PTSD Post Traumatic Stress Disorder
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Post Traumatic Stress Disorder
PTSD
Distributed By:
Maine Parent Federation
PO Box 2067
Augusta, Maine 04338
1-800-870-7746 (Maine Only)
207-588-1933
Email: parentconnect@mpf.org
Website: www.mpf.org
Online community: www.startingpointsforme.org
Original: (06/2008)
Updated: (05/2011)Post Traumatic Stress Disorder
Information Disclaimer
The purpose of the information packet is to provide individuals with reader friendly
information. We believe that a good overview is a realistic one. For this reason we have included
a variety of information that may include the more difficult characteristics of a diagnosis or topic
along with medical, educational and best practice information.
All information contained in this packet is for general knowledge, personal education and
enrichment purposes. It is not intended to be a substitute for professional advice. For specific
advice, diagnosis and treatment you should consult with a qualified professional.
When this packet was developed, Maine Parent Federation made every effort to ensure
that the information contained in this packet was accurate, current and reliable. Packets are
reviewed and updated periodically as changes occur.
12/2004
1 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
Table of Content
Page #
What is PTSD?...................................................................... 3
Common Reactions After Trauma……………….............. 6
How is PTSD Measured?..................................................... 9
Treatment of PTSD……………………………………….. 11
What Can I Do if I Think I Have PTSD?........................... 15
Discussing Trauma and PTSD with Your Doctor………. 17
Finding and Choosing a Therapist……………….............. 19
PTSD in Children and Teens……………………............... 23
Community Violence: Effects on Children and Teens….. 27
Lifestyle Changes Recommended for PTSD Patients…... 29
Helping a Family Member Who Has PTSD…………… 31
State and National Resources…………………………… 34
MPF Library Materials……………... 36
2 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
What is PTSD?
Used with permission by:
National Center for PTSD
http://www.ptsd.va.gov
Posttraumatic stress disorder (PTSD) is an anxiety disorder that can occur after you have been through a
traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During
this type of event, you think that your life or others' lives are in danger. You may feel afraid or feel that you
have no control over what is happening.
Anyone who has gone through a life-threatening event can develop PTSD. These events can include:
• Combat or military exposure
• Child sexual or physical abuse
• Terrorist attacks
• Sexual or physical assault
• Serious accidents, such as a car wreck.
• Natural disasters, such as a fire, tornado, hurricane, flood, or earthquake.
After the event, you may feel scared, confused, or angry. If these feelings don't go away or they get worse, you
may have PTSD. These symptoms may disrupt your life, making it hard to continue with your daily activities.
How does PTSD develop?
All people with PTSD have lived through a traumatic event that caused them to fear for their lives, see horrible
things, and feel helpless. Strong emotions caused by the event create changes in the brain that may result in
PTSD.
Most people who go through a traumatic event have some symptoms at the beginning. Yet only some will
develop PTSD. It isn't clear why some people develop PTSD and others don't. How likely you are to get PTSD
depends on many things:
• How intense the trauma was or how long it lasted
• If you lost someone you were close to or were hurt
• How close you were to the event
• How strong your reaction was
• How much you felt in control of events
• How much help and support you got after the event
Many people who develop PTSD get better at some time. But about 1 out of 3 people with PTSD may continue
to have some symptoms. Even if you continue to have symptoms, treatment can help you cope. Your symptoms
don't have to interfere with your everyday activities, work, and relationships.
3 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
What are the symptoms of PTSD?
Symptoms of PTSD can be terrifying. They may disrupt your life and make it hard to continue with your daily
activities. It may be hard just to get through the day.
PTSD symptoms usually start soon after the traumatic event, but they may not happen until months or years
later. They also may come and go over many years. If the symptoms last longer than 4 weeks, cause you great
distress, or interfere with your work or home life, you probably have PTSD.
There are four types of PTSD symptoms:
1. Reliving the event (also called re-experiencing symptoms):
Bad memories of the traumatic event can come back at any time. You may feel the same fear and horror you did
when the event took place. You may have nightmares. You even may feel like you're going through the event
again. This is called a flashback. Sometimes there is a trigger -- a sound or sight that causes you to relive the
event. Triggers might include:
o Hearing a car backfire, which can bring back memories of gunfire and war for a combat Veteran.
o Seeing a car accident, which can remind a crash survivor of his or her own accident.
o Seeing a news report of a sexual assault, which may bring back memories of assault for a woman
who was raped.
2. Avoiding situations that remind you of the event:
You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid
talking or thinking about the event. For example:
o A person who was in an earthquake may avoid watching television shows or movies in which
there are earthquakes.
o A person who was robbed at gunpoint while ordering at a hamburger drive-in may avoid fast-
food restaurants.
o Some people may keep very busy or avoid seeking help. This keeps them from having to think or
talk about the event.
3. Feeling numb:
You may find it hard to express your feelings. This is another way to avoid memories.
o You may not have positive or loving feelings toward other people and may stay away from
relationships.
o You may not be interested in activities you used to enjoy.
o You may not be able to remember parts of the traumatic event or not be able to talk about them.
4 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
4. Feeling keyed up (also called hyperarousal):
You may be jittery, or always alert and on the lookout for danger. This is known as hyperarousal. It can cause
you to:
o Suddenly become angry or irritable
o Have a hard time sleeping.
o Have trouble concentrating.
o Fear for your safety and always feel on guard.
o Be very startled when something surprises you.
What are other common problems?
People with PTSD may also have other problems. These include:
• Drinking or drug problems.
• Feelings of hopelessness, shame, or despair.
• Employment problems.
