Post-traumatic stress disorder: when you need help

Post-traumatic stress disorder (PTSD) is a mental disorder that develops after an unusual, excessively traumatic situation that goes beyond the limits of human experience. Often these are extreme life-threatening situations, especially if there is no algorithm of behavior known to man.

The term PTSD has appeared relatively recently, so it may seem like it’s just another fashion trend. But that's not true. In this article we will talk about what PTSD is, who gets PTSD and when it occurs, and how to get rid of it.

Do I have PTSD?

PTSD is not just the consequences of psychological trauma. The symptoms of PTSD go beyond the experience. People who experience this syndrome often experience profound personality changes.

At the end of the 19th century, psychologist Openheim proposed the term “traumatic neurosis.” In 1980, the term PTSD was introduced into ICD-10. The syndrome is a mental disorder and has a diagnosis code of F43.1

The causes of PTSD are events that should not happen:

• Wars, concentration camps, participation in hostilities;
• Terrorist attacks, hostage taking, shootings;
• Automobile, air and other accidents;
• Earthquakes, fires, floods and other natural disasters;
• Torture, attacks and other situations in which life and death are involved;
• Sexual violence.

Moreover, PTSD can develop not only if you were a direct participant in such events, but even if you witnessed them.

Shkryabina O.N., Klyushova O.V.,

educational psychologists

GBU JSC "

PTSD in Children: Indicators and Help Strategies

PTSD is a post-traumatic stress disorder that occurs due to exposure to external traumatic events. PTSD is a painful mental reaction that occurs as a result of exhaustion of the nervous system as a result of experiencing violence, humiliation, and being in constant fear of a person for his life or the lives of loved ones.

Children's responses to trauma are mediated by the child's age and developmental level. In short-term trauma, the younger the child, the more his response to trauma depends on how his parents react to the traumatic event. If parents cope well, most young children do not develop long-term symptoms of trauma. With injuries that begin at a young age and continue for a long time, the child's development can be distorted. Thus, age can be both a complicating and a protective factor. Some traumas, such as sexual assault, are particularly difficult for adolescents.

Reactions to the same traumatic event in children of the same age can be different: one child may become depressed and frightened, another may begin to behave aggressively, and a third may focus on caring for others. In many ways, these reactions are determined by how the child or adolescent understands what happened and what consequences this has for him personally, how much he feels support from others, how he feels about himself, the child’s characterological characteristics and his usual forms of responding to difficulties. Traumatic events affect all areas of a child’s functioning: his understanding of the world and himself, emotionality and behavior.

Let us consider in more detail the indicators of the psychological state of children who have experienced traumatic events [7]:

1. Feeling of insecurity and helplessness. Being in the position of a victim is subjectively experienced as helplessness and inability to change existing circumstances and manage one’s life. Children perceive the world as a source of unpredictable and ominous events.

2. Anxiety about the future, expectation of “bad things,” fear of change. Closely related to feelings of insecurity are anxiety and distrust of the future, and the expectation of something “bad.” Expectations of “bad things” in children mainly manifest themselves in wariness and fear of change.

3. Shame, low self-esteem and guilt. Due to a feeling of helplessness and distrust in the world, children often develop low self-esteem and a feeling of violated dignity. Low self-esteem in children manifests itself in the form of fear of self-disclosure and blocking of spontaneous activity. It is difficult for them to express their own opinion, to express themselves. Children also experience a feeling of guilt: they consider themselves guilty for remaining alive, while their peers died during a military conflict. It can be assumed that this kind of feeling is protective in nature and serves to reduce anxiety.

4. Anger, aggressiveness. Traumatized children have frustrated basic needs for safety, security and self-esteem. Frustration of these needs naturally causes a response of anger and an increase in the level of aggression. As a rule, not finding the source that causes aggression, children begin to select the most convenient “target” (another person or animal) to realize their aggressive feelings.

