Post Traumatic Stress Disorder

How to recognize the symptoms and

help people diagnosed with Post
Traumatic Stress Disorder
 Learner Objectives
• Learn how to define PTSD
• State the symptoms of PTSD
• Identify some of the physical, mental, and
emotional issues that occur when a person is
suffering from PTSD
• Learn how to help a person with PTSD
 Definition
Post traumatic stress disorder (PTSD) is a complex
health condition that can develop in response to a
traumatic experience such as a
life-threatening or extremely distressing situation
that causes a person to feel intense fear, horror or a
sense of helplessness.
PTSD can cause physical, mental, and emotional
problems for a person.

The National Institute of Mental Health (NIMH), http://www.nimh.nih.gov/health/topics/post-

traumatic-stress-disorder-ptsd/index.shtml
 Definition
PTSD is often comorbid with other illnesses such as
depression, panic disorders, obsessive-compulsive
behaviors, specific phobias or fears, or substance abuse.

• Depression-is an illness that affects the body, mood, and

thoughts. Some symptoms include persistent sad or anxious
mood, feelings of hopelessness or helplessness, and lost interest
in activities.
• Panic disorder- is an anxiety disorder and is characterized by
unexpected and repeated episodes of intense fear accompanied
by physical symptoms that may include chest pain, heart
palpitations, shortness of breath, dizziness, or abdominal
distress.

The National Institute of Mental Health (NIMH), http://www.nimh.nih.gov/health/topics/post-

traumatic-stress-disorder-ptsd/index.shtml
 Definition
• Obsessive-compulsive Disorder-is characterized by
recurrent, unwanted thoughts (obsessions) and/or
repetitive behaviors (compulsions). Ex. Someone is
worried about germs. They obsess over it so much
that they are constantly washing their hands.

• Specific phobias/fears- specific phobia is an intense

fear of something posing little or no actual danger.
Common specific phobias are closed-in places,
heights, escalators, tunnels, highway driving, water,
flying, dogs, and blood.

The National Institute of Mental Health (NIMH), http://www.nimh.nih.gov/health/topics/post-

traumatic-stress-disorder-ptsd/index.shtml
 Prevalence
•PTSD can affect anyone regardless of the person’s age, sex, religion,
culture or ethnicity

•5.2 millions Americans have Post Traumatic Stress Disorder per year.
70% of adults have experienced at least one major trauma in
their lives, and many of them develop PTSD
•It is estimated that 5% of the population currently have PTSD and
that 8% have had PTSD at some point in their lives.

•One out of 10 women will suffer from PTSD at some time in their
lives. Women are about twice as likely as men to develop PTSD. This
may be due to the fact that women tend to experience interpersonal
violence (such as domestic violence, rape or abuse) more often

• Almost 17 percent of men and 13 percent of women have

experienced more than three traumatic events in their lives.

http://www.depression-guide.com/post-traumatic-stress-disorder.htm
 Prevalence in Children

• A few studies of the general population have been conducted that examine
rates of exposure and PTSD in children and adolescents . Results from
these studies indicate that 15 to 43% of girls and 14 to 43% of boys have
experienced at least one traumatic event in their lifetime. Of those children
and adolescents who have experienced a trauma, 3 to 15% of girls and 1 to
6% of boys could be diagnosed with PTSD.
• Rates of PTSD are much higher in children and adolescents recruited from
at-risk samples. The rates of PTSD in these at-risk children and adolescents
vary from 3 to 100%. For example, studies have shown that as many as
100% of children who witness a parental homicide or sexual assault
develop PTSD. Similarly, 90% of sexually abused children, 77% of children
exposed to a school shooting, and 35% of urban youth exposed to
community violence develop PTSD.

http://www.ncptsd.va.gov/ncmain/information
 Identification and Symptoms
•PTSD is caused when a person is exposed to a
traumatic event.
•The traumatic experience can cause:
-intense feelings of fear
-helplessness
-horror for the person’s life
•The experience involved threatened or actual danger of
physical harm or death.
• The event can happen to the person
• Someone they love
• Even a complete stranger.
 Identification and Symptoms
•PTSD usually occurs within a couple months after the
traumatic event but can even develop years after the
event.

•PTSD is diagnosed when the event causes the person to

relive the experience and interferes with the person’s
daily life.

