Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder


Posttraumatic Stress Disorder is a condition from which nearly 10% of
Americans suffer. It, unlike other afflictions, is associated with a wide
variety of circumstances. Many war veterans suffer from Posttraumatic Stress
Disorder. However, a new group of people are quickly emerging as common suffers
of Posttraumatic Stress Disorder-sexually abused children. Posttraumatic Stress
Disorder is a prevalent problem associated with children who are victims of
sexual assault.
Posttraumatic Stress Disorder is classified as an anxiety disorder under
the Diagnostic and Statistical Manual of Disorders (DSM-III). The diagnoses for
Posttraumatic Stress Disorder was not formally diagnosed as part of DSM-III
until 1980. According to Famolaro, "the diagnoses of Posttraumatic Stress
Disorder requires: (a) experience of a significant traumatic events; (b) re-
experiencing of the trauma in one of several different thought, emotional, or
behavioral forms; (d) persistent symptoms of increased arousal, Particularly
when exposedto stimuli concretely or symbolically reminiscent of the trauma; (e)
symptoms lasting at least one month. (Famolaro, Maternal and Child
Posttraumatic... 28)".
Children are now becoming realized as significant sufferers of
Posttraumatic Stress Disorder. Posttraumatic Stress Disorder is particularly
bad for children under the age of 11, because they lack many of the skills
needed to protect themselves. Furthermore, this vulnerability is enhanced when
the child is exposed to any maltreatment. According to recent studies,
"Posttraumatic Stress Disorder is a common sequella of severe or chronic
maltreatment of children, particularly among sexually maltreated children (
Famularo, Symptom Differences... 28)". Posttraumatic Stress Disorder can be
caused if the child is exposed to just one traumatic episode (rape, witnessing a
violent crime, physical abuse); However, the child will become more susceptible
to Posttraumatic Stress Disorder if the maltreatment continues. Moreover, a
child is most likely to suffer from symptoms associated with Posttraumatic
Stress Disorder when sexual assault is involved(28).
Because children have not yet developed cognitively emotionally and are
very immature, they are likely candidates to develop symptoms related to
Posttraumatic Stress Disorder. As a child matures he/she becomes better
equipped to deal with and prevent contributing factors to the eventual suffering
from Posttraumatic Stress Disorder. Up to age two, young children can recreate
stressful events and even imagine such events recurring; However, the mind is
not developed enough to identify, anticipate, or prevent future traumatic
occurrences. At age three, children cannot, "distance themselves, in time,
appreciate roles and differences in behavior, access situation, or adopt
nonegocentric causality (Saigh 189)". This flaw opens them up to the impact of
trauma because the child cannot anticipate and protect themselves. By age four,
children have the ability to protect themselves by avoiding traumatic encounters.
They also have the ability to suppress their anxiety when it becomes difficult
to cope with. Because children do not have this ability any earlier they are
vulnerable to physical and sexual assault. Children continue as such until they
become concrete operational at about age six or seven (190).
Children who have been sexually abused develop many of the syndromes
associated with Posttraumatic Stress Disorder, some of which are, the inability
to establish normal relationships with adults and peers, to make a normal
transition from adolescence to adulthood, as well as to develop skills required
to progress in school. However, this was not the case with all sexually
assaulted children. Walder states, "not all those so exposed will develop a
Posttraumatic Stress Disorder reaction; some may have a certain "hardiness" that
helps them cope without any noticeable residual effects while others may have a
severe psychological reaction that renders them unable to function (Walker
130)."
Knowledge of sexual assaults has recently become more common. Random
surveys of adults indicate that approximately 28% of women and 16% of men were
victims of sexual abuse before the age of sixteen (Valentier 455). The nature
of the abuse stretched from fondling to sexual intercourse committed by an adult
that was five years older than the victim (Wolf et al). Women are more often
the victims of child sexual assault then men. According to John B. Murry, women
are the victims of child hood sexual abuse at a ratio of 10:1 over men (Murry
658). Furthermore, children of lower income families are also common victims of
sexual assault. But, as Murry points out, sexual abuse occurs in all types of
families regardless of their income; and, sexual assaults are usually committed
by a member of the family. It is difficult to get an accurate record of the
actual number of children that have been sexually abused. Many cases never come
to light and because of differences in definitions of sexual assault , some
cases are missed.(658).
Researchers have begun to explore the concept of Posttraumatic Stress
Disorder with children and adults that were victims of sexual assault. Many
times people associate particular events with particular stimuli. For example,
certain orders, colors, sounds, and people can trigger a memory of a past event.
