By Mrudula Rao, MD
A child who encounters trauma in any form is likely to experience fear and anxiety that can cause impairment in their daily activities. If these symptoms are not met with early treatment interventions, the symptoms can evolve into formal mental disorders such as mood disorders, posttraumatic disorder and other anxiety disorders.
Some factors that set the stage for posttraumatic disorder (PTSD) are early trauma (physical and emotional), sexual trauma, non-nurturing parents and mood or anxiety disorders.
Not everyone exposed to overwhelming trauma experiences mental disorders. Similarly, events that may appear less catastrophic to most people can cause debilitating disorders like PTSD in some people. PTSD is a type of anxiety disorder that is characterized by the observation that fear of the emotional response drives the disorder.
The primary clinical features of PTSD are the painful reexperiencing of the trauma, avoidance behavior and increased arousal.
The patient may also experience dissociative states, panic attacks, hallucinations, poor concentration and memory, aggression, poor impulse control, reduce social competencies, depression, fears, sleep disturbances, learning problems and substance related disorders. These symptoms can develop as soon as in one week or as long as 30 years after the trauma.
Some predisposing factors that can cause higher likelihood of developing PTSD include: genetic-constitution, poor support system, young age at time of trauma, stressful life changes and mental disorders.
If psychic trauma is encountered in early childhood, there is potential for arrest of emotional development and regression. Some warning signs to pay heed to are:
• Traumatic play: when children express themselves by acting out with toys or by drawing traumatic scenes
• Anxious attachment: clinging to caregivers for a sense of security, generalized fear due to loss of adult protective shield during the trauma
• Regression: developmental milestones may be lost, and nightmares or insomnia can occur due to anxiety. Nightmares and flashbacks are not necessarily harmful since they serve as brain’s own version of exposure therapy in the aftermath of a disaster.
It is imperative to rule out the possibility of a mental disorder due to a head injury since head injury can be experienced by the victim during trauma. Once other organic causes are ruled out it is warranted that immediate and early intervention can improve the prognosis for the child.
The major treatment approaches are support, encouragement to discuss the event and education to the child and caregivers of the coping mechanisms to be practiced. Both psychotropic management and psychotherapeutic approaches are most efficacious if therapy alone does not bring relief to the child. The most important clinical practice that can be provided by clinicians is to seek improvements in outcomes and treat patient until they achieve remission.
Finally, it is noteworthy to add that not only the child who encountered the trauma has impairment in social, academic and family settings, but the parent(s) and caregiver(s) can also experience distress, mood changes
and guilt feelings as they observe the victim’s pain.
Most family and friends are well wishers to the victim and often give advice to the victim, telling him or her to avoid thinking about the trauma and to put the trauma behind and move on…hoping recovery will ensue faster. On the contrary, the avoidance behavior is the very thing that can cause relapse of symptoms and negative sequela.
Mrudula Rao, M.D. is a Clinical Assistant Professor, Division of Psychiatry, at the University of Texas Health Science Center, San Antonio. Dr. Rao is in private practice, specializing in the treatment of adult, adolescent and child psychiatric disorders. She is a Consultant Psychiatrist at The Center for Health Care Services and also at the Jewish Family and Children Services. Dr. Rao is double board certified in adult, adolescent and child psychiatry.
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