Posttraumatic Stress Disorder in Children and Adolescents: A Review and Analysis

Only recently has the mental health community recognized the applicability of diagnostic criteria for posttraumatic stress disorder (PTSD) in children and adolescents, including a consideration of specific age-related features. This paper provides a current review of the literature on PTSD pertaining to children and adolescents. Following a discussion of issues on diagnostic criteria and assessment of this affective disorder in this population, there is an overview of the existing literature on prevalence, comorbidity, risk factors, parental and family factors, and issues of gender and age of onset. The remainder of the paper focuses on the range of traumatic stressors in children and adolescents that can result in PTSD, including natural or human disasters, war and violence, chronic or life-threatening medical conditions, community violence and the witnessing of traumatic events, and physical and/or sexual abuse and other forms of interpersonal violence. Throughout the paper, there is an emphasis on the importance of considering developmental factors. Finally, implications of the existing literature for future areas of research are addressed.     

Further Life Experiences Informing the Death and Adjustment Hypotheses

The meaning of life is never straight to us humans. At different turns of life, we perceive different meanings that are offered to us by our own lives. Near one’s death, professional disaster, enmity, family suffering, and fears for life all have their own dimensions. Nevertheless, when summing up, they seem to revolve around the same central themes again and again. In this article, we tried to offer the insights that we found from some very significant and traumatic events of our own lives through the spectacles of our theory—“Death and Adjustment Hypotheses.” Our life is always important; so is our peace and safety. But when we lose our values, we lose everything. It is often that we try to live through our offspring; however, it is our morality and humane values that can ultimately save them from the traumas of life and see them meaningfully through life and death as transcendental beings.     

A Community Responds to Collective Trauma: An Ecological Analysis of the James Byrd Murder in Jasper, Texas

The brutal murder of James Byrd Jr. in June 1998 unleashed a storm of media, interest groups, high profile individuals and criticism on the Southeast Texas community of Jasper. The crime and subsequent response—from within the community as well as across the world—engulfed the entire town in a collective trauma. Using natural disaster literature/theory and employing an ecological approach, Jasper, Texas was investigated via an interrupted time series analysis to identify how the community changed as compared to a control community (Center, Texas) on crime, economic, health, educational, and social capital measures collected at multiple pre- and post-crime time points between 1995 and 2003. Differences-in-differences (DD) analysis revealed significant post-event changes in Jasper, as well as a surprising degree of resilience and lack of negative consequences. Interviews with residents conducted between March 2005 and 2007 identified how the community responded to the crisis and augmented quantitative findings with qualitative, field-informed interpretation. Interviews suggest the intervention of external organizations exacerbated the severity of the events. However, using strengths of specific local social institutions—including faith based, law enforcement, media, business sector and civic government organizations—the community effectively responded to the initial threat and to the potential negative ramifications of external entities.     

Romancing the Family: Umberto Eco’s <Emphasis Type="Italic">Baudolino</Emphasis>

Referencing Umberto Eco’s novel Baudolino, the author discusses issues concerning the authenticity of the narrative, specifically the distortions in the story presented to the audience and doubts surrounding the veracity of the tale. The act of narration is associated with the shame caused by the abuse and neglect that is an integral part of this story. The ambivalence of the protagonist—to tell his story and to keep it (and his true identity) concealed—associates narration, a creative act, with lying. Trauma generates the lies and hiddenness as a means of coping with abuse and indifference. In order to deal with the feelings of inadequacy caused by his humble birth, the traumatized protagonist lies: he romanticizes his family origins, the illusion of being the offspring of distinguished parents. His attempt to win the love of the parents, by being both good and all-knowing, is one of the motivating forces of his family romance. Telling lies makes the protagonist omniscient: he is the only one who knows if and when he is telling the truth. Paradoxically, the narrator creates and undermines that image of omniscience by revealing the thought processes of one character while leaving opaque those of the protagonist, and by denying the trueness of the tale affirmed when he presents as objective his own subjective sentiments by indirectly attributing them to the protagonist. The uncertainty that underpins the narration is indicative of the storyteller’s absence. This vacancy structures the work because it allows kindred spirits, nonjudgmental readers (listeners) who willingly suspend disbelief, to enter the world of the narrator. This uncritical participation counters the chaos of the storyteller’s reality, as they create their own new world where the split parental images are united.     

Emotional Processing Therapy for post traumatic stress disorder

While prolonged exposure is considered one of the “gold standard” and recommended treatments for post traumatic stress disorder (PTSD), it has been poorly utilised in clinical practice. Individuals with PTSD often find it too distressing to confront memories, and therapists may be uncomfortable using the therapy. A new Emotional Processing Therapy is described in which an emotional approach to prolonged exposure provides individuals with a new insight into how trauma is processed. A conceptual analysis of exposure suggests that it is exposure to distressing emotional experiences which is a key element. Viewing it as an emotion-based therapy, allows the creative addition of new emotional elements. Through exploring the individual’s emotional processing style, previously learned and unhelpful patterns can be addressed, and the addition of an “emotional preparation” phase helps them understand why it is important to face emotionally distressing memories before exposure sessions begin. Emotional Processing Therapy is intuitive and makes sense to those affected by PTSD. It is framed in an emotional context and is presented as part of a lifestyle change that may reduce the likelihood of psychological problems developing in the future.     

