POST-TRAUMATIC STRESS IN CHILDREN educational and methodological manual

What is PTSD

Post-traumatic stress disorder Post-traumatic stress disorder (PTSD), or PTSD for short, is a mental condition that interferes with the life of some victims or observers. Post-traumatic stress disorder of terrible events: combat, disasters, accidents, physical or sexual violence.
Initially, the diagnosis was made to those who had been in war, but PTSD can develop in any person. Post‑Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care. Most people in mental health emergencies feel anxious, sad, angry or irritable after a traumatic event. They experience insomnia and constant fatigue. This is a normal reaction to a threat to life and health, a feeling of helplessness and loss of control over what is happening. But after a month of Post-Traumatic Stress Disorder (PTSD), these symptoms usually subside and people return to normal life.

If the symptoms do not subside, the person continues to be tormented by memories and nightmares, we can talk about the development of post-traumatic stress disorder. According to WHO Mental Health in Emergencies, 9% of those who have experienced something terrible need treatment for it. At the same time, women suffer from Post‑Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care PTSD is 2.5 times more likely than men, although men face more dangerous situations.

PTSD cannot be left untreated. The disorder disrupts Post‑traumatic stress disorder (PTSD) personal, social, and work relationships, and interferes with everyday tasks.

Prognosis and prevention

In the early stages of PSTD, the prognosis is favorable; the disorder can be eliminated with comprehensive psychotherapeutic assistance, supplemented by medication. The chronic form of the syndrome is more difficult to treat - complications develop, psychopathization of the personality occurs. Pathological changes are more stable and require long-term medical supervision. You can reduce the likelihood of post-traumatic syndrome by properly organizing your life. It is necessary to ensure maximum involvement of the child in social relationships: attending school, friendly meetings, sports clubs, active family recreation. Passion for the present is important - meetings, studies, creativity, achievements. If a child wants to discuss a difficult event that has happened, you cannot refuse, but you should talk about it as if it were a past experience.

Why does PTSD occur?

It is not known exactly why stress disorder develops in certain people. But there are Post‑traumatic stress disorder (PTSD) factors that increase the risks:

• Nature of injury. The stronger and longer the stress, the higher the likelihood of PTSD.
• Previously experienced psychological trauma. For example, childhood abuse.
• Heredity. Those who have family members with anxiety disorders or depression are at greater risk.
• Work or hobbies associated with constant stress or danger to life.
• Presence of other mental disorders.
• Temperament, and how the brain regulates hormones and other chemicals that are released in response to stress.
• Lack of support from loved ones after injury.
• Frequent use of alcohol and other psychoactive substances.

How does PTSD manifest?

Symptoms of post-traumatic stress disorder (PTSD) are most often detected within a month after the event, but sometimes they are not noticed until several years later. This can happen against the background of new stress or a random reminder of the experience.

Symptoms can be divided into four main groups.

Intrusive memories and dreams

• A person cannot forget and constantly replays what happened in his head.
• He has nightmares, which makes it scary to go to bed.
• Any reminder of the event causes strong emotions or physical manifestations. For example, after a car accident, the victim reacts to a car signal with trembling in his hands or a sudden attack of fear.

Avoidance

• The victim constantly tries to forget about the experience; a lot of effort and energy is spent on this.
• He diligently avoids places or people that might remind him of something terrible. For example, after the death of a loved one, a person may refuse to meet with other relatives so as not to talk about the deceased.
• Gives up favorite activities if they are somehow related to what happened. A girl who survived an attack in a hallway may refuse to train after work because she is afraid to return home in the evening.

Changes in mood and thinking

• Negative thoughts about yourself, other people, or the world appear.
• I am haunted by a feeling of hopelessness. There are no goals in life and no desire to change anything.
• Memory problems arise. Sometimes it is impossible to remember important details of a traumatic event.
• It becomes difficult to communicate with loved ones and maintain relationships.
• Loss of interest in hobbies or meeting friends.
• The victim is not able to rejoice or be sad, he only distantly observes life from the outside.

Changes in physical and emotional reactions

• A person constantly feels a threat to his life and strives to protect himself by any means.
• Often feels guilty or ashamed for what happened. He thinks about how he could have avoided what happened.
• Concentration is lost, it is difficult to work or just read a book.
• The victim may be hot-tempered and aggressive.
• Problems with sleep appear.
• A person unconsciously strives for self-destruction. For example, he drinks a lot or ignores traffic rules.

