Tiffany Putnam Calero

Psychological Trauma
November 4, 2004

Trauma and PTSD in Youth – the Wounded Lives of Young Victims

The rate at which traumatic experiences are felt by our young people is astounding. It is estimated

that at least 15 to 45% of girls and 14 to 43% of boys in the U.S. have experienced at least one

traumatic episode before the age of eighteen. As a result of this “epidemic,” it is estimated that

approximately 3 to 15% of girls and 1 to 6% of boys may be at risk for developing PTSD (Nat’l Ctr

for PTSD). One may experience trauma by witnessing or being a victim of a number of types of

events, such as a natural disaster, violent act or abusive relationship. Individuals throughout life

face traumatic situations of varying types and degrees; however, not everyone finds these

situations to be debilitating or to leave a long-lasting negative mark on their lives. The likelihood

that an event (or series of events) may lead to PTSD in a young person can depend upon any of the

following factors: the severity of the traumatic event, the reaction of a parent to the trauma, the

type of trauma (ie. a human-perpetrated event by one who is trusted by the child) or the physical

proximity of the event (Nat’l Ctr for PTSD). Young people are impressionable and may find an event

to be very traumatizing while an adult may not (NMHA). As well, it is noted that people who are

more likely to develop PTSD are those who were abused as children or had experienced other

traumas previously (NMHA). These points echo a critical need for us to evaluate the prevalence of

trauma and PTSD amongst our youth in an effort to recognize it early, properly treat it and most

importantly work toward preventing it.

The DSM-IV identifies the criteria for a PTSD diagnosis: 1.) A person exposed to a traumatic event

“outside the range of usual human experience” where a threat to physical integrity has been

experienced by oneself or another and a person’s response involved intense fear, helplessness or

horror (in children, may be expressed as disorganized or agitated state). 2.) Traumatic event is

consistently re-experienced (in children, may be seen as repetitive play, frightening dreams,

trauma-specific reenactment). 3.) Persistent avoidance of stimuli associated with trauma. 4.)

Persistent symptoms of increasing arousal. 5.) Duration of the disturbance is more than one month.

6.) The disturbance causes clinically significant distress or impairment in important areas of

functioning. (Nat’l Ctr for PTSD, Janoff-Bulman p.49-50). Some symptoms that are particularly

representative in children with PTSD are changes to mood, affect, thinking and behaviour, as well

as sleep disturbances, regression, phobias, fear of death/separation/further trauma,

misidentification of perpetrator, lack of disavowal or traumatic amnesia and absence of vegetative

and nervous effects (Eth & Pynoos [Terr] p. 8-9). I would like to focus on those traumatic events

that are human-induced as it is understood that these are the events that tend to produce more

severe and long-lasting effects (Eth & Pynoos p. 20) The younger and more immature the victim is,

the more likely there will be long-lasting negative consequences (Flannery p.66). Also, given that

these acts are generally dominated by the will of the perpetrator, there is a greater chance that

this will can be influenced somehow positively, thereby reducing the number of incidences of trauma

or PTSD experienced by young people.

There are several types of human-induced maltreatment or abuse – psychological, emotional, verbal,

physical and sexual. Acts that are committed by a person who is expected to represent a loving,

supportive or trustworthy figure in a young person’s life (ie. parent) are considered the most
difficult to endure (Straus, Gelles & Steinmetz p. 73). By nature, children arrive in this world

dependent on others to care for their needs, to provide a model for behaviours that they may

imitate and to teach them about the world in which they live. When these caregivers and role

models are hurtful (abusive) or absent (neglectful), a child may experience developmental delays,

physical impairments and psychological damage. Authors of the Psychologically Battered Child

address these matters as they define psychological maltreatment as an “attack by an adult on a

child’s development of self and social competence” as well as one that jeopardizes a child’s capacity

for having healthy interpersonal relationships (p. 1, 8) They further describe ways that adults may

threaten a child’s development – by rejecting (refusing to acknowledge child’s worth), isolating

(cutting child off from normal social experiences), terrorizing (verbally assaulting child, creating a

climate of fear), ignoring (depriving child of essential stimulation and responsiveness) or corrupting

(‘mis-socializing” the child, making him/her unfit for normal social experience) (p. 8).

