PTSD and the Lifespan: Impact and Co-occurring Issues

Hannah

Introduction

In all age groups, PTSD can form after any traumatic event in a person’s life which leads to feelings of distress, helplessness, fear, and the threat (real or imagined) of danger or harm towards themselves or others (The National Institute of Mental Health, 2016). The symptoms must last longer than a month, and can include intrusion (involuntary flashbacks, nightmares), avoidance (strenuous efforts to prevent experiencing any trauma-related stimuli), negative alterations in thinking and mood (dissociative amnesia, negative beliefs about self or the world, alienation from others, blunted affect, distorted sense of blame), changes in reactivity and arousal (aggression, recklessness, hypervigilance, intense startle response) (American Psychiatric Association, 2013).

8%of people in the U.S. alone meet criteria for a diagnosis of PTSD, and women experience a drastically higher likelihood for developing PTSD than men.(Norris& Slone, 2013). 8% may appear to be a small number, but according to the 2016 Census, the U.S. had an estimated 322,761,807 people living in the country in January, which means that this small percentage translates into nearly 26 million people. (U.S. Census, 2016). To put this into further perspective, about half of individuals who seek outpatient mental health services meet at least partial criteria for PTSD, and these rates are even higher among individuals who have served in a branch of the military (“PTSD Statistics,” 2013).

The effects of PTSD extend far beyond the traumatic events themselves, and can have a debilitating impact on numerous dimensions of clients’ lives and the lives of their support systems. As such, it is important for social workers to be well educated in regards to trauma informed care, and develop competency in the appropriate treatments for clients with PTSD.

The Main Section

Age / Causes, Impact, Issues
1-12 / Causes:
  • The traumatic events that precipitate symptoms of PTSD in children caninclude neglect, all forms of abuse, witnessing or experiencing violence, severe illness, etc. (Moroz, 2005).
Impact:
  • Children who develop PTSD may experience their symptoms differently than adults. Instead of verbalizing flashbacks, children may “recreate” their experiences through repetitive play that has themes related to the trauma (Kaminer, Seedat, & Stein, 2005).
  • They may display regression (loss of developmental skills), increased accidents, illness, hyperactivity, and separation anxiety following the traumatic events, and may also develop difficulty managing their emotions, which can result in mood swings and aggression (Moroz, 2005).
  • Children often develop profound attachment and trust issues, which impact their sense of self and development of individual identityin relation to the world (Moroz, 2005).
  • Childhood trauma measurably raises the risk of a child later developing substance use disorders, criminality, sexually transmitted infections (and other illnesses), and suicidality later in life (Moroz, 2005).
Issues:
  • Assessment and Diagnosis of PTSD can be harder for young children (below the age of seven), as it is more difficult for them to read and participate in self-assessment. (National Collaborating Centre for Mental Health, 2005). Younger children will not be able to verbalize their internal experiences, so a social worker should be prepared to make inferences based on observation of the child’s behaviors (Kaminer et al., 2005).
  • Screening tools such as the Children’s Impact of Events Scale are helpful in children ages eight and up. (National Collaborating Centre for Mental Health, 2005)
  • Safety is the number one priority for the child, and once this is secured, the social worker can begin to assemble a multi-level support system in order to improve resiliency and efficacy of treatment for the child (Kaminer et al., 2005).
  • Trauma-Focused Cognitive-Behavioral Therapy is considered among the most effective interventions for children with PTSD (National Collaborating Centre for Mental Health, 2005). Specifically, outcomes are most promising when a caregiver is involved in the process (and is not the abuser), and both child and caregiver receive education, anxiety management tools, and techniques such as positive imagery and reframing (Ramchandani & Jones, 2003).
  • Play Therapy is also an option that can assist children to indirectly address trauma, though empirical research is somewhat limited on its efficacy (National Collaborating Centre for Mental Health, 2005)
Here is a video on the impact of childhood trauma- This provides a great explanation about how trauma causes neural, biological, and psychological changes in the brain and body, and the long-reaching consequences for survivors.


