Serious Conditions: Stress Disorders

SERIOUS CONDITIONS: Stress Disorders

You've seen the list of stressors in the section above titled "Help! Stress Ahead!"

Now we need to discuss some of the serious reactions to such stresses. These reactions can persist, and can get harm students or adults alike.

This section is taken from the final chapter of Stressed Family , Strong Family.

Stress Disorders Are Different in Different People

Almost any of those stresses listed at the end of the book can cause an ASD or PTSD.Those disorders usually follow severe stress. However, you never know what's severe for your son, daughter, or an for an adult. One person might find something more severe than others do. It just hits them harder. Let's take a look at a few stresses or traumas:

They have been in a natural disaster (such as a flood, fire, or earthquake).
They might have been in a car wreck.
Someone's life has been threatened (for example, they see someone get robbed with a gun or knife, or they are robbed).
They may have seen people fighting, yelling, swearing, threatening to kill, beating, shooting, stabbing.
They have been severely injured: they needed care in an emergency room or hospital.
They may be an abused child, who was beaten, or hit over and over again. They may get hit hard enough to leave bruises.
They may have suffered sexual abuse or rape. This occurs when an older child, a teen, or adult touches their sex parts or makes them have sex, watch others have sex, pose for sexual photos or videos, etc.
Many other stresses can lead to an ASD or can go on to PTSD. The person develops a stress disorder, even though other people don't think the trauma is that bad.

TO REPEAT: any of the stresses in "Help! Stress Ahead!" on this site could be severe for someone. If they begin to have symptoms like those in the table below, then that stress was too much for them to handle at that time. At another time they might not have been so upset.

Stress Disorders Are not a Sign of Weakness

Sometimes one member of a family or class will develop an ASD or will go on to PTSD. Others who went through the same thing are feeling OK. That does not mean that the person with the stress disorder is weak, or not trying to get better. Usually they want very much to get over the trauma. But they were especially vulnerable to that stress.

Some kids or adults are more vulnerable to any kind of stress. After the table, there's a list of reasons, titled "Why Do Some Kids Develop PTSD After Bad Events...But Others Don't?"

ALERT! Any Youth Might Keep Abuse Secret

Before we go on, here's a problem:

Children and teens might not tell parents or other adults about bad things and traumas that happen to them. Sometimes kids themselves may not even realize that they have been severely stressed. But they develop some of the symptoms in the table.

Kids will keep secrets, even if trauma goes on for a long time. For example, other kids may be threatening to beat up, or even kill, a youth. The victim might feel too frightened to tell anyone.

Another example: a sexual abuser forces a child to keep the abuse secret. The abuser may threaten to kill the child if he or she tells anyone. Or the abuser may threaten to kill the child's parent, if the child discloses the abuse. So the frightened kid doesn't tell anyone. The abuser has now added severe mental abuse--deliberate creation of fear--to the trauma of sexual abuse.

Some kids don't even realize that sexual abuse is bad. They think that such acts happen to kids in all families. So they don't tell anyone. But they may develop a stress disorder without knowing that what they have been through is abuse.

But it's not just young kids who keep secrets. Teens who are threatened or abused may feel they ought to take care of things themselves. They think that telling their parent means they are chicken, or a baby.

Sometimes the youth doesn't realize how upset they really are. A child or teen may have heard about various kids getting shot at one time or another. They hear about this so often, getting shot seems familiar. If that kid then sees a shooting up close, they may not know how scared they were at the time or afterwards. They don't know how to tune into their own feelings and thoughts. They may only feel numb and uninterested in life around them. Or they may start having nightmares, maybe about something not connected to the shooting. Neither the youth not their family sees the link between the violence and their own symptoms.

IF THE YOUTH DOESN'T TELL, HOW DO YOU FIND OUT?

