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PTSD in Teens

Though it’s typically associated with war veterans, this intense anxiety disorder plagues thousands of young people as well. Some teens may view substance abuse as the only way to escape PTSD nightmares or panic attacks. If this sounds like your child, there is hope. Call us to get them help.

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20 min read

What Is PTSD?

Post-traumatic stress disorder, or PTSD, is a particular set of anxiety symptoms triggered by a highly distressing event. Those who suffer from it relive their traumatic experience over and over again, which can interfere with their day-to-day functionality in a big way. Approximately 7–8% of people in U.S. will have PTSD in their lifetime — about 10 of every 100 women and 4 of every 100 men.

Experts agree on 4 features shared by every case of post-traumatic stress disorder. These will be exhibited at some point during the illness — even for teenagers.

A patient with PTSD:

  • Has lived through a traumatic event
  • Re-experiences the most distressing aspects of the trauma
  • Avoids reminders of the experience in an effort to cope with symptoms
  • Is on edge, unable to relax and unable to think about the event without being obsessed

What are the Causes of Teen PTSD?

PTSD can be caused by a variety of factors

During a traumatic or potentially harmful event, the body typically reacts with a “fight-or-flight” response, a release of hormones that equips and primes a person to either face the event head-on or run away. In some cases, the hormonal change can be so extreme that it triggers PTSD — a form of anxiety disorder related to the event. Around 61% of men and 51% of women report at least one traumatic event in their lifetime. People experience “traumatic stress” during or immediately after an experience like this. Any stress associated with the event that a patient feels well afterwards is called “post-traumatic stress.”

The majority of people who experience a trauma will not develop PTSD, but will almost certainly have some amount of traumatic stress and post-traumatic stress. It’s nearly impossible to predict when and where the illness of PTSD will strike, but it can happen to anyone.

In teens — as is the case with adults — the likelihood of developing PTSD is higher if they:

  • Were seriously hurt during the event
  • Experienced a trauma that was long-lasting and very severe
  • Felt helpless during or had a severe reaction to the event (shaking, vomiting, “blacking out” for forgetting where they were)
  • Had an earlier life-threatening event
  • Have had recent, stressful life changes
  • Have another mental health problem
  • Have little support from friends or family
  • Are a heavy drinker
  • Are poorly educated

Types of Traumatic Events

Exposure to war, whether as a civilian or a member of the armed forces, is perhaps the most well-known type of traumatic event related to PTSD. One in 3 returning troops are diagnosed with severe PTSD, and an additional 20–25% will develop partial PTSD at some point in their lives. Around 67% of people who witness mass violence develop some degree of PTSD, making this the most troublesome traumatic event in regards to the disorder. In a study of kids who witnessed a school shooting, 77% had moderate to severe PTSD.

Other types of traumatic events include:

  • Physical abuse
  • Sexual assault or rape
  • Verbal abuse or being threatened
  • Car accident or plane crash
  • Natural disaster
  • Violent crime, such as a robbery or shooting
  • A loved one’s death

PTSD in Children

Post-traumatic stress disorder can develop in children and adolescents just as it can in adults — often following a disturbing or life-threatening experience. Around 4% of kids aged 13–18 will develop PTSD in their lifetime, with the highest prevalence (5.8%) in teens aged 17–18. As with adults, female teens are more likely than their male peers to suffer from PTSD, with an even larger disparity — 6.6% of girls compared to 1.6% of boys. This may be due, in part, to higher rates of sexual assault or harassment.

“I was like, PTSD? I thought it was just for veterans. But I found out it’s not; it’s for anyone who’s experienced an event where you keep thinking about it and it takes over your life.”

Stephanie Romero (developed symptoms after being harassed and attacked one night)

Each year, 5.5 million kids in the U.S. report some form of abuse. The trauma of abuse can set off PTSD in children, especially if it’s a recurring thing. Being neglected by family accounts for 65% of the reported abuse cases, followed by physical abuse (18%), sexual abuse (10%) and psychological abuse (7%). Another traumatic event is witnessing family violence, which 3–10 million do each year.

Up to 43% of people will go through at least one trauma in their childhood, with up to 3–15% of girls and 1–6% of boys who suffer a trauma going on to develop PTSD.

