Posttraumatic stress disorder (PTSD)
is the development of characteristic symptoms that occur following
direct or indirect exposure to a traumatic or terrifying event in
which physical harm was threatened, witnessed, or actually
experienced.
PTSD also can occur after the unexpected or violent death of a
family member or close friend, or following serious harm or threat
of death or injury to a loved one.
Studies show that PTSD occurs in 1%-14% of the population. It
can be diagnosed at at any age, and can occur as a sudden,
short-term response (called
acute stress disorder
) or develop gradually and become chronic or persistent.
Most people with the posttraumatic stress disorder try to avoid
any reminders or thoughts of the trauma. Despite this avoidance,
they often re-experience the ordeal in the form of intense
"flashbacks," memories, nightmares, or frightening
thoughts, especially when they're re-exposed to events or
objects that remind them of the trauma.
Survivor guilt (feelings of guilt for having survived an event
in which friends or family died) may also be a component of
PTSD.
Causes of PTSD
Traumatic events that can cause PTSD include:
- violent assaults such as rape
- fire
- physical or sexual abuse
- senseless acts of violence (such as school or neighborhood
shootings)
- natural or manmade disasters
- car accidents
- military combat (this form of PTSD is sometimes called
"shell shock")
- witnessing another person go through these kinds of traumatic
events
- diagnoses of life-threatening medical illnesses
Studies indicate that people with PTSD tend to have abnormal
levels of key hormones involved in the stress response. For
instance, research has shown that they have lower than normal
cortisol levels and higher than normal epinephrine and
norepinephrine levels - all of which play an important role in the
body's "fight-or-flight" reaction to sudden stress.
(It's known as "fight or flight" because that's
exactly what the body is preparing itself to do - to either fight
off the danger or run from it.)
The severity and likelihood of developing PTSD varies according
to the nature of the event, as well as individual factors such as
social support, family history, childhood experiences, personality,
and any existing mental health problems or stress.
Signs and Symptoms
Symptoms of posttraumatic stress disorder usually develop within
the first 3 months after the trauma, but they may not surface until
months or even years have passed. These symptoms often continue for
years following the trauma or, in some cases, may subside and
return later in life if another event triggers memories of the
trauma. In fact, anniversaries of the event can often cause a flood
of emotions and unpleasant memories.
Sometimes, symptoms are easy to identify - they often resemble
symptoms of
stress
,
anxiety
and
depression
. It is also usual for a person to have a period of adjustment
following an unpleasant event in their lives, so during this time,
it's important to offer support and love and monitor your child
carefully.
The following signs and symptoms are characteristic of PTSD if
they have lasted for about a month or more, following the
event:
Re-experiencing the event
- recurrent and intrusive (unwanted) memories of the event
- distressing dreams or nightmares of the event
- acting or feeling as though the event were happening again
(flashbacks)
- distress and fear when reminded of the event
- physiological reactivity (feeling jumpy, startled or anxious)
when reminded of the event
Persistent avoidance of any reminders of the event
- avoiding thinking about or talking about the trauma
- avoiding activities, places, or people that are reminders of
the event
- no memory of an important aspect of the event
- lack of interest and participation in activities (due to
wishing to avoid cues of the event)
- feeling detached or estranged from others
- limited range of emotions
- sense that they will not live to graduate college, get
married, have kids, etc.
Persistent feelings of anxiety or physical reactivity
- difficulty falling or staying asleep
- cranky, irritable, or angry
- problems paying attention or concentrating
- overly aware of noises or other cues that remind them of the
event (smells, visual cues)
- exaggerated startle response
People with PTSD often don't seek professional help because
they may not recognize the link between their symptoms and the
trauma they experienced. They also may want to continue avoiding
discussing the problem because it makes them feel anxious.
Treating PTSD
Many people recover from experiencing a traumatic event after a
period of adjustment. However, if your child or teen has
experienced a traumatic event and has experienced symptoms listed
above for over a month, it's time to get help from a
professional.
Your child's teacher, doctor, friends, and other family
members who know your child well can play an important role in
recognizing PTSD. Other mental health professionals who can help
include:
- psychologists
- psychiatrists
- licensed clinical social workers
- licensed professional counselors
- licensed trauma professionals
- bereavement specialists
Therapy can be extremely supportive and helpful, particularly if
the trauma was unusually severe or life threatening.
Cognitive-behavioral therapy
has been shown to be very effective for people who develop PTSD.
This type of therapy helps someone to adopt new thoughts (called
cognitions
) and behaviors in place of destructive or negative ones, while
safely revisiting aspects of the trauma.
In some cases, medication may be recommended to help alleviate
serious symptoms of depression and anxiety, which can help your
child cope with school and other daily activities while being
treated for PTSD. You can tell your child that medication is often
used as a temporary measure to help until people with the disorder
feel better.
Finally, group therapy or support groups can be beneficial
because they can help kids and teens understand they're not
alone. Groups also provide a safe atmosphere in which to share
feelings. Ask the therapist for specific referrals or suggestions
for a group.
Helping Your Child
It's helpful to understand that PTSD is an emotional problem
and that your child's traumatic experience has left
"emotional scar tissue." This means that first and
foremost your child needs your support and understanding.
It's usually necessary to seek help from a qualified therapist.
Family and friends can also play a key role in helping your child
recover.
Here are some other things parents can do to support kids with
PTSD:
- Let them talk about the traumatic event when and if they feel
ready. It's important not to force the issue if kids
don't feel like sharing their thoughts. Praise them for being
strong when they do talk about it.
- Reassure them that their feelings are normal and that
they're not "going crazy." Support and
understanding from parents can help kids accept their most
frightening emotions.
- Encourage them to get involved in a support group for trauma
survivors. Check with your pediatrician, school, or the library
to locate groups nearby.
- Get professional help immediately if there's any
suspicion that a child has thoughts of self-harm. Thoughts of
suicide
are serious at any age and require prompt and effective
intervention.
- Let them make simple decisions whenever appropriate. Because
PTSD often makes a child feel powerless, parents can help their
kids by showing them that they have control over certain aspects
of their lives. Depending on their children's ages, parents
might consider letting them decide things like what's for
dinner, what to wear, or select a weekend activity.
- Tell them that the traumatic event is not their fault.
Encourage kids to talk about their feelings of guilt, but
don't let them blame themselves for what happened.
- Stay in touch with caregivers. It's important to talk to
teachers, babysitters, and other people who care for kids with
PTSD.
- Do not criticize regressive behavior (returning to a previous
level of development). If children want to sleep with the lights
on or take a favorite stuffed animal to bed, it's perfectly
normal and can help them feel better.
Also, take care of yourself so that you're well equipped to
help your child. Dealing with PTSD can be very challenging and may
require a lot of patience and support, but just remember that
getting good help for your family can help everyone recover.
Reviewed by:
Michelle New, PhD
Date reviewed: September 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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