Symptoms may wax and wane and only appear when there is new stress or reminders of a scary event. The victim himself may not associate Post‑Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care problems with sleep or concentration with the trauma he has experienced, especially if a lot of time has passed. But at the same time, constant stress interferes with normal life.

Symptoms of PTSD in children

The behavior of children suffering from post-traumatic syndrome is aimed at avoiding situations that actualize trauma memories. Accidental interaction with a trigger (a fragment of a traumatic situation) is accompanied by an emotional attack, manifested by anxiety, screaming, panic, crying, and inappropriate impulsive actions. Examples of triggers include squeaking brakes, the sound of a gunshot, or the smell of certain medications. Memories occur more often at night, are rare during the day, and are easier to bear. Sleep disturbances and daytime sleepiness are often observed. The child’s desire to relive the traumatic situation again is often observed: the plot is reproduced in drawings, games, and written stories.

Children who have been subjected to physical violence become aggressive - they provoke conflicts and are the first to start a fight. In preschool children, against the background of PTSD, developmental regression is detected: speech and play become simpler, previously learned self-care and hygiene skills disappear. Violations of emotional and volitional functions are manifested by isolation, capriciousness, and irritability. Problems of socialization and social adaptation arise. Severe forms are accompanied by illusions, hallucinations, reflecting fragments of a traumatic situation.

Constant emotional stress and insomnia lead to the development of cerebrasthenic syndrome - a complex of symptoms of exhaustion of nervous activity. The child gets tired quickly, cannot cope with the educational load, tries to avoid physical activity, and has difficulty concentrating. Functional disorders of the cardiovascular, endocrine, and digestive systems gradually appear. Frequent symptoms are nocturnal enuresis, lethargy, weakness, drowsiness, epigastric pain, headaches, and heart pain.

How is PTSD treated?

You shouldn’t ignore post-traumatic syndrome; the problems won’t go away on their own. It's best to see a therapist first. He will check for physical illnesses that may cause mental changes. To do this, the doctor will conduct an examination and prescribe the necessary examinations. This may include a chest x-ray, blood tests, or a CT scan of the brain.

If everything is fine with the body, the therapist will refer you for consultation to a specialized specialist. He will determine whether medications are needed or whether psychotherapy will be sufficient.

Before meeting with a psychotherapist, it is worth preparing a list of symptoms, changes in behavior or lifestyle. At the appointment, ask the specialist about his experience of working with post-traumatic syndrome and the number of patients who have overcome it. It is important to ask all the questions that concern you at once, because the success of treatment largely depends on the trusting relationship between the patient and the psychotherapist.

What can psychotherapy be like?

According to the recommendations of the World Federation of Societies of Biological Psychiatry (WFSBP) on the pharmacotherapy of anxiety, obsessive-compulsive and post-traumatic disorder, experts believe that only psychotherapy can relieve PTSD. Medicines can only relieve acute symptoms and temporarily improve the quality of life.

Several Post‑traumatic stress disorder (PTSD) methods are used to treat PTSD:

• Cognitive therapy . The doctor will analyze thinking errors and stereotypes that prevent you from returning to normal life after an injury. For example, the thought “I’m bad because they did this to me” will gradually turn into “They did this to me, but that doesn’t make me bad.” The patient will keep a diary and describe in it his condition and reactions to different situations. Gradually, a person will learn to solve problems that were previously beyond his capabilities.
• Behavioral or exposure therapy . The point of the method is to return to a traumatic situation under the control of a psychotherapist. The patient is immersed in the past with the help of videos, sounds or verbal descriptions, but the specialist teaches how to cope without panic and horror. Over time, the memories stop frightening, and it becomes possible to live on without looking back at the trauma.
• EMDR, or EMDR Recommendations of the World Federation of Societies of Biological Psychiatry (WFSBP) for the pharmacotherapy of anxiety, obsessive-compulsive and post-traumatic disorder - eye movement desensitization and reprocessing. This method was developed specifically for the treatment of post-traumatic disorders. It is believed that the brain cannot cope with processing the stressful event and therefore the memories do not go away. During an EMDR session, the patient briefly focuses on the past and at the same time on eye movements or other stimuli: taps, sounds. This synchronizes the activity of both hemispheres and helps the brain process painful memories. If the injury was mild, four to five sessions may be enough.

