SYMPTOMS OF PTSD The symptoms usually start to appear days or weeks after the trauma, though it can also take months and even years. It can also be difficult to recognize the symptoms as posttraumatic stress disorder, which will be discussed later. Also important to note is that a person’s experience of PTSD can be affected by culture, age, sex, and socio-economic factors, although age and sex have borne the most conclusive variants. For some people there are periods of remission of the symptoms and times when they are worsened. For some, though, their symptoms may be consistent and severe. A diagnosis is made when a certain number of symptoms from each of three categories have lasted for more than one month and cause severe problems in the person’s day-to-day life. These categories are: Intrusion, which is characterized by flashbacks and/or nightmares which happen suddenly and are vivid. Avoidance, meaning the person will start to avoid people, places, close relationships, and events that might trigger reminders of the trauma. Linked to this avoidance is emotional numbness/diminished emotional capacity. There can also be a flood of emotions or numbness resulting from remembering or re-experiencing the event. Hyperarousal, recognizable as the person being extra alert and on-guard, as though they are constantly being threatened. They may also become suddenly angered, irritable or defensive, even when they are not provoked, and have an “exaggerated startle reaction.” (APA website) The physical symptoms include headaches, gastrointestinal and immune system problems, dizziness, chest pain, and physical discomfort, such as body aches. Age This really speaks to the difference between children’s PTSD and that experienced by adults. There are three factors that affect the development of PTSD in children, which can manifest itself in children as young as pre-elementary-school-aged. Those factors are the severity of the trauma the parental response to the event the child’s physical proximity to violence, if applicable. Symptoms for Pre-elementary ages: children may develop stranger/separation anxiety, avoidance of situations, whether or not they are related to the trauma, and the possible loss of an acquired skill, such as toilet training. Symptoms in Elementary ages: children in this age group may not experience the intrusion aspect of symptoms, but do suffer from two rather specific manifestations. The first is “time skew,” meaning they have trouble placing trauma-related events and occurrences in sequence. The second is “omen formation,” or the belief that there are signs that predict a traumatic event, so the child will believe that if they are vigilant and alert, they’ll recognize future omens and avoid other traumas. Posttraumatic play and reenactment also affects this age group. Whereas posttraumatic play is the literal acting-out of the trauma, posttraumatic reenactment is behavioral re-creations of the event, like carrying a weapon after exposure to violence. In posttraumatic play, there is a compulsion to repeat some part of the trauma that does little or nothing to relieve anxiety. Children may exhibit posttraumatic play and reenactment through art and verbalizations as well. Symptoms in Adolescents: mirror many of the adult symptoms, but this group is more likely to engage in posttraumatic reenactment, distinguished in this age group by incorporating aspects of the trauma into their daily lives. This age group is also the most likely of any other group to experience impulsive and aggressive behaviors. It is also important to be aware that children who do not develop PTSD will often develop other problems, including depression, anger, hostility, self-destructive behavior, feelings of isolation and stigma, low self-esteem, substance abuse, relationship problems with friends and family, and poor school performance, to name just a few. It is also possible for them to have behavioral, interpersonal, panic, or separation disorders, as well as attention deficit or hyperactivity disorders. Sex Research indicates that women are twice as likely as men to develop PTSD. While about 7.5% of male Vietnam veterans have experienced “clinically serious stress reaction symptoms,” almost half of all female Vietnam veterans have done so. Also, the comorbid traits occur in differing percentages between the sexes. The most prevalent problems for men are, in order: alcohol/substance abuse, major depression, and conduct disorders. For women, the order is major depression, simple phobias (fears of specific things or situations), social phobias (fear of humiliation and being watched doing things in front of people), and substance and alcohol abuse. WHY IT CAN BE DIFFICULT TO RECOGNIZE SOMEONE IS SUFFERING FROM PTSD The symptoms of PTSD, particularly the physical manifestations, can be very difficult for the person or others to recognize. Often, other people and the person who has been traumatized think and hope that they will get over it. The sufferer will also frequently feel guilt about the event and feel that they deserve the pain. The connection between the trauma and problems may not be made, particularly if these problems do not occur immediately after the trauma. More than 75% of people who have PTSD have other diagnosable problems. The most prevalent and encountered accompaniments to PTSD are: Depression Substance/Alcohol abuse Anxiety disorders Interpersonal/relationship disorders Phobias. Likewise, these accompanying disorders may be more prominent and recognizable, hence people only seek help for these problems. TREATMENT The therapies used to treat people with PTSD include psychological and drug therapies. The most promising therapy to date appears to be cognitive-behavioral therapy (which includes education on the disorder, anxiety management techniques, and exposure, or slowly exposing the patient to situations that trigger their symptoms in a controlled environment). Group and exposure therapies have also proven to be extremely effective. Of course, treatment for children is often different. Some children will actually undergo a natural remission by themselves through their own growth and development. But for the many who do not, cognitive-behavioral therapy (with parental involvement) is frequently used. Play therapy is often helpful for younger children as well. “I love color—deep, rich, intense and vivid color. Color… soothes and numbs, explains, speaks, and confuses.” (Theodore Gostas, NVVAM artist) Art therapy is another treatment option that is highly effective for both adults and children. The use of art therapy stems from the 1930s, when psychiatrists explored artwork their patients were doing. Concurrently, according to the American Art Therapy Association, “art educators were discovering that the free and spontaneous art expression of children represented both emotional and symbolic communications.” Significant work is being done at the Roudebush VA hospital in the Healing Arts Project by Drs. Michael Gatton and William Calvert, who have joined efforts in FOBHA, Free On Board Healing Arts, which is led by Jerry Baker. www.psych.org/public_info/ptsd.cfm. Retrived May 18, 2005. “What is PTSD?” ncptsd.va.gov. Retrieved May 17 www.ncptsd.va.gov/facts/general/fs_what_is_ptsd.html. Retrieved May 17, 2005. WHOM TO CONTACT FOR MORE INFORMATION These lists are by no means exhaustive. You can find more local resources in the Yellow Pages under “counseling,” “hospitals,” “mental health,” “psychologists,” “psychotherapists,” “social and human services,” “social workers” and in the Government sections as well. NATIONAL: Sidran Foundation at 410.825.8888 or online: www.sidran.org Anxiety Disorders Association of America at 800.964.2000 or online: www.adaa.org NAMI at 800.950.6264 or online: www.nami.org National Center for PTSD: www.ncptsd.va.gov The PTSD Alliance at 877.507.PTSD or online: www.ptsdalliance.org or via email: info@ptsdalliance.org American Psychiatric Association at 703.907.7300 or online: www.psych.org or via email: apa@psych.org American Psychological Association at 800.374.2721 or online: www.apa.org National Center for Victims of Crime at 703.276.2880 or online: www.nvc.org LOCAL: Community Mental Health; 3 locations -South: 877.976.7700 -West: 773.863.9749 -East: 773.863.4954 Com Psych: 312.595.4000 Community Counseling Center: 773.765.0653 Diversified Behavioral Comprehensive Care: 773.239.9700 Healing Center of Chicago: 773.784.0339 Illinois Psychiatric Society: 312.263.7391 Institute for Behavioral Health: 773.561.4161 Institute for Psychoanalysis: 312.922.7474 or online: www.chicagoanalysis.org Midwest Center for Youth and Families: 888.629.3471 Preventative Mental Healthcare Services: 312.782.8247 Counseling Center of Lake View: 773.549.5886 St. James Counseling Center: 773.373.6276 VETERANS: The US Veterans Center: 773.684.5500 VA Health Benefits Services: 877.222.VETS Jesse Brown VA Medical Center: 312.569.8387 Edward Hines Jr. VA Hospital (Hines, IL): 708.202.8387 North Chicago VA Medical Center: 847.688.1900