Posttraumatic Stress Disorder

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) might 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. The following signs and symptoms are characteristic of PTSD if they have lasted for about a month or more after 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:

• Most kids will need a period of adjustment following a stressful event, so during this time, it's especially important for parents to offer support and love, and to monitor their kids carefully.
• 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. Your child may prefer to draw or write about their experiences. Either way, encouragement and praise can help your child get their feelings out.
• Reassure them that their feelings are normal and that they're not "going crazy." Support and understanding from parents can help kids process difficult feelings.
• Some kids find it very helpful to get involved in a support group for trauma survivors. Check with your pediatrician, school, or local library to find 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.
• Help build self-confidence by encouraging kids to make everyday decisions whenever appropriate. PTSD can make a child feel powerless, so parents can help by showing their kids 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. Helping your child cope with PTSD can be very challenging and may require a lot of patience and support. Time does heal, and getting good support for your family can help everyone get past difficult life events.