Often, one form of abuse (ie. physical) goes hand-in-hand with another form (ie. psychological)

(Garbarino, Guttmann & Seeley p. 8). These authors also believe that in almost all cases the

psychological impact of an act is what defines it as abusive (p. 7). They bring another important

theme to the front – a child’s view of his or her experience at the hands of a perpetrator, what

they call the “subjective reality,” is a critical factor in determining the impact of an act on his or

her life (p. 7). Also important are children’s fundamental assumptions about themselves (internal

world) and the world they live in (external world). Are they worthy of care? Is the world

benevolent and meaningful? (Janoff-Bulman p. 5-6, 14). These assumptions and development of core

self can begin to develop at two months of age (p. 12, 16) Fortunately, there is a tendency for

assumptions to be positively biased. Children may experience an “illusion of invulnerability” and

“unrealistic optimism” as they experience life and these feelings can help give them a means to

trust and explore themselves and others (p. 19, 21, 25). Children develop assumptions about

themselves (comparable to the development of the “ego” and trust as presented by Erik Erikson)

based on the positive or negative interactions they have with others. An adult spends many years

solidifying his or her inner world; in contrast, a child has had relatively few years yet to do this

with any likelihood of unbending beliefs. A child’s pliable thoughts may help to protect (when made

to feel that he/she is good), but can also be devastating (when made to feel that he/she is not

good) (Garbarino, Guttmann, Seeley, p. 6, Janoff-Bulmann p. 13, 84) In ways, children are said to

have a certain level of “plasticity” with regard to development of personality; however, the author

proposes that assumptions of the self learned as early as infancy are fundamental to a child’s inner

world and that they are the beliefs that are least likely to be challenged. The authors use episodic

memory as it influences the formation of generalized episodes as well as “cognitive conservatism,”

or need for stability and coherence, as explanation for this thought (p. 5, 15, 17, 26, 83-84). This

suggests that though children may assimilate new positive information into their assumptions of

themselves, the first assumptions they develop based on their relationships with others are very

strong and resistant to change.

A child needs to have a safe environment and must be surrounded by caring and trustworthy people.

It is necessary that a child is free to know a “sense of coherence,” a feeling that one’s inner and

outer worlds are predictable and that things that don’t make sense will likely work out [Antonovsky]

(Janoff-Bulman p. 18) Additionally, a set of factors known as the three domains of human

functioning are necessary to the well-being of a child: reasonable mastery (ability to shape one’s

environment to one’s needs), caring attachments to others (as development is intrinsically social)
and a meaningful purpose in life. When any of these areas are disturbed, a child may have long-

term consequences; in fact, these are the areas that are disrupted as a result of experiencing

trauma or PTSD (Flannery p. 25, Garbarino, Guttman, Seeley p. 22). Children may experience

trauma as a result of mental injury (ie. verbal assault), neglect, or emotional, psychological, physical

or sexual abuse.

A child may experience physical symptoms such as mood irritabilities (ie. anxiety or depression),

panic, sleep disturbances, startle responses to certain reminders of trauma, affective constriction

and decline in performance or learning (ie. school) (Eth & Pynoos p. 24, 33, 136-7, Flannery p. 11).

Children also experience acute or chronic changes in physiological and neurological chemistry. As a

result of a trauma, neurochemicals and biochemicals act as both responders and effectors – they

change in response to stressful stimuli and in turn these chemical changes initiate additional

responses. Secretion of hormones, acceleration of heart rate, better respiration, dilation of pupils,

vasoconstriction, contraction of muscles, immunologic responses and alteration in mood and

emotional state may result (“fight or flight response” related to survival/self-preservation)

(Janoff-Bulman p. 53, 66, Flannery p. 50). Catecholamines (“emergency-mobilizing” chemicals) such

as norepinephrine, epinephrine and dopamine increase in response to stressors as well as endorphins

to bring clear thinking, relaxation and pain relief. With prolonged or repeated exposure to trauma,

catecholamines may deplete causing a change to neuron sensitivity where a victim can be left in a

state of hypersensitivity and experience autonomic arousal (hypervigilance) in response to minor

stress (“kindling”) (Janoff-Bulman p. 67, 88, Flannery p. 50-54). Children may also experience

intrusive symptoms such as recurring distressing recollections in the form of memories, flashbacks

or nightmares as well as avoidant symptoms such as avoiding certain thoughts and situations, denial,
emotional numbing and diminished interest in certain activities. Intrusive symptoms (associated

with the presence of both norepinephrine and endorphins that join efforts to stimulate learning)

seems to work in tandem with avoidant symptoms (associated with a decrease in levels of

norepinephrine and endorphins) allowing a victim to attempt recovery by both processing the details

of the trauma and guarding against the trauma (Janoff-Bulman p.96-97, Flannery p. 52-53). Victims

of repeated traumatic injury may resign to believing that their lives are worth little as they are

powerless to have an impact on outside factors (ie. powerless to prevent incest or to gain affection

of a negligent parent). These victims may display a depressive state of learned helplessness

