Can you develop Posttraumatic Stress Disorder (PTSD) months or even years after a traumatic event like 9/11? Without showing any previous symptoms?
There are studies of World War II veterans and victims of motor vehicle accidents that say Yes.
This phenomenon is called “delayed onset PTSD,” according to the therapist’s diagnostic bible known as the DSM-IV-TR. It states that symptoms first appear at least six months after the traumatic event. That could mean months or even years later.
Yet some mental health professionals argue that the individual must have had symptoms early on, but didn’t recognize them. They also suggest that the PTSD sufferer delayed getting help for months or years, not that the PTSD itself was delayed.
As an example of delayed onset PTSD, here is the story of a police officer that developed the disorder five years after 9/11…
On the morning of September 11th, 2001, thirty-one-year old K9 officer Jonathan Figueroa was told to head down to the burning World Trade Center. As his team was crossing the Brooklyn Bridge, his cell phone rang. His wife said that his sister had called, and his brother-in-law, Mario Santoro, an EMT, was already there. She wanted Jonathan to find him and make sure he was okay.
They reached city hall, which was about three blocks from the World Trade Center, and “it was just a cloud of dust. You couldn’t see anything. It looked like a major snow storm, a blizzard,” said Jonathan. They didn’t know that the south tower had already crumbled to the ground.
“Then we heard this large boom. It was earthshaking and metal twisting.” He was listening to the north tower in the process of collapsing.
Jonathan went to the Woolworth Building where triage was underway and asked about his brother-in-law, Mario, but nobody knew anything.
A few days later, he was ordered to work on the pile of rubble that was once a thriving financial district. “My whole motivation for going down there was to see if I could find my brother-in-law.” Though he knew it was unlikely he was still alive.
“I did the bucket brigade for awhile. You get a line of guys digging down, throwing stuff in a bucket, trying to clear debris. We didn’t have enough shovels, and we dug by hand, trying to recover something, somebody.
“On the first day, I found a skull. No flesh, no skin, like right out of a biology science class. I brought it over to a supervisor, and he said, ‘We’re looking for living people right now, put that down.’ And I did.”
A month after 9/11, he still had no word about what had happened to his brother-in-law, and his family assumed that Mario had died in one of the towers. It was difficult to grieve without a body, without knowing, and this weighed heavily on Jonathan’s mind.
Then, two months almost to the day after 9/11, on November 12, 2001, another unthinkable event occurred. At 9:17 AM, a jetliner with 260 people aboard exploded just after takeoff, and bodies and pieces of the plane fell into the Queens neighborhoods of Belle Harbor and Rockaway Beach, part of Long Island, fifteen miles from Manhattan and the pile.
Jonathan was among the first responders to the disaster. “We were recovering the bodies… mothers holding their babies, charred, stuffed in the airplane seats,” he said. “You can’t block that out.”
A few days after the plane crash a friend of his on a midnight phoned him at home and told him they had found his brother-in-law in the wreckage. At least his family had a body, unlike so many other families. Now they could bury him and mourn.
Jonathan continued to work on the pile and didn’t think about what it was doing to him emotionally and psychologically. “You don’t stop to think because if you stop to think, you won’t be able to do it.”
Jonathan knows now that he was suppressing his emotions. “People at work, we’d sit around, we didn’t talk about it. No way. That’s icky. Talking about our feelings, our emotions? You’re a wuss if you do because we’re macho men, we’re police officers, we can handle anything, nothing affects us. You stuff your emotions.”
While Jonathan was at the pile, his frustration built. “We weren’t recovering anything, we felt like we weren’t doing anything. I worked twelve, thirteen, fourteen hours a day. I had to get back to a regular life, you know, pay the bills, have dinner.”
During this time, his sister was staying at his home. “She had lost her husband. I was trying to comfort her, trying to maintain the family. I’m on the pile, I had the plane crash. There’s a lot going on but I was doing it.
“Then we were allowed to adopt a baby boy, but he wasn’t sleeping through the night yet. Here I’m up all these hours working and worrying and he’s not sleeping either. So even if I wanted to get some sleep, I couldn’t. Everything converged at the same time.”
Jonathan worked on the pile from September 11th to December 17th, 2001, 98 hellish days. Then he left the pile and returned to his normal routine at work. He did not attend counseling or peer support.
Five years after 9/11, on January 16th, 2007, he went into work and his sergeant told him that his friend Ronnie, another K9 officer, was hit by a car during his midnight shift and they were going to see him at the hospital.
“You know, I’ve seen many cops bandaged, bruised, beat up, in the hospital. So it was just another day to go see how Ronnie’s doing. We get to the hospital, and he’s on a stretcher. I saw the emotion with his mother and father and wife and I got anxious, and that’s when it bubbled over.”