Young children may not have the words to talk about being scared or abused. Instead, they may stop eating, stop talking, or suddenly have trouble sleeping. They may need the mom or the dad with them all the time. The child may get scared when the parent leaves them, even with a familiar sitter.
Older kids may withdraw, get angry more easily, start getting into trouble. They either don't know they've been through a bad stress, or don't want to talk about it.

What do you do if you start seeing some stress symptoms in your son, daughter, or pupil? You can't figure out why they feel so upset.

Try some of the following ideas with kids who aren't talking. (This section repeats what I wrote in earlier chapters.)

1. If you need to, practice what you're going to say ahead of time. Try saying it out loud, when you are alone, or say it to a friend. This will help you feel less tense when you bring it up with the youth.

2. In your own words explain what you know about stress. That when bad things happen, people get upset. But they may not tell anyone. You wonder if he or she might be feeling upset about something.
          You can go through the long list at the end of the book to try to figure out what the stress is. Show them the list or read it to them. Ask if any of those things have happened to them.
          Together you can look at the table below, How to Help with Stress Disorder Symptoms. Discuss any of the symptoms they have. You may need to point out some symptoms you see.
          Then try some of the ideas on how to help.

3. What if you never talk? If you and this person don't usually talk together, tell them that you want to try talking. Explain that you need to start by talking about something easy--things you each like. You could talk about a TV program, after you watch it together. What you are doing is practicing for the time when you can begin to talk about more serious things.

Don't be too concerned if this feels strange. When you don't usually talk, it can take many tries. Keep trying. You can even say something like: "Talking feels weird."

4. After you get the habit of talking, go back to Step 2.

5. If you just can't talk about anything, even pleasant things, then see a counselor for help.

6. If you are a teacher, what do you do if a student develops some of the symptoms of stress in the table below? If you can talk to the parent, tell them what you see. The parent can ask the student about stresses, using the list.
If the parent is unavailable or unreliable, get the support of your principal. Then you or the school counselor or nurse can ask the student if they want to talk about anything. Explain about stress and trauma. Look at the table together.
If the student is being abused or has suicidal or homicidal thoughts, explain that you need to get help from the state child protection agency.

7. What adults can do in general for the problems below:
          You can help most kids by reminding them that they did not always feel the way they do at the moment, that they will feel better.
          Mix and match among the suggestions. Use any suggestion for any problem where it works.
          Explain that you, the family, and the school want to help. Tell them there are others you can turn to.
          Tell him or her that other people who've been through a bad time also have similar feelings and thoughts.

Now here's the table of things to watch for, with ideas about how to help.

How to Help with Stress Disorder Symptoms

Note: Some of these ideas also could help adults with stress symptoms.
Few people with stress disorders have all of these symptoms. Children have somewhat different reactions from adults.

Showing agitated or confused behavior
[running around, squirming, yelling; forgetting what they know; not realizing parent is talking to them]

What to do:
Make sure the child doesn't hurt himself or herself
Hold and comfort if this helps
Remind child where he, she is (they may be having a flashback)
Use the ideas in other items.

Feeling intense fear, helplessness, anger, sadness, horror

What to do:
Tell child you can help keep him or her safe
Talk about the trauma or fears if this helps calm down
Do not allow the youth to watch scary TV or movies if these bring on feelings related to the trauma they went through
Video games might help, or make them worse. Use your judgment
Use the ideas in other items.

Denying the event took place, denying injuries, fears, etc.

What to do:
Do remind that scary things happen, and it's natural to want the memories to go away
Tell them it's OK to talk if they want
Don't force to talk
Don't try to correct them, or force them to face what happened
Don't try to force youth to look at own injuries until ready (example: might not want to look at scar at first)
Use the ideas in other items.

Showing severe withdrawal from their surroundings, called dissociation
[also called "spacing out," "lost in thought," or "daydreaming"]

Note: a short time of daydreaming or spacing out is not a stress disorder. In a stress disorder, the individual withdraws longer, for several minutes or more.

