Post-Traumatic Stress

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Post-traumatic Stress Disorder (PTSD):

In children, as well as adults, post-traumatic stress develops after a terrifying ordeal that involves physical harm or the threat of physical harm.  The child who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or strangers.

Having experienced a traumatic event, the child's response typically involves intense fear, helplessness, or horror.  On the other hand, the child may become agitated or disorganized.

Children with post-traumatic stress disorder re-experience the trauma in one or more ways.  They may have recurrent distressing recollections of the event including images, thoughts or perceptions.  The re-experience of the trauma may show up in the repetitive play of the child and in the repetition of themes involved in play.  Children may have dreams and nightmares about the trauma or may react strongly when they experience stimuli or events that remind the child of the traumatic event.

Children with PTSD may startle easily, become emotionally numb (especially in relation to people with whom they used to be close), lose interest in things they used to enjoy, have trouble feeling affectionate, be irritable, become more aggressive, or even become violent.

Many people with PTSD repeatedly relive the trauma in their thoughts during the day and in nightmares when they sleep.  These are called flashbacks.  A person having a flashback may lose touch with reality and believe that the traumatic event is happening all over again.

Symptoms usually begin within 3 months of the incident but occasionally emerge years afterward.  They must last more than a month to be considered PTSD.  The course of the disorder varies.  Some children recover within 6 months, whereas others  have symptoms that last much longer.   

309.81 Post-traumatic Stress Disorder

A. The person has been exposed to a traumatic event in which both of the following were present:

1. The person experienced, witnessed, 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 truamatic event is persistently re-experienced 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 truamatic 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. Persistence avoidance of stimuli associated with trauma and numbing of general responsiveness (not present before the trauma), as 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. Feeling of detachment or estrangement from others

6. Restricted range of affect (eg, unable to have loving feelings)

7. Sense of foreshortened future (eg, does not expect to have a career, marriage, children, or a normal life span.

D. Persistent symptoms of increased arousal (not present before the truama) as indicated by two (or more) of the following:

1. Difficulty falling or staying asleep

2. Irritability or outbursts of anger

3. Difficulty concentrating

4. Hypervigilance

5. Exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.

F. The disturbance causes clinically significant distres sor impairment in social, occupational, or other important areas of functioning.

Specify if:

Acute: if duration of symptoms is less than 3 months

Chronic: if duration of symptoms is 3 months or more

Specify if:

With Delayed Onset: If onset of symptoms is at least 6 months after the stressor.

308.3 Acute Stress Disorder

A. The person has been exposed to a traumatic event in which both of the following were present:

1. The person experienced, witnessed, 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

B. Either while experiencing or after experiencing the distressing event, the individual has three (or more) of the following dissociative symptoms:

1. A subjective sense of numbing, detachment, or absence of emotional responsiveness

2. A reduction in awareness of his or her surroundings (eg, "being in a daze")

3. De-realization

4. Depersonalization

5. Dissociative amnesia (ie, inability to recall an important aspect of the trauma)

C. The traumatic event is persistently re-experienced in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or distress on exposure to reminders of the truamatic event.

D. Marked avoidance of stimuli that arouse recollections of the trauma (eg, thoughts, feelings, conversations, activities, places, people).

E. Marked symptoms of anxiety or increased arousal (eg, difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness).

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual’s ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience.

G. The disturbance last for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the truamatic event.

H. The disturbance is not due to the direct physiological effects of a substance (eg, a drug of abuse, a medication) or a general medical condition.