Risk factors for childhood PTSD include:

  • The severity of the trauma
  • How the parents react to the event
  • How close or far away the child is to the trauma

Types of PTSD

Battling PTSD

PTSD is not always triggered immediately following trauma, and it doesn’t always last a very long time.

There are 3 types of PTSD as defined by doctors:

  • Acute – wherein the symptoms last between one and 3 months after the trauma
  • Chronic – when the patients shows symptoms for at least 3 months following trauma
  • Delayed – in which symptoms don’t pop until more than 6 months after trauma

Two additional subtypes have been defined more recently. They are:

  • PTSD in children under 6 – also known as the “preschool subtype,” which spawn from directly experiencing or witnessing a parent suffer sexual violation, serious injury or threatened death. This can cause prolonged psychological distress, recurrent distressing memories or nightmares (also known as PTSD nightmares), and occasional loss of awareness to present surroundings
  • Dissociative PTSD – marked by prominent dissociative symptoms (feelings that the world seems unreal, dreamlike or distorted, or feeling detached from one’s own body)

Doctors cannot formally diagnose PTSD until one month after a traumatic event. In one study of female rape victims, 94% met full symptom criteria approximately 12 days after the assault. One month in, 64% met the criteria for acute PTSD — three months in, 47% met the criteria for chronic PTSD. The majority of people who develop PTSD recover naturally within 3 months. In some cases, adults will develop delayed PTSD years after childhood trauma.

PTSD is also diagnosed as simple (developing from one incident) or complex (developing from repeated incidents). Those suffering from complex PTSD typically exhibit a broader range of symptoms.

History of PTSD

Psychological impairment from serious trauma has likely affected humans as long as trauma itself. It wasn’t until 1980 when the American Psychiatric Association (APA) defined the symptoms of PTSD and added it to to the Manual of Mental Disorders. The clinical definition of PTSD underlines the importance of outside agents (i.e. a traumatic event) rather than an inherited individual weakness. An individual cannot be diagnosed with PTSD unless they meet the specific “stressor criterion,” having indeed experienced a personally catastrophic event and their symptoms relate to thoughts of this particular event.

Famous Cases

Public figures encounter PTSD and similar mental health problems just as the rest of us do. Though they may not discuss it often, and can manage to keep the symptoms under control, celebrities have reported being diagnosed with PTSD for decades.

According to one story, world-famous singer and actress Barbra Streisand developed PTSD after forgetting the lyrics to a song during a massive concert, and was unable to perform for years because of it. When Mick Jagger of the Rolling Stones lost his girlfriend to suicide, he dealt with serious PTSD symptoms. While never officially diagnosed, First Lady Jackie Kennedy exhibited post-traumatic behavior after John F. Kennedy’s assassination, including constant fear that she would be targeted next.

A number of present-day celebrities have struggled with the disorder as well, including Chris Brown and Amanda Bynes, who have both come under intense public scrutiny for their troubled personal lives.

Misconceptions About PTSD

Post-traumatic stress disorder — which is sometimes written out as “posttraumatic stress disorder” — is an illness that’s often misunderstood. It’s believed that hundreds of veterans with PTSD — along with countless other individuals — are likely misdiagnosed with other disorders, leading their actual disorder to go unaddressed. The symptoms of PTSD can closely resemble those of other well-known mental health problems. Following a traumatic brain injury, as much as 59% of people exhibit the symptoms of PTSD, despite only 3% actually leading to legitimate cases.

If a loved one displays worrisome behavior, it’s important to get them properly assessed with a trusted doctor, so they aren’t incorrectly labeled with the wrong issue. A misdiagnosis can delay or even prevent a proper treatment plan indefinitely.

PTSD vs. Anxiety

PTSD in teens is most closely related to other teen anxiety disorders — and is itself often considered an anxiety disorder all its own. Clinical anxiety — which affects 18% of the U.S. population — causes people of all ages to feel tense and nervous on a daily basis, and unable to focus properly. It’s typically a more generalized feeling, though, whereas PTSD is closely related to one particular memory. The “hyperarousal” symptoms of PTSD can be interchangeable with those of other generalized anxiety disorders. If these symptoms appear more prominently than the other symptoms of PTSD, it’s not hard to confuse it with basic anxiety.

