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Post Traumatic Stress Disorder, PTSD, is an ongoing reaction to an
unusual and traumatic situation; wherein, you feel your health and
safety or the health and safety of a loved one is threatened. Although
this diagnosis was originally developed in relationship to Vietnam War
veterans, it is now used to include situation of abuse, rape,
kidnapping, torture, near fatal accidents, violent attacks and damaging
acts of nature. Symptoms may include sleep disturbances, appetite
disturbance, haunting vision at day or night of reliving the event,
emotional numbness, detachment, depression, anger or rage, avoidance of
triggers related to the event and the interference of these symptoms in
your everyday life. It is important to know that PTSD can be very
effectively treated with therapy, sometimes, in effective combination
with medication. You can get your life back
and regain a sense of emotional stability that you had before the event.
Please read the following information from the National Institute for
Mental Health. It is a great government resource and note the telephone
number at the end highlighted in red for
support.
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Post-Traumatic Stress Disorder, A Real Illness www.nih.nimh.gov Does This Sound Like You?Have you lived through a scary and dangerous event? Please put a check in the box next to any problems you have.
If you put a check in the box next to some of these problems, you may have Post-Traumatic Stress Disorder (PTSD). PTSD is a real illness that needs to be treated.Many people who have been through a frightening experience. It’s not your fault and you don’t have to suffer. Read this booklet and learn how to get help. You can feel better and get your life back! 1. What is Post-Traumatic Stress Disorder (PTSD)?PTSD is a real illness. People may get PTSD after living through a disturbing or frightening experience. It can be treated with medicine and therapy. You can get PTSD after you have been:
If you have PTSD, you often have nightmares or scary thoughts about the experience you went through. You try to stay away from anything that reminds you of your experience. You may feel angry and unable to trust or care about other people. You may always be on the lookout for danger. You can feel very upset when something happens suddenly or without warning. 2. When does PTSD start and how long does it last?For most people, PTSD starts within about three months of the event. For some people, signs of PTSD don’t show up until years later. PTSD can happen to anyone at any age. Even children can have it. Some people get better within six months, while others may have the illness for much longer. 3. Am I the only person with this illness?No. You are not alone. In any year, 5.2 million Americans have PTSD. 4. What can I do to help myself?
You can feel better. 5. What can a doctor or counselor do to help me?
Here is one person’s story.
Remember — you can get help now.
For More InformationPost-Traumatic Stress Disorder Information and Organizations are available from NLM’s MedlinePlus (en Español).
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PTSD
and KIDS
In children, Post Traumatic Stress Disorder looks very much the same as in adults with few age related exceptions. "Moving in the rhythm of the Child" allows you to access the world of your child. (This title comes from a wonderful video available at www.giftfromwithin.org ) Listen to their words and concerns and understand how the move through the world. Children express themselves through play and metaphor. The greater your understanding of these languages and rhythms, the greater the likelihood for successful resolution. The stress in children may be expressed in disorganized behavior that appears regressive and unusual for the child such as clinging, separation anxieties or bed wetting. If the parent is unaware of a preceding traumatic event, it may be through play therapy that the trauma is uncovered or expressed. In addition to facilitating healing, these modalities, play therapy, art therapy, sandplay, drama or music therapy, may be the first place where the nature of problems such as abuse or family violence is expressed. If your child is experiencing severe physical symptoms, such as rage, anxiety, sleep disturbance, depression ,etc. medication may be a valuable tool in their recovery. Please work with a physician. If the trauma is a large scale disaster, relief for some concerns may come from government agencies or the Red Cross. There are often additional nonprofit agencies in place to help with many of the concerns facing our clients.
Children tend to be quite resilient
and often work through issues related to PTSD catalysts like terrorism
and disasters relatively quickly. With
this in mind stay away from any tendency to overreact. Children are
often quite eager to express themselves through art, acting out, role
playing or any variety of letting us know that they have been affected
and want to "get it out." For a single occurrence of traumatic stress,
it may only take a few days for some kids to rebound to their more
typical selves. With ongoing family violence, intervention will be
more complex and of greater length.
Recognize once again that what may seem like
"abnormal" behavior may be a "normal response to an abnormal
situation." The longer duration of symptoms and interference with daily
life, the more likely there is may a need for clinical intervention.
Many people looked to the news and the internet for information on how
to talk with children following the events of Columbine and 9/11.
Nickelodeon and the Today show both hosted shows for children to talk
about their reactions and solutions. Not meeting violence with violence
emerged as the theme. The younger Nick group aged 9-12 was more
committed to this idea than the older adolescent group, but there was a
voice in opposition to a violent response and that is important.
Terrorism and Children
A National Center for PTSD Fact
Sheet
On Tuesday, September 11, 2001
the nation was shocked by the news of a terrorist attack on the United
States. Two airliners crashed into the World Trade Center and one struck
the Pentagon. There were reports of people seen jumping out of the World
Trade Center to their death. As adults, many of us gathered around
televisions and radio seeking as much information as we could find and
discussing the tragedy among our friends, family, and co-workers. But,
how should we speak to our children about this event? Should we shield
them from such horrors or talk openly about it? How can we help
children make sense of a tragedy that we ourselves cannot understand?