12-18 / Causes:
  • Teenagers may develop PTSD after experiencing traumatic events such as school violence, sexual abuse and assault, natural disasters, etc. (Moroz, 2005).
Impact:
  • Adolescents with a history of sexual abuse show a significantly increased risk for suicide and violence (Knox, 2008).
  • Adolescents who have experienced trauma become three times more likely to use substances, sometimes as a way to relieve symptoms (avoidant-style coping) (Kilpatrick, 2003).
  • The reverse may also be true. There is evidence that teens who are already using substances may have less resiliency and ability to cope if they experience trauma (The National Child Traumatic Stress Network, 2008).
Issues:
  • Early holistic approaches to detection and screening are important, as many adolescents may not be appropriately diagnosed and may not receive treatment until several years after experiencing trauma (Moroz, 2005).
  • The risk of teen suicide rates related to trauma can be ameliorated with factors such as family and community support, school protection, etc. (Knox, 2008).
  • Trauma-Focused Cognitive-Behavioral Therapy is a valued treatment for adolescents as well as children (National Collaborating Centre for Mental Health, 2005).
  • Adolescents may experience adverse reactions to anti-depressants such as increased depression and suicidality, so pharmacological therapy should be carefully considered as a treatment for PTSD (National Collaborating Centre for Mental Health, 2005).

18-60 / Causes:
  • Adults may be at risk for developing PTSD after experiencing things such as violent crime, accidents, disaster, traumatic childbirth, sexual violence, serious illnesses, combat, and terrorism. Women are at a higher risk for developing PTSD, though men are more likely to experience traumatic events (National Collaborating Centre for Mental Health, 2005).
Impact:
  • Adults who experience PTSD also often experience related problems in many different areas of life, including loss of employment, sleep disturbances, destruction of social relationships (or isolation), financial problems, homelessness, and comorbid psychological disorders such as depression, anxiety disorders, and substance use disorders (National Collaborating Centre for Mental Health, 2005).
  • Adults who experience PTSD also have a higher chance of experiencing medical problems and chronic conditions than those who do not have PTSD (National Collaborating Centre for Mental Health, 2005).
  • Combat veterans with co-occurring PTSD and major depression have a much higher risk for suicide than those without PTSD (Birmaher et al., 2005).
  • Young veterans with PTSD are at much higher risk for suicide than Middle aged or Older veterans with the same symptoms (Zivin et al., 2007).
Issues:
  • Adults may not necessarily enter treatment knowing they have PTSD, and may not report their primary clinical symptoms related to a traumatic event (National Collaborating Centre for Mental Health, 2005).
  • Trauma-focused CBT has the largest body of research and shows clinically significant indicators for improving symptoms of PTSD for many different types of trauma, including combat, sexual assault, and complex trauma in adults (National Collaborating Centre for Mental Health, 2005).
  • Eye Movement Desensitization and Reprocessing is also a validated treatment for trauma, and has been shown to specifically address and reduce the impact of traumatic memories (Shapiro, 2014).
This video gives more details on the process of EMDR-


Here’s another video providing some background on another treatment option that is gaining ground: prolonged exposure therapy in combat veterans.


60+ / Causes:
  • Older adults are more likely to experience negative life events and certain risk factors that contribute to the resurgence of PTSD symptoms, such as the death of loved ones, loss of social networks, health problems, limited autonomy or movement, and retirement(Ogle, Rubin, & Siegler, 2013).
Impact:
  • Older adults are more likely to develop PTSD symptoms at their present age if they have previously experienced traumatic events in childhood (Ogle, Rubin, & Siegler, 2013).
  • Older veterans with PTSD are more likely to attempt suicide than middle aged veterans who have PTSD, and the risk is highest for white males in this age group (Zivin et al., 2007).
Issues:
  • Older adults often experience natural cognitive decline, but Trauma-Focused Cognitive Behavioral Therapy and Exposure Therapy still show promise when the participants have no health issues which may be aggravated by resurgence of symptoms (Clapp & Beck, 2012).
  • There is very little research regarding the efficacy of any treatment for PTSD among older age groups. However, there is a relationship between aging and PTSD, where the prevalence and intensity of PTSD symptoms decline in the population as age increases(Ogle et al., 2013).