•Three factors increase a child’s chance of developing

PTSD.
-severity of the trauma
-parental reaction to it
-physical proximity of the child to the event.
 Traumatic Events
The following events are some examples of a traumatic
experience that can lead to the development of PTSD

• A violent crime
• A war
• Sexual abuse or rape
• Natural disasters such as a hurricane, tornado, fire, or
flooding
• Physical abuse
• An experience where a person thought they would be
harmed or killed
• A car wreck or airplane crash
 Common Symptoms of PTSD
The DSM-IV-TR defines the symptoms in the subsequent
ways:
The symptoms should occur for more than a month and
they cause significant distress or impairment in social,
occupational, or other important areas of functioning.
The traumatic event is persistently re-experienced in the
following ways:
• Reliving the experience though reoccurring memories, including
images, thoughts, or perceptions.
• Reoccurring stressful dreams of the event
• Believing the event happening over and over again though reliving
the experience, illusions, hallucinations, and dissociative flashback
episodes
• Becoming upset (both mentally and physically) when exposed to
anything that reminds the person of the event
Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, 4th Edition
 Common Symptoms of PTSD

Consistently avoiding anything that is associated with the

trauma and becoming unresponsive to the following:
• avoiding thoughts, feelings, or conversations related to the
trauma
• avoiding activities, places, or people that remind the person
of the trauma
• forgetting important details of the trauma
• losing interest activities that the person once enjoyed
• unable to form or maintain current close relationships with
other people and difficulty feeling strong emotions
• losing hope for the future

Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, 4th Edition

 Common Symptoms of PTSD

Ongoing symptoms of amplified stimulation

as indicated by two of the following:
• trouble falling or staying asleep
• emotional instability such as being angry for no
reason or easily irritated.
• inability to concentrate
• hyper vigilance
• exaggerated startle response

Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, 4th Edition

 Biological factors
• Women are more likely to suffer from PTSD than
men.
•A person’s temperament may play a role in the
development of PTSD too. A person may have a more
difficult time dealing with trauma due to their
temperament. A person with a difficult temperament
is more likely to develop PTSD. This may be because
they have little or no coping skills.
•Experts believe that people suffering from PTSD can
develop changes in brain chemistry which will result in
the development of some of the symptoms.
http://www.ncptsd.va.gov/ncmain/ncdocs/videos/emv_hoperecovery_gpv.html?
opm=1&rr=rr1545&srt=d&echorr=true
 Family Factors
• Genetics are a factor in the development of PTSD.
Research has found that a person is more likely to suffer
from PTSD when faced with a traumatic experience if a
family member has previously suffered from PTSD

• Families that live in high risk areas are more likely to

have a family member develop PTSD. Some high risk
areas include violent neighborhoods, low socioeconomic
areas, and areas with a lot of drug activities. Here,
research shows that individuals in high risk areas are
more likely to observe or be involved in a traumatic
event.
http://www.ncptsd.va.gov/ncmain/information/
 Family Factors
• Family support and parental coping have also been
shown to affect PTSD symptoms in children. Studies
show that children and adolescents with greater family
support and less parental distress have lower levels of
PTSD symptoms.
• A parent’s parenting style may increase a child’s risk for
developing PTSD. For example if a parent is anxious and
avoids dealing with issues that parent will teach those
traits to their child. Anxiety and avoidance are key
symptoms of a person with PTSD. If a trauma would
happen to that child; the child would not have the
appropriate coping skills needed to deal with the trauma.
http://www.ncptsd.va.gov/ncmain/information/
 School Factors

The following indicators are signs that a student may be

suffering from PTSD:
Dropping grades
Lack of concentration
Late or missing homework
Easily irritated
Avoidance of peers
Aggression/violence
More issues with discipline
 School Factors
• Students that are diagnosed with PTSD have a difficult time in the
school setting.

• The students have issues with:

-emotional regulation
-developing problem solving skills
-conflict resolution skills
-social skills
-poor decision making skills.
-developing close and trusting relationships with peers or authority
figures

• Students suffering from PTSD can misinterpret their peer’s words or

actions as threatening This causes the student with PTSD to become
defensive and further alienate themselves from their peers.

• The above problems make it even harder for a student with PTSD to
function in appropriate ways in school.
 How to Help

• Family and friends should reassure the person with PTSD that they
did not cause the traumatic event
• It is important to listen to the person when they are ready to talk.
• Remind them that they are loved and important and you are there
to help them
• Let them know that their feelings are important and it is ok to feel
them
• Closely monitor the person for any signs that he or she is suffering
from any of the symptoms associated with PTSD
 How Teachers Can Help
• Teachers and parents should communicate regularly
about the student’s progress in school
• Teachers should keep the classroom rules and routines
as consistent as possible. If the rules or routines need
to change the teacher should prepare the student in
advance.
• Teachers should be aware that the student could
become upset by something the reminds him or her of
the trauma; therefore the student should be removed
from the room. The student should be taken to a quiet
room where they can calm down and be away from
whatever triggered the response.
• Teachers should show support to students with PTSD
and be available if the student would like to discuss the
trauma but never force the person to talk. This could
cause the person to become even more upset.
 Psychological Treatments
• The person may require the help of a psychologist to recover from
the trauma. A psychologist will determine what treatment will work
best for the person.