What to do:

Make sure the child doesn't hurt self or put self in danger (absent-mindedly walk into street, not see a stairway, etc.)
Hold and comfort if holding does not cause agitation
Remind child in a calm voice where he, she is (they may be in a flashback and out of touch) remind them who's with them right now
Remind him or her that the trauma is all over, if it is over
Use the ideas in other items.

Avoiding situations or places that remind them of the trauma
[won't go near house where child got molested or attacked; afraid to go to school where kids beat him or her up]

What to do:
Don't force a kid to go to scene; discuss first with school counselor or therapist
If police need to ask young child to go to back to scene of trauma, parent should go with them
If fearful about hospital or doctor's office, tell them you will stay with them as long as you can, but that you may need to leave an operating room, for example
If avoiding school, meet with counselor and other school personnel to make plan for return
Use the ideas in other items.

Showing few feelings, less emotional response: depressed, withdrawn, and more detached from their feelings
[sits and does nothing; doesn't show feelings; not interested in things; doesn't answer when asked question; or looks sad, cries]

What to do:
Sit with him or her; talk if this seems to help
Encourage playing games, listening to music, or other activity to take mind off trauma
Talk in calm voice about pleasant things if this helps
Hold or hug if this seems OK (may not be OK if reminds child of trauma)
Use the ideas in other items.

NOTE: I have repeated the same suggestions for several of the following items.

Not able to feel anything at times; being emotionally numb
[more extreme than the above]

What to do:
Ask if he or she is having a bad memory
Explain that this happens from being upset
Ask if wants to talk about it
Tell them that the bad memories will usually go away after a time
Hold and hug if this is OK
Remind them that there are people who can help
Use the ideas in other items.

Having frequent upsetting memories of the bad event
[may not tell anyone that they're remembering the bad event; may just withdraw, clam up, cry, or shake]

What to do:
Ask if he or she is having a bad memory
Explain that this happens from being upset
Hold and hug if this is OK
Ask if wants to talk about it
Tell him or her that the bad memories will usually go away after a time
Use the ideas in other items.

Acting or feeling like the bad event is happening again
[called "flashbacks": child shakes, cries, yells; seems out of touch with people; doesn't answer when someone talks to him; may say "don't" or "no, no" or other things]

What to do:
Ask if he or she is having bad memory
Explain that this happens from being upset
Ask if wants to talk about it
Tell them that the bad memories will usually go away after a time
Hold and hug if this is OK
Remind them that there are people who can help
Use the ideas in other items.

Having upsetting and frightening dreams about the bad event
[may wake up crying and not be able to tell what dreamed about]

What to do:
If they are confused, remind them who you are and where they are
Tell them they are safe, are OK
Ask if he or she is having bad memory
Explain that this happens from being upset
Ask if wants to talk about it
Tell them that the bad memories will usually go away after a time
Hold and hug if this is OK
Remind them that there are people who can help
Use the ideas in other items.

Suffering repeated physical problems
[such as stomach aches, headaches, pain in body, even when nothing reminds them of the trauma]

What to do:
Ask if he or she is having bad memory when aches and pains occur
Explain that this happens from being upset
Ask if wants to talk about it
Tell them that the bad memories will usually go away after a time
Hold and hug if this is OK
Remind them that there are people who can help
Try aspirin, etc. if child not allergic
If not better in a few days, see nurse, health worker, or doctor
Use the ideas in other items. See also the "Resilience Checklist with Suggestions for Support," in Chapter 1.

Having recurring emotional symptoms
feelings of fear, helplessness, anger, sadness when something reminds child of the event [reminders might be such things as going to the playground where the trauma happened; seeing someone on the street who abused them; having to testify in court about abuses hearing people talking about the event; being in a thunder storm if they have stress reactions after a hurricane or tornado]

What to do:
Ask if he or she is having bad memory
Explain that this happens from being upset
Ask if wants to talk about it
Tell them that the bad memories will usually go away after a time
Hold and hug if this is OK
Remind them that there are people who can help
Use the ideas in other items.

