Posttraumatic Stress Disorder - Literature review Example

Post-Traumatic Stress Disorder In treating the psychological conditions of war veterans returning homefrom the battle lines, psychologists began realizing that many of them had the same general symptoms that were associated with other individuals who had suffered through terrifying ordeals. These symptoms included an overdeveloped startle reflex, an emotional numbness, a loss of interests, irritability, aggressiveness and a difficulty in expressing affection (“Anxiety Disorders”, 2006). The degree to which these symptoms affect their everyday life varies, with those experiencing the most severe symptoms being those whose terrifying experience was the result of a deliberate action on someone’s else’s part, such as a mugging, a rape or child abuse. When exposed to threatening or brutal emotional and/or physical treatment, wives and children experience traumatic stress disorders that require exceptional coping skills. Instances of domestic violence are usually unanticipated and uncontrollable which serve to devastate a family member’s sense of wellbeing and security. Negative effects that could damage a person’s psyche for a lifetime may result from a one-time occurrence and worsens from prolonged exposure to traumatic experiences involving family violence. “With repeated exposure to traumatic events, a proportion of individuals may develop Posttraumatic Stress Disorder. Most people who suffer from PTSD (especially, in severe cases) have considerable interpersonal and academic and occupational problems” (Meichenbaum, 1994). For a more comprehensive understanding of the effects of Posttraumatic Stress Disorder, or PTSD, its effects upon perhaps society’s most vulnerable population, its children, will be explored. Long-term exposure to depression and anxiety could become a symptom of domestic violence in both the mother and children which could lead to posttraumatic stress disorder. “A clinical concern for both mother and children of domestic violence is the potential for the development of posttraumatic stress disorder. This is a serious anxiety disorder owing to exposure to or witnessing of events that threaten life or injury and evoke intense fear of helplessness” (Chemtob, 2004, p. 210). The condition was first recognized in battle-weary soldiers, but has since been identified in several other life occurrences, such as domestic violence. Posttraumatic stress disorder (PTSD) develops following direct personal experience of a traumatic event, witnessing a traumatic event and/or experiencing an event that involves a threat to one’s own or another’s life (Cook-Cottone, 2004). It was also noted by Margolin and Gordis (2004) that: “Posttraumatic stress symptoms and posttraumatic stress disorder are important consequences of exposure to family violence because they can impair social and behavioural functioning” (p. 153). Based on past studies, it can be determined that many children will go through some kind of traumatic experience when exposed to domestic violence. “Abundant research is available on the effects of childhood trauma on adult mental health. The results generally suggest that traumatic experiences in childhood make people more vulnerable to adult distress and mental health problems” (Punamaki, 2001, p.283). The psychological impact of violence on children in a majority of cases can be a life changing event: Both physical and intellectual growth may be slowed in children from violent homes. It is not difficult to see how this should be so, considering that some of the most widely known and accepted psychological research, characterized by Maslow’s hierarchy of needs, shows that human beings must feel a sense of safety before self-esteem and self-actualization may take place. Some psychologists have found that even indirect exposure (hearing rather than seeing) a single episode of violence between parents can be very traumatic for a child. (Berry, 2000, p. 131) The majority of children studied who are living in domestic violence shelters indicate quantifiably high levels of PTSD. These children are at considerably higher risk than others to act out in a delinquent manner, abuse drugs, drop-out of school, and experience difficulties in relationships with family and friends. All of these dynamics combine to disrupt the family unit. Children of differing ages exhibit a broad range of responses from exposure to violence within their family. Children of preschool and kindergarten age seldom understand why they are being abused. They usually tend to think that they have done something wrong and this self-blame can advance feelings of worry, guilt and apprehension. Younger children in general do not have the intellectual or emotional capability to sufficiently articulate their opinions verbally. Because of this, the expressions of these emotions are often behavioral in nature. “Children may become withdrawn, non-verbal, and exhibit regressed behaviors such as clinging and whining. Eating and sleeping difficulty, concentration problems, generalized anxiety, and physical complaints are all common” (Graham-Bermann, 1994). Children of pre-adolescent age, unlike younger children, typically have a greater ability to verbalize negative sentiments. School-aged children who have experienced traumatic events exhibit similar symptoms as younger children such as regression bed wetting or refusal to go to school as well as demonstrating an increase in externalizing or internalizing behavioral expression and physiological complaints such as stomach aches and headaches (Cook-Cottone, 2004). Other symptoms may include fear, anxiety, depression, anger, aggression, feelings of isolation, poor self esteem, difficulty in trusting others and/or relationship problems with peers and family members. This generally results in a social withdrawal, avoiding contact with others and displaying a rebellious, disobedient behavior in school. Pre-teens of abusive situations have an increased propensity for temper tantrums, are often involved in fighting, abuse animals and act in threatening manners. This violent behavior mirrors what they see at home and is an attempt to gain attention as well as being an overt sign of PTSD as a result of their inability to escape the violence that has engulfed them. Teenagers of abusive house-holds are at much greater risk than those who are not to drop-out of school and abuse drugs. Research has suggested that a history of family violence is the most noteworthy reason that separates antisocial and ‘normal’ youths. “An estimated one-fifth to one-third of all teenagers who are involved in dating