• Relationships problems including divorce and violence.
• Physical symptoms.
Can children have PTSD?
Children can have PTSD too. They may have the symptoms described above or other symptoms depending on
how old they are. As children get older, their symptoms are more like those of adults. Here are some examples
of PTSD symptoms in children:
• Young children may become upset if their parents are not close by, have trouble sleeping, or suddenly
have trouble with toilet training or going to the bathroom.
• Children who are in the first few years of elementary school (ages 6 to 9) may act out the trauma
through play, drawings, or stories. They may complain of physical problems or become more irritable or
aggressive. They also may develop fears and anxiety that don't seem to be caused by the traumatic event.
What treatments are available?
When you have PTSD, dealing with the past can be hard. Instead of telling others how you feel, you may keep
your feelings bottled up. But treatment can help you get better.
There are good treatments available for PTSD. Cognitive behavioral therapy (CBT)appears to be the most
effective type of counseling for PTSD. There are different types of cognitive behavioral therapies such as
cognitive therapy and exposure therapy. A similar kind of therapy called EMDR, or eye movement
desensitization and reprocessing, is also used for PTSD. Medications can be effective too. A type of drug
known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for
PTSD.
www.ptsd.va.gov The National Center for PTSD does not provide direct clinical care or individual referrals.
FOR MORE INFORMATION on PTSD Email: ncptsd@va.gov or Call: The PTSD Information Line at (802) 296-6300
Reviewed/Updated Date: October 5, 2010
5 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
Common Reactions After Trauma
Used with permission by:
National Center for PTSD
http://www.ptsd.va.gov
After going through a trauma, survivors often say that their first feeling is relief to be alive. This may be
followed by stress, fear, and anger. Trauma survivors may also find they are unable to stop thinking about what
happened. Many survivors will show a high level of arousal, which causes them to react strongly to sounds and
sights around them.
Most people have some kind of stress reaction after a trauma. Having such a reaction has nothing to do with
personal weakness. Stress reactions may last for several days or even a few weeks. For most people, if
symptoms occur, they will slowly decrease over time.
All kinds of trauma survivors commonly experience stress reactions. This is true for veterans, children, and
disaster rescue or relief workers. If you understand what is happening when you or someone you know reacts to
a traumatic event, you may be less fearful and better able to handle things.
Reactions to a trauma may include:
• Feeling hopeless about the future
• Feeling detached or unconcerned about others
• Having trouble concentrating or making decisions
• Feeling jumpy and getting startled easily at sudden noises
• Feeling on guard and constantly alert
• Having disturbing dreams and memories or flashbacks
• Having work or school problems
You may also experience more physical reactions such as:
• Stomach upset and trouble eating
• Trouble sleeping and feeling very tired
• Pounding heart, rapid breathing, feeling edgy
• Sweating
• Severe headache if thinking of the event
• Failure to engage in exercise, diet, safe sex, regular health care
• Excess smoking, alcohol, drugs, food
• Having your ongoing medical problems get worse
You may have more emotional troubles such as:
• Feeling nervous, helpless, fearful, sad
• Feeling shocked, numb, and not able to feel love or joy
• Avoiding people, places, and things related to the event
• Being irritable or having outbursts of anger
• Becoming easily upset or agitated
6 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
• Blaming yourself or having negative views of oneself or the world
• Distrust of others, getting into conflicts, being over controlling
• Being withdrawn, feeling rejected or abandoned
• Loss of intimacy or feeling detached
Turn to your family and friends when you are ready to talk. They are your personal support system. Recovery is
an ongoing gradual process. It doesn't happen through suddenly being "cured" and it doesn't mean that you will
forget what happened. Most people will recover from trauma naturally. If your stress reactions are getting in the
way of your relationships, work, or other important activities, you may want to talk to a counselor or your
doctor. Good treatments are available.
Common problems that can occur after a trauma
Posttraumatic Stress Disorder (PTSD): PTSD is a condition that can develop after you have gone through a life-
threatening event. If you have PTSD, you may have trouble keeping yourself from thinking over and over about
what happened to you. You may try to avoid people and places that remind you of the trauma. You may feel
numb. Lastly, if you have PTSD, you might find that you have trouble relaxing. You may startle easily and you
may feel on guard most of the time.
Depression: Depression involves feeling down or sad more days than not. If you are depressed, you may lose
interest in activities that used to be enjoyable or fun. You may feel low in energy and be overly tired. You may
feel hopeless or in despair, and you may think that things will never get better. Depression is more likely
when you have had losses such as the death of close friends. If you are depressed, at times you might think
about hurting or killing yourself. For this reason, getting help for depression is very important.
Self-blame, guilt and shame: Sometimes in trying to make sense of a traumatic event, you may blame yourself
in some way. You may think you are responsible for bad things that happened, or for surviving when others
didn't. You may feel guilty for what you did or did not do. Remember, we all tend to be our own worst critics.
Most of the time, that guilt, shame or self-blame is not justified.
Suicidal thoughts: Trauma and personal loss can lead a depressed person to think about hurting or killing
themselves. If you think someone you know may be feeling suicidal, you should directly ask them. You will
NOT put the idea in their head. If someone is thinking about killing themselves, call the Suicide Prevention
Lifeline 1-800-273-TALK (8255) http://www.suicidepreventionlifeline.org*. You can also call a counselor,
doctor, or 911.
Anger or aggressive behavior: Trauma can be connected with anger in many ways. After a trauma, you might
think that what happened to you was unfair or unjust. You might not understand why the event happened and
why it happened to you. These thoughts can result in intense anger. Although anger is a natural and healthy
emotion, intense feelings of anger and aggressive behavior can cause problems with family, friends, or co-
workers. If you become violent when angry, you just make the situation worse. Violence can lead to people
being injured, and there may be legal consequences.
