Trauma and PTSD: Sources, Symptoms and Treatment (Family, Youth, and Caregiver Guide)

(Click here to view a PDF version of this guide: English)

Trauma is an emotional response to an extremely stressful or upsetting life event. For example, trauma can be common after witnessing a shocking death or an act of violence against the self or others. Trauma erodes a person’s sense of safety, making them feel frightened and vulnerable in their daily life.

Trauma is a normal reaction to disturbing events, but it can often pose challenges to a person’s daily functioning. With time, many people can recover from a traumatic experience and return to normal functioning. In other cases, a person may be unable to resolve their feelings of grief and hopelessness, leading to conditions like post-traumatic stress disorder (PTSD).

More than 2 in 3 children experience at least one traumatic event by age 16. Trauma may occur at any age, but long-term complications like PTSD are uncommon before the teenage years. Among adolescents ages 13–18, about 1 in 20 meet diagnosis criteria for PTSD. Girls are as much as 3.5 times more likely than boys to experience PTSD, although there are many factors besides gender that affect prevalence of trauma and PTSD.

Common Sources of Trauma

Trauma can result from any event or incident that diminishes a person’s sense of safety, autonomy, or purpose. However, there are some specific types of events that are commonly traumatizing when experienced or witnessed by children.

• Psychological, physical, or sexual abuse
• Physical or sexual assault
• Domestic violence
• Caregiver neglect
• Sudden or violent loss of a loved one
• Community or school violence
• Natural or man-made disasters
• Serious accidents or life-threatening illnesses
• Acts of terrorism
• Refugee or war experiences
• Military family stressors (e.g. deployment, parental loss or injury)
• Frightening medical procedures, operations or outcomes

Trauma is often grouped into two main categories based on the frequency of the traumatic event(s):

➤ Single-incident Trauma

As its name suggests, single-incident trauma (also called single trauma) is psychological trauma from an event that occurred only once. Examples could include a natural disaster, a robbery, a severe car wreck, or a sexual assault. It is possible for a person to suffer from multiple single-incident traumas; the important distinction is that the traumatic events are unrelated from each other and non-recurring.

➤ Complex Trauma

Complex trauma refers to traumatic events that are recurring and often interrelated. Complex trauma frequently occurs within the context of a specific personal relationship. Common examples include domestic violence, physical/emotional/sexual abuse, and neglect. Complex trauma can seriously impair a person’s psychological growth and development, especially because it may commonly begin during childhood or adolescence.

Symptoms of Trauma and PTSD

Reactions to traumatic events can vary between individual children and may depend on factors like severity of the trauma, frequency of the trauma, family dynamics, and cultural norms. However, some common reactions within different age groups are listed below.

➤ Ages 6 and under

• Fear of being separated from their parent or caregiver
• Frequent crying or screaming
• Poor appetite or weight loss
• Frequent nightmares

➤ Ages 7–11

• General anxiety or fearfulness
• Feelings of guilt or shame
• Difficulty concentrating
• Difficulty sleeping

➤ Ages 12–18

• Feelings of depression or isolation
• Challenges with eating disorders or self-harming behaviors
• Alcohol or drug abuse
• Engaging in risky sexual behaviors

A child or teen who has experienced trauma may be able to recover on their own or with assistance, resulting in symptoms disappearing over time. If their symptoms persist for an extended period, then they might meet diagnosis criteria for post-traumatic stress disorder.

An individual may be diagnosed with PTSD when all of the following criteria are met:

