The majority of adults in the US reported experiencing some type of traumatic event during their lifetime but most do not develop Posttraumatic Stress Disorder (PTSD). It is normal to have some type of reaction to traumatic events as our body engages the “fight or flight” response to help protect us from danger. However, PTSD only develops in approximately 7% of individuals who experience a traumatic event. PTSD is diagnosed when a normal reaction develops into chronic symptoms, which impair daily activities. Several factors can impact the likelihood of a person developing PTSD, which include but are not limited to, experiencing more than one traumatic event, the type of trauma, and level of social support prior to and following the trauma.
Some people experience an acute traumatic event, such as a car accident, but are not the victims of chronic or ongoing trauma. Approximately 1 in 6 Americans reported four or more traumatic events during their childhood. When there are multiple traumatic events occurring over a long period of time, this can cause severe and chronic symptoms of PTSD which is referred to as Complex PTSD (C-PTSD). Individuals diagnosed with C-PTSD tend to experience more severe and long-term symptoms compared to those who suffer from PTSD. The case below provides an example of a person who experiences multiple traumatic events and suffers from PTSD:
Amy is a 16-year-old female who was removed from her mother’s care approximately one year ago after disclosing physical abuse by her mother to her school counselor. She was initially placed in foster care before being placed with her paternal grandmother. Amy’s mother reportedly suffers from severe mental illness and substance abuse which impacted her mother’s ability to provide appropriate care for her child. Amy also disclosed witnessing ongoing domestic violence between her mother and her mother’s partners as well as physical abuse by her mother and partners over the course of several years upon being brought into foster care.
Amy has supervised visitation with her mother once every other week. Her grandmother expressed concern about Amy becoming more emotional in the day prior to and after her visit with her mother. She has also started having nightmares and trouble sleeping around the time she visits with her mother. Amy’s grandmother added she often tries to avoid visits with her mother and has asked they be discontinued. Amy has stated she is afraid when she sees her mother because she worries her is going to hurt her. The clinician supervising Amy’s visits reported Amy seems “on edge” and over reacts to any movements by her mother during their visits. Amy’s teachers have also noted concerns because she is extremely fearful of male staff, does not seem interested in interacting with her peers, and struggles with attention in the classroom. Amy has trouble making friends because she often interprets others as trying to harm her and becomes easily agitated which frustrates her peers when they try to interact with her.
Symptoms of PTSD
Although most people who have lived through a traumatic event experience short-term symptoms, the majority do not develop PTSD. For those diagnosed with PTSD, symptoms usually begin within three months of the traumatic event. These symptoms must last for more than a month and be severe enough to interfere with a person’s well-being, relationships, and work life. There are four categories of symptoms that characterize PTSD:
1. Re-experiencing symptoms
2. Avoidance symptoms
3. Arousal and reactivity symptoms
4. Cognition and mood symptoms
In order to be diagnosed with PTSD, a person must exhibit at least one re-experiencing symptom, one avoidance symptom, two arousal/reactivity symptoms, and two cognition/mood symptoms. Below are examples of each symptom category:
Re-experiencing Symptoms
· Unwanted, distressing thoughts about the event
· Recurring distressing dreams with content about the event or impact of the event
· Flashbacks in which the person feels and/or acts as if the event is re-occurring
· Intense emotional and/or physical distress when exposed to triggers related to the event
Avoidance Symptoms
· Attempts to avoid feelings, memories, or thoughts related to traumatic event
· Attempts to avoid external reminders (e.g. people, places, objects, situations, etc.) that cause distress and are associated with the traumatic event.
Arousal/Reactivity Symptoms
· Extreme irritability, anger, or aggression towards people which is an excessive response to the situation
· Reckless or self-destructive behaviors
· Hypervigilance
· Exaggerated startle response
· Problems with attention/concentration
· Sleep disturbance
Mood/Cognition Symptoms
· Difficulty remember certain aspects of the traumatic event
· Persistent negative beliefs about oneself or the world (e.g. “No one can be trusted,” etc.)