What medications can the doctor prescribe?

Medications are prescribed Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care simultaneously with psychotherapy if it is necessary to remove the most severe manifestations of the disorder and improve quality of life before psychotherapy works.

The recommendations of the World Federation of Societies of Biological Psychiatry (WFSBP) for the pharmacotherapy of anxiety, obsessive-compulsive and post-traumatic disorder are used in several groups of drugs:

• Antidepressants . They can reduce symptoms of anxiety and depression, improve sleep, memory and concentration.
• Mood stabilizers . Used to reduce impulsivity, attacks of anger and to reduce irritability.
• Antipsychotic drugs . They are prescribed if the shock was too severe and memories and emotions interfere with life.
• Benzodiazepines . Used to reduce severe anxiety and improve sleep. But now they are rarely prescribed.

What else can you do

Taking care of yourself helps you return to normal life faster and easier. For this there is Post‑traumatic stress disorder (PTSD):

• Follow the treatment plan, even if psychotherapy and medication do not seem to be helping. It takes time to get easier.
• Find opportunities for proper rest and sports or walks. Physical activity and good sleep relax and help you recover.
• Eat varied and tasty food. A lack of beneficial elements can worsen your mental state.
• Reduce or eliminate possible sources of stress. New concerns prolong treatment.
• Give up coffee, alcohol and cigarettes. They can increase anxiety.
• Communicate with loved ones and meet friends who can support and listen.
• Find interesting hobbies that will distract you from your experiences and memories.

Treatment of PTSD in children

Post-traumatic syndrome occurs when there is a violation of the processing of life experience in extreme situations - moments from the past exist in real life and change it. Therefore, treatment involves working with a child psychologist, psychotherapist - specialists who help to understand, survive, and let go of traumatic events. Complex therapy for PTSD in children includes:

• Cognitive-behavioral methods.
  Meetings with a specialist are aimed at understanding and re-experiencing psychotrauma. Key desensitization techniques are then used. Several stimuli of the same type, but of varying intensity, are selected. An emotional response (fear, crying) is provoked with gradual intensification, and skills to cope with the attack are developed. Over time, the connection between the trigger and the emotion breaks down.
• Psychocorrection of destructive feelings.
  Using projective methods and game situations, feelings of guilt are eliminated and attacks of aggression and self-aggression are corrected.
• Family psychotherapy.
  Working together with parents and close relatives is aimed at relieving anxiety and emotional stress. Situations are created through which the child can express himself, be active, and not be afraid.
• Drug treatment.
  Prescribed for severe PTSD to relieve phobias, panic attacks, and illusions. Sedatives and selective serotonin reuptake inhibitors (SSRIs) are used. The drugs relieve tension and obsessions, improve mood, eliminate anxiety, stabilize the functioning of the central nervous system, and reduce aggressiveness. Severe anxiety is corrected with tranquilizers, asthenic manifestations with nootropics, and psychotic symptoms with antipsychotics.

How successfully is PTSD treated?

Everything is individual. The result will depend on the severity of the symptoms, as well as the efforts of the patient and the support of loved ones.

But if you follow all the doctor’s recommendations, sooner or later you can recover and return to normal life.

Moreover, new drugs and methods are constantly appearing. For example, the US Food and Drug Administration recently approved the NightWare Receives FDA Marketing Permission for First and Only Medical Device to Reduce Sleep Disturbances Related to PTSD‑Associated Nightmares in Adults to interrupt nightmares.

How to help a loved one with PTSD

If a family member or friend has PTSD, the most important thing is to help them seek professional help. After all, the victim may perceive the situation inadequately and believe that everything will go away on its own.

In addition, Post‑traumatic stress disorder (PTSD) is important:

• Recognize that avoidance and withdrawal are symptoms of the disorder. Do not insist on your help if the person rejects it. Just explain that you are nearby.
• Be willing to listen. Let your loved one know that you can discuss what happened whenever they want. But don’t pressure, don’t force you to talk about the injury against your will.
• Go for a walk or do an interesting activity together.
• Plan more joint meetings, celebrate holidays.
• Take care of yourself. Being around someone who has gone through something terrible can be difficult. You may experience constant stress, guilt, and powerlessness. Therefore, do not forget to restore your resources: rest, eat right, exercise.
• Prepare a safe place to hide if your loved one becomes aggressive.