Post-Traumatic Stress Disorder
What is Post Traumatic Stress Disorder?
Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after experiencing or witnessing a major trauma. Children and teens with PTSD can have a number of symptoms after a trauma that fall into three categories:
- Reliving the trauma in some way.
- Attempts to avoid anything that reminds the child or teen of the trauma.
- Very high anxiety (also called "hyperarousal") and being easily startled. Children and teens with PTSD usually have some symptoms from each of these categories.
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Key Points:
- Although 15 - 43% of children will experience a traumatic event in their lives, many of them will not develop PTSD.
- The chance of developing PTSD increases with the severity of the trauma. For example, almost all children who are sexually abused or who witness the death or assault of a parent will later suffer PTSD.
- Children with PTSD may experience other problems as well, including depression, other anxiety problems, or acting-out behaviors. In teens with PTSD, substance abuse problems are also common (for example, drug or alcohol use).
Stories
The Story of 13-year-old Eric
Eric is a 13-year-old boy who was always very outgoing and had lots of friends in school. About a year ago, he dropped out of soccer and karate lessons, even though he used to love both activities. He started staying at home after school instead of seeing his friends, and arguing with his mom about going to school. Eric also started calling his mom many times on her cell phone whenever she left the house.
Eric's problems started after a trauma he experienced about a year ago. While driving to the mall with his mom, a car ran a red light and hit the side of their car. Eric's mom's car spun several times and hit a tree. The driver of the other car suffered a serious head wound. Luckily, neither Eric nor his mom were hurt. Eric said that he could still remember what the man in the other car looked like with blood trickling down from his forehead to his face, "like a color picture in my head".
After the accident, Eric was terrified of being in cars. He was even afraid of walking down the street, saying that there are "crazy drivers everywhere", and he was worried that he would get hit by a car. When he does leave the house, he insists that his mom come with him, and he becomes very anxious when she is out of his line of sight. Eric also has nightmares about car crashes, and he says he keeps having thoughts pop into his head about the accident. He gets very anxious when he hears a car horn honking, or if he sees a news article about car accidents. He no longer watches the news or TV shows that contain any violence.
The Story of 6-year-old Lucie
Lucie is a six-year-old girl who has been living with her grandmother for about six months. She often has violent temper tantrums "for no reason," and gets into fights with other kids at school. She has started wetting the bed at night, and her grandmother found some violent drawings in her room (for example, people being stabbed and shot). Lucie used to live with her mom, but about six months ago her mom and her mom's boyfriend got into a violent argument, and Lucie's mom was killed. Lucie was hiding under the bed at the time, and witnessed her mom's death. She went to stay with her grandmother after this happened. Her grandmother describes Lucie as sullen and withdrawn. She refuses to talk about what happened to her mom, but she seems to act it out when playing with dolls or drawing pictures. She has frequent nightmares about "monsters" chasing her. Lucie has no friends, does not want to play any sports or learn a hobby, and pleads everyday to stay at home from school and play alone in her room instead.
What Kinds of Trauma lead to PTSD?
There are many different types of traumas that can later lead to PTSD in children and teens, but what they all have in common is:
- The trauma was life-threatening or lead to potential or actual serious injury.
- The child or teen reacted to the trauma with intense fear, helplessness, or horror.
Children and teens can develop PTSD if they have been directly involved, or witnessed a serious traumatic event. Some common traumas include:
- Being involved in, or witnessing, a car accident.
- Undergoing major surgery (bone marrow transplant, extensive hospitalization, severe burns).
- Experiencing or witnessing natural disasters (earthquakes, hurricanes, floods, fire).
- Violent crimes (kidnapping, physical assault, assault or murder of a parent or loved one).
- Community violence (attacks at school, suicide of a friend, family member, or a child in the same-age group).
- Chronic physical or sexual abuse.
Symptoms
In order for a child or teen to be diagnosed with PTSD, they should have at least one symptom from each of the three symptoms categories.
1. Symptoms of reliving or "re-experiencing" the trauma
Upsetting memories about the trauma; which usually involves having repeated, vivid images about the trauma. For example, a child or teen who was involved in a car accident may keep remembering the image of blood on a parent's face. Young children may show this symptom by engaging in repetitive play. That is, playing games that involve themes of the trauma (for example, drawing pictures of cars crashing, or playing with toy cars and having them crash into each other).
Nightmares about the trauma. In young children, the nightmares may not be about the trauma itself (e.g., the car accident). Instead, they may have nightmares about monsters chasing them.
