This chapter of a psychiatry textbook covers all aspects of posttraumatic stress disorder (PTSD) in young people, including its development, diagnosis, and treatment. Several case studies at the end of the chapter illustrate important points.
Late in the 19th century, Pierre Janet and, later, Sigmund Freud lay the groundwork for the study of the constellation of symptoms that we now call PTSD. Today, a diagnosis of PTSD has six criteria. The first is witnessing or being confronted with an event involving death, serious injury, or threat to oneself. Second is re-experiencing the event-in dreams, for example. Avoidance of trauma reminders of the event is the third criteria. Fourth is increased arousal, such as irritability or trouble sleeping. The fifth requirement is that these symptoms last for at least one month. Finally, the symptoms must cause serious impairment to the person suffering from them.
Turning to treatment, crisis intervention and psychological first aid have important roles to play when traumatic events-school violence or natural disasters, for example-affect large numbers of children. The focus here is on helping children develop the skills to cope with grief and trauma. In the longer term, treatment studies have shown the usefulness of cognitive-behavioral therapy. Here, children are exposed to trauma reminders in a safe environment and are helped to make sense of the event by constructing a trauma narrative. Other elements of cognitive-behavioral therapy for trauma are relaxation exercises and cognitive restructuring-confronting and challenging self-blame, guilt, and other thoughts aroused by the trauma. Drug treatments are also discussed in this chapter. Any treatment must address the effect of the trauma within the context of the child's family.