PTSD (Post Traumatic Stress Disorder) By Michelle Solek, Caroline Nolan and Aly Kidrin

Etiology of PTSD – Develops as a result of seeing/experiencing a traumatic even involving threat of injury or death – PTSD can occur at any age after a natural disaster (flood, fire) or after events such as:War, Natural Disaster, Terrorism, Rape, Prison Stay, Domestic Abuse, Assault – More extreme threat to one’s life  higher chance of PTSD – Intentional human-inflicted harm (rape, assault)  more traumatic than natural/impersonal events (floods, fire) Examples of traumatic events:  People who were involved in, witnessed, or lost relatives from terrorist attacks on 9/11  Usually veterans coming home from war have PTSD – Develops as a result of seeing/experiencing a traumatic even involving threat of injury or death – PTSD can occur at any age after a natural disaster (flood, fire) or after events such as:War, Natural Disaster, Terrorism, Rape, Prison Stay, Domestic Abuse, Assault – More extreme threat to one’s life  higher chance of PTSD – Intentional human-inflicted harm (rape, assault)  more traumatic than natural/impersonal events (floods, fire) Examples of traumatic events:  People who were involved in, witnessed, or lost relatives from terrorist attacks on 9/11  Usually veterans coming home from war have PTSD

PTSD & 9-11 In the month following September 11, the number of prescriptions for anti-anxiety medication increased over 20%. A study released in May 2002, estimated that more than 400,000 New Yorkers experienced PTSD after September 11. Many are still experiencing PTSD symptoms. (AP Worldstream. Study says that more than 400,000 New Yorkers experienced post- traumatic stress disorder after Sept :May 18.) The study concluded that even people who where not present at the traumatic event experienced stress. In the month following September 11, the number of prescriptions for anti-anxiety medication increased over 20%. A study released in May 2002, estimated that more than 400,000 New Yorkers experienced PTSD after September 11. Many are still experiencing PTSD symptoms. (AP Worldstream. Study says that more than 400,000 New Yorkers experienced post- traumatic stress disorder after Sept :May 18.) The study concluded that even people who where not present at the traumatic event experienced stress.

Incidence and prevalence – American women: 10.4% – American Men: 5%. (Women are twice as likely to have PTSD at some point in their life.) – Sexual abuse is more common among women and more likely to lead to PTSD then any other trauma – Many people experience traumatic events in their lives, but do not necessarily develop PTSD. – American women: 10.4% – American Men: 5%. (Women are twice as likely to have PTSD at some point in their life.) – Sexual abuse is more common among women and more likely to lead to PTSD then any other trauma – Many people experience traumatic events in their lives, but do not necessarily develop PTSD.

PTSD in Children – Incidence: – Girls: 3-15% – Boys: 1-6% – Causes: – 65%-- neglect – 18%-- physical abuse – 10%-- sexual abuse – 7%-- psychological abuse – Incidence: – Girls: 3-15% – Boys: 1-6% – Causes: – 65%-- neglect – 18%-- physical abuse – 10%-- sexual abuse – 7%-- psychological abuse

Unclear Causes of PTSD The cause of PTSD is unknown, but there are psychological, genetic, physical and social factors involved. When a person has PTSD, their body’s response to stress is altered because their stress hormones and neurotransmitters (carry information between nerves) are affected. It is not clear why some people develop PTSD from traumatic events while others do not. However, if someone has a history of trauma, their risk for having PTSD increases after a traumatic event. The cause of PTSD is unknown, but there are psychological, genetic, physical and social factors involved. When a person has PTSD, their body’s response to stress is altered because their stress hormones and neurotransmitters (carry information between nerves) are affected. It is not clear why some people develop PTSD from traumatic events while others do not. However, if someone has a history of trauma, their risk for having PTSD increases after a traumatic event.

Risk Factors associated with PTSD Previous traumatic experiences in life Family history of PTSD or depression Family history of physical, sexual, or substance abuse High levels of stress in life Lack of support after experiencing traumatic event Lack of coping skills Previous traumatic experiences in life Family history of PTSD or depression Family history of physical, sexual, or substance abuse High levels of stress in life Lack of support after experiencing traumatic event Lack of coping skills

Symptoms of PTSD “Re-living” traumatic event ( disrupts everyday tasks)  flashbacks; repeated disturbing memories & nightmares; strong reactions to events similar to traumatic experience Avoidance & Numbing  emotional ‘numbing’ (not caring about anything); lack of interest in everyday activities; avoidance of places or people that remind person of traumatic event; feelings of having no future Arousal  difficulty concentrating; easily startled; irritability; outbursts of anger; problems sleeping “Re-living” traumatic event ( disrupts everyday tasks)  flashbacks; repeated disturbing memories & nightmares; strong reactions to events similar to traumatic experience Avoidance & Numbing  emotional ‘numbing’ (not caring about anything); lack of interest in everyday activities; avoidance of places or people that remind person of traumatic event; feelings of having no future Arousal  difficulty concentrating; easily startled; irritability; outbursts of anger; problems sleeping

Symptoms Common in Adults with PTSD “survival guilt”—person feels guilty about living through traumatic event they experienced Anxiety, stress, & tension Agitation Dizziness Accelerated heart beat Headaches Depression Stomachaches “survival guilt”—person feels guilty about living through traumatic event they experienced Anxiety, stress, & tension Agitation Dizziness Accelerated heart beat Headaches Depression Stomachaches