How will children react? How can we help our children? Fortunately,
there have been few terrorist attacks on the United States. One
consequence, however, is that there is little empirical research to help
us answer the above questions. Instead, information from related events
will be used to best try and answer the above questions.
How do children
respond to trauma?
There is a wide range of
emotional and physiological reactions that children may display
following disaster. Based on previous research we know that more
severe reactions are associated with a higher degree of exposure
(i.e. life threat, physical injury, witnessing death or injury,
hearing screams, etc.), closer proximity to the disaster, history of
prior traumas, female gender, and poor parental response and
parental psychopathology.
Findings from a study following the
Oklahoma City bombing indicate that
more severe reactions were
related to female gender, exposure through knowing someone injured
or killed, and bomb-related television viewing/media exposure
(Pfefferbaum et al., 1999; Pfefferbaum et al., 2000).
Below are some common
reactions that children and adolescents may
display
(Dewolfe, 2001; Pynoos & Nader, 1993).
Young Children (1-6)
Helplessness and passivity; lack of usual responsiveness
Generalized fear
Heightened arousal and confusion
Cognitive confusion
Difficulty talking about event; lack of verbalization
Difficulty identifying feelings
Sleep disturbances, nightmares
Separation fears and clinging to caregivers
Regressive symptoms (e.g. bedwetting, loss of acquired
speech and motor skills)
Unable to understand death as permanent
Anxieties about death
Grief related to abandonment of caregiver
Somatic symptoms (e.g. stomach aches, headaches)
Startle response to loud/unusual noises
"Freezing" (sudden immobility of body)
Fussiness, uncharacteristic crying, and neediness
Avoidance of or alarm response to specific trauma-related
reminders involving sights and physical sensations
School-aged Children (6-11 years)
Responsibility and guilt
Repetitious traumatic play and retelling
Reminders trigger disturbing feelings
Sleep disturbances, nightmares
Safety concerns, preoccupation with danger
Aggressive behavior, angry outbursts
Fear of feelings and trauma reactions
Close attention to parents' anxieties
School avoidance
Worry and concern for others
Changes in behavior, mood, and personality
Somatic symptoms (Complaints about bodily aches, pains)
Obvious anxiety and fearfulness.
Withdrawal and quieting
Specific, trauma-related fears; general fearfulness.
Regression to behavior of younger child.
Separation anxiety with primary caretakers.
Loss of interest in activities.
Confusion and inadequate understanding of traumatic events
most evident in play rather than discussion.
Unclear understanding of death and the causes of "bad"
events.
Magical explanations to fill in gaps in understanding.
Loss of ability to concentrate and attend at school, with
lowering of performance.
"Spacey" or distractible behavior.
Pre-adolesents and Adolescents (12-18 years)
Self-consciousness
Life-threatening reenactment
Rebellion at home or school
Abrupt shift in relationships
Depression, social withdrawal
Decline in school performance
Trauma-driven acting-out behavior: sexual acting out or
reckless, risk-taking behavior.
Effort to distance from feelings of shame, guilt, and
humiliation.
Flight into driven activity and involvement with others or
retreat from others in order to manage their inner turmoil.
Accident proneness.
Wish for revenge and action-oriented responses to trauma.
Increased self-focusing and withdrawal.
Sleep and eating disturbances; nightmares.
How to talk to
your child
Create a safe environment. One of the most important steps you can take is making children feel safe. If possible, children should be in a familiar environment with people that they feel close to.
Keep your child's
routine as similar as possible.
There is comfort in having
things be consistent and familiar.
Provide reassurance to
children and extra emotional support.
Adults need to create an
environment in which children feel
safe enough to ask questions,
express feelings, or just be by
themselves. Let your children
know they can ask questions.
Ask your children what they have
heard and how they feel
about it. Reassure your child that they
are safe and that you
will not abandon them.
Be honest with children about what happened.
Provide
accurate information, but make
sure it is appropriate to their
developmental level. Very young
children may be protected
because they are not old enough to be
aware that something
bad has happened. School age children
will need help
understanding what has happened. You
might want to tell
them that there has been a terrible
accident and that many
people have been hurt or killed.
Adolescents will have a
better idea of what has
happened. Talk to them about terrorism and how the United States
responds to terrorism. It
may be appropriate to watch selected
news coverage with
your adolescent and then discuss it.
Tell children what the government is doing.
Reassure children
that the state and federal
government, the police, firemen, and
the hospitals are doing
everything possible. Explain that
people from all over the country
and from other countries
offering their services.
