Post-Traumatic Stress Disorder (PTSD)

September 18, 2021

Team Mindsum

About the author: This article is written by our team of researchers and writers. Our content is published after careful review and approval by the editorial board.

‍What is Post Traumatic Stress Disorder (PTSD)?
Symptoms of PTSD in young children
Causes of PTSD in children
Treatments for PTSD
What types of professionals are involved?
The journey of treating PTSD
How to support someone with PTSD
Useful resources

What is Post Traumatic Stress Disorder (PTSD)?

‍Post-traumatic stress disorder is a form of anxiety that is experienced by people who have been exposed to traumatic events. It is a common mental health condition, that can affect people of all ages, including children and young people.

Following exposure to a traumatic event (e.g. witnessing a severe accident) it is normal for people to feel disturbed by the incident and have some difficulties, such as nightmares and low mood. This is known as an acute stress reaction and it usually disappears after some weeks.

For some people, these difficulties can be more severe and persist over time, lasting longer than one month. This is a sign that they could be suffering from PTSD.

PTSD is when the memories of a stressful event have not been processed properly. Think of memories as documents within a filing cabinet which is our brain. When events happen in our life, the documents (our memories) get filed away neatly within the filing cabinet (our brain) and so the filing cabinet shuts. With PTSD, the documents have not been filed properly, therefore, the filing cabinet is left open and sometimes the documents will fly out because they have not been filed away properly. This can cause symptoms such as flashbacks and nightmares.

The symptoms of PTSD

‍There are many possible symptoms of PTSD that a person can experience. These symptoms usually cause problems in the everyday life of the child or young person.

The main two symptoms that have to occur for a diagnosis of PTSD are:

Nightmares of the event
Flashbacks of the event. These make the child/person believe they are experiencing the event again and they will behave accordingly e.g. hiding as they feel that someone is going to hurt them. These flashbacks are not just the child thinking about the event but are unwelcome and intrusive, and the child/young person feels as if they cannot control when they occur.

Other symptoms include:

Avoidance (e.g. not going to certain places, staying away from certain people, pushing thoughts away)
Hyperarousal (e.g. hypervigilance, anger, being irritable)
Emotional numbing (e.g. not feeling anything, difficulty responding to other people’s emotions)
Other problems (e.g. feeling disconnected from reality, out-of-control emotions, problems with peers or family members, feeling worthless)

In some cases, people can have a form of PTSD that is extreme, known as Complex PTSD. This usually happens when the person is exposed to traumatic events that were horrific and life-threatening or that lasted a long time. In this case, the person will suffer from all of the above symptoms and the following:

Severe problems with managing emotions and behaviour
Believing that they are worthless, useless, defeated or shameful

Young people often have PTSD symptoms in a similar way to adults. But for younger children, these symptoms can be different. Younger children may show signs such as:

Nightmares of the trauma involving monsters
Drawing or playing out the trauma using toys (e.g. playing out car accidents with toy cars)
Losing interest in things that they used to enjoy
Problems at school
Expressing that they will not live long enough to grow older
Having regular headaches or stomach aches

“Mel is 19-years-old. It has been a few months since she came face to face with an intruder at night in her home. Since the incident, Mel has just not felt quite the same. During the day, she keeps having flashbacks of that night so she finds herself hiding under her bed for 20 minutes before realising there is no one in the house. She avoids going to bed unless someone else can sleep alongside her. Whenever nighttime sets in, Mel grows more and more anxious and tries her best to be on guard. Her parents suggested that she should see someone. Mel decided that it was time to speak to a mental health expert.”

Causes of PTSD

‍Some many different situations or events can cause a child or young person to develop PTSD. However, the event has to have made the child/young person feel that their life or someone’s life who is close to them was being threatened.

Examples of traumatic events include:

Serious car accidents
Physical or sexual abuse
Being attacked, kidnapped or held hostage
Childhood abuse
Witnessing or being involved in domestic abuse
Surviving war or natural disaster
Witnessing or being involved in torture
Witnessing death or the deceased
Learning that someone close to you has been affected by trauma (known as secondary trauma)

Not all exposure to distressing events will cause a person to develop PTSD. But there are some risk factors that can make this more likely to happen. This includes:

Being a child or young person
If the trauma was a physical assault or rape in nature
Having experienced previous traumas
Experiencing many stressors at the same time
Having a history of mental health disorders
Being a child with a lack of support from family members
Being a child of parents with mental health difficulties

Treatments for PTSD

‍Trauma-focused psychological therapies are important when treating PTSD. This can help the child or young person to recover from the disorder. These therapies include trauma-focused cognitive behavioural therapy and eye movement desensitisation and reprocessing. These will be discussed below.

