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POSTTRAUMATIC STRESS DISORDER (PTSD)

 

Posttraumatic stress disorder is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault. PTSD affects approximately 3.5 percent of U.S. adults or 8 million American adults, and an estimated one in 11 people will be diagnosed PTSD in their lifetime. Researchers estimate that as many as 40% of children and adolescents will experience at least one traumatic event in their lifetime. Women are twice as likely as men to have PTSD. There is evidence that it may run in families.

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PTSD can occur in all people, in people of any ethnicity, nationality or culture, and any age. People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.

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Whether a child or teen develops PTSD depends on many factors, including the severity of the trauma, how frequently it occurs, and how family members react to the event. A child or adolescent with PTSD feels that they are unable to escape the impact of the trauma. They try to avoid people or situations that remind them of the event. Sometimes they will experience memories or “flashbacks” of the event, or they may have nightmares about it that feel very real. These constant reminders make living day-to-day life a real challenge, especially for young people who might struggle to express what they’re feeling and experiencing.

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Causes

The cause of PTSD is unknown, but psychological, genetic, physical, and social factors are involved. PTSD changes the body's response to stress. It affects the stress hormones and chemicals that carry information between the nerves. People who have suffered childhood abuse or other previous traumatic experiences are likely to develop the disorder, sometimes months or years after the trauma. Temperamental variables such as externalizing behaviors or other anxiety issues may also increase risk. Other environmental risk factors include family dysfunction, childhood adversity, cultural variables, and family history of psychiatric illness. The greater the magnitude of the trauma, the greater the risk for PTSD—witnessing atrocities, severe personal injury, perpetrating violence. Inappropriate coping mechanisms, lack of social support, family instability, or financial stress may further worsen the outcome.

 

Resilience factors can help reduce the risk of the disorder. Some resilience factors are present before the trauma and others become important during and after a traumatic event. The resilience factors may reduce the risk of PTSD and include seeking out support from other people, such as mental health professionals, friends and family, finding a support group after a traumatic event, feeling good about one’s own actions in the face of danger, having a coping strategy, and being able to act and respond effectively despite feeling fear.

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Diagnosis

A diagnosis of PTSD requires exposure to an upsetting traumatic event. However, exposure could be indirect rather than first hand. It can also occur as a result of repeated exposure to horrible details of trauma. For people with PTSD the symptoms cause significant distress or problems functioning. PTSD often occurs with other related conditions, such as depression, substance use, memory problems and other physical and mental health problems. Criteria for adults, adolescents, and children older than six include those below:​

 

For a person to be diagnosed with PTSD condition lasts at least 1 month and results from experiencing actual or threatened death, serious injury, or sexual violence as manifested by at least one of the following:

  1. directly experiencing or witnessing the traumatic event(s)

  2. becoming aware of close friends or family members suffering a traumatic event(s)

  3. repeated exposure to aversive aspects of traumatic events​

 

Symptoms​

Intrusive Symptoms: Presence of at least one of the following after experiencing traumatic event(s)

  • recurring distressing memories of that event

  • frequent nightmares involving the traumatic event(s)

  • flashbacks that may be accompanied by dissociative reactions as if the individual were reliving the traumatic event(s)

  • intense reactive distress when in the presence of cues that serve as a reminder of the traumatic event(s)

  • severe physiological reactions upon exposure to cues resembling aspects of the traumatic event(s)

 

Avoidance Symptoms: Chronic avoidance behaviors beginning after occurrence of traumatic event(s), as manifested by at least one of the following:

  • attempts to avoid distressing thoughts, feelings, or memories reminiscent of traumatic event(s)

  • avoidance of external stimuli that may serve as reminders of the traumatic event(s)

 

Negative Mood: Negative transformations of mood or thought related to the traumatic event(s), with onset after the event transpired and manifested by at least two of the following:

  • dissociative amnesia

  • chronic and exceedingly negative attitudes and expectations about oneself, others, and surroundings

  • self blame due to chronic inaccurate thoughts about the cause or effect of traumatic event(s)

  • chronic negative affect

  • loss of interest in significant activities

  • alienation from others

  • chronic inability to experience positive affect

 

Arousal Symptoms: Significant changes in sensitivity to traumatic event(s) starting or worsening after the traumatic event(s), as indicated by at least two of the following:

  • unprovoked inability and temper tantrums

  • irresponsible self destructive activities

  • hypervigilance

  • heightened startle reaction

  • difficulty focusing or concentrating

  • disrupted sleep patterns​

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Treating PTSD in Children and Teens

It’s important to remember that if your child does exhibit trauma symptoms, chances are they will decrease and disappear within a few months. This does not mean, however, that you should not consult with a mental health professional for an assessment and to discuss treatment options when symptoms occur. PTSD is treatable, so never hesitate to ask for help and see what works best. Here are some common treatment options for children with Post-traumatic stress disorder.

