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Childhood and Adolescent Trauma: An Overview

There is no single accepted definition of what constitutes a traumatic event. The strictest definition would require the event to meet criteria of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) involving death, serious injury, or threat to the physical integrity of self or others, as well as fear, helplessness, horror, or (for children) disorganized or agitated behavior. However, research has shown that a much wider range of adverse life events, such as neglect, bereavement, bullying, or family dissolution, can lead to the full array of posttraumatic stress symptoms.

Not every upsetting event becomes traumatic. If the individual is able to face and work through the event, it is simply a difficult but productive growth experience. Resiliency and growth in the face of a potentially traumatic event is more likely with secure attachment status, good social support, and absence of prior trauma. On the other hand, if the individual experiences the event as overwhelming and is unable to integrate what happened, it is a trauma, at least in terms of its clinical impact. Psychological morbidity in the face of a potentially traumatic event is more likely with events of greater severity and with peritraumatic dissociation.

While what constitutes a traumatic event continues to be a subject of debate, researchers must explicitly define their inclusion criteria, and clinicians should probably use a broader definition of trauma in order to provide appropriate treatment for the client's symptoms regardless of whether the precipitating event(s) meet DSM criteria.

Prevalence

There are widely varying estimates of prevalence of trauma exposure among children and adolescents, depending on the methodology and the study sample. However, it is likely that the large majority of children and adolescents will experience at least one Criterion A traumatic event. If other significant adverse life events are also included, then trauma exposure (broadly defined) during childhood and adolescence is nearly universal. Thus, far from being “beyond the scope of normal human experience” as originally conceptualized, trauma exposure is a normative experience. Many individuals will experience more than one traumatic event, and a smaller number will experience repeated exposure to events such as abuse or witnessing violence.

Impact

The classic posttraumatic stress symptoms include avoidance, reexperiencing, numbing, and hyper-arousal. The individual may practice avoidance of reminders of the memory, as well as avoidance of situations that may seem to present opportunities for further traumatizing events. The individual may reexperience the memory by thinking about it at unwanted times, by having related bad dreams, or in rare cases by having flashbacks and momentarily believing that the event is occurring in the moment. The individual may feel numb or unable to experience any emotions. The individual may remain in a hyperaroused state, being on the constant lookout for danger, and having a heightened startle response. A child or adolescent with this cluster of symptoms may qualify for the diagnosis of posttraumatic stress disorder (PTSD).

However, the potential impact of trauma exposure goes far beyond the minority of trauma-exposed children or adolescents with PTSD. Trauma exposure can cause or exacerbate the full range of internalizing and externalizing disorders, including anxiety, depression, disruptive behaviors, and substance abuse. Trauma exposure has also been implicated in low self-esteem, school failure, juvenile delinquency, addictions, becoming a future victim of abuse, and aggression toward others, as well as a wide range of health problems.

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