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Definition
The DSMV-IV defines Post-Traumatic Stress Disorder (PTSD) as a type of anxiety disorder that is triggered by an extremely traumatic event, including actual or threatened serious injury or death. The person's response to the trauma must involve intense fear, helplessness, or horror. In children, the response must involve disorganized or agitated behavior. Symptoms of PTSD must be present for more than 1 month, and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. It is important to note that PTSD can also be triggered by witnessing a traumatic event or upon learning that a close friend or family suffered an unexpected or violent death or serious injury.
Characteristics
The symptoms of PTSD in adults can be grouped into 3 categories:
1. Persistent re-experiencing of the traumatic event (flashbacks, nightmares);
2. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (hopelessness, memory problems, withdrawal from close relationships); and
3. Persistent symptoms of increased anxiety or emotional arousal (trouble sleeping, easily startled or frightened, irritability or anger).
PTSD in adolescents and teens closely resembles the symptoms of PTSD in adults, although adolescents are more likely to exhibit posttraumatic reenactment. In children, “time skew” and “omen formation” can evidence the onset of PTSD. Time skew refers to incorrectly sequencing trauma related events when recalling them from memory, while omen formation is a belief that warnings signaled the impeding trauma and that if vigilant, future trauma can be avoided. Symptoms of PTSD in very young children include posttraumatic play, preoccupation with words or symbols (which may be unrelated to the trauma), separation anxiety, sleep disturbances, and even the loss of an acquired developmental skill (i.e. toilette training). In children who experience repeated trauma, dissociation (an emotional numbing to deaden or block the pain) may also take place.
Prevalence
The National Center for Post Traumatic Stress Disorder estimates that 15-43% of children experience some sort of traumatic event, with 3-15% of girls and 1-6% of boys exhibiting symptoms PTSD thereafter (Hamblen, 2009). As many as 90% of sexually abused children, 77% of children who experienced a school shooting, and 35% of urban youth exposed to community violence develop PTSD. Research also suggests that girls are more likely develop PTSD than boys.
Treatment
PTSD can be treated with antidepressant and anxiety medications that help to relieve depression, anxiety, and stress. Additionally, prazosin, which works by blocking the brain’s response to norepinephrine, can be prescribed for patients experiencing recurring nightmares. Patients can also participate in psychotherapy as a supplement or alternative to medication. Psychotherapeutic options include cognitive behavior therapy (CBT), play therapy, 12-step approaches, eye movement desensitization and reprocessing (EMDR), and exposure therapy. Studies have indicated that cognitive behavior therapy is the most effective treatment from children (Hamblen, 2009).
Prognosis
The outlook for those diagnosed with PTSD is moderate to very good. With treatment, children with PTSD will at least learn to manage their symptoms. The prognosis is most positive when onset of PTSD was brought on by a solitary traumatic event rather than recurring chronic abuse. Children and adolescents who have a strong support network have an even better outlook, with research indicating a correlation between family support and lower levels of PTSD symptoms (Hamblen, 2009).
Sources
Academy of Adolescent and Child Psychiatry. “Posttraumatic Stress Disorder (PTSD).” Facts for Families. 07 September 2009. Academy of Adolescent and Child Psychiatry.< http://www.aacap.org/cs/root/facts_for_families/posttraumatic_stress_disorder_ptsd>
AllPsych Online. “Post Traumatic Stress Disorder.” AllPsych Online--The Virtual Classroom. 07 September 2009. < http://allpsych.com/disorders/anxiety/ptsd.html>
Hamblen, Jessica. “PTSD in Children and Adolescents.” The National Center for Post Traumatic Stress Disorder. 07 September, 2009. United States Department of Veterans Affairs. < http://ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_children.html>
The Mayo Clinic. “Diseases and Conditions.” The Mayo Clinic. 5 September 2009.< http://www.mayoclinic.com/health/post-traumatic-stress-disorder/DS00246/DSECTION=symptoms>.