(associated with incremental arousal and decrease in levels of norepinephrine, endorphins and

serotonin, different from non-trauma related depression in that cortisol is not present), a

dissociation between the sympathetic-adrenal medullary system and the pituitary-adrenal cortical

system. (Janoff-Bulman p. 10, Flannery p. 53) Even a single case of trauma can create permanent

structural changes in the brain (Janoff-Bulman p. 68) So when others abuse a child, they are

effectively impeding his or her development, psychologically or physically.

Parents who tend to neglect or abuse children are those who experience family planning problems,

have little social contact, have primary responsibility of raising children with less help from the

other parent (especially mothers, who are seen as abusers more frequently), have marital discord,

are unemployed or who have been maltreated themselves. When a parent receives little assistance

with caring for children, has had poor training in the line of childrearing and at the same time has

needs that are unmet, a parent is often not an effective caregiver (Straus, Gelles, Steinmetz p. 65,

Garbarino, Guttman, Seeley p. 11, 16, 48-49). These factors, including crime rate, family income and

feelings about one’s social setting, were once considered “reliable predictors” of the rate of child
abuse (although in years ahead, abuse has been seen in families regardless of income level) (Straus,

Gelles, Steinmetz p. 210-11). There is a “circular negative relationship” between parents who

neglect/abuse children and the community; the community distances itself from these parents while

parents feel isolated and continue to be anti-social (p. 156) Parents may lack knowledge of the

developmental stages of their children and be unfamiliar with the importance of parent/child

interaction; they can have unreasonable ideas about what may be expected of children (p. 51). A

parent may consider a child an extension of him/herself, expecting wonders of the child (not

surprisingly, often in the areas that a parent was deficient), criticizing the child when some unfair

demands are not met (p. 56-7). It is critical that parents be given opportunities to learn proper

parenting skills and that intervention is made to ensure the safety and well-being of a child.

Children who are neglected often show an increased level of hostility and aggression, impaired self-

esteem, emotional instability, sleeping and eating abnormalities, growth impairment,

unresponsiveness and excessive dependence or “defensive independence” on another. Young

children who are neglected may experience a “non-organic failure to thrive” where physical and

psychological developmental growth is inhibited. With compensatory rehabilitation, development

may revive, but there may remain some permanent damage (p. 12, 15). Rejection makes a child feel

abandoned, unloved, meaningless. A parent may remove him/herself from a child, taking away the

feeling of permanence that is necessary for a child to feel secure enough to explore the world and

learn how to develop nurturing relationships (p. 16-17). Children who are abused often have fear for

their lives, are anxious, agitated, depressed, socially withdrawn, exhibit avoidant behaviours such as

“frozen watchfulness,” often have a lack of harmony with perpetrator and have psychological

disturbances (p. 3-4, Janoff-Bulman p. 53, Garbarino, Guttman, Seeley p. 61, Eth & Pynoos p. 137).
Abuse (especially sexual) may leave a child powerless and often because the abuse happens over and

over a child’s emotional and social development are jeopardized (Garbarino, Guttman, Seeley p. 17)

There are different degrees of severity with abuse. Depending on the age, maturity, previous

experiences and biological predisposition of children and depending on how close the perpetrators

are to these children, some abuses may lead to PTSD and some may not. Childrens’ responses differ

and some may be considered “resistant” to many stress factors. This does not mean that they do

not experience stress, but that they experience it differently. With some children, trauma is

counterbalanced by a nurturing other who may help them to continue to develop a positive view of

themselves. Some kids may develop psychosis or PTSD as a result of traumatic experiences while

others may find ways to be strengthened by them (more likely in the presence of caring others) (p.

