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Betsi Cadwaladr University Health Board

North Wales Child and Adolescent Mental Health Service



Post Traumatic Stress

What is traumatic stress?

Children and young people, sometimes experience, witness or hear about events which are extremely frightening and dangerous, such as a road accident, a serious injury or a crime.  This can cause a traumatic stress reaction, which affects the way you think, feel and behave.

It is important to remember that these are normal reactions to abnormal events.

It is important to remember that these are normal responses to an abnormal event and most people, in time and with the support of family and friends, recover from experiences like this without needing help.

However, for some people, experiencing a trauma during which they felt a sense of fear, helplessness or horror sets off a reaction that can last for many months or even years.  This is called Post Traumatic Stress Disorder, or PTSD for short.

When does Traumatic Stress become Post Traumatic Stress Disorder (PTSD)?

Although individuals react in different ways to traumatic events, for some people, the event feels so overwhelming and so big that it becomes impossible to make sense of the information.

It’s a bit like having a wardrobe which is too small to fit all your clothes in - your new chunky jumper is just too big and keeps falling out.

When we face dangerous or scary situations, our bodies respond to the threat by going into either a fight, flight or freeze response.

Sometimes, traumatic events are too big to fight.

If a mouse sees a cat, the mouse will know that the cat is much bigger than him, therefore the chances of surviving if he tries to fight the cat are very small.

If the cat is awake, the mouse needs to work out whether he can run fast enough (flight) to outrun the cat.  If this is unlikely, the mouse will probably freeze (play dead), in the hope that the cat will not see him.

This evaluation of risk all takes place in less than a second and the strategy which is most likely to help the mouse survive is the one which is chosen.  In other words, your brain is trying to keep you alive, when it decides whether to fight, flee or freeze.

Unfortunately, what we know about PTSD is that when people are unable to be active (freeze) or in control of a traumatic event (flight), they are more likely to be at risk of developing PTSD.  This may be because an individual’s emotional reaction may cause them to question their own sense of self, in trying to make sense of the traumatic event.  They may feel guilt or grief, or even blame themselves for not doing more to prevent or stop the event from happening, even if there was nothing they could have done.

As well as these emotional reactions to trauma, there are three main types of symptoms which are used to diagnose Post Traumatic Stress Disorder:

1.  Intrusions

Intrusions are when you become preoccupied with thoughts and memories of the event.  Some people may re-experience the memory, images, smells or sounds of a traumatic event even though they may be trying to do something else.  For example, being in a lesson at school but thinking about what happened during the traumatic event.

This happens because the mind is trying to replay the memory in order to make sense of it.  But because it’s so overwhelming and so big (remember the wardrobe?) It is difficult to make sense of.  Constant intrusions can make you feel trapped in the trauma, even though you know logically it’s in the past.

In some children, this can cause difficulties in concentrating and make them feel more irritable than usual.  It can also cause depression, mood and sleep problems.

Younger children may become fearful, clingy and anxious about being separated from their parents and appear to regress, by starting to bed-wet or thumb-suck again.  They may also experience temper tantrums and emotional outbursts.  Children may re-enact the traumatic experience through their drawings and their play as a way of trying to make sense of it.

Some people make experience flashbacks of the event.  This is when for a few moments, it seems as though you are re-living the experience in your mind, like watching an action-replay, which can be distressing and frightening.  Ordinary things can trigger off flashbacks and intrusions.  For instance, if you had a car crash in the rain, a rainy day might start you thinking about or re-experiencing the trauma.

2.  Avoidance and Numbing

You may deal with the emotional pain of your feelings by trying to feel nothing at all - by becoming emotionally numb. Some people may also drink too much alcohol or use drugs to try and ‘numb’ the emotional pain.  Or you may deliberately avoid situations which remind you about the trauma.  For example, if you have been in a car accident, you may avoid roads or even TV programmes about cars, because they remind you of the accident.  You may even try to avoid the people that remind you of the trauma and try not to talk about it.

Some people try to distract themselves by keeping themselves so busy that they don’t think about the traumatic event. Although this may seem like a good solution, it doesn’t work very well because at quieter times (such as bed time) when there aren’t things to distract themselves with, they often experience nightmares or intrusions of the traumatric event.

3.  Being ‘On Guard’ or ‘Hypervigilent’

This means feeling jumpy and ‘on-edge’ a lot of the time and ‘scanning’ the environment for ‘danger’.  You may feel anxious, finding it difficult to relax or sleep.  Because you may be preoccupied with making sure you are safe, you may seem more irritable than usual and experience other anxiety symptoms such as diarrhoea, irregular heartbeats and feelings of panic and fear.

Being ‘on guard’ is your brain’s way of trying to check out whether there is any danger around you, to make sure you are safe.  Unfortunately, you mind hasn’t realised that the trauma you experienced was in the past, which is why you may be constantly looking over your shoulder and double-checking that there isn’t any immediate danger.

Treatment for Post Traumatic Stress Disorder (PTSD)

There is help for Post Traumatic Stress Disorder.

Seeking help from your GP, Social Worker or School Nurse can help them to refer you to someone who speaiclises in helping your people with PTSD.

The National Institute of Clinical Excellence (NICE) gives advice on what sort of treatment is the best for different types of disorders and recommends that the best treatment for PTSD is either Trauma-Focussed Cognitive Behavioural Therapy (TF-CBT) or Eye Movement Desensitisation Reprocessing (EMDR).  Both of these therapies involve having to think about the traumatic event in order to change the way you feel about the trauma and to update the information you have about it, so that it can be left in the past, rather than continuing to affect you in the present.

Although the length of therapy will depend on the type of trauma you have experienced and how it has affected you, the recommended length of treatment by NICE is between 8 and 12 sessions of individual therapy.

For most people who have been diagnosed with Post Traumatic Stress Disorder, this means an average of around 3 months of individual therapy to have their lives back, free from the symptoms of PTSD.