Posttraumatic Stress Disorder (PTSD)

What Is Posttraumatic Stress Disorder (PTSD)?

Someone who is the victim of (or threatened by) violence, injury, or harm can develop a mental health problem called posttraumatic stress disorder (PTSD). PTSD can happen in the first few weeks after an event, or even years later.

People with PTSD often re-experience their trauma in the form of "flashbacks," memories, nightmares, or scary thoughts, especially when they're exposed to events or objects that remind them of the trauma.

Psychologists, therapists, or psychiatrists can help people with PTSD deal with hurtful thoughts and bad feelings and get back to a normal life.

What Causes PTSD?

PTSD is often associated with soldiers and others on the front lines of war. But anyone — even kids — can develop it after a traumatic event.

Traumas that might bring on PTSD include the unexpected or violent death of a family member or close friend, and serious harm or threat of death or injury to oneself or a loved one.

Situations that can cause such trauma include:

• violent attacks, like rape
• fire
• physical or sexual abuse
• acts of violence (such as school or neighborhood shootings)
• natural or manmade disasters
• car crashes
• military combat (sometimes called "shell shock")
• witnessing another person go through these kinds of traumatic events
• being diagnosed with a life-threatening illness

In some cases, PTSD can happen after repeated exposure to these events. Survivor guilt (feelings of guilt for having survived an event in which friends or family members died) also might contribute to PTSD.

What Are the Signs & Symptoms of PTSD?

People with PTSD have symptoms of stress, anxiety, and depression that include many of the following:

Intrusive thoughts or memories of the event

• unwanted memories of the event that keep coming back
• upsetting dreams or nightmares
• acting or feeling as though the event is happening again (flashbacks)
• heartache and fear when reminded of the event
• feeling jumpy, startled, or nervous when something triggers memories of the event
• children may reenact what happened in their play or drawings

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
• being unable to remember important parts of what happened

Negative thinking or mood since the event happened

• lasting worries and beliefs about people and the world being unsafe
• blaming oneself for the traumatic event
• lack of interest in participating in regular activities
• feelings of anger, shame, fear, or guilt about what happened
• feeling detached or estranged from people
• not able to have positive emotions (happiness, satisfaction, loving feelings)

Lasting feelings of anxiety or physical reactions

• trouble falling or staying asleep
• feeling cranky, grouchy, or angry
• problems paying attention or focusing
• always being on the lookout for danger or warning signs
• easily startled

Signs of PTSD in teens are similar to those in adults. But PTSD in children can look a little different. Younger kids can show more fearful and regressive behaviors. They may reenact the trauma through play.

Symptoms usually begin within the first month after the trauma, but they may not show up until months or even years have passed. These symptoms often continue for years after the trauma. In some cases, they may ease 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 bad memories.)

PTSD also can come on as a sudden, short-term response (called acute stress disorder) to an event and can last many days or up to one month.

People with PTSD may not get professional help because they think it's understandable to feel frightened after going through a traumatic event. Sometimes, people may not recognize the link between their symptoms and the trauma.

Teachers, doctors, school counselors, friends, and other family members who know a child or teen well can play an important role in recognizing PTSD symptoms.

Who Gets PTSD?

Not everyone who goes through a traumatic event gets PTSD. The chances of developing it and how severe it is vary based on things like personality, history of mental health issues, social support, family history, childhood experiences, current stress levels, and the nature of the traumatic event.

Children and teens who go through the most severe trauma tend to have the highest levels of PTSD symptoms. The more frequent the trauma, the higher the rate of PTSD.

Studies show that people with PTSD often have atypical 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 a big 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.)

How Is PTSD Treated?

Many people recover from a traumatic event after a period of adjustment. But if your child or teen has experienced a traumatic event and has symptoms of PTSD for more than a month, get help from an expert.

Therapy can help address symptoms of avoidance, intrusive and negative thoughts, and a depressed or negative mood. A therapist will work with your family to help you and your child or teen adjust to what happened and get back to living life.

Mental health professionals who can help include:

• psychologists
• psychiatrists
• licensed clinical social workers
• licensed professional counselors
• licensed trauma professionals
• bereavement specialists

Cognitive-behavioral therapy is very effective for people who develop PTSD. This type of therapy teaches ways to replace negative, unhelpful thoughts and feelings with more positive thinking. Behavioral strategies can be used at a child's own pace to help desensitize the child to the traumatic parts of what happened so he or she doesn't feel so afraid of them.

Eye movement desensitization and reprocessing therapy (EMDR) combines cognitive therapy with directed eye movements. This has been shown to be effective in treating people of all ages with PTSD.

Play therapy is used to treat young children with PTSD who can't directly deal with the trauma.

In some cases, medicine can help treat serious symptoms of depression and anxiety. This can help those with PTSD cope with school and other daily activities while being treated. Medicine often is used only until someone feels better, then therapy can help get the person back on track.

Finally, group therapy or support groups are helpful because they let kids and teens know that they're not alone. Groups also provide a safe place to share feelings. Ask your child's therapist for referrals or suggestions.

How Can Parents Help?

Above all, your child needs your support and understanding. Sometimes other family members like parents and siblings will need support too. While family and friends can play a key role in helping someone recover, help usually is needed from a trained therapist.

Here are some other things parents can do to support kids with PTSD:

• Most kids will need time to adjust after a stressful event. While they do, it's important for parents to offer support, love, and understanding.
• Try to keep kids' schedules and lives as similar as possible to before the event. This means not allowing your child to take off too much time from school or activities, even if it's hard at the beginning.
• Let them talk about the traumatic event when and if they feel ready. Praise them for being strong when they do talk about it, but don't force the issue if they don't feel like sharing their thoughts. Some kids may prefer to draw or write about their experiences. Either way, encouragement and praise can help them get feelings out.
• Reassure them that their feelings are typical and that they're not "going crazy." Support and understanding from parents can help with handling difficult feelings.
• Some kids and teens find it helpful to get involved in a support group for trauma survivors. Look online or check with your pediatrician or the school counselor to find groups nearby.
• Get professional help immediately if you have any concern that a child has thoughts of self-harm. Thoughts of suicide are serious at any age and should be treated right away.
• Help build self-confidence by encouraging kids to make everyday decisions where appropriate. PTSD can make kids feel powerless, so parents can help by showing their kids that they have control over some parts of their lives. Depending on a child's age, parents might consider letting him or her choose a weekend activity or decide things like what's for dinner or what to wear.
• Tell them that the traumatic event is not their fault. Encourage kids to talk about any 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 are involved in your child's life.
• 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 might help them get through this difficult time. Speak to your child's doctor or therapist if you're not sure about what is helpful for your son or daughter.

Looking Ahead

Be sure to also take care of yourself. Helping your child or teen 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 move forward.