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About Post-Traumatic Stress Disorder (PTSD)
Post-traumatic stress disorder (PTSD) is a trauma-related disorder caused by an individual’s exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways:
- directly experiences the traumatic event;
- witnesses the traumatic event in person;
- learns that the traumatic event occurred to a close family member or close friend (with the actual or threatened death being either violent or accidental); or
- experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television, or movies unless work-related).
The disturbance, regardless of its trigger, causes clinically significant distress or impairment in the individual's interactions and capacity to work. Be aware that some individuals with PTSD will never need an accommodation, while other may need accommodations that change over time.
JAN's Accommodation Solutions: Executive Functioning Deficits is a publication detailing accommodations for individuals with limitations related to executive functioning. These ideas may be helpful in determining accommodations.
Post-Traumatic Stress Disorder (PTSD) and the Americans with Disabilities Act
The ADA does not contain a definitive list of medical conditions that constitute disabilities. Instead, the ADA defines a person with a disability as someone who (1) has a physical or mental impairment that substantially limits one or more "major life activities," (2) has a record of such an impairment, or (3) is regarded as having such an impairment. For more information about how to determine whether a person has a disability under the ADA, see How to Determine Whether a Person Has a Disability under the Americans with Disabilities Act Amendments Act (ADAAA).
Accommodating Employees with Post-Traumatic Stress Disorder (PTSD)
People with PTSD may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with PTSD will need accommodations to perform their jobs, and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.
Questions to Consider:
- What limitations is the employee experiencing?
- How do these limitations affect the employee and the employee’s job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
- Once accommodations are in place, would it be useful to meet with the employee to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
- Do supervisory personnel and employees need training?
Situations and Solutions:
The following situations and solutions are real-life examples of accommodations that were made by JAN customers. Because accommodations are made on a case-by-case basis, these examples may not be effective for every workplace but give you an idea about the types of accommodations that are possible.
A postal employee with PTSD requested accommodations to help him deal with recurring flashbacks.
His flashbacks were triggered by the smell of gasoline and the noise from the mail truck. The employee tried wearing a respirator to give him a clean air supply. He also tried wearing headphones to reduce the noise from the truck, but he still experienced stress and edginess. JAN suggested a position transfer as an accommodation. JAN also suggested allowing this employee to take a break when he experiences extreme anxiety and allow him to use relaxation and visualization techniques in a private space on the job.
A vocational school teacher with PTSD requested accommodations due to anxiety and flashbacks.
She taught in a building separated from the main school, and she had difficulty dealing with large classrooms of unruly students. As an accommodation, JAN suggested training the teacher on special behavior management techniques and providing administrative support for student disciplinary actions. The school also provided the teacher a two-way radio, which allowed her to contact an administrator quickly when she needed immediate assistance in her classroom.
A building manager with post-traumatic stress disorder (PTSD) asked to bring an emotional support animal to work with her.
The employer was concerned about the behavior of the animal as the employee trained it herself. The employer and employee agree to a trial period to assess whether the animal could be in the workplace without causing a disruption.
A tax specialist with post-traumatic stress disorder had difficulty handling stress and controlling his emotions.
The employee’s physician stated that these limitations were due to his PTSD and the side effects of changing his medication. His job performance and attendance were declining. As a reasonable accommodation, the employer allowed the employee to use a service animal. By making this accommodation the employee was able to be more effective. The employer benefited from improving productivity and attendance. Reported cost: $0.
A veteran who recently returned to the workforce after spending several years overseas has Post Traumatic Stress Disorder (PTSD) and a Traumatic Brain Injury (TBI), which causes difficulty with memory and mood regulation.
He was recently hired as a customer service representative. After disclosing his disability and requesting reasonable accommodations, his employer provided him with a cubicle close to an exit, with his back facing a wall. This helped to alleviate some of his stress, but he still had difficulty with memory and emotional outbursts. The employer obtained a job coach through the Department of Veterans Affairs to assist the employee with adjusting to his new position. The job coach worked with the employer and employee to develop a customized form for taking notes from customers and a system for organizing the employee's workspace. The job coach also suggested the employee e-mail his supervisor when he has questions so he will have responses in written form that he can refer to later if he forgets something. Finally, the job coach helped the employee incorporate breaks into his day to walk and do breathing exercises to help reduce the likelihood of emotional outbursts. After the job coach comes in twice a week for three weeks, the employee is able to incorporate the job coach's suggestions into his regular routine and perform his job duties without assistance.
