You can’t talk about childhood trauma without broaching the topic of PTSD in children. In the eyes of most people, PTSD is a widespread condition, and an inevitable consequence of trauma. It is perhaps the most well-known psychiatric diagnosis, and one that’s frequently discussed throughout the media. Yet if you step outside of popular culture, it also happens to be one of the most controversial diagnoses, for reasons we’ll get into shortly. But first let’s discuss a little bit about what PTSD is and what it isn’t.
What is PTSD?
Post-Traumatic Stress Disorder, typically referred to as PTSD for short, is defined as the persistence of intrusive and unwanted symptoms that impair a child’s functioning following a traumatic event. The condition is characterized by the presence of 3 symptom clusters: 1) Replaying the experience via nightmares, flashbacks, or intrusive thoughts; 2) Numbness, withdrawal, or avoidance, and 3) Hyperarousal – such as elevated heart rate, irritability, insomnia, aggression, or trouble concentrating – that arise in response to a life-threatening event.
PTSD has become such a fixture of modern culture that many people would be surprised to learn it’s actually a fairly recent invention, added to the diagnostic manual used by clinicians in 1980. Diagnosis of the condition soon exploded, making it one of the most widely diagnosed (and over-diagnosed) labels in psychiatry.
Myth: PTSD is a natural outcome of traumatic experiences
Fact: True PTSD is fairly rare. On average it occurs in just 5-10% of those who experience a significant trauma. (Dobbs, 2009) Although more than half of people in the U.S. will experience a trauma such as rape, a natural disaster, or being attacked sometime in their life, only a very small portion will go on to develop any type of post-traumatic pathology or require any professional treatment. (Ozer et al., 2003)
Notice the condition is not referred to as post-traumatic stress reaction but post-traumatic stress disorder. Humans possess a natural ability to cope with difficult or traumatic experiences, and most do. PTSD occurs when a person’s coping mechanisms break down. This typically happens for one of two reasons: Either an experience is so intense that it overwhelms a person’s ability to cope, or more commonly, a person’s belief system has gone awry and is creating this pain and keeping it alive long after the incident is over.
Myth: Children are more likely to suffer PTSD
Fact: Children are naturally resilient, and frequently cope with difficult experiences better than adults. There’s no evidence to suggest PTSD is more likely in children, and in fact, many studies suggest it is less likely.
Understanding PTSD in children
Here’s the premise behind PTSD: Fear and pain release the neurotransmitter norepinephrine in the brain, which promotes protein synthesis, thereby aiding long-term memory formation. Even something as simple as sticking one’s hand in a bucket of ice water has been shown to produce this effect. (Adler, 2012) The more powerful or intense the experience, the stronger the reaction in the brain.
This is by design. As Jerry Adler states, “Survival is enhanced by remembering danger, not by forgetting it.” Nature wants us to be particularly attuned to threatening situations, so that we can better avoid the danger. In the game of survival, an overabundance of caution is less costly than carelessness. Therefore our brains have evolved to pay special attention to negative stimulus.
True PTSD occurs when an intensely painful or fearful experience sends this natural process into overdrive, resulting in a powerful release of memory-boosting neurochemicals that burn an indelible memory of the threat into the victim’s brain. This more powerful memory then crops up in places it shouldn’t be, trespassing into everyday life and making it difficult for a person to function as they normally would.
Classic PTSD symptoms emerge from a memory circuit gone awry. A child may experience more nightmares because this memory circuit is activated more often during sleep. Everyday things can trigger flashbacks to the trauma in question, because they happen to be linked to he circuitry encoding the traumatic memory. A mere reminder of the traumatic experience can activate this neurocircuitry and thrust the sufferer into a state of fear all over again. These “triggers” can be anything – a loud noise that reminds a child of a gunshot; a scent that’s similar to the cologne an attacker was wearing; or a food they were eating right before it happened.
It doesn’t help that our brains are built to over-react to potential risks, prone to look for danger even when it isn’t there. This makes everyday living a potential minefield that keeps drawing a person back into their trauma.
Each time a memory is accessed, two things happen: 1) It returns to a plastic state with the potential to be modified and re-encoded, and 2) The connections linking the memory are strengthened. Just as you can use repetition to memorize something you want to remember, the more times we access a memory, the more ingrained that memory becomes. Therefore the symptoms of PTSD end up creating their own negative feedback loop, wherein the memory and the negative emotions it evokes are strengthened every time that memory is triggered.
While this process seems fairly straightforward, and is well-grounded in neuroscience, there are many problems and controversies surrounding PTSD. For one, it is massively overdiagnosed, and frequently applied to experiences that do not fit the true definition of trauma, in which case all the mechanisms I just discussed would not apply. Second, PTSD is heavily rooted in memory and belief. So it’s not so much a trauma disorder as it is a belief disorder, fueled by a person’s catastrophic thinking. Finally, studies have had the darndest time lending credibility to this theory. In fact, PTSD symptoms show almost ZERO correlation to actual trauma in most balanced studies, meaning those who don’t experience trauma are just as likely to show “PTSD symptoms” as those who do. Moreover, PTSD symptoms show no relation to the severity of the trauma. A person who experiences a mild trauma may be more disturbed afterwards than someone whose trauma was quite severe. This calls into question the entire premise of the condition. (More on the problems and controversies surrounding PTSD can be found in our e-book, Child Trauma & Recovery.