Alcohol/Drug abuse: Drinking or "self-medicating" with drugs is a common, and unhealthy, way of
coping with upsetting events. You may drink too much or use drugs to numb yourself and to try to deal with
difficult thoughts, feelings, and memories related to the trauma. While using alcohol or drugs may offer a quick
7 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
solution, it can actually lead to more problems. If someone close begins to lose control of drinking or drug use,
you should try to get them to see a health care provider about managing their drinking or drug use.
Summing it all up
Right after a trauma, almost every survivor will find him or herself unable to stop thinking about what
happened. Stress reactions such as increased fear, nervousness, jumpiness, upsetting memories, and efforts to
avoid reminders, will gradually decrease over time for most people.
Use your personal support systems, family and friends, when you are ready to talk. Recovery is an ongoing
gradual process. It doesn't happen through suddenly being "cured" and it doesn't mean that you will forget what
happened. Most people will recover from trauma naturally over time. If your emotional reactions are getting in
the way of your relationships, work, or other important activities, you may want to talk to a counselor or your
doctor. Good treatments are available.
www.ptsd.va.gov The National Center for PTSD does not provide direct clinical care or individual referrals.
FOR MORE INFORMATION on PTSD Email: ncptsd@va.gov or Call: The PTSD Information Line at (802) 296-6300
Reviewed/Updated Date: April 13, 2011
8 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
How is PTSD Measured?
Used with permission by:
National Center for PTSD
http://www.ptsd.va.gov
To develop PTSD, a person must have gone through a trauma. Almost all people who go through trauma have
some symptoms as a result. Yet most people do not get PTSD. A certain pattern of symptoms is involved in
PTSD. There are four major types of symptoms: re-experiencing, avoidance, numbing, and arousal.
Deciding if someone has PTSD can involve several steps. The diagnosis of PTSD is most often made by a
mental health provider.
What is a PTSD screen?
A person who went through trauma might be given a screen to see if he or she could have PTSD. A screen is a
very short list of questions just to see if a person needs to be assessed further. A positive screen does not mean a
person has PTSD. A positive screen means that this person should be assessed further.
What can I expect from an assessment for PTSD?
Assessments for PTSD can vary widely depending on their purpose as well as the training of the evaluator. The
evaluator needs to assess the effect a trauma has had on your life. He or she can then judge whether treatment
for PTSD is needed. While an interview may take as little as 15 minutes, the most common evaluation takes
about one hour. Some PTSD assessments can take eight or more 1-hour sessions. This is more likely when the
information is needed for legal reasons or disability claims.
You can expect to be asked questions about events that may have been traumatic for you. You will be asked
about symptoms you may have as a result of these events. Assessments that are more complete are likely to
involve structured sets of questions. You may be given psychological tests on which you record your thoughts
and feelings. Your spouse or partner may be asked to provide extra information. You may also be asked to go
through a test that looks at how your body reacts to mild reminders of your trauma.
No matter what your case involves, you should always be able to ask questions in advance. The evaluator
should be able to tell you what the assessment will include. You can also ask what information the professional
expects to get from the assessment.
What are some of the common measures used?
There are two main types of measures used in PTSD evaluations.
Structured Interviews
A structured interview is a standard set of questions that an interviewer asks. Some examples of structured
interviews are:
9 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
• Clinician Administered PTSD Scale (CAPS). Created by the National Center for PTSD staff, the CAPS
is one of the most widely used PTSD interviews. The questions ask how often you have PTSD
symptoms and how intense they are. The CAPS also asks about other symptoms that commonly occur
with PTSD.
• Structured Clinical Interview for DSM (SCID). The SCID is another widely used interview. The SCID
can be used to assess a range of mental health disorders including PTSD.
Other interviews include:
• Anxiety Disorders Interview Schedule-Revised (ADIS)
• PTSD-Interview
• Structured Interview for PTSD (SI-PTSD)
• PTSD Symptom Scale Interview (PSS-I)
Each has special features that might make it a good choice for a particular evaluation.
Self-report Questionnaires
A self-report questionnaire is a set of questions, usually printed out, that you are given to answer. This kind of
measure often takes less time and may be less costly than an interview. These measures provide a single score
to measure the amount of distress a person has.
Examples of self-report measures include:
• PTSD Checklist (PCL). The PCL is another widely used measure developed by National Center for
PTSD staff. This measure comes in several versions including one for civilians and another designed for
military personnel and Veterans.
Other self-report measures are:
• Impact of Events Scale-Revised (IES-R)
• Keane PTSD Scale of the MMPI-2
• Mississippi Scale for Combat Related PTSD and the Mississippi Scale for Civilians
• Posttraumatic Diagnostic Scale (PDS)
• Penn Inventory for Posttraumatic Stress
• Los Angeles Symptom Checklist (LASC).
www.ptsd.va.gov The National Center for PTSD does not provide direct clinical care or individual referrals.
FOR MORE INFORMATION on PTSD Email: ncptsd@va.gov or Call: The PTSD Information Line at (802) 296-6300
Reviewed/Updated Date: February 17, 2011
10 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
Treatment of PTSD
Used with permission by:
National Center for PTSD
http://www.ptsd.va.gov
Today, there are good treatments available for PTSD. When you have PTSD, dealing with the past can be hard.
Instead of telling others how you feel, you may keep your feelings bottled up. But talking with a therapist can
help you get better.
