Therapy in L.A.


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November 2001
By Joyce Parker, Ph.D.

Reuters News Agency reported on Oct 29, 2001 from the 48th Annual Meeting of the American Academy of Child and Adolescent Psychiatry information concerning PostTraumatic Stress Disorder or PTSD. In one study, of the 60% of children and adults who experienced a traumatic stressor, 20% to 30% had full symptomatic Post-Traumatic Stress Disorder. Approximately 20% of the subjects had partial PTSD. This means that 40% to 50% of individuals who experience a traumatic event such as an injury, serious illness or death in the family, family violence, a natural disaster, a severe accident or a violent criminal act are vulnerable to this disorder

The symptoms of PTSD involve re-experiencing the traumatic event in various ways. Often the individual has recurrent and intrusive memories of the event. The trauma can be re-experienced through distressing dreams that replay the event. Sometimes the person actually feels as if they are reliving the event and behave as though they are experiencing the event in the present. Intense psychological distress can occur when the person is exposed to a triggering event that is similar to the trauma. For example, a soldier who has been discharged from the military and is home but seeks cover when hearing firecrackers go off. Or a woman who has been raped in a public bathroom feels intense anxiety when walking into a public restroom.

Often, an individual will attempt to avoid thoughts, feelings or conversations about the traumatic event. There is a diminished responsiveness to the external world and those people who are closest to the individual. This feeling is often described as a “psychic numbing”. There is a reduced ability to feel emotions, a feeling of detachment from others. The individual may complain of diminished interest or enjoyment of activities and interests. There may also be persistent symptoms of anxiety not present before the trauma. Insomnia may occur as well as hypervigilance and an exaggerated startle response. Some individuals may become very irritable or have outbursts of anger. Some may have difficulty concentrating or completing tasks.

Children who have full or partial PTSD often exhibit problems with anxiety and depression. They can also become disruptive at home or in school. Clinicians may then diagnose mood or anxiety disorders and miss the PTSD diagnosis. Children are unable to conceptualize the reasons for their feelings or problematic behavior. They lack awareness of why they do what they do or feel what they feel that is not concrete in nature. Therefore they usually report concrete daily events as stressors such as falling off a bike or being bullied by another child. They would not be able to report their misbehavior at school or their anxiety on the playground as having to do with family violence or a serious accident suffered by a member of their family.

When children are exposed to domestic violence, 42% of them may develop PTSD according to Dr. Claude Chemtob of the National Center for PTSD in Honolulu, Hawaii. Dr. Eyal Shemesh, of Mount Sinai Medical Center, found high levels of PTSD in another study of children being treated in an emergency room for injuries or illness and among child transplant recipients.

Thus, professionals and parents need to be aware of the symptoms of PTSD that their children may be exhibiting after a traumatic event, because the child may not be able to report accurately what they are feeling and why they are feeling that way. In a survey of mothers who used domestic violence agencies, the mothers could report their own symptoms but could not describe symptoms in their children that would have helped to determine if the children had PTSD. It is clear that interventions to help families deal with traumatic events must focus on the affected children as well as the family unit or the adults in order to be successful.

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