When do the effects of trauma cross the line into PTSD?

ID-100105038Welcome to the seventh installment of our Fall 2013 blog series: Trauma and Kids…A Primer for Pastors, Church Staff and Parents. Today, we’ll look at the specific criteria for the syndrome we describe as Post-Traumatic Stress Disorder (PTSD).

Not all trauma leads to the development of Post-Traumatic Stress Disorder (PTSD).

When we use the term PTSD, we refer to a clinical syndrome resulting from exposure to actual (or threatened death), serious injury or sexual violence that…

  • is directly experienced
  • is witnessed, in person, the event(s) as it occurred to others
  • follows learning the event(s) occurred to a close family member or friend
  • occurs after experiencing repeated or extreme exposure to aversive details of traumatic events

PTSD is characterized by “intrusion symptoms” associated with the traumatic event, beginning after the traumatic event, including…

  • recurrent, involuntary and intrusive distressing memories
  • recurrent, distressing dreams
  • flashbacks (dissociative reactions in which the person responds as if the traumatic event is recurring
  • intense, prolonged psychological distress, or marked physiologic reaction upon exposure to internal or external cues associated with the event

PTSD is also characterized by persistent avoidance of stimuli associated with the traumatic event, including distressing thoughts, memories, feelings and distressing reminders of the event.

Children and adults with PTSD experience negative alterations in cognition and mood associated with the traumatic event, including at least two of the following symptoms…

  • inability to remember some important aspect of the traumatic event
  • persistent, exaggerated negative beliefs or expectations about oneself, others or the world
  • distorted cognitions about the cause(s) of the traumatic event, leading to self-blame
  • persistent, negative emotional states (fear, horror, anger, guilt, shame)
  • markedly diminished interest or participation in significant activities
  • detachment or estrangement from others
  • persistent inability to experience positive emotions

Persons with PTSD experience marked increases in arousal and reactivity associated with the traumatic event, as characterized by two or more of the following…

  • verbal and/or physical aggression toward people or objects
  • reckless, self-destructive behavior
  • hypervigilance
  • exaggerated startle response
  • difficulties with concentration
  • disturbed sleep

By definition, symptoms must persist for more than one month following the traumatic event in question and result in significant functional impairment.

Developmental regression is common in children with PTSD. Young children are more likely to manifest re-experiencing symptoms through play that refers directly or symbolically to the traumatic event. Persons with PTSD are 80% more likely than those without PTSD to have at least one or more “comorbid” disorders…kids with PTSD are more likely to have Oppositional Defiant Disorder and Separation Anxiety Disorder, males with PTSD are more likely to have concomitant substance use disorders and Conduct Disorder, with depressive, bipolar, anxiety and substance use disorders occurring more commonly among adults with PTSD.

Next…Does a PTSD diagnosis really matter?

Photo courtesy of http://www.freedigitalphotos.net

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600817_10200479396001791_905419060_nConfused about all the changes in diagnostic terminology for kids with mental heath disorders? Key Ministry has a resource page summarizing our recent blog series examining the impact of the DSM-5 on kids with mental health disorders. Click this link for summary articles describing the changes in diagnostic criteria for conditions common among children and teens, along with links to other helpful resources!

About Dr. G

Dr. Stephen Grcevich serves as President and Founder of Key Ministry, a non-profit organization providing free training, consultation, resources and support to help churches serve families of children with disabilities. Dr. Grcevich is a graduate of Northeastern Ohio Medical University (NEOMED), trained in General Psychiatry at the Cleveland Clinic Foundation and in Child and Adolescent Psychiatry at University Hospitals of Cleveland/Case Western Reserve University. He is a faculty member in Child and Adolescent Psychiatry at two medical schools, leads a group practice in suburban Cleveland (Family Center by the Falls), and continues to be involved in research evaluating the safety and effectiveness of medications prescribed to children for ADHD, anxiety and depression. He is a past recipient of the Exemplary Psychiatrist Award from the National Alliance on Mental Illness (NAMI). Dr. Grcevich was recently recognized by Sharecare as one of the top ten online influencers in children’s mental health. His blog for Key Ministry, www.church4everychild.org was ranked fourth among the top 100 children's ministry blogs in 2015 by Ministry to Children.
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