PTSD vs. Depression

PTSD and depression

Clinical depression, or major depressive disorder (MDD), plagues millions around the world. It’s also closely associated with PTSD, and is the most common co-occurring mental health problem with PTSD. Most people with depression feel sad, down and even partially incapacitated for weeks at a time. According to a national survey, those with PTSD are 3–5 times more likely to develop depression. But it’s important to realize that the two are separate problems, each demanding special attention.

PTSD vs. Bipolar Disorder

The anxiety stemming from teen PTSD can resemble the mania caused by adolescent bipolar disorder – a serious, debilitating brain disease that causes uncontrollable ups and downs, referred to as “mania” and “depression.” Both disorders may have similar roots in the brain as well. Bipolar individuals are 6 times more likely to develop PTSD than the general population. If the two disorders coexist — as they often do — it can drastically lower the person’s quality of life, increase the frequency of mood swings and reduce the likelihood of remaining well. It can also increase the chance of self-harm or suicide attempts.

Myths about PTSD

Perhaps the most common myth about post-traumatic stress disorder is that only military veterans experience this disease — that seeing the horrors of war and having “shell shock” constitute the cases of the disorder, and that you’re fine as long as you don’t ever join the army. While it’s true that veterans make up a large number of cases (e.g. 31% of Vietnam vets developed the disorder), it can happen to anyone who lives through a major life trauma. Young people, as far back as preschool, are as susceptible this disorder just as much as a grizzled Navy SEAL. And teens can be more at-risk than anyone, as common adolescent problems like depression and anxiety make them more vulnerable if and when they experience trauma.

The average person, when talking about PTSD, might also consider it a sign of weakness — that victims should “get over it” and are in control of their emotions related to the event. This is far from the truth. Even the strongest-willed people can undergo a transformation due to trauma, and PTSD cannot be turned off with the flick of a switch. In serious cases, these individuals need psychological help to reprogram their brain and properly cope with their traumatic experiences. Because of myths like these, patients suffering from PTSD are looked down upon for their struggle. This can prevent them from fully returning to normal, happy lives.

Symptoms of PTSD

The symptoms of PTSD are grouped into 3 categories: re-experiencing, avoidance and hyperarousal. To be diagnosed with PTSD, a teenager must display at least one re-experiencing symptom, at least 3 avoidance symptoms and at least 2 hyperarousal symptoms for at least 1 month, as well as trouble with their daily routine caused by the disorder.

Re-experiencing symptoms can include:

  • Frightening thoughts
  • Bad dreams
  • Flashbacks, or repeatedly reliving the event, which cause physical symptoms such as sweating and rapid heart rate

Avoidance symptoms may include:

  • Staying away from places, people or objects that remind them of the trauma
  • Feeling guilt, depression or worry
  • Feeling emotionally numb
  • Having trouble remembering the event
  • Losing interest in activities that were enjoyable in the past

Hyperarousal symptoms are constant, rather than being directly tied to the traumatic event.

These symptoms can include:

  • Being “on edge” and constantly tense
  • Being easily startled
  • Difficulty sleeping
  • Angry outbursts

Acute stress disorder, or ASD, involves a handful of serious symptoms following a trauma that go away within a few weeks. The more symptoms add up, and the longer they last, the higher the chance that someone has PTSD.

Teens battling PTSD may display certain changes in addition to the usual symptoms.

These can include:

  • Reverting to childlike behavior
  • Difficult talking or expressing themselves
  • Refusing to go places or do things with friends
  • Frequent complaining of stomachaches or headaches
  • Acting out the traumatic events during recreational time
  • Becoming extremely clingy to parents and other adults
  • Having intense temper tantrums

What Are the Effects of PTSD?

PTSD is a life-changing disorder. Its effects can be seen and felt in all aspects of a patient’s life, from minor details to their day-to-day abilities. Some cases are more serious than others, but in any case, this disorder is not to be taken lightly.

