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Although your child wasn't seriously injured, over the past month you've noticed that your teen has become increasingly withdrawn and anxious.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
- fire
- physical or sexual abuse
- senseless acts of violence (such as school or neighborhood shootings)
- natural or man-made disasters
- car accidents
- military combat (this form of PTSD is sometimes called "shell shock")
- witnessing another person go through these kinds of traumatic events
- diagnoses of life-threatening medical illnesses (now recognized by mental health professionals as a trigger for PTSD in some people)
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.
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.
Causes of PTSD
Any of the traumatic events listed above can cause PTSD. Studies also indicate that people who live with the disorder tend to have abnormal levels of key hormones involved in the stress response.
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.
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, symptoms are easy to identify — they often resemble symptoms of depression. However, posttraumatic stress is not the same as depression.
Signs and symptoms of PTSD include:
- sleeplessness
- nightmares
- inability to get along with others, particularly in close relationships
- paranoia and distrust
- unwillingness to discuss or revisit in any way the site of the trauma
- persistent, intense fear and anxiety
- feeling easily irritated or agitated
- having difficulty concentrating
- feeling numb or detached
- no longer finding pleasure in previously enjoyable activities
- feeling helpless or "out of control"
- experiencing intense survivor guilt
- being preoccupied with the traumatic event
- physical symptoms such as headaches, gastrointestinal distress, or dizziness
- suicidal thoughts, plans, or gestures
People with the disorder often don't seek professional help because they don't recognize the link between their symptoms and the trauma they experienced. They also may avoid discussing the problem because dealing with anything related to the event makes them feel anxious or helpless.
Treating PTSD
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 instances, symptoms of PTSD might not even appear for several months or longer following the traumatic event. Fortunately, mental health and medical professionals can effectively treat it.
Your child's teacher, doctor, or any other caregiver who routinely sees your child can play an important role in recognizing and treating PTSD. Other mental health professionals who can help 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 to help alleviate serious symptoms of depression and anxiety, which can help your child cope with school and other daily activities while being treated for PTSD. 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 the therapist for specific referrals or suggestions for a group.
Helping Your Child
It's essential to understand that PTSD is an emotional condition and that your child's traumatic experience has left "emotional scar tissue." So, it's important to show 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.
Here are some other things parents can do to support kids with PTSD:
- 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." Support and understanding from parents can help kids accept their most frightening emotions.
- Encourage them to get involved in a support group for trauma survivors. Check with local hospitals or mental health associations to locate groups nearby.
- Get professional help immediately if there's any suspicion that a child might be suicidal. Thoughts of suicide are serious at any age and require prompt and effective intervention.
- Let them make simple decisions whenever appropriate. Because PTSD often makes a child feel powerless, parents can help their kids by showing them that they have control over certain aspects of their lives. Depending upon their children's ages, parents might consider letting them decide things like what's for dinner or how to spend the day.
- Tell them that the traumatic event is not their fault. Encourage kids to talk about their 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 care for kids with PTSD.
- 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's perfectly normal and can help kids to self-soothe.
Also, take care of yourself so that you're well equipped to help your child. You can't be supportive if you're neglecting your own emotional or physical health. Dealing with PTSD can be very challenging, but appropriate treatment and support are available to you and your loved ones.
Reviewed by: David V. Sheslow, PhD
Date reviewed: November 2004
Originally reviewed by: Jodie M. Ambrosino, PhD