5. Alienation and isolation from the surrounding physical and social reality. A traumatized child seeks solitude, immersing himself deeply in memories associated with the trauma. As a rule, this period is associated with a slight decrease in contact and the need for communication, even if the child was previously socially active.

6. Uncryed grief. Uncryed grief and sadness are the most important characteristics of trauma, which is always associated with a feeling of loss - be it the loss of a loved one, self-image, hope, etc. The main obstacle here is feelings of shame and helplessness, and the desire to restrain the aggressive impulse. But if an adult can potentially still express and express grief, then the child is in a more difficult position - his thinking and speech are not yet fully developed so that he can convey his experiences in words. Often the only way for a child to express emotions is crying, but even in this, those around him can “block” him: “You’re already an adult and don’t cry...”, “You’re such a brave girl...”, etc. The child has two options - or experience traumatic experiences deep inside, emotionally isolate yourself from others and withdraw into yourself, or resort to protest reactions - anger, aggression, regressive behavior, etc.

7. Traumatic play and repetitive actions. Traumatic games repeat one or another episode of trauma. In these games, the child most often personifies himself. Traumatic play differs significantly from ordinary imitation play in the following ways:

— First of all, an ordinary game is accompanied by positive emotions and enthusiasm, which a traumatic game is completely devoid of. It is characterized by monotony and is so close to the plot of trauma that it causes anxiety and fear.

- Ordinary imitative play is appropriate behavior and serves the development and socialization of the child, for this it includes a wide range of roles (mom, dad, doctor, warrior, etc.). The more roles a child tries on, the more he develops. In contrast, traumatic play is not advisable. It is repeated with the inflexibility and monotony characteristic of obsession - it is not subject to improvisation, and exactly repeats the plot of the trauma. The child here plays himself and is burdened with negative emotions. Typically, imitation play takes place between the ages of 3 and 12 years. As for traumatic play, it can continue in subsequent years, and in adults it changes into traumatic activity. For example, if a person has creative abilities, this can be embodied in the subjects of artistic production.

8. Deformation of the picture of the world. Trauma distorts a person's picture of the world. A child with a not yet formed belief system faces the danger of developing, under the influence of trauma, an initially deformed picture of the world. Often the world is presented as a source of ominous events, hostile, persecuting, and the person himself in it is unprotected, helpless, a victim. Such a picture of the world deprives a person of freedom of choice and blocks his vitality. Similar tendencies are often expressed in the creativity of children.

9. Problems of attention, memory, learning. An uncryed traumatic experience is a psychologically unfinished phenomenon, therefore it carries with it a tendency of constant actualization. For a person, especially a child, this actualization is a rather painful process, so most of his life energy is aimed at resisting this tendency, at curbing painful emotions. This, naturally, leaves an imprint on cognitive activity - attention becomes scattered, difficulties arise in concentration, memory capacity decreases, and “viscosity” of thinking may arise.

10. Various kinds of fears. Fear performs a protective function and, therefore, is expedient in nature. At different age stages, a child is characterized by different “normal fears”. Unlike “normal fears,” neurotic fears that arise as a result of trauma, on the one hand, have super-strong (panic) intensity, on the other, they are long-lasting and therefore destructive in nature. Children often have fears “inherited” from their parents.

11. Traumatic dreams and sleep disorders. Traumatic recurring dreams are one of the signs of an “unlived”, still unresolved traumatic experience. Traumatic dreams differ in how accurately they reflect the traumatic event. A dream can reproduce what happened completely or with changes, and perhaps not exactly. But in any case, a traumatic dream causes painful emotions (screaming, muttering, crying, jumping out of bed, walking while sleeping). Often the next morning the child does not remember what he dreamed. Nightmares and associated reactions may also occur in untraumatized children, but if they are repeated in nature and duration, this should be considered a sign of trauma. Psychosomatic disorders. In a traumatized child, psychosomatic disorders such as logoneurosis, enuresis, bronchial asthma, neurodermatitis, etc. can be encountered. Therefore, in the process of psychosocial rehabilitation, it is important to direct work not only to the treatment of these symptoms, but also to the processing of traumatic experience.

