Posttraumatic Stress Disorder (PTSD) Reactions

REEXPERIENCING

• Intrusive thoughts, feelings
• Traumatic dreams
• Flashbacks
• Intense psychological distress triggered
  by reminders
• Physiological reactivity

PERSISTENT AVOIDANCE

• Of thoughts, feelings, talking of activities, places, people associated with trauma
• Inability to recall
• Numbing, detachment, estrangement
• Restricted affect
• Foreshortened future

INCREASED AROUSAL

• Sleep difficulty
• Irritability, assaultive behavior
• Difficulty concentrating
• Difficulty remembering
• Hypervigilance
• Startle response

PTSD is diagnosed when reactions persist or develop four weeks beyond the initial traumatic incident and when there exists one or more reexperiencing reactions; three or more avoidance reactions and two or more arousal reactions.

PTSD Reactions in Children

• Cognitive dysfunction involving memory and learning. “A” students become “C” students; severe reactions cause others to fail altogether.
• Inability to concentrate. Children who once could complete two and three different tasks now have difficulty with a single task. Parents and educators often react negatively to this behavior because they simply do not understand its cause.
• Tremendous fear and anxiety. One boy who witnessed his father kill his mother when he was seventeen-months-old is now seven-years-old. He still sleeps on the floor, ever ready to run from danger. Six-year-old Elizabeth, whose sister was killed one year earlier, is also sleeping on the floor. She did not witness her sister’s murder, yet she is experiencing this same hypervigilant PTSD response.
• Increased aggression, fighting, assaultive behavior – these are the first reactions generally identified as a change since the trauma. Revenge is a constant theme when the incident has been a violent one.
• Survivor guilt: Students not in school at the time of a random shooting and subsequent death of a fellow student feel accountable and experience intrusive thoughts and images. Another form of survivor guilt is the belief that “It should have been me instead” or “I wish it would have been me instead.”
• Intrusive images (flashbacks): Two years later, teachers still notice this teenage girl engaging in a plucking motion with her hand. She was home when the beating occurred. She did not know her mother was already dead when she ran to help her. When she rolled her mother over, her mother’s mouth was filled with blood and broken teeth. The daughter began pulling the broken teeth from her mother’s mouth so she wouldn’t choke on them. Two years later, that plucking motion still occurred when she’s reexperiencing her experience.
• Traumatic dreams: We first met eleven-year-old Tommy one year after his sister had been stabbed repeatedly in the chest/stomach area and was killed by a serial killer. His sister. He was still having dreams of his “guts” being ripped out by “Candyman ” even though he was not a witness.
• Inappropriate age-related behavior: These include clinging to mother, bed-wetting, and other regressive behaviors. Eleven-year-old Tommy, the boy mentioned above, has started to stutter.
• Startle reactions: After her father beat her mother to death, the police arrived to take pictures and arrest the father. Two years later, this daughter still cannot allow her picture to be taken because it reminds her of that day.
• Emotional detachment: Fifteen-year-old Mary, whose sister was also killed by a serial killer, had made friends that her mother described as “real trouble.” Mary never even cried at the funeral. She had received help, but not trauma-specific help.

Children may exhibit the following behaviors:

• Trouble sleeping, being afraid to sleep alone even for short periods of time.
• Be easily startled (terrorized) by sounds, sights, smells similar to those that existed at the time of the event – a car backfiring may sound like the gun shot that killed someone; for one child, his dog pouncing down the stairs brought back the sound of his father falling down the stairs and dying.
• Become hypervigilant – forever watching out for and anticipating that they are about to be or are in danger.
• Seek safety “spots” in their environment, in whatever room they may be in at the time. Children who sleep on the floor instead of their bed after a trauma do so because they fear the comfort of a bed will let them sleep so hard that they won’t hear danger coming.
• Become irritable, aggressive, act tough, provoke fights.
• Verbalize a desire for revenge.
• Act as if they are no longer afraid of anything or anyone verbalizing that nothing ever scares them anymore and in the face of danger, respond inappropriately.
• Forget recently acquired skills.
• Return to behaviors they had previously stopped, i.e. bed-wetting, nail-biting, or developing disturbing behaviors such as stuttering.
• Withdraw and want to do less with their friends.
• Develop physical complaints: headaches, stomach problems, fatigue, and other ailments not previously present.
• Become accident prone, taking risks they had previously avoided, putting themselves in life threatening situations, reenacting the event as a victim or a hero.
• Developing a pessimistic view of the future, losing their resilience to overcome additional difficulties, losing hope, losing their passion to survive, play, and enjoy life.