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Posttraumatic Stress Disorder

Your 17-year-old was recently involved in an automobile accident in which a close friend was killed instantly. Although your child wasn't seriously injured, over the past month, you've noticed that your teen has become increasingly withdrawn and anxious. Your once adventurous offspring often expresses fear about driving and has recurrent nightmares about the night of the car accident.

Although you suspect that your teen 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 your teen feel OK again?

It's important to recognize that your child 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 the disorder include:

• violent assaults such as rape
• acts of violence (such as school or neighborhood shootings)
• natural or man-made disasters
• car accidents
• military combat (this form of posttraumatic stress disorder is sometimes called "shell shock")
• witnessing another person go through these kinds of traumatic events
• diagnoses of life-threatening medical illnesses (which is now recognized by mental health professionals as a trigger for the disorder in some individuals)

Also, those who've been abused as children or had other previous traumatic experiences are more likely to develop the condition.

Posttraumatic stress can happen at any age. It can occur as a sudden, short-term response, or it can develop gradually and become chronic or persistent. (Many Holocaust survivors, for example, have been found to experience chronic posttraumatic stress disorder.)

Most people with the disorder try to avoid any reminders or thoughts of the trauma. Despite this avoidance, people with posttraumatic stress disorder 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, 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 the disorder.

What Causes It?

Any of the traumatic events listed above can cause posttraumatic stress disorder. Studies also indicate that people who live with the disorder 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. (It's known as "fight or flight" because that's exactly what the body is preparing itself to do - to fight off the danger or to run like crazy to get away.)

The body of a person with chronic posttraumatic stress 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.

What Are the 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, the symptoms of the disorder are easy to identify - they often resemble the symptoms of anxiety

People with the disorder often don't 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 posttraumatic stress without treatment, sometimes within 6 months. However, this isn't 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 the disorder.

Your child's teacher, doctor, or any other caregiver who routinely sees your child can play an important role in recognizing and treating posttraumatic stress. Other mental health professionals who can help your child include:

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

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 (called cognitions) and behaviors in place of destructive or negative ones, while safely revisiting aspects of the trauma.

A therapist or mental health professional might also recommend medications for your child. 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 the treatment for posttraumatic stress disorder continues. Explain to your child that medication is often used as a temporary measure to help until people with the disorder feel better on their own.

Finally, group therapy or support groups can be beneficial because they can help kids understand that they're 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's suited to your child's needs.

Helping Your Child

It's essential to understand that posttraumatic stress disorder is an emotional condition and that your child's traumatic experience has left "emotional scar tissue." So, it's important to show your child compassion and understanding. And it's usually necessary to seek immediate help from a qualified therapist. Family and friends can also play a key role in helping your child recover from the disorder.

Here are some other things parents can do that may help provide support for their children with posttraumatic stress disorder:

• 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.
• Reassure them that their feelings are normal and that they're not "going crazy." The support and understanding parents provide can help kids accept their most frightening emotions.
• Encourage them to get involved in a support group for trauma survivors. Parents can check their local hospital or mental health association to locate groups nearby.
• Get professional help immediately if there's any suspicion that a child might be David V. Sheslow, PhD
  Date reviewed: November 2004
  Originally reviewed by:
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