Summary

It is critical for social workers to be knowledgeable on the symptoms and associated challenges of PTSD, so that the can accurately identify potential symptoms and initiate screening and appropriate treatment plans. More than 50% of the American civilian population will endure one or more traumatic events in their lifetimes (Norris & Slone, 2013). But many who develop symptoms may not recognize them as a result of trauma, or may wish to avoid sharing them; one common feature of PTSD is feelings of shame related to the event (National Collaborating Centre for Mental Health, 2005). Many times, individuals suffer in silence until the secondary consequences (such as loss of job or important relationships) intensify beyond their ability to cope. For this reason, social workers need also be competent in early detection and screening techniques, to help reduce the social, emotional, and economic impact of PTSD. Finally, it is critical to act as a broker to resources for clients with PTSD, as individuals who have higher education, sense of self-esteem, social support, access to health and mental health care, a sense of resilience, and feelings of having control over their lives are more likely to respond in proactive and positive ways to trauma, thereby reducing the risk of developing PTSD (The Institute of Medicine of the National Academies, 2006).

References

American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders, (5th ed.). Washington, DC: Author.

Birmaher, B., Brent, D. A., Burke, A. K., Ellis, S. P., Firinciogullari, S., Greenhill, L., Kolko, D., Mann, J. J., Oquendo, M., Stanley, B., Zelazny, J. (2005). Posttraumatic stress disorder comorbid with major depression: factors mediating the association with suicidal behavior. The American Journal of Psychiatry, volume 162, issue 3. Retrieved on April 16, 2016, from

Clapp, J. D., & Beck, J. G. (2012). Treatment of PTSD in older adults: Do cognitive-behavioral interventions remain viable?Cognitive and Behavioral Practice,19(1), 126–135. Retrieved on April 16, 2016, from

Kaminer, D., Seedat, S., & Stein, D. J. (2005). Post-traumatic stress disorder in children.World Psychiatry,4(2), 121–125. Retrieved April 5, 2016, from

Kilpatrick, D. G., Saunders, B. E., and Smith, D. W. (2003). Youth Victimization: Prevalence and Implications. Washington, DC: U.S. Department of Justice, Office of Justice Programs, National Institute of Justice. Retrieved April 16, 2016 from

Knox, K. L. (2008). Epidemiology of the relationship between traumatic experience and suicidal behaviors. PTSD Research Quarterly, volume 19, number 4. Retrieved on April 10, 2016, from

Moroz, K. J. (2005) TheEffectsofPsychological TraumaonChildren andAdolescents. Retrieved April 10, 2016, from

National Collaborating Centre for Mental Health (2005). Children and young people with PTSD. In Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care - NICE Clinical Guidelines, No. 26.(Chapters 2,5, and 9). Retrieved April 10, 2016, from

Norris, F. H., Slone, L. B. (2013). Understanding research on the epidemiology of trauma and ptsd. PTSD Research Quarterly, volume 24, no. 2-3. Retrieved on April 16, 2016, from

Ogle, C. M., Rubin, D. C., Siegler, I. C. (2013). The Impact of the Developmental Timing of Trauma Exposure on PTSD Symptoms and Psychosocial Functioning Among Older Adults.Developmental Psychology,49(11), 10.1037/a0031985. Retrieved on April 10, 2016, from

PTSD United, Inc. (2013). PTSD Statistics. Retrieved April 5, 2016, from

Ramchandani, P., Jones, D. P. H. (2003) Treating psychological symptoms in sexually abused children. The British Journal of Psychiatry, 183 (6) 484-490; DOI: 10.1192/03-99. Retrieved on April 15, 2016, from

Shapiro, F. (2014). The Role of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in Medicine: Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experiences.The Permanente Journal,18(1), 71–77. Retrieved on April 16, 2016, from

The Institute of Medicine of the National Academies. (2006). Posttraumatic stress disorder: diagnosis and assessment, appendix c. Washington, D.C.: The National Academies Press. Retrieved on April 16, 2016, from

The National Child Traumatic Stress Network. (2008). Making the connection: trauma and substance abuse. Retrieved on April 10, 2016, from

The National Institute of Mental Health. (2016). Post-Traumatic Stress Disorder. Retrieved April 10, 2016, from

U.S. Census Bureau. (2016, April 10). U.S. and World Population Clock. Retrieved April 10, 2016, from

Zivin, K., Kim, H. M., McCarthy, J. F., Austin, K. L., Hoggatt, K. J., Walters, H., & Valenstein, M. (2007). Suicide Mortality Among Individuals Receiving Treatment for Depression in the Veterans Affairs Health System: Associations with Patient and Treatment Setting Characteristics.American Journal of Public Health,97(12), 2193–2198. Retrieved on April 10, 2016, from