Cognitive behavioral therapy (CBT) is one type of counseling. It appears to be the most effective type of
counseling for PTSD. The VA is providing two forms of cognitive behavioral therapy to Veterans with PTSD:
Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy.
There is also a similar kind of therapy called eye movement desensitization and reprocessing (EMDR) that is
used for PTSD. Medications have also been shown to be effective. A type of drug known as a selective
serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD.
Types of cognitive behavioral therapy
What is cognitive therapy?
In cognitive therapy, your therapist helps you understand and change how you think about your trauma and its
aftermath. Your goal is to understand how certain thoughts about your trauma cause you stress and make your
symptoms worse.
You will learn to identify thoughts about the world and yourself that are making you feel afraid or upset. With
the help of your therapist, you will learn to replace these thoughts with more accurate and less distressing
thoughts. You will also learn ways to cope with feelings such as anger, guilt, and fear.
After a traumatic event, you might blame yourself for things you couldn't have changed. For example, a soldier
may feel guilty about decisions he or she had to make during war. Cognitive therapy, a type of CBT, helps you
understand that the traumatic event you lived through was not your fault.
What is exposure therapy?
In exposure therapy your goal is to have less fear about your memories. It is based on the idea that people learn
to fear thoughts, feelings, and situations that remind them of a past traumatic event.
By talking about your trauma repeatedly with a therapist, you'll learn to get control of your thoughts and
feelings about the trauma. You'll learn that you do not have to be afraid of your memories. This may be hard at
first. It might seem strange to think about stressful things on purpose. But you'll feel less overwhelmed over
time.
With the help of your therapist, you can change how you react to the stressful memories. Talking in a place
where you feel secure makes this easier.
11 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
You may focus on memories that are less upsetting before talking about worse ones. This is called
"desensitization," and it allows you to deal with bad memories a little bit at a time. Your therapist also may ask
you to remember a lot of bad memories at once. This is called "flooding," and it helps you learn not to feel
overwhelmed.
You also may practice different ways to relax when you're having a stressful memory. Breathing exercises are
sometimes used for this.
What is EMDR?
Eye movement desensitization and reprocessing (EMDR) is another type of therapy for PTSD. Like other kinds
of counseling, it can help change how you react to memories of your trauma.
While thinking of or talking about your memories, you'll focus on other stimuli like eye movements, hand taps,
and sounds. For example, your therapist will move his or her hand near your face, and you'll follow this
movement with your eyes.
Experts are still learning how EMDR works. Studies have shown that it may help you have fewer PTSD
symptoms. But research also suggests that the eye movements are not a necessary part of the treatment.
Medication
Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant medicine. These can help you feel
less sad and worried. They appear to be helpful, and for some people they are very effective. SSRIs include
citalopram (Celexa), fluoxetine (such as Prozac), paroxetine (Paxil), and sertraline (Zoloft).
Chemicals in your brain affect the way you feel. For example, when you have depression you may not have
enough of a chemical called serotonin. SSRIs raise the level of serotonin in your brain.
There are other medications that have been used with some success. Talk to your doctor about which
medications are right for you.
Other types of treatment
Some other kinds of counseling may be helpful in your recovery. However, more evidence is needed to support
these types of treatment for PTSD.
Group therapy
Many people want to talk about their trauma with others who have had similar experiences.
In group therapy, you talk with a group of people who also have been through a trauma and who have PTSD.
Sharing your story with others may help you feel more comfortable talking about your trauma. This can help
you cope with your symptoms, memories, and other parts of your life.
12 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
Group therapy helps you build relationships with others who understand what you've been through. You learn to
deal with emotions such as shame, guilt, anger, rage, and fear. Sharing with the group also can help you build
self-confidence and trust. You'll learn to focus on your present life, rather than feeling overwhelmed by the past.
Brief psychodynamic psychotherapy
In this type of therapy, you learn ways of dealing with emotional conflicts caused by your trauma. This therapy
helps you understand how your past affects the way you feel now.
Your therapist can help you:
• Identify what triggers your stressful memories and other symptoms.
• Find ways to cope with intense feelings about the past.
• Become more aware of your thoughts and feelings, so you can change your reactions to them.
• Raise your self-esteem.
Family therapy
PTSD can affect your whole family. Your kids or your partner may not understand why you get angry
sometimes, or why you're under so much stress. They may feel scared, guilty, or even angry about your
condition.
Family therapy is a type of counseling that involves your whole family. A therapist helps you and your family
to communicate, maintain good relationships, and cope with tough emotions. Your family can learn more about
PTSD and how it is treated.
In family therapy, each person can express his or her fears and concerns. It's important to be honest about your
feelings and to listen to others. You can talk about your PTSD symptoms and what triggers them. You also can
discuss the important parts of your treatment and recovery. By doing this, your family will be better prepared to
help you.
You may consider having individual therapy for your PTSD symptoms and family therapy to help you with
your relationships.
How long does treatment last?
CBT treatment for PTSD often lasts for 3 to 6 months. Other types of treatment for PTSD can last longer. If you
have other mental health problems as well as PTSD, treatment may last for 1 to 2 years or longer.
What if someone has PTSD and another disorder? Is the treatment different?
It is very common to have PTSD at that same time as another mental health problem. Depression, alcohol or
drug abuse problems, panic disorder, and other anxiety disorders often occur along with PTSD. In many cases,
the PTSD treatments described above will also help with the other disorders. The best treatment results occur
when both PTSD and the other problems are treated together rather than one after the other.
13 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
What will we work on in therapy?