 

  • Cognitive Behavioral Therapy (CBT)

    • CBT is one of the most common forms of “talk therapy,” and therapists can use a trauma-focused style of the therapy to work with children and adults. A trauma-focused CBT therapist helps a child identity and correct irrational or illogical thoughts they might have about the trauma itself or people and situations they encounter in everyday life. CBT also typically includes psychoeducation about relaxation and coping techniques for stress.

 

  • Play Therapy 

    • This type of therapy can work especially well for younger children who struggle to communicate their reactions to the trauma and understanding of what happened. Play therapists use art therapy, games, and other interventions to help a child process a trauma and cope resiliently with life.

 

  • Eye Movement Desensitization and Reprocessing (EMDR)

    • EMDR is a technique that is increasingly in popularity among mental health professionals. The therapy incorporates guided eye movement exercises while a child recalls the traumatic event and works through cognitions and emotional responses they have about it.

 

Additional Health Approaches:

  • Yoga

  • Aqua therapy

  • Acupuncture

  • Mindfulness and meditation strategies and practices

  • Service dogs

 

Additional Trauma and Stressor Related Disorders:​

  • Acute stress disorder

    • ​Occurs in reaction to a traumatic event, just as PTSD does, and the symptoms are similar. However, the symptoms occur between three days and one month after the event. People with acute stress disorder may relive the trauma, have flashbacks or nightmares and may feel numb or detached from themselves.  These symptoms cause major distress and cause problems in their daily lives. About half of people with acute stress disorder go on to have PTSD.

    • An estimated 13 to 21 percent of survivors of car accidents develop acute stress disorder and between 20 and 50 percent of survivors of assault, rape or mass shootings develop it.

    • Psychotherapy, including cognitive behavior therapy can help control symptoms and help prevent them from getting worse and developing into PTSD.  Medication, such as SSRI antidepressants can help ease the symptoms.

 

  • Adjustment disorder

    • Occurs in response to a stressful life event (or events). The emotional or behavioral symptoms a person experiences in response to the stressor are generally more severe or more intense than what would be reasonably expected for the type of event that occurred.

    • Symptoms can include feeling tense, sad or hopeless; withdrawing from other people; acting defiantly or showing impulsive behavior; or physical manifestations like tremors, palpitations, and headaches. The symptoms cause significant distress or problems functioning in important areas of someone’s life, for example, at work, school or in social interactions. Symptoms of adjustment disorders begin within three months of a stressful event and last no longer than six months after the stressor or its consequences have ended.

    • The stressor may be a single event (such as a romantic breakup), or there may be more than one event with a cumulative effect. Stressors may be recurring or continuous (such as an ongoing painful illness with increasing disability). Stressors may affect a single individual, an entire family, or a larger group or community (for example, in the case of a natural disaster).

    • An estimated 5% to 20% of individuals in outpatient mental health treatment have a principal diagnosis of adjustment disorder. A recent study found that more than 15% of adults with cancer had adjustment disorder. It is typically treated with psychotherapy.     

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  • Disinhibited Social Engagement Disorder

    • Occurs in children who have experienced severe social neglect or deprivation before the age of 2. Similar to reactive attachment disorder, it can occur when children lack the basic emotional needs for comfort, stimulation and affection, or when repeated changes in caregivers (such as frequent foster care changes) prevent them from forming stable attachments.​

    • Involves a child engaging in overly familiar or culturally inappropriate behavior with unfamiliar adults. For example, the child may be willing to go off with an unfamiliar adult with minimal or no hesitation. These behaviors cause problems in the child’s ability to relate to adults and peers. Moving the child to a normal caregiving environment improves the symptoms. However, even after placement in a positive environment, some children continue to have symptoms through adolescence. Developmental delays, especially cognitive and language delays, may co-occur along with the disorder. The prevalence of disinhibited social engagement disorder is unknown, but it is thought to be rare. Most severely neglected children do not develop the disorder. Treatment involves the child and family working with a therapist to strengthen their relationship.   

 

  • Reactive attachment disorder

    • Occurs in children who have experienced severe social neglect or deprivation during their first years of life. It can occur when children lack the basic emotional needs for comfort, stimulation and affection, or when repeated changes in caregivers (such as frequent foster care changes) prevent them from forming stable attachments. Children with reactive attachment disorder are emotionally withdrawn from their adult caregivers. They rarely turn to caregivers for comfort, support or protection or do not respond to comforting when they are distressed. During routine interactions with caregivers, they show little positive emotion and may show unexplained fear or sadness. The problems appear before age 5. Developmental delays, especially cognitive and language delays, often occur along with the disorder.

    • Reactive attachment disorder is uncommon, even in severely neglected children. Treatment involves the child and family working with a therapist to strengthen their relationship.

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