Yes, Sport Divers Get PTSD, Too

A bad scare such as almost running out of air, witnessing another person suffer a heart-attack underwater, or even being incapacitated by severe leg cramps, can make a diver hang up his or her fins forever. When you've witnessed someone recovered from the water but unsuccessfully resuscitated, the aftermath could make you reassess whether it's worth it to keep on diving.

Experienced divers can sometimes underestimate the stress a new diver goes through, and there are plenty of divers who haven't been battle-hardened by the slings and arrows of misfortune that await anyone involved in this adventurous activity.

In short, we divers should be more aware of simple post-traumatic stress disorder (Simple PTSD) that can affect all of us, says James A. Lapenta, a veteran dive instructor who runs UDM Aquatic Services in Canonsburg, PA, and has created multiple technical diving courses. Lapenta has also written two books on diver training and safety, and in his most recent one, SCUBA: A Practical Guide to Advanced Level Training, Volume 2, he states that PTSD is a real possibility for those who have just been involved with a life-or-death situation in a recreational dive setting. Accidents that seem to have only caused injury to a diver's ego may actually have deeper, more damaging effects on all divers involved.

Below is an excerpt from Lapenta's book about PTSD.

The rescue/recovery of a human being is a profound experience. Ask any firefighter, police officer or EMT. Any of them will tell you honestly that each rescue has an effect on them. That even though they may have performed thousands, there's often one that has affected them for a long time.

Members of our armed forces were the first to be diagnosed with PTSD. Previously it was called "battle fatigue," "shell shock," or some other term. Soon psychiatrists, psychologists and therapists began to see the exact same signs and symptoms in patients who had never experienced combat or saw the effects of it. What they realized was these people were experiencing the same effects of PTSD as a result of having been involved in traumatic events, or, in some cases, from witnessing these events.

Whatever the cause, the result can be summed up by saying that anyone involved in a serious rescue scenario with a fellow diver stands a chance of being injured by that scenario -- not physically injured, but injured mentally.

What we are talking about here is PTSD that is brought on by a single event. Known as Simple PTSD, it is a reaction of the subconscious mind to a single violent or frightening event. For our purposes, this single event is a diving accident. It need not be a fatality or even a life-threatening event to shock the system and produce signs and symptoms of PTSD. Even an event with a successful outcome can have long-lasting effects.

So, what are the signs and symptoms that someone may be experiencing this?

Signs and Symptoms of PTSD

Repetitive Thinking: A frequent sign of PTSD is repetitively thinking about the event. These thoughts may suddenly come into your mind even when you don't want them to. They may come in the form of nightmares or flashbacks about the event, and can result in inflated reactions at inconvenient times. You may get upset simply by being reminded of what happened. You may react when someone mentions it, you see a picture of the place where it occurred, or you see another person who was there. You may also experience these episodes in small snippets of the event. You may see the face of the victim or others who were there.

All of these incidents have the potential to occur at any time. These are normal occurrences in the period immediately after the event, but when they persist and interfere with daily life, they need to be addressed.

Hypervigilance: Another common sign of PTSD, this state of heightened alertness is brought on by a mental injury. Many situations call for one to be alert and watchful, but the person suffering from PTSD is often like this constantly. They're not able to relax, and the smallest disturbance can create an overblown reaction. It may also lead to dangerous situations when an overreaction to a stimulus happens in a situation where that reaction presents the opportunity for injury.

Insomnia: Thoughts and images of the event may cause you to lose sleep or keep from getting truly restful sleep. Insomnia may be a result of seeing the event when you close your eyes, it may be hypervigilance, or a reason you cannot identify. In some cases, medication may help, but only for a short time. Another common complaint is that while you are exhausted and sleep for what should be a sufficient period of time, you wake up still feeling rundown and lacking energy.

Avoidance: You may find yourself going to great lengths to avoid things that remind you of the event; the location where it happened, the people who were there, maybe even the activity itself in extreme cases. Some people involved in a diver rescue that did not have a good outcome may go so far as to stop diving. If the events are so traumatic and upsetting that recalling them detracts from the dive-planning process -- so that diving itself now becomes unsafe due to inattention to detail -- then perhaps it is for the best that the diver stop diving.

Panic attacks: These appear as a feeling of intense fear, accompanied by shortness of breath, dizziness, sweating, nausea and a racing heart. Other physical symptoms may be chronic pain, headaches, stomach pain, muscle cramps or low back pain. If you are able to recognize this occurring, stopping whatever you are doing, closing your eyes, thinking of a calm setting or relaxing image, and breathing deeply and slowly may help greatly. Another valuable technique is to assess your current location. Look around, observe the area, focus on a few items and decide if they would truly be located in the place where you experienced the event.

Feelings of mistrust: This wariness may be directed toward strangers, friends, family, or the world in general, and can result in feelings of loneliness and isolation. In addition, you may lose trust in people you know and look at the world itself as something to be feared. This may result in errors in judgment or being overly cautious to the point of inaction.

Chronic fatigue: Another possible sign that something may be wrong, especially if no physical cause can be pointed to as the source of your feeling tired. It takes a great deal of energy to maintain a hyper-vigilant state. Not being able to rest or sleep only adds to that. The panic attacks also use up valuable energy.

Guilt: Another possible sign of trouble is a sense of guilt or responsibility toward others who may have been affected by the event. You may see yourself as being somehow responsible or not having done enough.

Don't Say, "I Know How You Feel"

Instructors, divemasters, assistant instructors and other professionals associated with the dive can be especially at risk here. They may feel that this happened on their watch, and while nothing they did could have prevented the event, they still may feel the need to make up for something. It may affect how and whether they will ever teach again.

Everyone is different and will react differently. But there is a huge difference in the theoretical versus the real-life experience of someone who has been through this. Those who have not experienced this really have no idea how it feels, and while support is appreciated, one thing to avoid saying is "I know how you must feel." Because you don't. An injury or death where a student is involved is like nothing you've ever experienced.

The diver may have been highly experienced and very well trained. They had all the right medical clearances. No one did anything wrong. It wasn't even a dive accident as far as the medical examiner and doctors are concerned. Everyone knows and says it wasn't your fault. You may be able to accept that in your head fairly quickly (a few weeks, months maybe). It's in your heart that can take a long time.

Why? Because you cared. You care about other divers and it annoys you when you see safety taken lightly. You have seen first-hand how quickly life can be completely turned upside down in every possible way, in a few seconds or feet, and it seems that others don't get that.

Those are the feelings you need to be aware of that can cause you to overreact or react too fast, too slow, or not at all. So we need to be sure we are ready before getting back in the water. That may take a little time and require the help and support of others we trust and can rely on.