relationships are regularly abusing or being abused by their partners verbally, mentally, emotionally, sexually, and/or physically. Between 30 and 50 percent of dating relationships can exhibit the same cycle of escalating violence as marital relationships” (Sexual Assault Survivor Services, 1996). Thus, the symptoms of PTSD are an integral part of the repeating cycle of violence within the household, both the result and the cause of further violence. In addition to any physical damage domestic violence may inflict upon a child, PTSD can have a significant impact upon the child’s developmental cycle. For example, Freud’s theory encompasses five stages of development from the onset of life through late adulthood and is primarily concerned with the development of the id, the ego and the superego (Margolin & Gordis, 2004). The stages are the oral stage from ages 0 to 1, the anal stage from ages 2 to 3 , the phallic stage from ages 4 to 5, the latency stage from ages 6 to 12 and the genital stage from 14 to late adulthood. According to this theory, the id is the unconscious mind that responds only to urges and gratification which is most apparent in the infant and small child (Margolin & Gordis, 2004). As we mature, we begin to act upon those impulses and develop a conscious mind, the ego. The development of the ego is shaped to a great extent upon how well or poorly our needs were met in our earlier development. As the ego recognizes that some of the actions desired by the id are not appropriate within a given society, it begins to develop a sense of morals and ethics, the superego. Like the ego, this development is largely shaped by the experiences of the child and the examples he or she is given by those closest to him or her. To resolve many of the conflicting issues between what we want (our id), what we need (our ego) and what we believe is right (our superego), Freud suggests we develop a complex relationship of defense mechanisms that span an entire range of expression (Margolin & Gordis, 2004). PTSD blocks many of these connections within the mind as the child learns to avoid those memories and actions that have led to violence or pain in the past as well as preventing them from progressing along these more ‘normal’ lines of development. “Most people with PTSD repeatedly relive the trauma in their thoughts during the day and in nightmares when they sleep. These are called flashbacks. Flashbacks may consist of images, sounds, smells, or feelings, and are often triggered by ordinary occurrences, such as a door slamming or a car backfiring on the street. A person having a flashback may lose touch with reality and believe that the traumatic incident is happening all over again” (“Anxiety Disorders”, 2006). With much of the mind’s concentration focused upon avoiding trauma and the rest of the mind being inappropriately trained regarding expected behaviors, there is not much room left for appropriate development. Erikson (Margolin & Gordis, 2004) focused more on developmental psychosocial development in his examination of the development of a child. Erikson focused his ideas on the importance of specific life events taking place at key periods rather than the precedence of biological factors in the shaping of personality. Erikson identified eight psychosocial stages of development of which half occur in adolescence and childhood. “In Freud’s theory all the cognitive skills develop only because the child needs them to obtain gratification: they have no independent life. In Erikson’s theory, cognitive skills are a set of ego functions that are presumed to develop independently, rather than being entirely in the surface of basic gratification” (Bee, 1995, p 274). Erik Erikson was an influential theorist in psychoanalytical theory. His theory, like Freud’s, covers various parts of one’s life span although Erikson was more detailed in his analysis by creating additional categories for later stages in one’s life span (Bee, 1995). Again, PTSD functions as a stopper for many of these developmental milestones as the child continues to struggle with unaccomplished tasks as a result of their experienced symptoms. Depending upon when in life the individual experiences PTSD will help determine the degree of damage that might be inflicted as well as whether or not the individual will be able to overcome the damage done. Generally, symptoms of PTSD emerge within three months of the traumatic event that triggers it. In the case of child abuse, this is a recurring action, therefore the child is never given the opportunity to overcome the violence and return to a state of relative equilibrium. They live in a constant state of fear that is likely to develop into a chronic condition. The outward symptoms of an overactive startle response and a general avoidance of social situations then becomes reason for ridicule by others (further driving the child into isolation) and restricts their access to appropriate guidance and counseling – even the informal kind that can be offered through normal interaction between friends. Because of its potentially long-lasting effects, the dynamics of posttraumatic stress disorder need to be better understood because better understanding can lead to faster healing which could serve to help break the cycles of violence seen in the community. References “Anxiety Disorders.” (2006). Washington D.C.: National Institute of Mental Health. Available July 25, 2007 from Bee, H. (1995). The Developing Child. 6th Ed. New York: Allyn & Bacon. Berry. D. B. (2000). The domestic violence sourcebook: Everything you need to know. Los Angeles, CA: Lowell House. Chemtob, C. M. (2004). “Psychological effects of domestic violence on children and their mothers.” International Journal of Stress Management. Vol. 11, N. 3, pp. 209-222. Cooke-Cotton, C. (2004). “Childhood posttraumatic stress disorder: Diagnosis, treatment and school reintegration.” School Psychology Review. Vol. 33. Graham-Bermann, S. (1994). Preventing Domestic Violence. MI: University of Michigan. Margolin, G., & Gordis, E. B. (2000). “The effects of family and community violence on children.” Annual Review of Psychology. Vol. 51, pp. 445-479. Meichenbaum, D. (1994). A Clinical Handbook/Practical Therapist Manual for Assessing and Treating Adults with Post-Traumatic Stress Disorder. Ontario, Canada: Institute Press. Punamaki, R.L. (2001). “From childhood trauma to adult well-being through psychosocial assistance of chilean families.” Journal of Community Psychology. Vol. 29, N. 3, pp. 281-303. Sexual Assault Survivor Services. (1996). Facts About Domestic Violence. SASS. Available July 25, 2007 from Read More