When you begin therapy, you and your therapist should decide together what goals you hope to reach in
therapy. Not every person with PTSD will have the same treatment goals. For instance, not all people with
PTSD are focused on reducing their symptoms.
Some people want to learn the best way to live with their symptoms and how to cope with other problems
associated with PTSD. Perhaps you want to feel less guilt and sadness. Perhaps you would like to work on
improving your relationships at work, or communicating with your friends and family.
Your therapist should help you decide which of these goals seems most important to you, and he or she should
discuss with you which goals might take a long time to achieve.
What can I expect from my therapist?
Your therapist should give you a good explanation for the therapy. You should understand why your therapist is
choosing a specific treatment for you, how long they expect the therapy to last, and how they will tell if it is
working.
The two of you should agree at the beginning that this plan makes sense for you. You should also agree on what
you will do if it does not seem to be working. If you have any questions about the treatment, your therapist
should be able to answer them.
You should feel comfortable with your therapist and feel you are working as a team to tackle your problems. It
can be difficult to talk about painful situations in your life, or about traumatic experiences that you have had.
Feelings that emerge during therapy can be scary and challenging. Talking with your therapist about the process
of therapy, and about your hopes and fears in regards to therapy, will help make therapy successful.
If you do not like your therapist or feel that the therapist is not helping you, it might be helpful to talk with
another professional. In most cases, you should tell your therapist that you are seeking a second opinion.
www.ptsd.va.gov The National Center for PTSD does not provide direct clinical care or individual referrals.
FOR MORE INFORMATION on PTSD Email: ncptsd@va.gov or Call: The PTSD Information Line at (802) 296-6300
Reviewed/Updated Date: October 5, 2010
14 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
What Can I Do if I Think I Have PTSD?
Used with permission by:
National Center for PTSD
http://www.ptsd.va.gov
If you think you have PTSD, it's important to get treatment. Treatment can work, and early treatment may help
reduce long-term symptoms.
If you think you have PTSD:
• Talk to your family doctor.
• Talk to a mental health professional, such as a therapist.
• If you're a veteran, contact your local VA hospital or Vet Center.
• Talk to a close friend or family member. He or she may be able to support you and find you help.
• Talk to a religious leader.
• Fill out a PTSD screen and take it with you to the doctor. While this online PTSD screen asks about
stressful military experiences, you can also answer the questions as they would apply to any other kind
of trauma.
Many people who might need assistance with something like the symptoms of PTSD are afraid to go for help.
• 1 out of 5 people say they might not get help because of what other people might think.
• 1 out of 3 people say they would not want anyone else to know they were in therapy.
A study that's been done of soldiers coming home from Iraq found that only 4 in 10 service members with
mental health problems said they would get help. Some of the most common reasons they gave were:
• Worried about what others would think
• Thought it might hurt their military career
• Might be seen as weak
Why seek help?
Here are some of the reasons why you should seek help:
• Early treatment is better
Symptoms of PTSD may get worse. Dealing with them now might help stop them from getting worse in the
future. Finding out more about what treatments work, where to look for help, and what kind of questions to ask
can make it easier to get help and lead to better outcomes.
• PTSD symptoms can change family life
PTSD symptoms can get in the way of your family life. You may find that you pull away from loved ones, are
not able to get along with people, or that you are angry or even violent. Getting help for your PTSD can help
improve your family life.
• PTSD can be related to other health problems
15 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
PTSD symptoms can worsen physical health problems. For example, a few studies have shown a relationship
between PTSD and heart trouble. By getting help for your PTSD, you could also improve your physical health.
• It may not be PTSD
Having symptoms of PTSD does not always mean you have PTSD. Some of the symptoms of PTSD are also
symptoms for other mental health problems. For example, trouble concentrating or feeling less interested in
things you used to enjoy can be symptoms of both depression and PTSD. Since different problems have
different treatments, it's important to have your symptoms assessed.
While it may be tempting to identify PTSD in yourself or someone you know, the diagnosis generally is made
by a mental health professional. This will usually involve an evaluation by a psychiatrist, psychologist, or
clinical social worker specifically trained to assess psychological problems.
What you can do?
If you have PTSD or PTSD symptoms, you may feel helpless.
Here are ways, though, that you can help yourself:
• Learn more about PTSD from this website or from other places.
• Talk to your doctor or a chaplain or other religious leader.
• Go for a PTSD evaluation by a mental health professional specifically trained to assess psychological
problems.
If you do not want to be evaluated, but feel you have symptoms of PTSD, you may choose "watchful waiting."
Watchful waiting means taking a wait-and-see approach.
• If you get better on your own, you won't need treatment.
• If your symptoms do not get better after 3 months, and they are either causing you distress or are getting
in the way of your work or home life, talk with a health professional.
In a few cases, your symptoms may be so severe that you need immediate help. Call 911 or other emergency
services immediately if you think that you cannot keep from hurting yourself or someone else.
What treatments are available?
Today, there are good treatments available for PTSD. When you have PTSD dealing with the past can be hard.
Instead of telling others how you feel, you may keep your feelings bottled up. But talking with a therapist can
help you get better.
Cognitive behavioral therapy (CBT) appears to be the most effective type of counseling for PTSD. There are
different types of cognitive behavioral therapies such as cognitive therapy and exposure therapy. There is also a
similar kind of therapy called eye movement desensitization and reprocessing (EMDR) that is used for PTSD.
Medications have also been shown to be effective. A type of drug known as a selective serotonin reuptake
inhibitor (SSRI), which is also used for depression, is effective for PTSD.
www.ptsd.va.gov The National Center for PTSD does not provide direct clinical care or individual referrals.