Worrying about dying at an early age
[may not talk about this unless asked by someone they trust]

What to do:
Tell him or her that this will not happen
Say you will help them to have a good long life
Explain that other people also get this feeling after bad things happen
Ask about suicidal or homicidal feelings (see suggestions, Chapter 1)
Use the ideas in other items.

Losing interest in activities
[doesn't want to play; quits sports; stops hanging out with friends]

What to do:
Encourage to do things but don't force
Try having a friend of the youth's ask to play
If trauma involved friends, counselor should talk to all
Use the ideas in other items.

Showing more sudden and extreme emotional reactions
[stronger feelings such as getting more angry, upset, afraid, sad, crying easier than usual]

What to do:
Tell child you can help keep him or her safe
If talking about the trauma or fears seems to help calm down, do so
Protect child from putting self in danger (keep from running into street, etc.)
Use the ideas in other items.

Having problems getting to sleep or staying asleep

What to do:
Tell him or her that this is common and should get better
Sit with young kids a short time
But don't let this become a habit
Allow a night light if this helps
Others in same room need to get used to the night light for a while
Use the ideas in other items.

Showing irritability or angry outbursts

What to do:
Tell him or her that this is common and should get better
Don't allow him or her to hurt anyone
Restrain arms and legs if necessary and if it does not panic the child
Use the ideas in other items.

Having problems concentrating
[examples: can't stay interested in TV for as long as before; can't finish school work in school or at home; has trouble listening to what someone tells them; doesn't enjoy playing games as much]

What to do:
Talk to school counselor about ways to adjust school work
At home, allow to take a break, move around, do something else
Then go back and do some more school work
Ask older brother or sister to sit with child while both do homework if this helps
Parent can sit, also
Use the ideas in other items.

Acting younger than their age
[clingy or whiny behavior, thumb sucking]

What to do:
Try to interest him or her in the things they used to do
Don't punish for babyish actions
This will usually get better in time
Use the ideas in other items.

Showing increased alertness to the what's going on around them
[asking "what's that?" when they hear a sound or see something they would usually ignore; needing to look all around before they go outside to make sure there's no danger]

What to do:
Tell them that they are safe
Explain that other kids and adults also feel this way after stress
Answer their questions
Use the ideas in other items.

Playing or play-acting parts of the trauma over and over again
[young children may play being firefighter, police officer, rescue squad; play going to hospital; may attack toy or people]

What to do:
This is quite common. Playing out parts of the trauma seems to help get over it.
If child gets too excited, can't stop the play-acting to talk about something else, try to shift attention to other things
Don't allow the youth to hurt others
Use the ideas in other items.

This list is adapted from Facts for Families, pamphlet #70, Posttraumatic Stress Disorder, available from the American Academy of Child and Adolescent Psychiatry, 3615 Wisconsin Ave. NW, Washington, DC 20016-3007 phone 202 966-7300 fax 202 966-2891, or available via the Internet http://www.aacap.org

That's a long list of symptoms. As I mentioned above, few people have all of them. But even a small number can seem like a mountain. Kids and adults with symptoms will need your support, and may need to see a therapist for help.

The right medicine can sometimes help people to cope with ASD or PTSD symptoms. There are many different pills for depression and for fears (anxiety.) You may have heard bad things about medicine for depression or fears. Talk over your questions with a nurse or doctor. They can help you decide whether the youth or adult with PTSD needs medication to help get better.

Some teens get over PTSD faster and more completely when they have the chance to talk to a therapist. The therapist should be someone who is trained to help with stress disorders.

When a child or teen is right at the scene or directly affected by the trauma, they are more likely to have a stress disorder afterward. Therapy can make a difference.

Remember that even youth or adults who were not directly harmed by the event can develop ASD symptoms.