A veteran with PTSD was working for state government on a team project.
The employer decided to move the team’s office to the basement of a building. Once the move occurred, the veteran realized that the noises in the basement were triggering memories of explosions and causing flare ups of his PTSD. The employer did not want to move the entire team again but was able to find an office on the first floor of the same building for the veteran. The rest of the team remained in the basement, but team meetings were held upstairs.
Lexie is a nurse with PTSD.
She has applied for a nursing position and has been called for an interview. In her last interview that didn’t go very well, she sat across the table in a very small room from four people, the nursing administrator, the personnel director, a nurse manager, and a physician. Lexie feels that if there were no more than two people in the room, she would be able to better represent herself, making her interview more successful. In order to limit the interviewers, Lexie may have to disclose and ask for an accommodation.
An office worker with PTSD asked to use his service animal at work.
Part of the service animal’s training included notifying the worker when someone was approaching from behind so the worker would not be startled. The employer wanted to explore other accommodation options so offered to set up mirrors in the employee’s workstation so he could better see people approaching. The employer found that the employee could not concentrate on his work because he had to look up at the mirrors so often because he did not feel the sense of security he felt when his service animal was present. The employer decided to allow the service animal.
A veteran, who is now a delivery truck driver, had PTSD that resulted in a sleep disorder.
He was having difficulty with his nightshift schedule. His employer transferred him to a dayshift when an opening became available.
A veteran with head and neck injuries and post-traumatic stress disorder (PTSD) was working as a graphic designer in a cubicle environment.
He had chronic pain, which was exacerbated by using a computer mouse, and PTSD, which was exacerbated by noise. The employer preferred to have the designer work in the office with his team, but there were no private offices available. Instead, the employer provided an ergonomic mouse and a noise canceling headset.
A veteran with post-traumatic stress disorder (PTSD) was working for state government on a team project.
The employer decided to move the team's office to the basement of a building. Once the move occurred, the veteran realized that the noises in the basement were triggering memories of explosions and causing flare ups of his PTSD. The employer did not want to move the entire team again but was able to find an office on the first floor of the same building for the veteran. The rest of the team remained in the basement, but team meetings were held upstairs.
A counselor with PTSD needed to use a service dog at work to decrease his anxiety.
Even as a veteran, his employer was concerned about having a dog present when clients were being counseled. The employer allowed the use of the service dog, but provided a separate area for the dog to stay in during counseling sessions with clients.
An administrative assistant with PTSD works at a museum, which is currently under construction.
Construction workers, who were strangers, caused the employee extreme anxiety. As an accommodation, a JAN consultant suggested temporarily relocating the employee’s work space away from the construction area. The museum also developed an ID badge for construction workers and required them to sign in at their job locations.
A prison guard, recently attacked by an inmate, has PTSD and anxiety.
The prison guard was fearful of returning to the worksite, even to discuss her return-to-work options. A JAN consultant offered the following suggestions: allow the employee to bring a support person or support animal to the meeting, move the meeting to an alternative location, or allow the employee to attend the meeting via telephone.
A veteran who is now an office employee has PTSD and anxiety.
He is easily frightened when being approached unsuspectingly. This employee works in a structured cubicle environment facing his computer and cubicle walls, with his back to the cubicle entrance. He wants to be alerted when a coworker or supervisor walks into the cubicle behind him. JAN suggested using a monitor-mounted mirror, so he could see the entrance behind him. JAN also suggested placing a sensor mat at the entrance of the cubicle, which will make an audible alert when someone steps on it.
A secretary with PTSD, who had been carjacked several years earlier, experienced significant anxiety during commutes after dark.
This caused difficulty concentrating and irritability. She was accommodated with the ability to have a support animal at work and a flexible schedule with work from home during periods of minimal sunlight.
JAN Publications & Articles Regarding Post-Traumatic Stress Disorder (PTSD)
Accommodation and Compliance Series
Consultants' Corner Articles
- Accommodating Social Anxiety Disorder (Social Phobia)
- Accommodations for Difficulties with Assisting Others on the Telephone Due to Stress, Anxiety, and Interpersonal Communications
- Communication Difficulties in the Workplace
- I Understand You Are Stressed...But Aren’t We All?
- My Disability Made Me Do It! When It Does and Doesn’t Matter
- PTSD and Dealing with Conflict in the Workplace
- Return to Work After Hospitalization for Mental Health Treatment