Effects on the Brain

Hormonal changes caused by overwhelming or harmful events can impact the teenage brain in a big way. In patients with PTSD, levels of cortisol — a chemical the body produces in response to stress — reach dangerous levels. Under normal circumstances, the production of this chemical is a good thing, as it can help people move out of harm’s way or make other quick decisions under stress. But in excessive amounts, cortisol can destroy neurons in the brain, which are responsible for transmitting nerve impulses. This can throw off emotional regulation, and impair the ability to be resilient in the automatic way a healthy person experiences it.

“A lot of what we look at with emotion is focused on certain regions of the brain. One of them is the amygdala, which is really important not only for guiding your attention and focus on a threat stimulus, but also for affecting your body. But somebody with PTSD doesn’t activate that circuitry well.”

Dr. Amit Etkin (led a study on the emotional reactions of patients with PTSD)

The damaged communication in a PTSD patient’s brain can make them unattached and unaware, in addition to their more prominent symptoms such as nightmares and panic attacks. They will have trouble making sense of their surroundings and “fitting in” under varying social contexts.

Effects on the Body

Serious PTSD is commonly associated with poor physical health. Patients with PTSD often have difficulty sleeping and regulating their weight, along with general hygiene or self-care. After living with the disorder for a period of time, an individual can appear out of shape and unwell. They will often dedicate increasing amounts of mental energy to managing their panic attacks and coping with their other side effects. In doing so, they may lose sight of their overall health, becoming frequently sick and developing random injuries.

Studies also show a relationship between childhood abuse — which often predicates PTSD — and the development of disorders including cancer, heart disease and lung disease. Damage to the brain, poor diet and exercise habits, weakened immune system and misuse of drugs or alcohol are all contributing factors. When PTSD takes over, it can cause a domino effect into each avenue of one’s health. Chronic musculoskeletal pain, hypertension, hyperlipidemia (high levels of fat particles in the blood) and obesity are commonly associated with PTSD patients.

PTSD and Teen Suicide

Self-harm and suicide are ways that PTSD victims attempt to cope and deal with their suffering. According to one study, 10% of teens with PTSD attempt suicide. Teens with PTSD are among those who attempt suicide or engage in self-harming behaviors (e.g. cutting or burning themselves, punching walls, etc.). Without getting the help they need, adolescents battling PTSD are dangers to themselves, when self-harm or even suicide seem like logical ways to end the pain.

Other Effects

School performance, relationships and friendships can all be impacted when a teen develops PTSD. The longer these symptoms go without treatment, the more hurdles they can create into adulthood.

Living through traumatic events is associated with decreased IQ and reading ability, lower grades, more missed school days and decreased rates of high school graduation. Decreased social competence and increased rates of peer rejection are also seen in youth cases. Students who witness violence may be at risk for perpetrating violence on others.

The emotional roller coaster of PTSD (e.g. worry, detachment, tension, anger) can spell danger for relationships and levels of trust. While most are able to eventually work through these problems, 5–10% of people with PTSD may have lasting relationship problems. Being friends with someone seriously disabled by PTSD can be an arduous experience, and therefore, somebody with the disease may see their social life deteriorate as the symptoms worsen.

Co-Occurring Disorders

Causes of PTSD

Depression, anxiety, bipolar disorder and substance problems (also known as substance use disorders) are all commonly diagnosed alongside PTSD. Individuals with PTSD are more vulnerable to additional psychiatric problems than the average person. Additionally, many cases of PTSD develop in those with preexisting mental health issues. When someone is diagnosed with PTSD and a second (or even third) mental health problem simultaneously, these are considered co-occurring disorders. Around 75% of patients with PTSD have additional mental health problems.

Panic disorders, conduct disorders, dissociative identity disorder and eating disorders are also commonly diagnosed in people with PTSD. When a person struggles with multiple disorders, it makes their path to recovery far more treacherous. These individuals are more prone to added health and personal problems as well.

These might include:

  • Financial instability
  • Homelessness or troubled living situations
  • Violence towards others
  • Difficulty finding or maintaining employment
  • Self-harm or suicide
  • Hospital visits
  • Social impairment

PTSD and Substance Abuse

When PTSD co-occurs with a substance use disorder (or addiction), it’s called a dual diagnosis. In one study of patients admitted to a hospital for drug or alcohol detoxification, 25% had significant PTSD symptomatology. A natural reaction for thousands with PTSD is to seek self-medication. This often comes in the form of alcohol or illicit drugs.

