberately — consistently carries higher risk than accidents, in part because it also damages a person’s sense that the world is safe and that people can be trusted.

In Europe, PTSD affects approximately 1–3% of the general population in any given year — around 7.7 million people. Individual risk factors include limited social support (the single most consistently replicated protective factor), prior trauma exposure, peritraumatic dissociation (feeling detached during the event itself), and pre-existing mental health conditions.

Carrying more into the job: Two groups worth knowing about

Within your workforce, some individuals arrive with a heavier load. Two groups deserve specific mention.

Veterans

Former armed forces personnel are disproportionately represented in construction, security, transport, and utilities. Many bring with them a history of trauma exposure that pre-dates their civilian role. Combat-related PTSD is often more complex than single-incident civilian trauma: it involves multiple events layered across years of deployment, frequently accompanied by moral injury — the distress that comes from witnessing or participating in events that violate a person’s moral framework. It is also important to recognise that trauma exposure within the armed forces occurs in a context that is fundamentally different from civilian life.

Trauma exposure in the armed forces takes place within highly structured teams characterised by strong peer support, shared experience, and routine awareness of combat related stress and PTSD. These protective factors often help personnel process traumatic events effectively at the time. Following transition to civilian life, this structure and camaraderie are lost. As a result, veterans in high-exposure civilian roles may respond to new incidents in ways that seem disproportionate — not because they are less resilient, but because for some, each new event lands on ground that was already unsettled and for others because the coping mechanisms that once relied on collective support are no longer available. Veteran-aware support pathways can make a real difference.

People with Complex PTSD (cPTSD) and adverse childhood experiences (ACEs)

cPTSD develops following prolonged, repeated trauma in childhood — neglect, abuse, unsafe home environments — when the person had no ability to escape. The child’s brain adapts intelligently to that environment: learning to spot danger early, suppress needs that might provoke a reaction, dissociate from pain. These are not failures of development. They are solutions.

The problem is that when the environment changes in adulthood, the brain doesn’t automatically update its instructions. The alarm system built for a genuinely threatening world keeps running — in relationships, workplaces, and situations that no longer warrant it. It is running the right programme for the wrong context.

ACEs are more common in economically disadvantaged populations — and economic disadvantage is overrepresented in the at-risk sectors mentioned in my previous article. This doesn’t pathologise your workforce. Most people with difficult childhoods are resilient and functioning. But it does mean some individuals will have a narrower capacity to absorb new traumatic stress and will need more — or different — support. Standard PTSD treatment is often insufficient for cPTSD; a stabilisation-focused approach is needed first.

What to look for: A manager’s guide

You are not expected to diagnose PTSD. But you are in a position to notice — and noticing early is what makes the difference between timely help and a crisis two years down the line.

Consider a referral to occupational health or suggest a GP appointment if someone:

• Has not returned to their usual self more than a month after a significant incident.
  
  
• Is visibly distressed by specific triggers — sounds, routes, tasks, or situations that remind them of what happened.
  
  
• Describes feeling like they “can’t stop seeing it” or seems emotionally absent, as though they’re not quite present.
  
  
• Has increased their alcohol use, particularly if they mention sleep difficulties.
  
  
• Is avoiding particular tasks, sites, or colleagues without a clear practical reason.
  
  
• Shows marked mood change, irritability, or withdrawal since the incident.

The conversation doesn’t need to be clinical. “I’ve noticed you haven’t quite seemed yourself since [the incident]. I wanted to check in — how are you doing?” That is enough. What matters is that you open the door.

What effective treatment looks like

There are two NICE-recommended treatments for PTSD: Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR). Both target the same thing: helping the brain complete the processing it was trying to do, register that the danger has passed, and file the memory as past rather than present.

Both typically run for 8–12 sessions, though complex or cumulative trauma may need longer. Both require a trained, qualified practitioner — not just anyone with “trauma-informed” in their title.

What doesn’t work:

• Mandatory group debriefing immediately after an incident — not evidence-based and potentially counterproductive.
  
  
• Asking someone to recount the incident repeatedly without a structured therapeutic framework.
  
  
• Waiting once symptoms have persisted for more than three months with significant impairment.

Getting help

If someone in your team is struggling:

• Occupational health (OH) referral: your OH provider should triage, assess, and match to the right support. 
  
  
• GP referral: into NHS Talking Therapies or, for more severe presentations, secondary mental health services.
  
  
• BPS, EMDR Association UK and the BABCP hold registers of accredited practitioners for private treatment.

PTSD is treatable. With the right intervention at the right time, most people recover substantially. The obstacle is rarely the availability of treatment. It is recognition, and the willingness to act on it.

Dr Judith Bird is Head of Mental Health Services at Medigold Health, a national occupational health provider. She holds a doctorate in clinical and health psychology and has worked across public and private sector mental health services for approximately 20 years.

LinkedIn: www.linkedin.com/in/dr-judith-bird 

Previous edition: When the Job Leaves a Mark: Understanding Psychological Trauma at Work.

References

1. Koenen KC, et al. (2017). Posttraumatic stress disorder in the World Mental Health Surveys. Psychological Medicine, 47(13), 2260–2274. https://pmc.ncbi.nlm.nih.gov/articles/PMC6034513/ 
2. Kessler RC, et al. (2017). Trauma and PTSD in the WHO World Mental Health Surveys. European Journal of Psychotraumatology, 8(sup5), 1353383. https://www.tandfonline.com/doi/full/10.1080/20008198.2017.1353383 
3. Stergiopoulos E, et al. (2014). Psychological distress and post-traumatic symptoms following occupational accidents. International Journal of Environmental Research and Public Health, 11(11), 11205–11234.  https://pmc.ncbi.nlm.nih.gov/articles/PMC4217600/ 
4. Xiao S, et al. (2018). Prevalence of posttraumatic stress disorder among road traffic accident survivors: a PRISMA-compliant meta-analysis. Medicine, 96(3), e5985 — [verify specific figures before publication]. https://pmc.ncbi.nlm.nih.gov/articles/PMC5779792/ 
5. Wittchen H-U, et al. (2011). Trauma and PTSD in Europe. In Post-Traumatic Stress Disorder. Oxford University Press. https://academic.oup.com/book/24487/chapter/187582261