Some types of treatments

• Cognitive Behavioral Therapy (CBT)
This therapy changes the way a person thinks and feels
about the traumatic event.
• Exposure therapy
This is used to teach people to have less fear about the
memories
• Eye movement desensitization and reprocessing (EMDR)
While talking about your memories, you'll focus on
distractions like eye movements, hand taps, and sounds
• Medication
Medication can be used to help control the symptoms such
as antidepressants or anit-anxiety
Prozac, Paxil, Zoloft, or Xanax
Avoid the following when helping a
person with PTSD
• Never force the person to talk about the traumatic event. If the
person is not ready to talk forcing them may make the situation
worse.
• Never ask the person for personal details if they do not offer to tell
them to you.
• Never use words that minimize the person’s experience or feelings.
For example: Everything is ok or at least you survived
• Never blame the person for the traumatic event by telling them they
caused or could have prevented the event
• Never make promises you cannot keep. For Example: nothing bad
will ever happen to you again.
 Parent Information

See Brochure Hand Out

Things to think about
• Has my child shown any of the symptoms mentioned in
the brochure?
• What should I do if I notice any symptoms?
• Does this mean my child is suffering from PTSD?
• Where do I get help from?
 Helpful Resources

Books:
When Something Feels Wrong: A Survival Guide
About Abuse for Young People by Deanna S. Pledge
The Anxiety Cure for Kids: A Guide for Parents
by Elizabeth DuPont Spencer, Robert L. DuPont, Caroline M.
DuPont
 Case Study
The following link is of a video on PTSD from the
National Center for Posttraumatic Stress Disorder
web site. This video shows a couple different
people suffering from PTSD.

http://www.ncptsd.va.gov/ncmain/ncdocs/videos/
emv_hoperecovery_gpv.html?
opm=1&rr=rr1545&srt=d&echorr=true
 Glossary
Cognitive Behavioral Therapy (CBT) - is a type of psychotherapy based
on changing thoughts, assumptions, beliefs and behaviors, with the
aim of influencing disturbed emotions
Comorbid - to two illnesses that occur at the same time
Depression - a condition of general emotional unhappiness and
withdrawal; sadness greater and more extended than necessary
given the reason
Dissociative flashback episodes - This is when a person with PTSD
experiences the trauma like it was happening all over again. This is
usually caused by a trigger that reminds the person of the original
trauma.
DSM-IV-TR - handbook for mental health professionals that lists
different categories of mental disorder and the criteria for
diagnosing them
Exaggerated startle response - is the response of mind and body to a
sudden unexpected stimulus such as being easily frightened by a
noise
Exposure therapy - is used to teach people to have less fear about
their memories. It is based on the idea that people learn to fear
thoughts, feelings, and situations that remind them of a past
traumatic event.
 Glossary
Eye movement desensitization and reprocessing (EMDR) - this therapy
is used to help change how people react to memories of the
trauma.
Hyper vigilance - is an enhanced state of sensory sensitivity
accompanied by an inflated intensity of behaviors whose purpose is
to detect threats. For example a person suffering from PTSD will
constantly monitoring their environment looking for danger.
Obsessive-compulsive behaviors - is an anxiety disorder most
commonly characterized by the person’s obsessive, distressing,
intrusive thoughts and related compulsions (tasks or "rituals") which
attempt to counteract the obsessions
Panic disorders - is a condition characterized by persistent panic
attacks in combination with considerable changes in behavior or at
least a month of ongoing worry about concern about having other
attacks
Specific phobias or fears - is a type of anxiety disorder that causes
people to feel an unreasonable or irrational fear related to exposure
to specific objects or situations
Post Traumatic Stress Disorder

• Impact of traumatic experiences affects

capacity to function in school
• Physical abuse
• Sexual abuse
• Domestic violence
PTSD
• Nature, duration, severity, and history of
exposure is critical in shaping the brain
response. Children reflect the world in
which they are raised.
• Dramatic, unpredictable, threatening
changes in the environment
• Stress response
Trauma and Immigration