Jonathan’s wife called and he suddenly worried that maybe one of his babies was sick. She told him that her cousin’s wife was killed in a car accident.
“I started feeling shaky and nervous, and right on that day, I spiraled down, and everything from the past came out: 9/11, the plane crash, my brother-in-law, the first homicide I ever saw as a rookie.”
That began his night sweats, night terrors, anxiety, panic attacks, dry mouth, aches and pains, heart palpitations, nightmares and flashbacks of horrific images—except he became the victim.
“I was that first homicide on the street. I was my brother-in-law underneath the rubble. I was in the plane crash, strapped to a seat holding a charred baby.”
For the next three months, Jonathan couldn’t sleep, had difficulty eating, and lost weight. “And I became obsessive-compulsive about death because it seemed like that’s all I ever saw. Death on TV, death in my job, death in the newspaper.”
Jonathan began taking days off work. He didn’t tell anybody about the turmoil inside him. “Because I didn’t know what the heck was wrong with me. I didn’t think depression or anxiety, no way. I figured it would pass. You know, let me get a good night’s sleep. I was trying to rationalize it all. I didn’t know anything about PTSD.”
On a few occasions, Jonathan rushed himself to the hospital in the middle of the night thinking he was having a heart attack. He couldn’t breathe, had cold sweats, he was dizzy and hyperventilating. The CAT scans showed nothing.
After five days with no sleep, Jonathan started acting strange. “I had no control over the thoughts in my head. This obsessiveness with death, this fear… I was walking around like a zombie, shaking, cotton mouthed, stuttering, I couldn’t talk right.
“I felt physically ill. I had lost 17 pounds, and had diarrhea, stomach cramps, the shakiness. I couldn’t lay in bed, I couldn’t close my eyes, I was afraid that I wasn’t gonna wake up.
“I finally decided, I’m gonna get some sleep on my own terms. So I got myself into work, I opened my locker to get my gun…”
On the back of the locker were pictures of his wife and kids. “That’s what stopped me. They’re gonna think it’s their fault. Daddy killed himself, and they’ll always wonder if it was because of something they did. I couldn’t do this to them.”
He went to his sergeant, and said, “Listen, something’s wrong with me, I can’t eat, I can’t sleep, I can’t think, I feel sick. I can’t do this anymore. Is there someplace I can go, people I can talk to?”
His sergeant got him the phone number for a peer support organization called Police Organization Providing Peer Assistance (POPPA). Jonathan phoned and was assigned to a Peer Support Officer (PSO). “This is another police officer who reassures you it’s gonna be okay, we’re gonna help you out. They want to meet you, and then they ask if you’ve had any thoughts of suicide.
“I was honest and said, ‘Absolutely.’ So then they got me over to a psychologist who sat down and talked with me, and he said, ‘You got PTSD, without a doubt.’”
The department took away Jonathan’s gun and put him on sick leave. He signed a contract with POPPA that he would take the prescribed medication, not drink, go to meetings every Thursday and call every Monday. “I knew that whatever they asked me, I had to do.”
At POPPA, he was taught how to deal with his thoughts and feelings. “They gave me the tools to get through life, to get through any situation. They taught me that whatever I’m feeling, I have to communicate, I have to express myself.
“They taught me to use journaling. Whenever something triggers a reaction, I write in my journal. I get the obsessive-compulsive thoughts out of my head and put them down on paper.
“After they’re on paper, they just don’t seem as big as I thought. Writing them out helped to validate my feelings. To say, Okay, this is what I’m thinking, what I’m worrying about, I can get through this.
“Talk therapy does work, and group therapy with my peers helps, because there are other people just like me. I thought I was all alone in this situation, but it was happening to others, too.
“They prescribed medication to alleviate the symptoms. Which is the panic attacks, the anxiety and to help me get some sleep—that’s what I really needed, to get some sleep, so I could deal with this rationally with a clear head.”
Today, Jonathan is back to full duty in the K9 Unit. “People say, ‘If I can just get back to where I was,’ and I think, No, no… You don’t want to go back, you want to get here. I’m better now, aware, I have some enlightenment. When you come out of this, you come out so much better, so much clearer. I’m enjoying the job and enjoying life.”
The important question is: Did Jonathan have delayed onset PTSD five years after 9/11 without having shown any previous symptoms or did he show symptoms early on?
A ground-breaking study conducted by the University of London in 2007 on delayed onset PTSD in the military throws some light on the subject. The study reveals that delayed onsets accounted for almost 40 percent of PTSD in combat troops. (Andrews, B. et al. 2007, Sept. Delayed-onset posttraumatic stress disorder: a systematic review of the evidence. American Journal of Psychiatry. 164:1319-1326.)