• The person directly experienced, witnessed, or learned about an instance of actual or threatened death, actual or threatened serious injury, or actual or threatened sexual violence.
• The person persistently re-experiences the traumatic event(s) through unwanted upsetting memories, nightmares, flashbacks, emotional distress after traumatic reminders, and/or physical reactivity after traumatic reminders.
• The person actively avoids trauma-related stimuli, including trauma-related thoughts and feelings and/or trauma-related reminders.
• The person has negative thoughts or feelings that began or worsened after the trauma, including at least 2 of the following: inability to recall key features of the trauma, overly negative thoughts and assumptions about oneself or the world, exaggerated blame of self or others for causing the trauma, negative affect, decreased interest in activities, feelings of isolation, and difficulty experiencing positive affect.
• The person experiences trauma-related arousal and reactivity that began or worsened after the trauma, including at least 2 of the following: irritability or aggression, risky or destructive behavior, hypervigilance, heightened startle reaction, difficulty concentrating, difficulty sleeping.
• The person’s symptoms have persisted for more than one month.
• The person’s symptoms cause them distress or functional impairment.
• The person’s symptoms are not the result of medication, substance use, or another illness.

Treatments

Trauma and PTSD can be extremely challenging to live with, but they are treatable, and children who experience trauma can go on to live full, normal lives. If post-traumatic stress does not resolve itself naturally, then therapy and medication can help reduce your child’s symptoms.

Trauma, PTSD, and other mental health disorders tend to be highly intertwined with a child’s personal relationships. As such, it is imperative for caregivers and family members to be involved in and supportive of their child’s treatment. If their relationships and home/school environments do not change to support their treatment, then its efficacy will be greatly reduced.

➤ Therapy and Skills Training

Professional therapy and counseling are important components of treatment for trauma and PTSD. Treatments like individual therapy, family therapy, and skills training can help children and their families learn how to manage symptoms of post-traumatic stress.

Some common therapeutic practices include:

• Teaching you and your child what trauma is and how it affects different people.
• Reviewing the traumatic event(s) with a therapist in a safe environment.
• Having your child describe the traumatic event(s) in writing (known as “creating a narrative”).
• Talking about the way your child thinks about themself and how these thoughts make them feel. When talking about these thoughts, the therapist may be able to help change thoughts of guilt or self-blame and help your child feel differently.
• Helping your child confront and reprocess traumatic memories in order to become less troubled by them in the future. This can be done using techniques like cognitive processing therapy (CPT), exposure therapy, and eye movement desensitization and reprocessing therapy (EMDR).
• Looking at the activities your child is involved in and working on ways for your child to participate in them while enjoying themself.
• Talking about whom your child feels close to and the different relationships in their life, and discussing how these relationships can ease your child’s distress.
• Guiding your child through relaxation, meditation, and deep breathing techniques, and teaching your child how to perform these techniques on their own.
• Teaching your child personal safety skills to help ease feelings of anxiety.
• Teaching your child how to take care of their personal health, including how to keep a healthy diet and get enough exercise.

➤ Medication

Certain psychiatric medications can help your child manage symptoms of stress, depression and anxiety related to trauma or PTSD.

These medications, called selective serotonin reuptake inhibitors (SSRIs), work by increasing the levels of the neurotransmitter serotonin in the brain. This in turn can reduce the severity and frequency of depression, anxiety, irritability, panic attacks, and nightmares.

Medication for PTSD is especially effective when prescribed alongside therapy that addresses the root causes of post-traumatic stress.

Supporting a Child with Post-Traumatic Stress

Parents, caregivers, and other family members play an important role in supporting children who suffer from trauma or PTSD. The younger the child, the more likely they’ll need help learning how to manage their symptoms. Family members can be instrumental in modeling and guiding new coping behaviors.

The following section includes tips that can be helpful for supporting your child’s progress. Keep in mind they might not all be right for you and your family, but it could be useful to give them a try.

➤ Educate yourself

Stay educated on what trauma is, how it affects children, and what particular event or events have caused trauma in your child’s life. Help your child understand what trauma is and what the treatment process will be like.

➤ Get involved in therapy

Actively participate with the clinician in your child’s treatment plan, and assist your child with taking any medications at home. Be open and flexible about meeting for treatment. Make time for both you and your child to participate individually and as a family.

➤ Stay involved with school

Your child spends a lot of their time at school, so it is important to set up support systems there. If you inform the necessary school staff about your child’s struggle with trauma, they can help keep your child safe and supported when you are not around.

