1. Posttraumatic Stress Disorder
Trauma- and Stressor-Related Disorders
Chapter 12

2. PTSD diagnostic criteria (for children > age 6)
Traumatic event
Exposure to actual or threatened death, serious injury, or sexual violence
Most common childhood traumas that lead to PTSD:
Accident
Natural disaster
Kidnapping
Physical assault
War
Sexual abuse
Intrusion symptoms (1+)
Recurrent, involuntary, intrusive distressing memories of the trauma
In children, may be play with themes of trauma expressed
Recurrent, distressing dreams with or without recognizable content
Dissociative reactions (e.g., flashbacks) where child feels or acts as if the
traumatic event is recurring
In children, reenacting trauma may occur through play
Emotional reminders of trauma
Physiological reminders of trauma
Avoidance symptoms (1+)
Avoiding memories, thoughts, or feelings about the trauma
Avoiding external reminders (conversations, activities, places, people) of trauma

3. PTSD criteria continued
Negative Alterations in Cognitions and Mood symptoms (2+)
Forgets parts of the trauma
Persistent & exaggerated negative beliefs / expectations about self, others, or world (e.g., “I am bad”; “No one can be trusted”)
Persistent, distorted cognitions about the cause or consequences of the trauma that leads individual to blame self or others
Persistent negative emotional state (fear, horror, anger, guilt, shame)
Diminished interest in significant activities
Estrangement from others
Inability to experience positive emotions
Alterations in Arousal and Reactivity symptoms (2+)
Irritability and angry outbursts (verbal or physical aggression towards people or objects)
Reckless or self-destructive behavior
Hypervilgilance
Exaggerated startle response
Problems with concentration
Sleep problems

4. PTSD diagnostic criteria (for children <= age 6)
Traumatic event
Exposure to actual or threatened death, serious injury, or sexual violence through
Direct experience
Witnessing, in person, the event, as it occurred to others (esp primary caregivers)
Learning that the traumatic event occurred to a parent or caregiver
B Intrusion symptoms (1+)
Repetitive play with themes of trauma expressed
Recurrent, distressing dreams with or without recognizable content
Flashbacks in which child feels or acts as if trauma were recurring (may occur in play)
Emotional reminders of trauma
Physiological reminders of trauma
C Avoidance symptoms (1+ from avoidance or negative alterations in cognition)
Avoids external reminders (conversations, activities, places) of trauma
Avoids people, conversations, interpersonal situations that remind child of trauma
Negative Alterations in Cognitions symptoms
Increased frequency of negative emotional state (fear, horror, anger, sadness, shame)
Diminished interest or participation in significant activities, including constriction of play
Socially withdrawn behavior
Persistent reduction in expression of positive emotions
Increased Arousal (2+)
Irritability and angry outbursts (verbal or physical aggression towards people or objects, including temper tantrums)
Hypervilgilance
Exaggerated startle response
Problems with concentration
Sleep problems

5. PTSD Trauma exposure PTSD rates are higher among
2/3 of children report exposure to a traumatic event by age 16
Most do not develop PTSD; the prevalence of PTSD in childhood is unknown
PTSD rates are higher among
Children who are exposed to life threatening situations
Children who experience repeated/chronic traumas
Children who are in closer proximity to the trauma
Effective treatment for PTSD includes CBT involving
psychoeducation
trauma processing
imagined or real life exposure to feared / avoided stimuli
cognitive restructuring