Post Traumatic Stress Disorder and Complex Post Traumatic Stress Disorder in Children and Teenagers

When we hear the word PTSD, images of soldiers and veterans spring to mind. For decades, people associated post traumatic stress disorder with terrifying events that occurred during a war, in fact, until the 1980’s this stress disorder was known as ‘shell shock’ or ‘battle fatigue.’ The reality is that PTSD has existed forever, but only recently has it been recognised as a serious mental disorder that can affect anyone regardless of age, gender, race, occupation. Research conducted in 2018 found that approximately 85 percent of first responders experience symptoms of PTSD, up to 20 percent of Iraqi war veterans are diagnosed with PTSD each year (the numbers are only slightly less for other wars), 12.3 percent of victims of sexual assault and up to 15 percent of children/teenagers develop PTSD every year. in the USA, it is estimated that 8 million children and adults have PTSD.

The Effect of PTSD/CPTSD on the Brain
Whenever we experience a stressful, frightening or life-threatening event, our body responds to the extreme stress by going into fight/flight/fight mode. With PTSD and CPTSD the wiring in the brain gets stuck in danger mode. The areas affected: the amygdala, hippocampus, ventromedial prefrontal cortex are part of the neural circuitry that manages stress, and all play a role in triggering the symptoms of PTSD. For example, the amygdala helps to process emotions and fear responses. The hippocampus controls appropriate responses to environmental stimuli so the amygdala does not go into stress mode unnecessarily, and the ventromedial prefrontal cortex regulates emotional responses by controlling the amygdala. In PTSD, there is hyperactivity in the amygdala which triggers feelings of anxiety, panic and stress when reminded of the trauma. The hippocampus becomes hypoactive due to shrinkage which results in difficulty distinguishing between past/present memories, whilst shrinkage in the ventromedial prefrontal cortex results in difficulty correctly interpreting environmental contexts, consequently, the amygdala goes into a ‘tizzy’ (Wlasoff, 2015). The five trauma responses that someone with PTSD/CPTSD experience include:

  • Fight: angry, aggressive outbursts, may bully others, self-preservation at all costs, may try to control others
  • Flight: panic and anxiety, over worrying, may become obsessive compulsive, unable to relax, may have a hiding place
  • Freeze: dissociates, brain fog, isolates self, unable to make decisions, feels lifeless, spaced out
  • Flop/Fawn: overcaring, scared to speak opinion, can be seen as a ‘sucker’ or people pleaser
  • Friend: bonds with and will protect abuser (usually occurs after prolonged childhood abuse)

 

Post Traumatic Stress Disorder (PTSD)
PTSD usually occurs in those who have experienced (or were threatened by) a shocking, scary or dangerous event. It usually occurs within the first month of the trauma but for some, symptoms may not show up until months or even years later. It is estimated that approximately 43 percent of children/teenagers experience a severe traumatic event before the age of 18 years. Of those kids, 3 to 15 percent of girls and 1 to 6 percent of boys develop PTSD. The general consensus is that children/teenagers who experience the most severe trauma usually have the highest levels of PTSD symptoms, and the more frequent the trauma, the more likelihood the child/teenager will exhibit signs and symptoms of CPTSD. What is important to point out however, is that not everyone who experiences a traumatic event will develop PTSD. The likelihood of developing PTSD is based on many factors including:

  • Support network
  • Personality and previous coping strategies
  • History of mental health issues
  • Family history
  • ACEs (adverse childhood events)
  • Current stress level and ability to manage stress
  • Type of traumatic event
  • Pre-existing mental disorder, learning difficulties and/or other health problems

Traumatic Experiences which can lead to PTSD include:

  • Violent attack: rape, assault, mugging
  • Motor vehicle accident, transportation accident
  • Natural disasters: fire, earthquake, hurricane
  • Being diagnosed with life threatening illness
  • Abuse: physical, sexual, emotional, or witness to abuse
  • Survivor guilt
  • Bullying
  • Unexpected and/or violent death of a parent or other family member, friend, teacher
  • Violence at school/community: mass shootings
  • Traumatic event such as drowning, choking

Signs & Symptoms of PTSD
Signs and symptoms of PTSD in children/teenagers, are similar to those of adults, however, younger children may exhibit more fearful and regressive behaviours, and may enact the trauma through play and/or drawings. Children and teenagers with PTSD have symptoms of stress, anxiety and depression that include:

  • Repeated memories of traumatic event: nightmares, flashbacks, feeling on edge, emotional distress when reminded of event
  • Avoidance of any reminder of the event: will not talk/think about event; avoids places, people, activities connected with event; unable to recall important details about traumatic experience
  • Ongoing negative mood: feelings of anger, shame, guilt; blames self; detaches self from others and from once enjoyed activities; unable to experience hope/positive emotions; fixed beliefs that world is unsafe
  • Emotional and physical responses: sleep difficulties, mood swings, easily startled, hypervigilant, poor attention span,

Complex Post Traumatic Stress Disorder (CPTSD)
CPTSD results from repeated trauma over months, even years rather than a single event. The difference between PTSD and CPTSD is that in CPTSD there is a distortion of the person’s core identity and significant emotional dysregulation. It is thought that trauma has lasting effects on the amygdala, hippocampus and prefrontal cortex, all of which play a role in memory function and response to stressful situations. Traumatic experiences that can lead to CPTSD include:

  • Human trafficking
  • Chronic abuse: sexual, physical, social, emotional, psychological
  • Living/fighting in a war zone
  • Victim of a kidnapping/hostage situation
  • Domestic violence
  • Sweatshop workers
  • Severe, ongoing neglect
  • Belonging to a religious cult

Signs & Symptoms of CPTSD

Children and teenagers with CPTSD will experience the symptoms of PTSD and
difficulty controlling emotions

  • feeling empty, damaged and worthless, nobody understands him/her
  • hostile and distrustful of others and the world
  • distortions in relationships: has few if any friends, hostile behaviour with family
  • withdrawal and isolation
  • suicidal ideation
  • dissociation memory disturbances: time loss, blackouts, source amnesia, fugue episodes
  • dissociation process symptoms: depersonalization, trance like states, alter personality states, switching behaviours, auditory hallucinations

It is important to point out that signs and symptoms of CPTSD are very similar to borderline personality disorder, therefore a thorough assessment, cognitive testing and psychiatric evaluation is imperative to ensure an appropriate treatment plan is initiated.

Treatment Options for PTSD & CPTSD
Treatment of PTSD and CPTSD is multilayered and very specific to the person’s individual needs. In effect, the healing must begin from the inside out.

  • Medications: antidepressants, anti-anxiety medications may be prescribed short-term
  • Therapy: Two specific therapeutic interventions have been found to be very successful in treating PTSD and CPTSD: Cognitive Behavioural Therapy and Eye Movement
  • Desensitization and Reprocessing Therapy
  • CBT teaches the child/teenager ways to replace negative thoughts and feeling with positive ones. Over time, these behavioural strategies help desensitize the child/teenager to the traumatic event and reduces the anxiety and fear
  • EMDR combines cognitive therapy with directed eye movements
  • Play therapy is most helpful with young children
  • Group therapy/support groups are also helpful as they offer peer support and guidance, and help the child/teenager understand that he/she is not alone.
  • Pet Therapy: provide companionship, assist with medical crisis, provide treatment related assistace, offer safety and security, safely awakens child/teen from flashbacks, assist with depression, anxiety, emotional overload

How to Help a Child/Teenager with PTSD or CPTSD

  • Be patient, supportive, understanding and show love
  • Reassure the child/teen that the feelings and mood changes are ‘normal’ and it will get better
  • Reinforce to the child/teenager that the traumatic event is not his/her fault
  • Be there for your child/teen, let them talk about the trauma in his/her own time. Do not pressure, instead listen, validate and praise
  • Do not criticize or tease any regressive behaviour eg sleep with light on
  • Maintain a daily routine and try to keep to child/teenager’s schedule as much as possible
  • Encourage healthy lifestyle: exercise, rest, diet
  • Follow up with medical appointments, therapy
  • Ensure medications are taken (if prescribed) and monitor for potential side effects
  • Meet with teacher, school counsellor and discuss plan of care. Research indicates that kids with PTSD will experience academic problems
  • Talk with siblings, other family members, friends. Explain how best to support and empower child/teenager
  • If child/teenager has a pre-existing mental disorder, health ailment, learning disability, continue to monitor, treat and observe for any changes
  • Know the warning signs of suicide. If child/teenager appears suicidal or expresses a wish to die, seek medical help immediately
  • Check on-line activity, sites visited, chatrooms, etc
  • Be alert to sudden changes in friends, style of dress, behaviour, routine. Children/teenagers with PTSD can turn to alcohol and drugs to help deal with emotional pain, may self-harm, can become the victim of a bully and/or become a bully

*V. Wlassoff. How Does PTSD Change the Brain. The Brain Blogger 1, 24:15

In my next Blog #22
I will discuss Borderline Personality Disorder in Children and Teenagers

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