The appearance of these symptoms (even one or two) is a very alarming sign. Such manifestations require not only accurate psychological diagnosis, but also psychotherapeutic assistance to the child, since many symptoms, having the ability to “fix” in childhood, then have an impact on a person’s entire life, forming destructive psychological defenses.

Many authors believe that the rehabilitation of children and adolescents with PTSD should be implemented within the framework of a comprehensive targeted program of psychological, pedagogical and medical-social rehabilitation of children (biopsychosocial approach), including the following main stages: diagnostic (presence of a screening assessment);

emergency medical and psychological assistance,

comprehensive psychological-pedagogical and medical-social rehabilitation (in individual and group form),

monitoring of psychological and mental state, psychoeducation of the patient and parents, anti-relapse therapy,

social skills training [1].

A.L. Wenger recommends including family members, relatives, friends in the psychotherapeutic process and conducting group debriefing and psychoeducation. He notes that only a multimodal approach, i.e. the use of art therapy, play therapy, relaxation techniques, behavioral techniques aimed at responding to aggression. Zoning of the rehabilitation space (zone of role-playing games, constructive activities, sports activities, response to aggression, creative activities) is effective in the treatment of children and adolescents with PTSD [3]. In domestic clinical psychology, forms of express correction of acute symptoms of psychotrauma are being actively developed, consisting of:

1. stabilization of the mental state, restoration of the neuropsychic state;

2. ensuring stable social activity;

3. training in skills to overcome behavioral and emotional problems (fears, anxious rumination, negative automatic thoughts, flashback effects);

4. correction of impaired communication skills [4].

It has been shown that support groups for children in grief and traumatic situations can be of great importance in improving the mental state of children and adolescents with PTSD. The purpose of the group is to encourage children in their desire to share their experiences, thoughts and feelings; This way they become more deeply aware of all kinds of circumstances and themselves in them. Children are given the opportunity to analyze their own experience, their reactions to the traumatic situation and how it affects their mental state. The group analyzes various topics that combine the issues of grief, trauma and the concepts of integrity, clarity, self-analysis and self-awareness [1].

L. Schneider, when providing psychological assistance to children and adolescents in crisis, recommends using the following techniques: information, metaphor (analogies), establishing logical relationships, conducting logical justification, self-disclosure, specific wishes, paradoxical instructions, working with beliefs, emotional contagion, responding to unconstructive emotions, relaxation, reappraisal, role playing, internal negotiations, etc. [9]. However, the isolated use of these techniques without understanding the psychotherapeutic targets and constructing a conceptualization (cognitive model of the disorder) is recognized as ineffective treatment.

The main targets of help for PTSD:

1. Game therapy and art therapy. A.L. Wenger and E.I. Morozova recommend conducting therapy with younger children primarily using play therapy methods, and with older children – art therapy [2]. It is recommended that each lesson in art therapy and play therapy for children with PTSD be structured according to an algorithm: first, gradually include children in the activity, increase its intensity according to a gradient type, reach a certain maximum, and then reduce it. End the session with quiet activity (for example, drawing) or relaxation techniques (breathing, muscle exercises). It is mandatory to include free play and free artistic activity in the rehabilitation process of children, both in individual and group form [5].

2. Psychosynthesis when working with children and adolescents with PTSD. This direction of therapy focuses on the use of imagery techniques to teach coping skills with traumatic experiences and problematic situations. The image visualization process is used, which includes teaching children and adolescents relaxation techniques (breathing and muscle techniques), and reproducing situations in which the child finds himself in difficult and dangerous circumstances and can successfully cope with them with the help of breathing techniques and imagination.