• Escaping political terror or ethnic

persecution
• Cumulative losses
• Staggered patterns of entry
PTSD - Symptoms
• Hyperarousal (most common symptom;
startled response, behavioral irritability,
sleep disturbances, regulatory functions
off, hypervigilance, emotional numbing, or
dissociation)
• Nightmares
• Flashbacks
• Upsetting reminders and triggers
Active Avoidance
Passive Avoidance
Fight or Flight
• Fight or Flight response alarm reaction
then fear (experience in the high school,
sometimes inappropriate escalating
behavior by adults to child’s apparent
impertinence)
• Freezing: hyperarousal, dissociation
response seen as oppositional
Trauma: Common Ways of
Thinking (Automatic)
• “All or nothing”
• “Again and Again”
• “Must”, “Should”, or “Never”
• “End of the world”
• Always blaming yourself
• Thinking on the downside
Impact of Trauma on Learning

• Hypervigilant
• Highly aroused
• High speed “on” or “off”
Impact of Trauma on Learning
(ctd.)

• Interference with cognition and

information processing
• Difficulty processing verbal information
with a disproportionate emphasis on
nonverbal clues
• Difficulty regulating emotions
and differentiating emotions
• Language used to distance
people
• Locus of control gives up
easily
PTSD (ctd.)

• No particular medication
• Low doses of SSRI if depression and
anxiety present
• Risks/benefits
Exercise: The 5 Steps of
Cognitive Restructuring

1. SITUATION
Ask yourself: What happened that made
me upset?” Write down a brief
description of the situation.
Situation: _________________________
2. FEELING
Circle your strongest feeling (if more
than one applies, use a separate sheet
for each feeling):

Fear/Anxiety Sadness/
Depression
Guilt/Shame Anger
3. THOUGHT
Ask yourself: “What am I thinking that
is leading me to feel this way?” Identify
the thought that is most strongly
related to the circled feeling. Write
down your thought below.
THOUGHT: _______________________

________________________________
__
If it applies, circle your common style of
thinking:

Again and Again Too Much Risk

Must/Should/Never End of the
World
Always Blaming Yourself All or None
Thinking on the Downside
Thinking With Your Feelings
4. CHALLENGE YOUR THOUGHT
Rewrite thought from Step 3: __________
Now ask yourself: “What evidence do I have
for this thought? Is there an alternative way
to look at the situation? How would someone
else think about the situation?” Write down
the answers that DO and DO NOT support
your thought:
Things that DO support my thought:
__________

_____________________________________
___
5. OUTCOME
Next, ask yourself: “Overall, does the
evidence support my thought or not?”
Look at all the things that support your
thought and balance them against all
the things that do not support your
thought. Check the box below to see
whether your thought it supported by
the evidence or not:
No, my thought is not supported
by the evidence.
If your thought is NOT supported by the
evidence, come up with a new thought that is
supported by the evidence. These thoughts
are usually more balanced and helpful. Write
your new, more helpful thought in the space
below. And remember, when you think of this
upsetting situation in the future, replace your
unhelpful, automatic thought with the new,
more accurate thought.
New Thought:
__________________________

_____________________________________
_
In some cases, even if you decide that
your thought is not supported by the
evidence, or is only partially supported,
you may want to come up with an
action plan. Typically this is to help you
cope with upsetting feelings that arise
even though you have come up with a
more balanced thought. If you have an
action plan for the situation, write it
below.
Action Plan:
_________________________
 YES, my thought is supported by the
evidence.
If your thought IS supported by the evidence,
decide what you need to do next in order to
deal with the situation. Ask yourself: “Do I
need to get more information about what to
do?” “Do I need to get some help?” “Do I
need to take steps to make sure I am safe?”
Write down your action plan to deal with the
upsetting situation below.
Action Plan:
_____________________________

_____________________________________
 Guide to Thoughts and
Feelings
FEELINGS ASK YOURSELF Related Thoughts

Fear, nervousness, What bad thing do I •Something terrible is

anxiety expect to happen? going to happen
What am I scared is •I am going to be attacked
or hurt
going to happen?
•I am going to be rejected
or abandoned
•I am going to lose control
or go crazy

Sadness or depression What have I lost? •I am not worth anything

What is missing in me •I don’t have anyone I can
or in my life? depend on
•Nothing will ever get
better
•Life is not worth living
 Guide to Thoughts and
Feelings
FEELINGS ASK YOURSELF Related Thoughts

Guilt or shame What bad thing have I •I am not good enough

done? •I am to blame for what
What is wrong with me? happened to me
•I am a bad person
•I am a failure

Anger What is unfair about the •I am being treated

situation? unfairly
Who has wronged me? •I am being used
•The situation is unfair
•Someone has done
something wrong to me