More than half of men with PTSD also have a drinking problem, and up to 75% of people who survive violent or abusive trauma report drinking problems. While these people may feel that alcohol will help them forget, drinking can actually worsen the symptoms of PTSD — including the anger and irritability, emotional numbness and social isolation typically associated with the disorder. The introduction of alcohol into the equation also can lead to an entirely new slew of side effects and risks.

A survey of lifetime PTSD patients in the U.S. revealed that 34.5% of males and 26.9% of females also struggled with a drug problem at some point. These problems include abuse — misusing the drug in large amounts — and dependence, where they come to rely on the drug to function on a physical and mental level.

If a loved one with PTSD also develops a substance problem, it can make their already delicate situation far more complicated. The health and social risks of those with co-occurring PTSD and substance problems are endless. Finding help for people in this situation is urgent.

Treating PTSD

Teens and adults with PTSD, particularly acute PTSD, can overcome the illness naturally over time. Many others need a helping hand. If your teen experiences any sort of traumatic event — or displays certain symptoms of PTSD — you should take them to see a doctor.

Help for PTSD is usually found in forms of psychotherapy and “talk” therapy, which can last 6–12 weeks in most cases. Done in one-on-one or group sessions, psychotherapy places patients with a therapist and helps them talk through their issues. By doing this, patients can learn to face and control their fears, make sense of their bad memories and PTSD flashbacks, and reduce their anxiety by learning how to look back on their trauma in a healthy way. PTSD rehab and PTSD treatment centers can also help patients put everything in perspective, and shape positive behaviors so they can forward with their life.

PTSD Medication

Doctors may prescribe medication as a supplement to therapy. The two FDA-approved medications for managing PTSD are the antidepressants sertraline (Zoloft) and paroxetine (Paxil). These are also commonly prescribed for treating depression, and can reduce PTSD symptoms such as worry, sadness, anger and emotional unresponsiveness.

Your child’s doctor may recommend another medication as well. Doctors will often prescribe medications on an “off-label” basis — suggesting medications to help manage certain symptoms, even though they aren’t necessarily approved for the disorder on a whole. Other common medications used in PTSD treatment include the following:

Antidepressants:

  • Fluoxetine (Prozac)
  • Mirtazapine (Remeron)
  • Venlafaxine (Effexor)
  • Nefazodone (Serzone)

Mood stabilizers:

  • Carbamazepine (Tegretol)
  • Divalproex (Depakote)
  • Lamotrigine (Lamictal)
  • Topiramate (Topimax)

Benzodiazepines:

Other medications:

  • Prazosin (Minipress)
  • Tricyclic Antidepressants (Imipramine)
  • Monoamine Oxidase Inhibitors, or MAOIs (Phenelzine)

Be sure to research any medications before your teen begins taking them — each of these prescriptions has a number of potential side effects and needs to be used carefully. Benzodiazepines in particular can be habit-forming, and should not be used for periods longer than 5 days without frequent re-evaluations.

Does Your Teenager Need Rehab?

If your child has developed signs of substance abuse after enduring a traumatic event, sit them down with a counselor, even if they insist it is not necessary. A doctor or therapist can determine if addiction is present and whether rehab is needed.

Addiction can creep up silently, and devastate everyone in its path. Fortunately, high-quality holistic rehab has been proven to help teens like yours work through both addiction and mental disorders, and return to health.

You can’t always protect your children from addiction or trauma, but you can help them deal with these problems early and avoid a lifetime of turmoil. We at TeenRehabCenter.org can help you help your child get well again. We’re available to discuss any and all matters related to your teen’s addiction. Whether you need help wading through insurance requirements or you could use a curated list of vetted, teen-centric rehab facilities, we’ve got you covered. Best of all, our help comes to you free of cost and obligation. Too many parents say that they wish they had acted sooner than they did — don’t let this happen to your family. Call today and start getting your child the help they need.

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