3. Cognitive behavioral therapy when working with children and adolescents with PTSD. In psychotherapeutic work with children of middle and older preschool age throughout the world, the standard is cognitive-behavioral psychotherapy, focused on working with psychological trauma [6]. Cognitive-behavioral psychotherapy is short-term psychocorrectional work, which includes 12-18 sessions from 20-30 minutes to 50-90 minutes, depending on the age characteristics of the child, the need for psychotherapeutic assistance, and the degree of the child’s psychological state. Visual diagrams and toys are used (bibabo toys are especially useful), an interactive board for drawings, and a tablet computer with an installed program (Triangle of Life) are actively used. Classes are conducted individually. They include classes with a child and a parent (guardian), or joint classes with a child and a parent together. Each session is designed to build a therapeutic relationship, as well as psychoeducation, teaching skills to effectively cope with stress, organizing a safe environment for resolving and processing traumatic experiences.

4. Gestalt therapy. Aimed at helping the child understand what is happening to him “here and now” [1]. For children with PTSD and especially for victims of violence, this awareness is especially relevant. Most Gestalt techniques are recommended for working with children aged 5-12 years. The key to therapy is taking responsibility (using “I” instead of “we” or “you”) for your thoughts, feelings, and behaviors. Replacing “I can’t” with “I don’t want” (“why” with “what” and “how”; “I should” with “I want”) in order to understand what share of responsibility the child takes on for what happened is effective when working with personal dissociations in children resulting from trauma.

Used Books:

1. Bryazgunov I.P. Posttraumatic stress disorder in children and adolescents. Medpraktika-M, 2008. 144 p.

2. Wenger A.L. Psychological assistance to children and adolescents in emergency situations (based on the experience of working with victims of the terrorist attack in Beslan) // Consultative psychology and psychotherapy. 2006. No. 1.

3. Wenger A.L., Morozova E.I. Psychological assistance to children and adolescents after the Beslan tragedy. Vladimir: Transit-IKS, 2009. 150 p.

4. Kadyrov R.V. Post-traumatic stress disorder (PTSD): state of the problem, psychodiagnosis and psychological assistance. St. Petersburg: Rech, 2012. 448 p.

5. Melyokhin A.I. Game-based cognitive behavioral therapy // Modern content of preschool education: variability, initiative, sustainable development. Irkutsk: ICPT “Mix”, 2016. pp. 68-71.

6. Pushkarev A.L. Features of correction of post-traumatic stress disorder (PTSD) in participants of military operations. Mn.: 1997. 40 p.

7. Tarabrina N.V. Psychology of post-traumatic stress: Theory and practice. M.: Publishing house "Institute of Psychology RAS", 2009. 304 p.

8. Tsutsieva Zh.Ch. Phenomenology, psychodiagnostics and psychological correction of post-traumatic stress disorders in children victims of a terrorist attack: features, psychodiagnostics and correction // Bulletin of psychotherapy. 2009. No. 32 (37). P.84-90.

9. Schneider L. Crisis states in children and adolescents: directions of work of a school psychologist. URL: https://psy.1september.ru/view_article.php?ID=200901812 (Access date: 09.15.16)

Causes of PTSD

On the one hand, the causes of post-traumatic syndrome are obvious: these are extreme situations. On the other hand, not all victims exposed to the same conditions develop PTSD. This phenomenon certainly arouses interest.

Russian scientist I.I. Pavlov, who studied the nervous system of dogs for a long time, noted that dogs of different temperaments react differently to stress.

In 1924, there was a major flood that flooded Pavlov's laboratory. Some experimental dogs died, others were saved. In his research, Pavlov notes that in dogs with a melancholic temperament, the effects of nervous stress persisted longer than others.

Other factors that influence the likelihood of developing PTSD include:

• Age;
• Individual sensitivity;
• The degree of preparedness for the situation;
• Physical and mental state (last straw effect).

The repetition of events has a destructive effect. This factor is especially significant in histories of domestic violence associated with sexual dysfunction and incest. It is known that victims of pedophilia who are regularly abused experience profound personality changes as adults.

Next, let's talk about what kind of PSTD disorder it actually is, and how it manifests itself.