FOR MORE INFORMATION on PTSD Email: ncptsd@va.gov or Call: The PTSD Information Line at (802) 296-6300
Reviewed/Updated Date: July 30, 2010
16 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
Discussing Trauma and PTSD with Your Doctor
Used with permission by:
National Center for PTSD
http://www.ptsd.va.gov
If you have been through a traumatic event, you may find it helpful to tell this to your doctor and report any
symptoms you may have. Witnessing or going through a trauma can lead to both emotional and physical
problems. You can help your doctor to understand you and plan your treatment better by sharing this crucial
information about yourself. Not everyone who goes through trauma will get PTSD, but keep in mind that good
treatments are available even if you only have some PTSD symptoms.
At first, you may find it hard to discuss your experiences. For this reason, National Center for PTSD staff have
put together the checklist below. You can complete this list and show it to your doctor.
Brief Checklist of Trauma Symptoms
Check the symptoms below that you experience. Include symptoms you have even if you are not sure they are
related to a traumatic event.
I experienced or witnessed a traumatic event during which I felt extreme fear, helplessness, or horror.
The event happened on (day/month/year) _______________.
What happened? ________________________________________.
1) I have symptoms of re-experiencing or reliving the traumatic event:
• Have bad dreams or nightmares about the event or something similar to it
• Behave or feel as if the event were happening all over again (this is known as having flashbacks)
• Have a lot of intense feelings when I am reminded of the event
• Have a lot of physical sensations when I am reminded of the event (for example, my heart races or
pounds, I sweat, find it hard to breathe, feel faint, feel like I'm going to lose control)
2) I have symptoms of avoiding reminders of the traumatic event:
• Avoid thoughts, conversations, or feelings that remind me about the event
• Avoid people, places, or activities that remind me of the event
• Have trouble remembering some important part of the event
3) I have noticed these symptoms since the event happened:
• Have lost interest in, or just don't do, things that used to be important to me
• Feel detached from people; find it hard to trust people
• Feel emotionally "numb" and find it hard to have loving feelings even toward those who are emotionally
close to me
• Have a hard time falling or staying asleep
17 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
• Am irritable and have problems with my anger
• Have a hard time concentrating
• Think I may not live very long and feel there's no point in planning for the future
• Am jumpy and get startled easily
• Am always "on guard"
4) I experience these medical or emotional problems:
• Stomach problems
• Intestinal (bowel) problems
• Gynecological (female) problems
• Weight gain or loss
• Pain, for example, in back, neck, or pelvic area
• Headaches
• Skin rashes and other skin problems
• Lack of energy; feel tired all the time
• Alcohol, drug, or other substance use problems
• Depression or feeling down
• Anxiety or worry
• Panic attacks
• Other symptoms such as: ______________________________
Summing it up
If you think you have PTSD, or even just some of the symptoms, it is important for you to let your doctor know.
Your doctor needs this information to plan your medical treatment. It can also help your doctor connect you
with other services you may need, such as a mental health provider, lab tests, and so on.
You may find it helpful to print this fact sheet to show your doctor.
www.ptsd.va.gov The National Center for PTSD does not provide direct clinical care or individual referrals.
FOR MORE INFORMATION on PTSD Email: ncptsd@va.gov or Call: The PTSD Information Line at (802) 296-6300
Reviewed/Updated Date: June 15, 2010
18 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
Finding and Choosing a Therapist
Used with permission by:
National Center for PTSD
http://www.ptsd.va.gov
These resources can help you locate and choose a therapist who is right for you. A special section for Veterans
is included.
Finding a therapist
There are many ways to find a therapist. You can start by asking friends and family if they can recommend
anyone. Make sure the therapist has skills in treating trauma survivors.
On the phone
One way to locate a therapist is to make some phone calls. When you call, say that you are trying to find a
therapist who specializes in effective treatment for PTSD, such as cognitive behavioral therapy (CBT) or Eye
Movement Desensitization and Reprocessing (EMDR).
• Contact your local mental health agency or family doctor.
• Call your state psychological association.
• Call the psychology department at a local college or university.
• Call the Anxiety Disorders Association of America at (240) 485-1001 to access their referral network
• Call the National Center for Victims of Crime's toll-free information and referral service at 1-800-FYI-
CALL.
• Call the Sidran Institute’s Help Desk at 410-825-8888 for help finding a therapist who specializes in
trauma treatment. You can also email Sidran at help@sidran.org.
• If you work for a large company, call the human resources office or employee assistance plan to see if
they make referrals.
• If you have health insurance, call to find out about mental health providers the insurance company will
cover.
Some mental health services are listed in the phone book. In the Government pages, look in the "County
Government Offices" section. In that section, look for "Health Services (Dept. of)" or "Department of Health
Services." Then in that section, look under "Mental Health."
In the yellow pages, therapists are listed under "counseling," "psychologists," "social workers,"
"psychotherapists," "social and human services," or "mental health."
Online
Information can also be found using the Internet. Some organizations have databases that allow you to search
for therapists near you. These databases include profiles of therapists with their areas of expertise and the types
of therapy they provide. Search online for “find a therapist.” Websites you can try are:
• Anxiety Disorders Association of America*
19 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
• The Find a Therapist Service* from the Association of Behavioral and Cognitive Therapies
• EMDR International Association*
• The Psychologist Locator* from the American Psychology Association
• Psychology Today’s Therapy Directory*
• The Mental Health Services Locator from the Substance Abuse and Mental Health Services
Administration
Help for Veterans
All VA Medical Centers provide PTSD care. Or you can use this online VA PTSD Program Locator to find a
VA PTSD Treatment program at a VA facility near you. You can also go online to read more about services at
Vet Centers.
