What is mental trauma in children
The definition proposed by G. Fischer and R. Riedsser describe psychological trauma in children as an experience of vital discrepancy between threatening situational factors and individual capacities to manage the situation. This is accompanied by feelings of helplessness and abandonment, defenselessness, and thus leads to a profound impairment of the understanding of the self and the world around.
What influences psychological trauma in children?
There are certain factors that influence the traumatic potential of an event:
❶ The degree of control a person has over the event. In a domestic violence situation, the victim may have more control than in a situation of advanced cancer diagnosis
❷ Degree of unpredictability. A sudden death in a car accident is more unpredictable than death after a progression of a chronic disease
❸ Number of people affected. The situation is perceived as less serious if more people are affected. (e.g. in a coach accident there is a sense of belonging to the group, which is a protective factor)
❹ The degree of affection of those in the entourage. The feeling of helplessness increases if there are people around who are equally affected by the situation.
❺ How to participate in the situation, directly or indirectly. A person will be affected in a different way if he/she is not the one going through it, but a relative/friend.
❻ Relationship with the trauma-inducing person. If the aggressor is a known, close person, such as a parent, partner, friend, the situation is much more traumatic than if the aggressor is a stranger (Diana Vasile – Family trauma and compensatory resources).
What causes mental trauma in children
Any event/occurrence that threatens a person’s physical or mental integrity can trigger trauma in children or post-traumatic stress disorder.
- Sexual abuse with or without violence (need not be repeated, one event is enough to traumatize)
- Physical abuse
- Natural disasters or accidents – fires, floods, earthquakes
- Violent crimes such as kidnappings, attacks at school (armed students)
- Car accidents, plane crashes
Risk factors for post-traumatic stress disorder are: female gender; previous exposure to a traumatic situation; personal history of mental disorders; parents with mental disorders; criminality of a parent; loss of mother; low social support; low income
How common is psychological trauma in children
A study in the US showed that out of 10,000 teenagers surveyed aged 13 to 18, 5% met the criteria for post-traumatic stress disorder. There is a higher prevalence in girls (girls outnumber boys 4 to 1).
The prevalence also increases with age.
How do I know if I have trauma symptoms
Mental trauma in children
Children exposed to a traumatic event experience intense fear and feel in great danger. They tend to relive the event through painful memories. Memories can be triggered by people or situations in everyday life, or they can spontaneously invade the mind.
For example, a certain place, or a certain smell, or a person involved in that situation may trigger a replay of that event. People with this disorder avoid any stimulus associated with trauma. The child may replay scenes they have experienced or have nightmares about the threatening factor that caused the trauma.
He/she may have severe discomfort and neurovegetative disorders. E.g.: tremor, palpitations, tachycardia, pallor, excessive sweating, loss of sphincter control. The child has sleep disturbances (falls asleep with difficulty and wakes up during the night; is irritable and has unjustified tantrums; is alert, flinches at any noise.
Psychological trauma in adolescents
Adolescents may experience adult-like symptoms such as:
- inability to evoke an important aspect of the trauma,
- feeling detached or alienated from others,
- marked decrease in interest in activities he used to enjoy,
- a sense of a narrowed future. They don’t hope to have a career, get married, have children or a normal life.
The diagnosis is made if the child/adolescent has had these symptoms for at least one month. It is considered a chronic disorder if symptoms are present for more than 3 months. (DSM IV-TR)
How trauma can be avoided in children
Protective factors for post-traumatic stress disorder are:
- good family relationships
- help from the grandparents for the dispossession of the mother
- the existence of a group of friends
Psychological treatment should start from the exposure to the traumatic factor, not wait for the onset of PTSD.
Crisis intervention has three objectives: to give those affected security, to be available as an empathetic discussion partner and to foster understanding about the event and the effects of the trauma.
Transmitting safety means removing those affected from the scene of the disaster (as far as possible, the place where victims are treated should be further away from the scene of the disaster) and separating the perpetrators from the victims.
Gentle body contact, e.g. holding hands, is indicated. Accident victims need to be told that they are safe, that the ambulance is coming. Relaxation and reassurance must take precedence over information.
After the onset of post-traumatic stress disorder symptoms, patients are treated with psychotherapy sessions and, in complicated cases, medication.
Cognitive-behavioral therapy is indicated by studies as the most effective in the treatment of this disorder. This includes gradual exposure – helping the child talk about the traumatic event, anxiety control techniques – relaxation and assertiveness training, and correcting false thoughts and beliefs caused by the trauma. The family is also involved in this therapy and will be taught to have fair and supportive attitudes towards the child.
Play therapy is useful for children who cannot process trauma-related events directly (e.g. young children). The psychotherapist uses games, drawings and other techniques to help the child process traumatic memories.
Specialized interventions are used for children or adolescents with problem behaviors. E.g.: inappropriate sexual behavior, violence, substance abuse
Psychiatric drugs used in the treatment of psychological trauma in children are:
- ISRS antidepressants (can be taken after the age of 6),
- anxiolytics (benzodiazepines, short-term treatment – maximum 1 month)
- antispasmodics for the treatment of associated somatic symptoms.
Treatment is given until the symptoms disappear.