Stages of development of post-traumatic stress disorder

The development of post-traumatic stress disorder includes three stages. The first is an acute stress reaction or ASR stage (Acute stress reaction). This is a healthy reaction of the body to a stressful situation, which is most often accompanied by fear or sudden fear. This stage lasts up to 48 hours. During this time, it is possible to take effective measures and prevent further development of PTSD.

Often in the first 48 hours a person's stress response is very strong and symptoms are especially intense. Immediately after a stressful situation, people may behave differently. Someone withdraws into himself and does not react to the surrounding reality. Someone begins to behave very nervously, constantly rushing about and does not know what to do with themselves. And someone feels the need to overcome their condition and again put themselves in a stressful situation, for example, getting behind the wheel again after an accident or returning to the battlefield after being in war. This reaction is considered correct, but before putting yourself in a stressful situation again, it is very important to work with a psychotherapist. Otherwise, a person may develop severe anxiety, depression or panic attacks. If, after experiencing stress, a person continues to behave as usual and does not complain about anything, there is a possibility that he has coped with his condition on his own. However, it also happens that a person simply does not realize that something is happening to him, or ignores this fact.

A person can remain in a state of PTSD throughout his life until he receives qualified help from specialists.

After the acute stress reaction stage, acute stress disorder or ASD (Acute stress disorder) begins. This stage can last about a month. During this time, it is also possible to help the person prevent the development of PTSD. The symptoms of ASR and ASD are very similar, but at this stage they are less intense than in the previous one. The last stage of the disease is post-traumatic stress disorder itself. A person can remain in a state of PTSD throughout his life until he receives qualified help from specialists.

Symptoms of PTSD

Descriptions of PTSD can be found both in the writings of doctors and in works of fiction under the name of a nervous disorder or nervous breakdown.

Sometimes the first symptoms appear almost immediately after the traumatic event and quickly increase over 1-2 weeks. But sometimes there is a period of imaginary well-being, when the psyche as a whole copes with the experiences, and symptoms appear gradually over 6-8 months.

Symptoms of PTSD are:

• Nightmares;
• High nervous excitability, irritability;
• Constant memories, thoughts about what happened;
• Tendency to aggression, hot temper;
• Difficulties with self-control;
• Fixation on a traumatic event: it “does not let go”, the person plunges into it again and again;
• Escaping reality.

Phantom pain (pain without cause) is also possible. With a long course - personality changes: isolation, hermit lifestyle.

Sexual desire is reduced or absent. Since the importance of sex in the lives of different people is not the same, sometimes this becomes the first complaint with which a person turns to a psychologist.

It is not uncommon for people with PTSD to engage in suicidal behavior. Due to outbursts of uncontrolled aggression, they can pose a danger not only to themselves, but also to others. According to Russian legislation, the existence of a threat to the lives of other people or one’s own is grounds for hospitalization without the patient’s consent.

Free consultation with a sexologist

Get access

Symptoms of Post-Traumatic Stress Disorder

With post-traumatic stress disorder, the symptoms that appeared in the first two stages of the disease become chronic. Their intensity decreases, irritability, intolerance towards other people and the inability to concentrate on work and daily tasks appear. Many people confuse this condition with attention deficit disorder. Symptoms of PTSD disrupt social relationships as it becomes difficult to communicate with the person suffering from the disorder. People with PTSD may change jobs and partners frequently.

Diagnosis and treatment of PTSD

Diagnosis is carried out by a specialist who knows everything about PTSD: a psychiatrist or psychologist. Treatment, as a rule, is complex: a psychiatrist prescribes drug therapy, and a psychologist helps to cope with the consequences of a traumatic event and survive the pain.

Perhaps compared to the causes of PTSD, other problems seem less serious. But it's important to remember that no matter who you are, you don't have to be a PTSD sufferer to seek help. Anyone experiencing stress has the right to be listened to.

Sometimes timely consultation with a specialist can protect you from very serious consequences. If you find yourself in a difficult life situation, call the hotline or seek help from a psychologist.