Other resources include:
• The 24/7 Veteran Combat Call Center: 1-877-927-8387 (WAR-VETS)
• VA Mental Health for Returning Veterans
• VA Returning Service Members (OEF/OIF/OND) Page
• My HealtheVet
VA Medical Centers and Vet Centers are listed in the phone book. In the Government pages, look under
"United States Government Offices." Then look for "Veterans Affairs, Dept of." In that section, look under
"Medical Care" and "Vet Centers - Counseling and Guidance."
Finding a support group
Many VA Medical Centers and Vet Centers have various types of support groups. Use the information in the
“Help for Veterans” section above to find out more.
• Anxiety Disorders Association of America* offers a self-help group network.
• National Alliance for Mental Illness* (NAMI) has a website with information for those with mental
health problems. You may also find family support groups in a state or local affiliate of NAMI.
• About.com's PTSD Forum* An online discussion forum.
Choosing a therapist
There are a many things to consider in choosing a therapist. Some practical issues are location, cost, and what
insurance the therapist accepts. Other issues include the therapist's background, training, and the way he or she
works with people.
Here is a list of questions you may want to ask a possible therapist.
• What is your education? Are you licensed? How many years have you been practicing?
• What are your special areas of practice?
• Have you ever worked with people who have been through trauma? Do you have any special training in
PTSD treatment?
20 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
• What kinds of PTSD treatments do you use? Have they been proven effective for dealing with my kind
of problem or issue?
• What are your fees? (Fees are usually based on a 45-minute to 50-minute session.) Do you have any
discounted fees? How much therapy would you recommend?
• What types of insurance do you accept? Do you file insurance claims? Do you accept Medicare or
Medicaid insurance?
These questions are just guidelines. In the end, your choice of a therapist will come down to many factors.
Think about your comfort with the person as well as his or her qualifications and experience treating PTSD.
And keep in mind the importance of evidence-based, trauma-focused treatments like Cognitive Processing
Therapy, Prolonged Exposure, and Eye Movement Desensitization and Reprocessing.
Paying for therapy
If you have health insurance, check to see what mental health services are covered. Medicare, Medicaid, and
most major health plans typically cover a certain number of mental health counseling sessions per year, though
you may have a small additional amount you will have to pay called a co-pay. Call your insurance company to
see what they cover so you won’t be surprised by a big bill.
If you don’t have health insurance that will cover your therapy, you may still be able to get counseling, even if
you can’t afford to pay full price. Many community mental health centers have sliding scales that base your fee
on what you are able to pay.
Who is available to provide therapy?
There are many types of professionals who can provide therapy for trauma issues.
Clinical Psychologists
Clinical psychologists focus on mental health assessment and treatment. Licensed psychologists have doctoral
degrees (PhD, PsyD, EdD). Their graduate training is in clinical, counseling, or school psychology. In addition
to their graduate study, licensed psychologists must have another 1 to 2 years of supervised clinical experience.
Psychologists have the title of "doctor," but in most states they cannot prescribe medicine.
Clinical Social Workers
The purpose of social work is to enhance human well-being. Social workers help meet the basic human needs of
all people. They help people manage the forces around them that contribute to problems in living. Certified
social workers have a master's degree or doctoral degree in social work (MSW, DSW, or PhD).
Master's Level Clinicians
Master's Level Clinicians have a master's degree in counseling, psychology, or marriage and family therapy
(MA, MFT). They have at least 2 years of training beyond the 4-year college degree. To be licensed, master's
level clinicians must meet requirements that vary by state.
21 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
Psychiatrists
Psychiatrists have a Doctor of Medicine degree (MD). After they complete 4 years of medical school, they must
have 3 to 4 years of residency training. Board certified psychiatrists have also passed written and oral exams
given by the American Board of Psychiatry and Neurology. Since they are medical doctors, psychiatrists can
prescribe medicine. Some also provide psychotherapy.
www.ptsd.va.gov The National Center for PTSD does not provide direct clinical care or individual referrals.
FOR MORE INFORMATION on PTSD Email: ncptsd@va.gov or Call: The PTSD Information Line at (802) 296-6300
Reviewed/Updated Date: May 13, 2011
22 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
PTSD in Children and Teens
Used with permission by:
National Center for PTSD
http://www.ptsd.va.gov
This fact sheet provides an overview of how trauma affects school-aged children and teens. You will also find
information on treatments for PTSD in children.
.
What events cause ptsd in children?
Children and teens could have PTSD if they have lived through an event that could have caused them or
someone else to be killed or badly hurt. Such events include sexual or physical abuse or other violent crimes.
Disasters such as floods, school shootings, car crashes, or fires might also cause PTSD. Other events that can
cause PTSD are war, a friend's suicide, or seeing violence in the area they live.
Child protection services in the U.S. get around 3 million reports each year. This involves 5.5 million children.
Of the reported cases, there is proof of abuse in about 30%. From these cases, we have an idea how often
different types of abuse occur:
• 65% neglect
• 18% physical abuse
• 10% sexual abuse
• 7% psychological (mental) abuse
Also, 3-10 million children witness family violence each year. Around 40-60% of those cases involve child
physical abuse. (Note: It is thought that two-thirds of child abuse cases are not reported.)
How many children get PTSD?
Studies show that about 15-43% of girls and 14-43% of boys go through at least one trauma. Of those children
and teens who have had a trauma, 3-15% of girls and 1-6% of boys develop PTSD.
