Download Psychic Trauma - Rutgers University Behavioral Health Care

Psychic Trauma
& Children’s Mental Health
Robert L. Johnson, MD, FAAP
Professor and Chair of Pediatrics
Professor of Psychiatry
Director of Adolescent and Young Adult Medicine
Keith Bratcher
Administrative Aide
Psychic Trauma
 Experience that is emotionally painful,
distressful, or shocking, which often results
in lasting mental and physical effects.
 A normal response to an extreme event.
 Involves the creation of emotional memories
about the distressful event that are stored in
structures deep within the brain.
Psychic Trauma
 In general, it is believed that the more direct
the exposure to the traumatic event, the
higher the risk for emotional harm.
 But even second-hand exposure to violence
can be traumatic.
Traumatic events
 Violence
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personal assaults such as rape or mugging
exposure to violence in the home or on the streets can
lead to emotional harm
directly or indirectly witnessing or experiencing a violent
or catastrophic event
 Natural or human-caused disasters
 Accidents
 Military combat
Reactions to Psychic Trauma
 Some suffer only worries and bad memories
that fade with emotional support and the
passage of time.
 Others are more deeply affected and
experience long-term problems.
Reactions to Psychic Trauma:
Children And Adolescents
 Children 5 years of age and younger:
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Fear of being separated from the parent
Crying
Whimpering
Screaming
Immobility and/or aimless motion
Trembling
Frightened facial expressions and excessive clinging.
Reactions to Psychic Trauma:
Children And Adolescents
 Children 5 years of age and younger:
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Returning to behaviors exhibited at earlier ages
(these are called regressive behaviors), such as
thumb-sucking, bedwetting, and fear of darkness.
Children in this age bracket tend to be strongly
affected by the parents' reactions to the traumatic
event.
Reactions to Psychic Trauma:
Children And Adolescents
 Children 6 to 11 years old :
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extreme withdrawal
disruptive behavior
inability to pay attention
regressive behaviors, nightmares, sleep problems,
irrational fears
irritability
refusal to attend school or poor school performance
outbursts of anger and fighting
Reactions to Psychic Trauma:
Children And Adolescents
 Children 6 to 11 years old :
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Stomach aches
Somatic symptoms that have no medical basis
Depression
Anxiety
Feelings of guilt
Emotional numbing or "flatness"
Reactions to Psychic Trauma:
Children And Adolescents
 Adolescents 12 to 17 years old:
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Responses similar to those of adults
ATOD abuse
Problems with peers
Anti-social behavior
Withdrawal and isolation
Physical complaints
Suicidal thoughts
School avoidance, academic decline
Reactions to Psychic Trauma:
Children And Adolescents
 Adolescents 12 to 17 years old:
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Feelings of extreme guilt over his or her failure
to prevent injury or loss of life
Revenge fantasies that interfere with recovery
from the trauma.
Post-traumatic stress disorder
(PTSD)
 An anxiety disorder
 Exposure to a terrifying event or ordeal
 Grave physical harm occurred or was
threatened
Prevalence of PTSD
 3.6 percent of U.S. adults ages 18 to 54 (5.2 million
people) have PTSD during the course of a given
year.
 Rates of PTSD identified in child and adult
survivors of violence and disasters vary widely.
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2% after a natural disaster (tornado)
28% after an episode of terrorism
29% after a plane crash
Symptoms of PTSD
 Symptoms last more than 1 month
 Repeatedly re-experience the ordeal in the
form of
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Flashback episodes
Memories
Nightmares
Frightening thoughts
Symptoms of PTSD
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Emotional numbness
Sleep disturbances
Depression
Anxiety, irritability
Outbursts of anger
Feelings of intense guilt
Poor concentration
Startle reaction
Regressive behavior
Symptoms of PTSD
 Symptoms worsened by exposure to events
(anniversaries) or objects reminiscent of the
trauma.
 Routine avoidance of reminders of the event
or a general lack of responsiveness (e.g.,
diminished interests or a sense of having a
foreshortened future).
When Does PTSD First
Occur?
 PTSD can develop at any age, including in
childhood.
 Symptoms typically begin within 3 months of a
traumatic event, although occasionally they do not
begin until years later.
 Once PTSD occurs, the severity and duration of the
illness varies. Some people recover within 6
months, while others suffer much longer.
Co -morbidities
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Depression
Alcohol or other substance abuse
Anxiety disorder
Headaches
Gastrointestinal complaints
Immune system problems
Dizziness
Chest pain
Discomfort in other parts of the body
Predilections
 Characteristics of the trauma exposure
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Proximity to trauma
Severity
Duration
Predilections
 Characteristics of the individual
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Prior trauma exposures
Childhood abuse
Family history/prior mental illness
Gender
Family support
Predilections
 Post-trauma factors
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Availability of social support
Emergence of avoidance/numbing
Hyperarousal
Re-experiencing symptoms
Treatment
 Trauma/grief-focused psychotherapy
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cognitive-behavioral therapy
group therapy
exposure therapy
 Medications
 Counseling soon after a catastrophic event