Symptoms of PTSD for Children & Adolescence Fear of being separated from their parents Losing previous skills (such as toilet training) Nightmares New phobias/anxieties that do not relate to the traumatic event (such as fear of monsters) Aches/pains without specific causes Irritability and aggression Fear of being separated from their parents Losing previous skills (such as toilet training) Nightmares New phobias/anxieties that do not relate to the traumatic event (such as fear of monsters) Aches/pains without specific causes Irritability and aggression

Signs & Diagnosis of PTSD No tests exist to diagnose PTSD, but symptoms are used to determine whether someone has the disorder Person who is being diagnosed may be asked how long they have had symptoms Symptoms will determine whether person has PTSD or Acute Stress Disorder (ASD) – PTSD: symptoms are evident for at least 30 days – ASD: symptoms are evident for shorter amount of time No tests exist to diagnose PTSD, but symptoms are used to determine whether someone has the disorder Person who is being diagnosed may be asked how long they have had symptoms Symptoms will determine whether person has PTSD or Acute Stress Disorder (ASD) – PTSD: symptoms are evident for at least 30 days – ASD: symptoms are evident for shorter amount of time

Treatments (cont.) Trauma-focused behavioral cognitive therapy  exposing oneself to thoughts and feelings of trauma, replacing distorted thoughts of event with rational ones Family Therapy  helpful to family members who are also affected by PTSD, gives them a change to understand what person is experiencing and learn methods to communicate about traumatic event Medication  prescribed to alleviate symptoms of depression & anxiety Antidepressants: Prozac, Zoloft—can help with some feelings, but do not treat the disorder EMDR (Eye Movement Desensitization & Reprocessing)  Helps to ‘unfreeze’ the brain’s information processing system, which is altered during stressful situations. Also helps to form a more consistent memory. Trauma-focused behavioral cognitive therapy  exposing oneself to thoughts and feelings of trauma, replacing distorted thoughts of event with rational ones Family Therapy  helpful to family members who are also affected by PTSD, gives them a change to understand what person is experiencing and learn methods to communicate about traumatic event Medication  prescribed to alleviate symptoms of depression & anxiety Antidepressants: Prozac, Zoloft—can help with some feelings, but do not treat the disorder EMDR (Eye Movement Desensitization & Reprocessing)  Helps to ‘unfreeze’ the brain’s information processing system, which is altered during stressful situations. Also helps to form a more consistent memory.

Impact on development of academic and social skills --General (children & teens): Difficulty concentrating Preoccupied and easily confused May be unable to perform previously required skills May lose interest activities and avoid interactions with other children – Children (ages 5-12) In their play may repeat parts of their trauma Shooting games may result if child witnesses a school shooting Often regress in behaviors and act younger for their age – Teens More likely to show impulsive and aggressive behaviors 0ut of place sexual behavior, drugs and alcohol abuse --General (children & teens): Difficulty concentrating Preoccupied and easily confused May be unable to perform previously required skills May lose interest activities and avoid interactions with other children – Children (ages 5-12) In their play may repeat parts of their trauma Shooting games may result if child witnesses a school shooting Often regress in behaviors and act younger for their age – Teens More likely to show impulsive and aggressive behaviors 0ut of place sexual behavior, drugs and alcohol abuse

Teacher’s Role for Students with PTSD Teacher is often first one to note symptoms of posttraumatic stress in children, but their responsibility doesn’t end by referring student to professional counselor. They need to play an active role in helping students cope with PTSD. Depending on type of trauma and age of child, appropriate classroom activities can help child overcome negative effects of PTSD. Teacher is often first one to note symptoms of posttraumatic stress in children, but their responsibility doesn’t end by referring student to professional counselor. They need to play an active role in helping students cope with PTSD. Depending on type of trauma and age of child, appropriate classroom activities can help child overcome negative effects of PTSD.

Possible Classroom solutions (ACEI) Association for Childhood Education International(promotes childhood education & developmental programs) suggests: – Use toys/materials to provide situations for child to reenact events from their traumatic event – Include gentle physical contact and activities that release tension, give child a sense of security – Encourage group discussion; help students learn from each other by sharing feelings – Encourage children to draw, write, or talk about their fears, feelings – Integrate books that portray people/children who have confronted and solved similar problems; see how others face anxieties – Collaborate with parents to monitor child’s progress, at home and at school (ACEI) Association for Childhood Education International(promotes childhood education & developmental programs) suggests: – Use toys/materials to provide situations for child to reenact events from their traumatic event – Include gentle physical contact and activities that release tension, give child a sense of security – Encourage group discussion; help students learn from each other by sharing feelings – Encourage children to draw, write, or talk about their fears, feelings – Integrate books that portray people/children who have confronted and solved similar problems; see how others face anxieties – Collaborate with parents to monitor child’s progress, at home and at school

Classroom accommodations Establish a feeling of safety and acceptance in the classroom Greet child warmly each day, let them know they’re valued Make eye contact with child Provide consistent and predictable routine Simple room arrangements Balance between noisy and quiet areas in the classroom Reassure child that their symptoms and behaviors are a common response to their trauma and that they’re not irrational Incorporate simple exercises into the day to relieve anxiety and restlessness (skipping, jumping, stretching) Establish a feeling of safety and acceptance in the classroom Greet child warmly each day, let them know they’re valued Make eye contact with child Provide consistent and predictable routine Simple room arrangements Balance between noisy and quiet areas in the classroom Reassure child that their symptoms and behaviors are a common response to their trauma and that they’re not irrational Incorporate simple exercises into the day to relieve anxiety and restlessness (skipping, jumping, stretching)

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