Rates of PTSD are higher for certain types of trauma survivors. Nearly 100% of children get PTSD if they see a
parent being killed or if they see a sexual assault. PTSD develops in 90% of sexually abused children, 77% of
children who see a school shooting, and 35% who see violence in the area they live get PTSD.
What are the risk factors for PTSD?
Three factors have been shown to raise the chances that children will get PTSD. These factors are:
• how severe the trauma is
• how the parents react to the trauma
• how close or far away the child is from the trauma
23 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
Children and teens that go through the most severe traumas tend to have the highest levels of PTSD symptoms.
The PTSD symptoms may be less severe if the child has more family support and if the parents are less upset by
the trauma. Lastly, children and teens who are farther away from the event report less distress.
Other factors can also affect PTSD. Events that involve people hurting other people, such as rape and assault,
are more likely to result in PTSD than other types of traumas. Also, the more traumas a child goes through, the
higher the risk of getting PTSD. Girls are more likely than boys to get PTSD.
It is not clear whether a child's ethnic group may affect PTSD. Some research shows that minorities have higher
levels of PTSD symptoms. Other research suggests this may be because minorities may go through more
traumas.
Another question is whether a child's age at the time of the trauma has an effect on PTSD. Researchers think it
may not be that the effects of trauma differ according to the child's age. Rather, it may be that PTSD looks
different in children of different ages.
What does PTSD look like in children?
School-aged children (ages 5-12):
These children may not have flashbacks or problems remembering parts of the trauma, the way adults with
PTSD often do. Children, though, might put the events of the trauma in the wrong order. They might also think
there were signs that the trauma was going to happen. As a result, they think that they will see these signs again
before another trauma happens. They think that if they pay attention, they can avoid future traumas.
Children of this age might also show signs of PTSD in their play. They might keep repeating a part of the
trauma. These games do not make their worry and distress go away. For example, a child might always want to
play shooting games after he sees a school shooting. Children may also fit parts of the trauma into their daily
lives. For example, a child might carry a gun to school after seeing a school shooting.
Teens (ages 12-18):
Teens are in between children and adults. Some PTSD symptoms in teens begin to look like those of adults.
One difference is that teens are more likely than younger children or adults to show impulsive and aggressive
behaviors.
What are the other effects of trauma on children?
Besides PTSD, children and teens that have gone through trauma often have other types of problems. Much of
what we know about the effects of trauma on children comes from the research on child sexual abuse. This
research shows that sexually abused children often have problems with
• fear, worry, sadness, anger, feeling alone and apart from others, feeling as if people are looking down on
them, low self-worth, and not being able to trust others
• behaviors such as aggression, out-of-place sexual behavior, self-harm, and abuse of drugs or alcohol
24 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
How is PTSD treated in children and teens?
For many children, PTSD symptoms go away on their own after a few months. Yet some children show
symptoms for years if they do not get treatment. There are many treatment options, described below:
Cognitive-Behavioral Therapy (CBT)
CBT is the most effective approach for treating children. One type of CBT is called Trauma-Focused CBT (TF-
CBT). In TF-CBT, the child may talk about his or her memory of the trauma. TF-CBT also includes techniques
to help lower worry and stress. The child may learn how to assert him or herself. The therapy may involve
learning to change thoughts or beliefs about the trauma that are not correct or true. For example, after a trauma,
a child may start thinking, "the world is totally unsafe."
Some may question whether children should be asked to think about and remember events that scared them.
However, this type of treatment approach is useful when children are distressed by memories of the trauma. The
child can be taught at his or her own pace to relax while they are thinking about the trauma. That way, they
learn that they do not have to be afraid of their memories. Research shows that TF-CBT is safe and effective for
children with PTSD.
CBT often uses training for parents and caregivers as well. It is important for caregivers to understand the
effects of PTSD. Parents need to learn coping skills that will help them help their children.
Psychological first aid/crisis management
Psychological First Aid (PFA) has been used with school-aged children and teens that have been through
violence where they live. PFA can be used in schools and traditional settings. It involves providing comfort and
support, and letting children know their reactions are normal. PFA teaches calming and problem solving skills.
PFA also helps caregivers deal with changes in the child's feelings and behavior. Children with more severe
symptoms may be referred for added treatment.
Eye movement desensitization and reprocessing (EMDR)
EMDR combines cognitive therapy with directed eye movements. EMDR is effective in treating both children
and adults with PTSD, yet studies indicate that the eye movements are not needed to make it work.
Play therapy
Play therapy can be used to treat young children with PTSD who are not able to deal with the trauma more
directly. The therapist uses games , drawings, and other methods to help children process their traumatic
memories.
Other treatments
Special treatments may be needed for children who show out-of-place sexual behaviors, extreme behavior
problems, or problems with drugs or alcohol.
25 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011Post Traumatic Stress Disorder
What can you do to help?
Reading this fact sheet is a first step toward helping your child. Learn about PTSD and pay attention to how
your child is doing. Watch for signs such as sleep problems, anger, and avoidance of certain people or places.
Also watch for changes in school performance and problems with friends.
You may need to get professional help for your child. Find a mental health provider who has treated PTSD in
children. Ask how the therapist treats PTSD, and choose someone who makes you and your child feel at ease.
You as a parent might also get help from talking to a therapist on your own.
www.ptsd.va.gov The National Center for PTSD does not provide direct clinical care or individual referrals.
FOR MORE INFORMATION on PTSD Email: ncptsd@va.gov or Call: The PTSD Information Line at (802) 296
Reviewed/Updated Date: June 15, 2010
26 Distributed by Maine Parent Federation
1-800-870-7746
www.mpf.org
05/2011You can also read