9, Rubin p. 2, Garbarino, Guttman, Seeley p. 13). In The Psychologically Battered Child, the authors

believe that the key to stress-resistance is the absence of psychological battering (p. 5). Perhaps

the strongest predictor/preventor is how the trauma is perceived. As other authors note, what a

traumatic event means to a child personally is possibly more important than the trauma itself – the

danger is less caused by a fear of personal harm and more related to a fear of how that harm may

affect a child’s inner world (ie. loss of caring other) (Eth & Pynoos p. 24, Rubin p. 13). There are

both continuities and discontinuities to be experienced and “transcendence” above a trauma is

determined by a child’s “personal appraisal” of it. The author notes that most specialists believe

that a child’s early experiences within a family predict how a child decides to act or react upon a

situation at an early age and determines much of how he/she will respond to future situations. A

child can continue to remain attached to an abuser or can empower him/herself to “disidentify”

from the abuser. (Rubin p. 2-5, 50, Janoff-Bulman p. 52). Many children come to a decision to
disidentify when they are made to feel that they “don’t fit” into the family picture, when they have

other caring attachments to encourage them or when they realize that to “survive” they must

detach (Rubin p. 5, 8). Children find ways to transcend and become “stress-resistant” by becoming

“adoptable” (attracting others who become mentors/surrogate parents) and by “escaping” (finding a

place or hobby that removes him/her from an abusive situation) (Rubin p. 9, 11). These situations

allow children to develop healthier relationships with caring attachments (if they are willing to trust

others) and help a child find meaningful purpose and a sense of mission to make a difference in

themselves and others (Rubin p. 12).

Based on the victim’s perspective, Rubin talks about the lives of some of these transcendent

individuals who in youth experienced horrible traumas. Sara, who was given to her grandmother by

her mother (abandoned) as a baby, experienced happiness for 7 short years of her life. Her mother

had her removed from the only family she knew to live again with her. She was physically,

emotionally and verbally abused by her mother and brother, segregated from family activities

including dinner, sexually abused by her step-father and brother from ages 9 – 14 and finally sent

away again when she refused to accept her step-father’s sexual advances (rejected). She felt

shameful, dirty, like there was no way out and received mixed messages of “love/sex” from the only

one in the family that gave her attention, her step-father (albeit, corrupt). Still, there were

moments that she showed “stubborn courage” by standing up for herself. This anger (dysfunctional

in some ways, but functional on this occasion in that she denied being a victim) was the beginning of

her transcendence, to know inside that she was not like them. She was successful in school and was

adopted and affirmed by others. She did not stay trapped in her fears, instead she learned to

master her world. Though she lives with impulses to react to stressors/stimuli and has repeated
some of the abuse that she had experienced (she actively chose not to repeat as well), she has

fewer “dark moments” or feelings of marginality. Interestingly, she was the only one of her siblings

to have escaped severe psychological pathologies (Rubin p. 17, 22, 26-30, 33-34, 44-45). This was

the case for Petar as well, who was terrorized, neglected and without a loving parent. He remained

the only sibling to stay out of trouble – by age 9 or 10, he had separated himself from the family as

an observer vs. a participant (p. 47-52). Lynne found ways to gain mastery over her physically

abusive situation by talking with and acting out on a stuffed gorilla as a toddler and by seeking out a

surrogate (family cook) to protect her from her abusers (p. 73-74). She learned how to become

resilient and later was encouraged by a friend’s mother (surrogate) to go away to school to get away

from her family – she learned about how other families worked and that they are not all like her

own (p. 80-82).

There is a high correlation between the abuse of a child and a child becoming an adult abuser. Over

the last couple of generations, awareness has increased regarding violence and abuse that leads to

trauma/PTSD. A cycle of trauma may occur without the attention of the family, community or

physician. Symptoms of trauma and PTSD may be visible (at times not visible in children), but too

often people are misinformed or too uncomfortable to take action. There are psychological tests

that may be given to help diagnose PTSD properly and there are many programs that offer

intervention and support to families that may help reduce or detect PTSD. If children can be

helped soon after a traumatic episode, they have a better chance at recovery. Time does not

always heal, but by early attention to trauma, children may be taught coping skills and can live safer

(Strais. Gelles, Steinmetz p. 101, 108-111, 121-22, Eth & Pynoos p. 11, 14, 106-150, Flannery p. 65).