· Blaming themselves for the traumatic event
· Persistent distressing emotions
· Inability to experience pleasurable emotions
· Decreased interest or participation in activities
· Feeling detached from others
Diagnosis of PTSD is not a perfect science. Many people experience symptoms in some of these categories, but do not have symptoms in all of these categories or do not have the number of symptoms required for diagnosis. Although the person may not meet criteria for PTSD, they still may require treatment to address trauma related symptoms.
Do Children React to Trauma Differently than Adults?
Just like adults, children and teens can have extreme reactions to trauma but their symptoms can appear differently due to their developmental level. In children, symptoms may include:
· Acting out the event during play
· Wetting the bed after being toilet trained
· Regression in skills (e.g. speech)
· Being unusually clingy with a parent or caregiver
· Extreme tantrums which last long periods of time
It is important to note children may have trouble describing their experience and symptoms so they are more likely to show their symptoms in their behaviors. This can make it difficult for adults to understand their symptoms. If your child’s behavior has changed following a traumatic event, it is important to seek professional help. Teenagers are more likely to show symptoms similar to those seen in adults. They may also become more disruptive, disrespectful, or destructive.
Treatment Options for PTSD
PTSD does not just go away over time but can actually become worse without treatment. Treatment by a mental health professional to help manage symptoms, build coping skills, and re-process trauma in a healthy way is essential for recovery. The main treatment options include medication and trauma-focused therapy. It should be noted medication is typically used to help manage mood and anxiety symptoms but is only a temporary fix. Therapy is needed to address the trauma and help a person work through the root of the symptoms. Treatment for PTSD is highly specific to the person’s individual needs which means a person may need to explore different treatments to find what works for them.
The most well-researched type of medication for treating PTSD are antidepressants. Antidepressants may help control symptoms such as worry, sadness, and anger. Medications have also been used to manage sleep problems and nightmares. It is important to work with your doctor to find the right medication and dose to mange symptoms.
Trauma-focused therapy is the preferred treatment for PTSD. Trauma-focused therapy is similar to traditional counseling in that it helps people manage social, family, or work-related problems by increasing emotion regulation skills, building coping strategies, and improving social skills. However, trauma-focused therapy also incorporates a component to help the client re-process traumatic memories so they do not negatively impact daily life. Many people are hesitant to address their trauma due to fear. It is important to find a therapist who specializes in treating trauma so they can teach a person skills and provide support prior to starting trauma-specific work.
Support from family and friends is also important in managing symptoms related to trauma. Developing reliable and consistent relationships provides support the person but it also helps them learn how to have healthy relationships with others. Family and friends can help a loved one who has experienced trauma by:
· Becoming trauma informed and recognizing trauma symptoms
· Allowing the person to share their trauma history on their own terms
· Being a consistent and reliable relationship
· Incorporating routines, structure, and consistency into daily activities
· Giving choices
· Assist in identifying helpful resources
· Setting reasonable expectations
It is important to get appropriate treatment for PTSD to get relief from symptoms and help you feel more like yourself. Gateway Behavioral Health Consultants specializes in treating anxiety disorders, including trauma, in teens and adults through therapy services. Dr. Ritchie will be hosting a live Q&A on June 23rd at 6pm to answer your questions about treatment for mental health disorders.
For more information about services provided at Gateway Behavioral Health Consultants, click the following link to sign up for our newsletter (https://www.gbhconsultants.com/contact) or contact us at our office via phone (314-325-2685) or email (gbhconsultants@gmail.com).
References
Preventing Adverse Childhood Experiences |Violence Prevention|Injury Center|CDC. (2020, April 03). Retrieved May 27, 2020, from https://www.cdc.gov/violenceprevention/childabuseandneglect/aces/fastfact.html
Post-Traumatic Stress Disorder (PTSD). (2017, November). Retrieved May 27, 2020, from https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd.shtml
Post-Traumatic Stress Disorder. (2019, May). Retrieved May 27, 2020, from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
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