Karen KneisleyChild & Adolescent Psychopathology Argosy University
PTSD is an abnormal reaction to an abnormal event involving a complex interaction of biological, psychological, and social causes. (Yehuda & McFarlane, 1995)
o Majority of individuals exposed to trauma do not develop the disordero Not rare relative to other disorderso DSM-IV cites prevalence rates ranging from 3% to 8%o Of 5,687 young Americans reactions to Hurricane Hugo, 5.4% met Criteria A-D for PTSDo 3.5% of youths seeking alcohol or drug care were diagnosed with PTSD
o 3% of those using mental health serviceso 2.8% of those identified with serious mental health problems at schoolo 1.7% of those in the child welfare systemo 3.1% of those in the juvenile justice system
A. The person has been exposed to a traumatic event in which both of the following were present : (1) the person experienced, witnesses, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) the person’s response involved intense fear, helplessness, or horror. Note : In children, this may be expressed instead by disorganized or agitated behavior.B. The traumatic event is persistently reexperienced in one (or more) of the following ways: (1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.(3) acting or feeling as if the traumatic event were recurring ( includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(5) Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness ( not present before the trauma), is indicated by three (or more) of the following: (1) efforts to avoid thoughts, feelings, or conversations associated with the trauma (2) efforts to avoid activities, places, or people that arouse recollections of the trauma (3) inability to recall an important aspect of the trauma (4) markedly diminished interest or participation in significant activities (5) feelings of detachment or estrangement from others (6) restricted range of affect ( e.g., unable to have loving feelings) (7) sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
D. Persistent symptoms of increased arousal ( not present before the trauma), as indicated by two (or more) of the following: (1) difficultly falling or staying asleep (2) irritability or outbursts of anger (3) difficulty concentrating (4) hypervigilance (5) exaggerated startle responseE. Duration of the disturbance (symptoms in Criteria B, C, and D ) is more than 1 month.F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
o Combato Violent crimeo Childhood physical or sexual abuseo Accidentso Natural disasters
Re-experiencingo Repetitive and intrusive thoughtso Vivid re-enactment of the traumao Sleep cycle disturbanceso Changes in mood and behavior
Avoidanceo Avoid thoughts and feelings or situations or activitieso Suppression of negative affecto Emotional constrictiono Foreshortened view of the future
Ethnic and Cultural Variationso Reactions to acute, nonabusive stressorso Reactions to chronic or abusive stressors
Developmental Differenceso Reactions to overwhelming stimulio Cognitive development
o Social supporto Parenting styleo Family discord vs. cohesion
o Focus on the self, environment or othero Serve to solve problems or manage emotionso Coping styles can include- Information seeking Support seeking Direct action Inhibition of action Intrapsychic coping
o Trauma Symptom Checklist for Childreno Child’s Reaction to Traumatic Eventso Child PTSD Reaction Indexo Childhood PTSD Interviewo Children’s PTSD Inventoryo Child Behavior Checklist
o Psycho-educationo Symptom-monitoringo Re-establishing routineso Coping skills trainingo Graded exposureo Safety skills & self-regulationo Parent training