Be aware that children
will often take on the anxiety of the
adults
around them. Parents have a difficult job of finding a
balance between sharing their
own feelings with their children
while at the same time not
placing their anxiety on their
children. For many, the attack
on the United States was
inconceivable. Our sense of safety and
freedom was
shattered. Many parents may feel
scared and fearful of
another attack. Others may be angry and
revengeful. Parents
must deal with their own
emotional reactions before being
able to help children understand
and label their feelings.
If you are frightened, tell your child,
but also talk about your ability to cope and how you as a family can
help each other.
Try and place the attack in
perspective. Although you
yourself may be anxious or scared,
children need to know
that what they witnessed or
heard about regarding the attack
is a rare event. Most people
will never be attacked by
terrorists and the world is
generally a safe place.
When healing from a
traumatic event learn all you can about the nature of PTSD,
education and normalization are part of the healing process. Try to
make time to engage in normal pleasurable activities. Do not push
yourself too fast or too soon, Things have happened that were
outside of your control, give yourself permission to regain some
control, take small steps and regain your trust.
When should you seek professional
help for your self or your child?
Parents of children with prolonged
reactions or more severe reactions may want to seek the assistance
of a mental health counselor. It is important to find a counselor
who has experience working with children as well as with trauma.
Referrals can be obtained though the American Psychological
Association at
1-800-964-2000.
You may also access referrals through
National Association of Social Workers
California Association of Marriage
and Family Therapists National
Board of Certified Counselors
References:
DeWolfe, D. (2001).
Mental Health Response to Mass Violence and
Terrorism: A Training Manual for Mental Health
Workers and Human
Service Workers.
Monahan, C. (1993).
Children and Trauma: A Parent's Guide to Helping
Children Heal. Lexington Books, New York, NY.
Pfefferbaum , B.,
Nixon, S., Tucker, P., Tivis, R., Moore, V., Gurwitch,
R., Pynoos, R., & Geis, H. (1999). Posttraumatic
stress response in
bereaved children after Oklahoma City bombing.
Journal of the American
Academy of Child and Adolescent Psychiatry, 38,
1372-1379.
Pfefferbaum, B.,
Seale, T., McDonald, N., Brandt, E., Rainwater, S.,
Maynard, B., Meierhoefer, B. & Miller, P. (2000).
Posttraumatic stress
two years after the Oklahoma City bombing in
youths geographically
distant from the explosion. Psychiatry, 63,
358-370.
Pynoos, R. & Nader,
K. (1993). Issues in the treatment of posttraumatic
stress in children and adolescents. In J.P.
Wilson and B. Rapheal (Eds.),
International Handbook of Traumatic Stress
Syndromes (pp. 535-549).
New York: Plenum.
The information on this
Web site is presented for educational purposes only. It is not a
substitute for informed medical advice or training. Do not use this
information to diagnose or treat a mental health problem without
consulting a qualified health or mental health care provider.
The
best resource I have found for understanding PTSD and receiving support
from a community of survivors is
Gift From Within. Please visit this valuable resource.
We gratefully acknowledge the following authors and sources for permission to link and download.
The National Center for Post
traumatic StressPrins, A., Kimerling, R., Cameron, R., Oumiette, P.C.,
Shaw, J., Thrailkill, A., Sheikh, J. & Gusman, F.
(1999).
The Primary Care PTSD Screen (PC-PTSD). Paper presented at the 15th
annual meeting of the
International Society for Traumatic Stress Studies, Miami, FL.
National Clearinghouse for Child Abuse and Neglect at http://calib.com/nccanch
Richard Leslie, The California Therapist January/February 1990 issue of The California Therapist, the publication of the California Association of Marriage and Family Therapists, San Diego, California.)
A National Center for PTSD
Fact Sheet
References:
DeWolfe, D.
(2001). Mental Health Response to Mass Violence and
Terrorism: A Training Manual for Mental Health Workers and Human
Service
Workers.
Monahan, C.
(1993). Children and Trauma: A Parent's Guide to Helping
Children Heal. Lexington Books, New York, NY.
Pfefferbaum ,
B., Nixon, S., Tucker, P., Tivis, R., Moore, V., Gurwitch,
R.,
Pynoos, R., & Geis, H. (1999). Posttraumatic stress response in
bereaved children after Oklahoma City bombing. Journal of the American
Academy
of Child and Adolescent Psychiatry, 38, 1372-1379.
Pfefferbaum,
B., Seale, T., McDonald, N., Brandt, E., Rainwater, S.,
Maynard, B., Meierhoefer, B. & Miller, P. (2000). Posttraumatic stress
two
years after the Oklahoma City bombing in youths geographically
distant
from the explosion. Psychiatry, 63, 358-370.
Pynoos, R. &
Nader, K. (1993). Issues in the treatment of posttraumatic
stress
in children and adolescents. In J.P. Wilson and B. Rapheal (Eds.),
International Handbook of Traumatic Stress Syndromes (pp. 535-549).
New
York: Plenum.
http://playtherapycentral.com/ideas.html
Moving in The Rhythm of the Child video, Gift From Within
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