Acting as if the trauma were happening ("reliving the trauma"). This can sometimes be a "flashback," where a child loses touch with the present moment, and speaks and acts as if the trauma were happening now. Young children with this symptom will sometimes engage in trauma reenactment, where they play out certain parts of the trauma. For example, if a child were trapped in a car, he or she might pretend being trapped in a small space (a box, a closet) while playing.
Anxiety when reminded of the trauma. Children and teens with this symptom may become very anxious (cry, temper tantrums) when they see or hear reminders of the trauma (for example, being in a car, or hearing a car squeal its tires).
2. Symptoms of avoidance
- Avoiding reminders of the trauma. Children and teens with PTSD often try to avoid anything that reminds them of what happened. Reminders can include:
- Circumstances (the actual date of the event, clothes worn, place where the event occurred).
- Things associated with the trauma (e.g., being in a car if the trauma was a car accident).
- General signs of danger (TV shows about violence, news, sirens, school alarms).
- Discussions related to trauma (e.g., hearing a conversation about a car accident).
- Forgetting (amnesia) parts of the trauma. Some children and teens with PTSD may forget parts of the traumatic event, or be confused about the timeline of the trauma.
- Reduced interest in previously enjoyed activities. After a trauma, some children and teens may stop seeing their friends, or drop out of social activities they used to enjoy (such as dropping out of sports teams).
- Feeling detached from others/feeling numb. Some children and teens with PTSD may show little emotion after a trauma, and choose to isolate themselves from others. Younger children are often unable to express "feeling numb", and are more likely to simply isolate themselves from others and avoid talking about how they feel.
- Very young children will sometimes regress slightly in their normal development. For example, a child with PTSD may become less verbal, or begin thumb sucking (after having already stopped) or bed-wetting.
3. Symptoms of high anxiety or "hyperarousal"
- Sleep difficulties. Many children and teens with PTSD have problems falling or staying asleep, which is usually the result of feeling highly anxious all day.
- Anger outbursts. After a trauma, some children and teens with PTSD have a hard time controlling their anger. This can include impatience, yelling, temper tantrums, or even hitting.
- Concentration difficulties. After a trauma, some children and teens have difficulty concentrating on daily activities (for example, paying attention in school).
- Hypervigilance. Children and teens with PTSD are often "on guard" or "on alert" all the time. Thus, they are easily startled, often jumping at the slightest sound or potential threat (for example, the school bell going off, the telephone ringing).
How do you know if your Child or Teen has PTSD?
Obviously, there are many symptoms of PTSD, some of which can be seen in children and teens without PTSD. For example, it is not uncommon for children or teens to have sleep problems, angry outbursts, or nightmares. There are two ways that you can determine if your child has PTSD:
Tip #1: If your child's symptoms only started after a traumatic event and were not already present, then he or she may have PTSD.
Tip #2: It is normal to be very anxious immediately after a trauma. But over time, those anxious feelings should settle down. If your child is experiencing symptoms of anxiety for over one month after the trauma, he or she might have PTSD.
What can PTSD look like in very Young Children?
Very young children may not have many symptoms of PTSD. Instead, they may show their anxiety in the following ways:
- Fear of strangers.
- Fear of family members.
- General avoidance of situations that are not related to the trauma (for example, avoiding going to school, going out in public).
- Traumatic play; re-enacting parts of the trauma in their play (drawings, acting out).
- Regressive behavior (thumb sucking, bed-wetting).
What can PTSD look like in Elementary School Aged Children?
Elementary-school-aged children with PTSD may not have symptoms of amnesia; however, they might have some of the following symptoms:
Omen formation. This is the belief that there were "warning signs" before the trauma occurred. Children with this belief are always on the alert for signs or warnings of "future danger". For example, if it was raining on the day of a car accident, your child might believe that the rain was a "warning" of something bad happening, and refuse to leave the house when it rains.
Traumatic play. Similar to very young children, elementary school children may re-enact part of the trauma in their play. For example, a child who was traumatized by a car accident may then play with toy cars, and have them crash in to each other.
What can PTSD look like in Teens?
In addition to the symptoms already described, some teens may also have some of the following symptoms:
After the traumatic event, your teen may start showing a fear of separation from family members (for example, afraid of being away from parents). Some teens may also show impulsive and aggressive behavior, such as having angry outbursts, or using recreational drugs.
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