This is more true for victims of sexual assault. According to Wolf, Sas, and
Wekerle, "traumatic episodes become associated with particular eliciting stimuli
and can lead to maladaptive or a typical reactions. Such conditioning can play
an important role in the formation of children's adjustment disorders subsequent
to sexual abuse (Wolf et al 38)." Because people do not anticipate an abusive
episode there are usually things the victim can not control. Sexual abuse is
just such a stressful event that will produce a form of a coping reaction.
Because children are impressionable the perpetrator may consult, threaten of
confuse the child to confession. Child victims of child sexual assault are also
tortured by nightmares, recurring images of the event and troubling memories.
"Based on interviews with children who have been exploited by adults through sex
rings and pornography, 65 of 60 children reported intrusive thoughts, flashbacks,
and nightmares. Physical symptoms (eg. Somatic complaints, sleep problems,
excessive crying) and greater social withdraw and distrust of others were also
noted among a sizeable proportion of this sample (Wolf et al 39)."
Posttraumatic Stress Disorder is diagnosed with the Posttraumatic Stress
Disorder Symptom Checklist. The test consists of a list of 43 "adjustment
problems" with 23 items spanning the range of symptoms characterizing
Posttraumatic Stress Disorder as defined in the DSM-III Categories for
Posttraumatic Stress Disorder. Participants were considered Posttraumatic
Stress Disorder positive if they indicated on the test that they had
reexperienced the traumatic event, became avoident, and had increased arousal.
The test also indicated whether or not the participant had a "moderate problem"
or "partial" Posttraumatic Stress Disorder (Rowan 55)." In one study using the
PTSD symptom checklist on 42 sexually abused children, 64% of the participants
were considered PSD"positive", with another 19% meeting the criteria for
"partial" PTSD(56)."
The sample of nighty children comprised of 21 boys and 69 girls. The
average age was 12.4 years old. Based on the most severe forms of abuse
reported by these children, 52.2% had alleged sexual touching (including
fondling of genitals, masturbation, 34.4% reported oral, anal, or vaginal
intercourse with the offender, 10% reported attempted or simulated intercourse,
and the remaining 3,3% reported being the victim of indecent exposure. Out of
the sample, 44.7% had been abused only once, 32.9% of the sample were abused two
to ten times, 7.1% were abused ten to twenty times, and 15.3% more than twenty
times. Almost all alleged perpetrators were persons known to the child, 54.4%
were non-family members, 25.6% were abused by a parent or stepparent, 20% were
abused by a member of the extended family or a stranger (Findelnor 1406).
The results of the test indicated that of the ninety children tested, 44
showed positive signs of PTSD and 46 did not. Of the 44 children testing
positive, 49.8% self-reported showing total fear, 53.2% indicated fears of abuse,
57.7% showed anxiety ,and 59.3% felt depressed. Guilt and self-blame were also
diagnosed at 25% and 11% respectively. Parents of the 44 children that tested
positive, 64.2% internalized their anxiety while 61.5% externalized (140).
In a separate study done by Famularo, he evaluated a test group for both
acute and chronic PTSD. Sexually abused children which had an onset of symptoms
within six months of the abuse and a duration of symptoms lasting longer than
six months were diagnosed as having acute PTSD. Conversely, sexually abused
children with symptoms lasting longer thatn six months were diagnosed with
chronic PTSD. Twenty-four of the 28 sexually abused children tested showed
evidence of either acute or chronic symptoms of PTSD. Of this group 3.1% had
recurrent intrusive recollections and 3.33% recreated the trauma in their play.
2.61% experienced nightmares, 3.33% of the group acted as if the event were
occurring.
Distress of exposure to symbolic real re-exposure was experienced by
2.1% of the children. 3.49% of the victims avoided thoughts related to the
event and activities that arouse recollections of the event. Furthermore, 1.8%
of the children could not recall aspects of the trauma. 3.2% demonstrated a
diminished interest in games and recreational activities. 16.3% of those tested
suffered regression. Of these victims, 3.14% detached and estranged themselves
from others. Sadly, 2.61% of these traumatized children exhibited and expressed
the belief that their lives would be short. While 2.9% felt that life was going
to be difficult and long(144).
Until recently, sexually abused children were never studied for symptoms
of PTSD. As the aforementioned case studies suggest, it as a problem that
deserves attention. These children do suffer the symptoms of PTSD and should be
diagnosed and treated accordingly. This could be difficult as many instances of
sexual abuse remain unreported; however, their problems are real and deserve the
help that further research could facilitate.