Trauma-focused cognitive behavioural therapy (TF-CBT)

TF-CBT is a therapy that focuses on how we think and act towards traumatic memories and how this affects the way we feel. Research shows that it is an effective treatment for trauma in children and young people.

The idea behind TF-CBT is to help people to change the way they think about past traumatic events and to respond to these memories differently.

The child or young person will learn to process certain memories, manage flashbacks, cope with anxiety and work with personal meaning related to the trauma.

In the case of complex PTSD, this process might take longer to achieve. The therapist will also help the child or young person to deal with other issues that may be a barrier to improvement.

Eye movement desensitisation and reprocessing (EMDR)

EMDR is a specialised therapy that helps people to process and make sense of traumatic memories. It is appropriate for children from the age of 7 years or older and when TF-CBT has not been effective. Research shows that EMDR is an effective treatment for trauma in children and young people.

The idea behind this is within PTSD traumatic memories are not fully processed. Therefore, it is helpful for the person to process these painful memories in a controlled way, that allows them to come to terms with the event.

The therapist will engage the child or young person to perform eye movements, tones and taps that allow them to think about painful memories in small chunks at a time. What they think and feel during these exercises might then be discussed with the therapist.

Eventually, the child or young person will have processed all parts of the traumatic event and this will help them to recover from the symptoms of PTSD as the memories would have been processed properly.

Medication

‍Medication is not usually prescribed for children under the age of 18 with PTSD. For adults, it may be prescribed if therapy does not work, or is difficult to complete due to another mental health condition.

What types of professionals are involved?

‍Different professionals may or may not be involved throughout the treatment process of PTSD for children and young people. These might include counsellors, psychotherapists, cognitive behavioural therapists, doctors/psychiatrists and social workers. These terms might be confusing, but the main difference is in the training that each of these professionals has received.

In the UK, there is not much of a distinction made between counsellor and psychotherapist. Both of these professionals provide therapy. However, there are some slight differences between these two professional terms. These are outlined below.

Counsellors

Compared to psychotherapists, counsellors tend to have shorter training and they help people deal with their issues on a more short-term basis. There may be school-based counsellors available that children and young people can approach at their own schools. Here at Mindsum, we have counsellors who are available to provide support.

Psychotherapists

Psychotherapy training tends to be longer. Psychotherapists can also give counselling but their approach to talk therapy is more in-depth, exploring the history and causes of certain behaviours and emotional issues. Here at Mindsum, we have psychotherapists who are available to provide support.

It doesn’t mean that one professional is better than the other. All professionals in this field go through intensive training before they begin to practice. When dealing with PTSD, counsellors and psychotherapists with training in working with PTSD will be the ones to provide support.

Cognitive Behavioural Therapists

This is the therapist the child/young person is most likely to be treated by for PTSD. These are therapists who have been trained in Cognitive Behavioural Therapy using this model to form an idea of a patient’s mental health difficulties and to treat them. When working with PTSD the therapists would have been trained in trauma-focused CBT learning about how to help people struggling with PTSD re-process their memories to reduce their symptoms.

Doctors

‍These are professionals who are trained in medicine. This will likely be the family GP, who might find it necessary to prescribe certain medications for other conditions. Medication is not usually prescribed for PTSD in children and young people though.

Psychiatrist

These are professionals who are also trained in medicine. However, they also specialised in the field of psychiatry. So they can provide consultation and medication for a wide range of mental disorders such as anxiety, depression, and bipolar affective disorder.

Social workers

Workers trained in protecting vulnerable individuals might also be involved with the child or young person, especially in trauma cases such as domestic violence, neglect and child abuse. Social workers will provide support or will help to plan for support. They will work to ensure the safety and well-being of the child or young person.

The journey of recovery from PTSD

The journey of recovery from PTSD can look different for each child or young person. This also depends on the complexity of PTSD. However, some things are expected when going through therapy for PTSD.

Assessment

This is an important phase, where the therapist will get a feel of what is going on. The therapist might try to identify the severity of the PTSD, along with other important background information. At this stage, the therapist will need to ask many questions. This will help to create a full picture of what is going on and to know what type of treatment will be most helpful.