Confirmatory Factor Analysis of the Posttraumatic Stress Disorder Checklist

Several studies have employed confirmatory factor analysis (CFA) to examine the latent structure of the Posttraumatic Stress Disorder (PTSD) Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993), a measure that assesses PTSD symptomatology. Findings have failed to support the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision [DSM–IV–TR]; American Psychiatric Association, 2000) PTSD model, consisting of reexperiencing, avoidance/numbing, and arousal factors, and no consensus has emerged regarding the best fitting alternative model. Additionally, most studies have utilized homogeneous trauma samples. This study used CFA to examine the PCL factor structure in a sample with exposure to various traumatic events. Superior fit was demonstrated by a model specifying reexperiencing, avoidance, dysphoria, and arousal factors.     

Treatment of Assaultiveness

Summary

Assaultiveness and abusiveness have a psychology that must be addressed in therapy; they are not merely the product of “bad attitudes” or social roles, nor can they be narrowly defined as the robotic imitation of action. Perceptions and feelings about the world of intimate relationships both sustain and are sustained by abusive actions. These provide points of intervention for cognitive behavioral therapy (CBT). Given the tendency to shame easily, abusive men must not be confronted too quickly or too strongly. On the other hand, given their well-established denial system and tendency to minimize the consequences of their abusiveness, some confrontation must occur. Hence a “Zen” line of least resistance must be found between the opposites of acceptance and confrontation. Treatment outcome studies indicate moderate success for cognitive behavioral treatment (CBT) for batterers. Treatment is less successful with men who have personality disorders, especially psychopathy.     

Psychological Adjustment,Coping, and Emotion Regulation as Predictors of Posttraumatic Growth

Abstract

The present study examined factors contributing to reported benefits of traumatic experiences or posttraumatic growth (PTG) in a college sample. Specifically, we examined dimensions typically associated with trauma recovery (i.e., psychological functioning, coping, emotion regulation) and features of the trauma (i.e., number and recency of traumatic events, average, and maximal distress). Participants (N= 193) completed standardized questionnaires measuring these constructs. Results indicated that active coping and subjective well-being independently contributed to PTG, but social desirability and symptom distress were independent of growth. These results were consistent with study expectations. Although not specifically predicted, maximal trauma distress also uniquely predicted PTG. Contrary to expectations, effective emotion regulation did not contribute to PTG.     

American Indian Historical Trauma: Community Perspectives from Two Great Plains Medicine Men

The field of community psychology has long been interested in the relations between how community problems are defined, what interventions are developed in response, and to what degree power is distributed as a result. Tensions around these issues have come to the fore in debates over the influence of historical trauma (HT) in American Indian (AI) communities. After interviewing the two most influential medicine men on a Great Plains reservation to investigate how these tensions were being resolved, we found that both respondents were engaging with their own unique elaboration of HT theory. The first, George, engaged in a therapeutic discourse that reconfigured HT as a recognizable but malleable term that could help to communicate his “spiritual perspective” on distress and the need for healing in the reservation community. The second, Henry, engaged in a nation-building discourse that shifted attention away from past colonial military violence toward ongoing systemic oppression and the need for sociostructural change. These two interviews located HT at the heart of important tensions between globalization and indigeneity while opening the door for constructive but critical reflection within AI communities, as well as dialogue with allied social scientists, to consider how emerging discourses surrounding behavioral health disparities might be helpful for promoting healing and/or sociostructural change.     

The Going Gets Tough,So Let's Go Shopping: On Materialism,Coping, and Consumer Behaviors Under Traumatic Stress

This study investigated the way in which exposure to traumatic stress, posttraumatic reactions, and materialistic values impact coping and maladaptive consumption behaviors in a real-life traumatic situation. One hundred thirty-nine Israelis were sampled from a town under constant rocket fire (a high-stress environment), and 187 comparison respondents were sampled from a low-stress location. Our data show a main effect for materialism for all of the distress and maladaptive consumer behaviors under study, as well as for most coping behaviors with the exception of interpersonal expressive coping. In the high-stress group, interpersonal expressive coping, reflecting an inclination to utilize social support, was highest among mildly materialistic individuals. Highly materialistic persons were, presumably, more oriented to objects than humans, rendering a more support-seeking way of coping less relevant for them. Highly materialistic participants in the high-stress group reported the highest levels of posttraumatic stress symptoms. The results of this study also suggest that the pleasures of shopping cannot attenuate posttraumatic distress and that maladaptive shopping behaviors increase with the level of traumatic exposure.