Posttraumatic stress disorder: overview and clinical considerations

PTSD

Posttraumatic Stress Disorder is a condition from which nearly 10% of Americans suffer from. PTSD, unlike other afflictions, is associated with a wide variety of circumstances. Many war veterans suffer from Posttraumatic Stress Disorder. However, sexually abused children are quickly emerging as common suffers of Posttraumatic Stress Disorder. Posttraumatic Stress Disorder is a prevalent problem associated with children who are victims of sexual assault.

Posttraumatic Stress Disorder is classified as an anxiety disorder under the Diagnostic and Statistical Manual of Disorders (DSM-III). The diagnosis of Posttraumatic Stress Disorder was not formally diagnosed as part of DSM-III until 1980. According to Famolaro, 'the diagnoses of Posttraumatic Stress Disorder requires: (a) experience of a significant traumatic events; (b) re-experiencing of the trauma in one of several different thought, emotional, or behavioral forms; (d) persistent symptoms of increased arousal, Particularly when exposed to stimuli concretely or symbolically reminiscent of the trauma; (e) symptoms lasting at least one month. (Famolaro, Maternal and Child Posttraumatic... 28)'.

Children are now becoming realized as significant sufferers of Posttraumatic Stress Disorder. Posttraumatic Stress Disorder is particularly bad for children under the age of 11, because they lack many of the skills needed to protect themselves. Furthermore, this vulnerability is enhanced when the child is exposed to any maltreatment. According to recent studies, 'Posttraumatic Stress Disorder is a common sequella of severe or chronic maltreatment of children, particularly among sexually maltreated children ( Famularo, Symptom Differences... 28)'. Posttraumatic Stress Disorder can be caused if the child is exposed to just one traumatic episode (rape, witnessing a violent crime, physical abuse). However, the child will become more susceptible to Posttraumatic Stress Disorder if the maltreatment continues. Moreover, a child is most likely to suffer from symptoms associated with Posttraumatic Stress Disorder when sexual assault is involved (28).

Because children have not yet developed emotionally and are very immature, they are likely candidates to develop symptoms related to Posttraumatic Stress Disorder. As a child matures, he or she becomes better equipped to deal with and prevent contributing factors to the eventual suffering from Posttraumatic Stress Disorder. Up to age two, young children can recreate stressful events and can even imagine such events recurring. However, the mind has not developed enough to identify, anticipate, or prevent future traumatic occurrences. At age three, children cannot, 'distance themselves, in time, appreciate roles and differences in behavior, access situation, or adopt non-egocentric causality (Saigh 189)'. This flaw opens them up to the impact of trauma because the child cannot anticipate and protect themselves. By age four, children have the ability to protect themselves by avoiding traumatic encounters. They also have the ability to suppress their anxiety when it becomes difficult to cope with. Since children do not have this ability early in life, they are vulnerable to physical and sexual assault. Children continue as such until they become concrete operational at about age six or seven (190).

Children who have been sexually abused develop many of the syndromes associated with Posttraumatic Stress Disorder, some of which are, the inability to establish normal relationships with adults and peers, to make a normal transition from adolescence to adulthood, as well as to develop skills required to progress in school. However, this was not the case with all sexually assaulted children. Walder states, 'not all those so exposed will develop a Posttraumatic Stress Disorder reaction; some may have a certain 'hardiness' that helps them cope without any noticeable residual effects while others may have a severe psychological reaction that renders them unable to function (Walker 130).'

Knowledge of sexual assaults has recently become more common. Random surveys of adults indicate that approximately 28% of women and 16% of men were victims of sexual abuse before the age of sixteen (Valentier 455). The nature of the abuse stretched from fondling to sexual intercourse committed by an adult that was five years older than the victim (Wolf et al.). Women are more often the victims of child sexual assault then men. According to John B. Murray, women are the victims of child hood sexual abuse at a ratio of 10:1 over men (Murray 658). Furthermore, children of lower income families are also common victims of sexual assault. but, as Murray points out, sexual abuse occurs in all types of families regardless of their income; and, sexual assaults are usually committed by a member of the family. It is difficult to get an accurate record of the actual number of children that have been sexually abused. Many cases never come to light and because of differences in definitions of sexual assault, some cases are missed (658).

Researchers have begun to explore the concept of Posttraumatic Stress Disorder with children and adults that were victims of sexual assault. Many times people associate particular events with particular stimuli. For example, certain orders, colors, sounds, and people can trigger a memory of a past event. This is truer for victims of sexual assault. According to Wolf, Sas, and Wekerle, 'traumatic episodes become associated with particular eliciting stimuli and can lead to maladaptive or a typical reactions. Such conditioning can play an important role in the formation of children's adjustment disorders subsequent to sexual abuse (Wolf et al. 38).'

Because people do not anticipate an abusive episode, there are usually things the victim cannot control. Sexual abuse is such a stressful event to where it has the capability to produce a form of a coping reaction. Since children are impressionable, the perpetrator may threaten the child not to confess. Child victims of child sexual assault are also tortured by nightmares, recurring images of the event, and troubling memories. 'Based on interviews with children who have been exploited by adults through sex rings and pornography, 65 of 60 children reported intrusive thoughts, flashbacks, and nightmares. Physical symptoms (eg. Somatic complaints, sleep problems, excessive crying) and greater social withdraw and distrust of others were also noted among a sizeable proportion of this sample (Wolf et al. 39).'

Posttraumatic Stress Disorder is diagnosed with the Posttraumatic Stress Disorder Symptom Checklist. The test consists of a list of 43 'adjustment problems' with 23 items spanning the range of symptoms characterizing Posttraumatic Stress Disorder as defined in the DSM-III Categories for Posttraumatic Stress Disorder. Participants were considered Posttraumatic Stress Disorder positive if they indicated on the test that they had re-experienced the traumatic event, became avoidant, and had increased arousal. The test also indicated whether or not the participant had a 'moderate problem' or 'partial' Posttraumatic Stress Disorder (Rowan 55).'