When you hear about post-traumatic stress disorder (PTSD), you probably think of war veterans who have returned and are somehow psychologically impaired. In fact, many people don't believe in the existence of PTSD. This disorder deserves attention here because it is clearly associated with depression, and the results can be crippling.

Without understanding these symptoms, you will likely miss the existence of this disorder in your child. To gain an insight into PTSD, here's the definition from the DSM-IV:

A. The person has been exposed to a traumatic event in which both of the following were present:

• The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others

• The person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.

What Is Considered an “Event”?

With regard to the event itself, your child may have observed severe physical abuse toward a parent and was afraid she was next. Perhaps the child was the victim of either sexual or physical abuse, or both. If you and your child were involved in a car accident in which someone was seriously hurt or even killed, this can cause PTSD. Another example is the death of a loved one.

Basically, any event that is out of the range of normal, everyday happenings that threatens your child's sense of security can be a trigger for what the DSM-IV calls a post-traumatic stress response, which is characterized by the following:

B. The traumatic event is persistently re-experienced in one or more of the following ways:

• Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.

• Recurrent, distressing dreams of the event. Note: In young children, there may be frightening dreams without recognizable content.

Essential

Adults take in information and process it differently than children. Just because you don't believe what your child experienced isn't traumatic, do not assume she is interpreting the event in the same way. Doing so will cause you to miss your child's distress and increase her chances for depression.

• Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific re-enactment might occur.

• Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

• Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

Avoidance and Arousal

Along with the post-traumatic response to the stressor, a child will persistently avoid things that remind her of the trauma. She may refuse to think about it or to talk about it. She may report an inability to remember a critical piece of the trauma. She is likely to avoid anything that reminds her of the experience. You may notice your child seems detached from others and her own emotions.

The other set of symptoms include increased arousal that was not present prior to the traumatic event. These include difficulties falling or staying asleep, irritability or outbursts of anger, problems with concentration, hyper vigilance, and an exaggerated startle response.

Now you can see how ravaging PTSD can be. Symptoms of depression almost always accompany this disorder. Much of the symptomatology can be avoided or minimized by getting help for your child as soon after the traumatic event as possible. Even if your child claims to be fine, it's better to be safe than sorry.