Therapy sessions

These sessions will take place at a time and regularity that suits the child or young person and their parents. An important aspect of the therapy session is the relationship the therapist will build with the child or young person. This will create a safe space to encourage them to talk about their feelings and engage fully in the exercises. In cases of more complex trauma, therapy may take a long time before improvements can be made.

Progress and setbacks

When having treatment for PTSD, there will be progress and setbacks. This is because the child or young person will be learning to cope with very sensitive and painful memories, which is often disturbing. It is important not to feel discouraged when setbacks happen, as this can be quite normal when dealing with PTSD or any type of serious mental health difficulties. These situations provide opportunities to discover new ways to move forward together with the therapist.

Ending therapy

The therapist will eventually prepare the child or young person and their parents for the end of therapy. This is a very important phase because the child or young person needs to become confident in coping without relying too much on the professional. The end of therapy will take place once the child or young person has made a lot of progress or has completely recovered from PTSD. The child or young person will leave therapy with many skills that they can use without the help of the therapist.

Follow up

There might be an agreement with the therapist to have a follow-up meeting. This is to check how the child or young person is coping. If they are doing well, there will be no need for more support. But if they continue to have challenges with PTSD or any other issues, this will be an opportunity to have extra support.

How to support someone with PTSD

It can be challenging when you have a loved one who suffers from PTSD. It is a disorder that tends to interfere with their everyday life. Fortunately, there are some things that you can do to help. These are discussed below.

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Understand PTSD

It is a good idea to read as much information on PTSD as you can. Understanding PTSD and how it works will help you to recognise the ways that your loved one is affected, and the ways that you can help.

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Help them to feel safe and supported

A person with PTSD sees the world as a dangerous and frightening place. You need to help them feel safe and supported.

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Be dependable and trustworthy

Try to stick to your promises and commitment towards them. Remind them that you are there for them, whenever they need you.

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Show acceptance

PTSD might be difficult for you to understand, but it is a real problem for them. Let them know that they are accepted no matter what. Avoid being judgemental or critical about their difficulties. Here are 20 things not to say to someone with PTSD.

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Be patient

PTSD might make it difficult for them to do certain activities. It will take some time before they can recover from this disorder. Be patient and continue to show your support without putting too much pressure.

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Help them to find the right support

You can encourage them to find support through a GP or a therapist. If this involves your young child, you can contact these services. You might:

Help them to book an appointment with a GP or therapist
Offer support when they attend appointments (e.g. waiting in the waiting room or attending some sessions if you need to)
Help them search for support groups or self-help resources (e.g. leaflets, mindfulness apps, relaxation sessions)
Encourage them to keep attending sessions and to not give up
Give them small reminders to do their homework assigned by the therapist

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Create a secure environment for them

You can make some adjustments that will help them feel more safe and secure, wherever they are. You might:

Avoid the things that trigger them (e.g. crowded places, loud noises, sudden movements)
Let friends and family know how to approach them
Try to keep a calm atmosphere at home
Minimise stress at home (e.g. avoiding arguments, letting the neighbours know)
Allow them to have their personal space

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Be open to listen

Take the time to just sit with them and listen. You do not always need to give advice and have all the answers. It is more important that your loved one feels heard by you. This will help to create a safe space for them, where they can feel comfortable sharing their difficulties out loud.

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Help them cope during a flashback

Be prepared to support your loved one as they experience a flashback or panic attack. This can be a very stressful situation for both you and your loved one. Here are some things that you can do:

Stay calm and relaxed
Be mindful of making sudden movements
Help them ground themselves by getting them to describe their surroundings
Encourage them to take some deep breaths for a few minutes
Let them know that they might be having a flashback
Reassure them that they are safe now

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Help them to have a routine

Having a routine can help them to feel less anxious because they will know what to expect. You might help them to:

Make a schedule for their day
Make a checklist
Have a regular dinner and bedtime routine
Talk in advance about any changes to the schedule

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Know what not to do

When it comes to our loved ones, it makes sense to do whatever it takes to help them feel better. But this is not always a good thing.

Here are some things to be mindful of when supporting a loved one with PTSD:

Do not blame or be critical of their difficulties
Do not tell them to snap out of it
Do not pressure them into situations that make them uncomfortable
Avoid overpowering them by doing everything for them when they are capable of doing it themselves
Don’t assume they will be okay in certain situations without asking first

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Look after yourself too

You need to look after yourself. Whether you are a parent, family member or a friend, you will be in a better position to give help, as long as you are taking care of your well-being too. To do this you might:

Get other family members also involved in supporting your loved one
Schedule some time off for yourself
See a professional that can support your mental health