Post Traumatic Stress Disorder in Children
Traumatic stress is produced by exposure to events that are so extreme or severe and threatening, that they demand extraordinary coping efforts. Such events are often unpredicted and uncontrollable. They overwhelm a person’s sense of safety and security. Children are more at risk for post traumatic stress disorder than adults because they lack the cognitive abilities as well as the emotional understanding that helps people cope with traumatic events such as witnessing battering. From the point of view of a child, domestic violence is more than “daddy hits mommy” or “daddy says that mommy is stupid”. From their point of view, their main attachment figure and source of life is being attacked and hurt by an equally loved adult who alternates between acts of violence and acts of love. This is all very confusing for children to witness.
More than half of the school-age children in domestic violence shelters show clinical levels of anxiety or post-traumatic stress disorder (Graham-Bermann, 1994). Without treatment, these children are at significant risk for delinquency, substance abuse, school drop-out, and difficulties in their own relationships.
Children may exhibit a wide range of reactions to exposure to violence in their home. Younger children (e.g., pre-school and kindergarten) oftentimes, do not understand the meaning of the abuse they observe and tend to believe that they “must have done something wrong.” Self-blame can precipitate feelings of guilt, worry, and anxiety. It is important to consider that children, especially younger children, typically do not have the ability to adequately express their feelings verbally. Consequently, the manifestation of these emotions are often behavioral. Children may become withdrawn, non-verbal, and exhibit regressed behaviors such as clinging and whining. Eating and sleeping difficulty, concentration problems, generalized anxiety, and physical complaints (e.g., headaches) are all common.
Unlike younger children, the pre-adolescent child typically has greater ability to externalize negative emotions (e.g., to verbalize). In addition to symptoms commonly seen with childhood anxiety (e.g., sleep problems, eating disturbance, nightmares), victims within this age group may show a loss of interest in social activities, low self-concept, withdrawal or avoidance of peer relations, rebelliousness and oppositional-defiant behavior in the school setting. It is also common to observe temper tantrums, irritability, frequent fighting at school or between siblings, lashing out at objects, treating pets cruelly or abusively, threatening of peers or siblings with violence (e.g., “give me a pen or I will smack you”), and attempts to gain attention through hitting, kicking, or choking peers and/or family members. Incidentally, girls are more likely to exhibit withdrawal and unfortunately, run the risk of being overlooked as a child in need of support.
Adolescents are at risk of academic failure, school drop-out, delinquency, and substance abuse. Some investigators have suggested that a history of family violence or abuse is the most significant difference between delinquent and non delinquent youth. An estimated 1/5 to 1/3 of all teenagers who are involved in dating relationships are regularly abusing or being abused by their partners verbally, mentally, emotionally, sexually, and/or physically (SASS, 1996).