Posttraumatic Stress Disorder
July 13, 2004, KidsHealth.org

Your 17-year-old daughter was recently involved in an automobile accident in which her best friend was killed instantly. Although your daughter was not seriously injured, over the past month, you have noticed that she has become increasingly withdrawn and anxious. She often expresses fear about driving and has recurrent nightmares about the night of the car accident.

Although you suspect that your daughter is feeling distressed, you aren't sure how to intervene. How do you know if your child is depressed or experiencing a more serious problem? What can you do to help her feel like herself again?

It's important to recognize that she may be experiencing an emotional reaction to the accident, and to understand that people who experience a traumatic event can be affected by an anxiety disorder called posttraumatic stress disorder.

What Is Posttraumatic Stress Disorder?
Posttraumatic stress disorder (PTSD) is an emotional condition that often occurs after direct or indirect exposure to a terrifying event in which physical harm was threatened, witnessed, or actually experienced. Traumatic events that can cause PTSD include violent assaults such as rape, physical or sexual abuse, school or neighborhood shootings, natural or manmade disasters, or car accidents. People who have been involved in military combat can also experience PTSD; this form of PTSD is sometimes called "shell shock." Mental health professionals also now recognize that the diagnosis of a life- threatening medical illness can also trigger PTSD in some individuals.

Most people with PTSD try to avoid any reminders or thoughts of the trauma. Despite this avoidance, people with PTSD often re-experience the ordeal in the form of intense "flashbacks," memories, nightmares, or frightening thoughts, especially when they are re-exposed to events or objects that remind them of the trauma, according to the National Institute of Mental Health (NIMH).

Survivor guilt (feelings of guilt that result from having survived an event in which friends or family died) is also often a significant component of PTSD.

What Causes PTSD?
Any traumatic event, such as an accident, rape, fire, senseless act of violence, or life-threatening illness can cause this disorder, as can witnessing another person go through such an event. Those who have been abused as children or who have had other previous traumatic experiences are more likely to develop the condition.

PTSD can happen at any age. "Research has not shown that specific groups of people are more vulnerable to PTSD, but those in certain age groups are more susceptible to external forces, such as children under 10 and teenagers up to age 21," explains author and therapist Richard Peterson, PhD, a trauma specialist.

PTSD can occur as a sudden, acute response, or it can develop gradually and become chronic or persistent. (Many Holocaust survivors, for example, have been found to experience chronic PTSD.) Studies indicate that people who live with PTSD tend to have abnormal levels of key hormones involved in the stress response, according to the NIMH. For example, research has shown that their cortisol levels are lower than normal and their epinephrine and norepinephrine are higher than normal - all of which play an important role in the body's fight-or-flight reaction to sudden stress. The body of a person with chronic PTSD may show such adaptations to the stress over time - a phenomenon that researchers call "physiologic habituation." Currently, research is being conducted to further investigate the causes and consequences of posttraumatic stress disorder.

Signs and Symptoms
Symptoms of PTSD 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, the symptoms of PTSD are easy to identify; they often resemble the symptoms of depression. However PTSD is not the same as depression. "Posttraumatic stress disorder is characterized by sleeplessness; nightmares; apathy; inability to get along with others, particularly in close relationships; paranoia and distrust; and an unwillingness to discuss or revisit in any way the site of the trauma," says Dr. Peterson.

Other signs and symptoms of PTSD include:
o persistent, intense fear and anxiety
o feeling easily irritated or agitated
o having difficulty concentrating
o feeling numb or detached
o no longer finding pleasure in previously enjoyable activities
o feeling helpless or "out of control"
o experiencing intense survivor guilt
o being preoccupied with the traumatic event
o physical symptoms such as headache, gastrointestinal distress, or dizziness
o suicidal thoughts, plans, or gestures

People with PTSD often do not seek professional help because they don't recognize the link between their symptoms and the traumatic event they experienced. They also may avoid discussing the problem because dealing with anything related to the event makes them feel anxious or helpless.

How Is It Treated?
Depending upon the circumstances, some people can recover from PTSD without treatment, sometimes within 6 months. However, this is not always the case; in some cases, symptoms of PTSD may not even appear for several months or longer following the traumatic event. Fortunately, mental health and medical professionals can effectively treat PTSD.

Your child's teacher, doctor, or any other caregiver who routinely sees your child can play an important role in recognizing and treating PTSD. Other mental health professionals who can help your child include:
o psychologists
o psychiatrists
o licensed clinical social workers
o licensed professional counselors
o licensed trauma professionals

If your child needs therapy, try not to feel alarmed or discouraged. Therapy can be extremely supportive and helpful, particularly if the trauma was unusually severe or life-threatening. Cognitive-behavioral therapy is often helpful for trauma survivors. This type of therapy helps your child to adopt new thoughts (cognitions) and behaviors in place of destructive or negative ones while safely revisiting aspects of the trauma.

A therapist or mental health professional might recommend medications for your child or teenager. These medications can help alleviate serious symptoms of depression and anxiety, which can help your child cope with school and other daily living activities while treatment for PTSD continues. Explain to your child that medication is often used as a temporary measure to help until she feels better on her own.

Finally, group therapy or support groups can be beneficial because they help your child understand that she is not alone. Groups also provide a safe atmosphere in which to share feelings. Ask your child's therapist for specific referrals or suggestions for a group that is suited to her needs.

Helping Your Child
It is essential to understand that PTSD is an emotional condition and that your child's traumatic experience has left "emotional scar tissue," according to Dr. Peterson. "The best way to help, other than showing compassion and understanding, is by finding a qualified therapist," explains Dr. Peterson.

Family and friends play a key role in helping your child recover from PTSD. Although it's usually necessary to seek immediate help from a qualified therapist, consider these tips in providing support for your child:
o Let your child talk about the traumatic event when and if she feels ready. It's important not to force the issue if your child does not feel like sharing her thoughts.
o Reassure your child that her feelings are normal and that she is not "going crazy." The support and understanding that you provide can help her accept her most frightening emotions.
o Encourage your child to get involved in a support group for trauma survivors. Check your local hospital or mental health association to locate a group close to you.
o If you suspect that your child is suicidal, get professional help immediately. Thoughts of suicide are serious at any age and require prompt and effective intervention.
o Let your child make simple decisions whenever appropriate. Because PTSD often makes a child feel powerless, you can help her by showing her that she has control over certain aspects of her life. Depending upon her age, you might consider letting your child decide things like what is for dinner or how to spend the day.
o Tell your child that the traumatic event is not her fault. Encourage her to talk about her feelings of guilt, but don't let her blame herself for what happened.
o Stay in touch with your child's caregivers. It's important to talk to teachers, babysitters, and other people who care for her.
o Do not criticize regressive behavior. If your child wants to sleep with the lights on or take a favorite stuffed animal to bed, it's perfectly normal and can help your child to soothe herself.
o Take care of yourself so that you are well equipped to help your child. You can't be supportive if you're neglecting your own emotional or physical health.

Although dealing with PTSD can be very challenging, appropriate treatment and support is available to you and your loved ones.