➤ Create a positive home environment

Make sure that your home is a safe place for your child and the rest of your family. Have meals together, take walks as a family, and spend plenty of positive time together. Help your child to socialize, relax, and participate in things that they enjoy doing.

➤ Create support systems

Make sure everyone who lives in your home is informed about what is going on in order to create a strong family support for your child. Find people you can trust and confide in to help you with transportation to appointments, taking care of other family members, and emotional support.

➤ Develop structures

Changes in routine are inevitable if your child begins treatment of any kind. Do your best to stay organized with appointments, medication, work, and social plans with friends and family. Remember to stay flexible and allow extra time for your child during transitions.

➤ Practice coping skills

There are a variety of coping skills you can practice with your child to help them manage their symptoms. Examples include mindfulness, meditation, deep breathing, and using imagery. Moving the body can also help to reduce symptoms of depression and anxiety.

➤ Be patient

Recovering from traumatic events takes time. Don’t rush your child, and be supportive of their treatment. Never pressure your child to discuss the event(s) with you or anyone else. Clinicians have a certain way of talking with your child to help them successfully heal from trauma.

➤ Be attentive at night

Nighttime can be difficult for children who have experienced trauma. Spend extra time reading, talking, or playing games with them at night. If possible, give them a stuffed animal or blanket to sleep with. Some children, adolescents or teens may start wetting the bed again. Be patient and understanding about this.

➤ Don’t place blame

Blaming yourself, your child, or anyone else will not help the situation. Be supportive in any way possible and don’t feel guilty about what your child is going through. Don’t judge their reaction to the traumatic event(s) compared to how you or someone else has handled it.

➤ Take care of yourself

Know your limits and seek support if you need it. Join support groups, check out community services, and seek professional guidance if you think it would be helpful. You are your child’s source of support and comfort, so feeling your best will help your child feel their best!

➤ Be proud of yourself

This is a difficult time. You are already on the right path just by staying informed and involved in your child’s life.

References

➤ American Psychological Association. (2023, October). Trauma. Retrieved November 2023. https://www.apa.org/topics/trauma

➤ Family Caregiver Alliance. (n.d.) Taking Care of YOU: Self-Care for Family Caregivers. Retrieved November 2023. https://www.caregiver.org/resource/taking-care-you-self-care-family-caregivers/

➤ International Society for the Study of Trauma and Dissociation. (2020). Trauma and Complex Trauma: An Overview. Retrieved November 2023. https://www.isst-d.org/wp-content/uploads/2020/03/Fact-Sheet-I-Trauma-and-Complex-Trauma_-An-Overview-1.pdf

➤ Kessler, R. C., Amminger, G. P., Aguilar-Gaxiola, S., Alonso, J., Lee, S., & Ustun, T. B. (2007, July). Age of Onset of Mental Disorders: A Review of Recent Literature. Current Opinion in Psychiatry, 20(4), 359–364. https://doi.org/10.1097/YCO.0b013e32816ebc8c

➤ Mayo Clinic. (2022, December 13). Post-Traumatic Stress Disorder (PTSD). Retrieved November 2023. https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967

➤ National Institute of Mental Health. (2023, May). Post-Traumatic Stress Disorder. Retrieved November 2023. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd

➤ National Institute of Mental Health. (n.d.) Post-Traumatic Stress Disorder (PTSD). Retrieved November 2023. https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd

➤ Robinson, L., Smith, M., & Segal, J. (2023, June 6). Emotional and Psychological Trauma. HelpGuide.org. Retrieved November 2023. https://www.helpguide.org/articles/ptsd-trauma/coping-with-emotional-and-psychological-trauma.htm

➤ Substance Abuse and Mental Health Services Administration. (2023, March 17). Understanding Child Trauma. Retrieved November 2023. https://www.samhsa.gov/child-trauma/understanding-child-trauma

➤ U.S. Department of Veterans Affairs. (2023, June 9). PTSD and DSM-5. Retrieved November 2023. https://www.ptsd.va.gov/professional/treat/essentials/dsm5_ptsd.asp