Overview of the common symptoms of PTSD. Overview of the common
problems in children of veterans with PTSD including some common
mechanisms of vicarious experiences of PTSD in children. Identify
interventions for children who may be experiencing indirect effects
of their parents traumatization while deployed. Overview of the
effects of PTSD on the couples relationship. Describe a
recoverybased psycho-education model that provides families with
resources that will help them manage and cope more effectively with
their loved ones PTSD. Slide 2 Veterans suffering from PTSD or
other forms of post-traumatic stress have symptoms that can become
catastrophic for families. Catastrophic stress is sudden,
unexpected and produces frightening experiences that are often
accompanied by a sense of helplessness, destruction, disruption and
loss. Slide 3 What distinguishes this loss from normal loss is
there is little time to prepare for it, no previous experience, no
guidance, feeling isolated, remaining in crises for long period of
time, lack of control, disruption and destruction and high
emotional impact. Slide 4 A. 1. 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. 2. The persons response involved
intense fear, helplessness or horror. Slide 5 B. The traumatic
event is persistently re- experienced in one or more of the
following ways: Recurrent and intrusive images Recurrent
distressing dreams of event. Acting or feeling as if the traumatic
event were recurring Intense psychological distress at exposure to
internal or external cues Physiological reactivity Slide 6 C.
Persistent avoidance of stimuli associated with the trauma and
numbing of general responsiveness. Efforts to avoid thoughts,
feelings or conversations associated with the trauma. Efforts to
avoid activities places, or people that arouse recollection of the
trauma. D. Marked avoidance of stimuli that arouse recollections of
the trauma Slide 7 Re-experiencing Traumatic Events Avoidance and
Numbing Symptoms Hyperarousal Easily Startled Irritability and
Anger Avoidance of Activities Difficulty Concentrating Difficulty
with Trust Slide 8 Extensive research with family members of
Vietnam Veterans in the last 20 years has revealed there can be
serious consequences on the family of veterans with PTSD. Slide 9
Slide 10 Children may be frightened by watching a parent
re-experiencing their symptoms. Children likely do not understand
what is happening, and they may start to worry about their parents
well-being. Children also may be fearful that their parents cannot
properly care for them. Slide 11 A common response to PTSD,
Emotional numbing may prevent the Veteran from experiencing
positive emotions toward family members. As a result, children may
feel unloved or assume that their parent is angry toward them.
Slide 12 Parents with PTSD often avoid activities outside the home,
including activities with their children. As a result of this lack
of involvement, children may feel that their parents do not care
for them. Social avoidance and emotional numbing influence the
satisfaction that parents with PTSD experience from parenting.
Slide 13 Living with someone who is expressing high levels of
anxiety and arousal, as well as being constantly on guard for
danger, often results in the child developing the belief that the
world is a dangerous place one in which he/she needs to be fearful.
Slide 14 Children living with individuals who exhibit constant
irritability often results in children feeling unloved by their
parents. Research has found that this creates barriers to and
prevents close family relationships. Increased potential for
violence in the home. Slide 15 Substance abuse is often a
co-occurring condition in veterans with PTSD (i.e., 50% of
veterans). Substance abuse alone results in an array of
psychological trauma for children that has been well documented in
research and clinical literature. Slide 16 Social and Behavioral
Problems Depression, Anxiety Hyperactivity & Difficulty with
Concentration Difficulty forming and maintaining friendships.
Nightmares about parents trauma. Secondary PTSD related to violence
in the home. Slide 17 Over-identified child- experiences secondary
traumatization and comes to experience many of the symptoms the
parents is having. Rescuer-child takes on parental roles and
responsibilities to compensate for the parents difficulties
Emotionally uninvolved child-this child receives little emotional
support and does not learn how to appropriately cope with emotions,
which results in problems at school, depression, anxiety, and
relationship problems later in life. Slide 18 Poor Attitude and
lack of motivation at school. Negative attitude toward fathers and
other authority figures. Higher levels of depression and anxiety.
Lower creativity and described as not working up to their ability.
Problematic behavior at home and at school. Slide 19 Children are
taught to avoid discussion of events, situations, thoughts, or
emotions related to their parents experience. They perceive this is
a taboo subject and resist asking questions. This tends to increase
their anxiety as they often worry about provoking the parents
symptoms. Because a child does not understand the parents symptoms,
or have details about the traumatic event, the child may develop
ideas that are even more horrifying than what actually occurred.
Slide 20 When children are exposed to graphic details about their
parents traumatic experience, they may start to experience their
own set of PTSD symptoms in response to horrific images generated.
This has often been referred to as vicarious traumatization. Slide
21 Children may start to identify with the parent to such a degree
that they begin to share in his or her symptoms as a way to connect
with the parent. Slide 22 Children also may be pulled to re-enact
some aspect of the traumatic experience because the traumatized
parent has difficulty separating past experiences from present.
Slide 23 Redefining Roles, Expectations, and Division of Labor.
Managing Strong Emotions. Abandoning Emotional Constriction
Creating Intimacy in relationship Creating a Sense of Shared
Meaning Surrounding Deployment Experience. Slide 24 .a traumatized
soldier often returns to a traumatized family and neither is
recognizing the other (Hutchinson & Banks- Williams, 2006, p.
67) Slide 25 Some adjustment issues resolve on their own. Often,
however, returning soldiers can exacerbate the familys trauma,
(resulting from the deployment experience), because they have
difficulty connecting to others, have sleep problems, and miss the
structure and camaraderie of military service. Divorce rates among
active duty Army officers tripled between 2001 and 2004. Rates
among enlisted men increased by 50%. Domestic violence rates among
military personnel increased also (Perry & Flournoy, 2006).
Slide 26 Short and long-term disruptions to intimacy. Increased
difficulties with trust. Avoidance of partner. Preoccupation with
guilt, shame and self- blame. Difficulty accessing and managing
emotions. Isolating and withdrawing from partner. Increased use of
drugs/alcohol. Slide 27 Can identify their problems and express
their commitment to resolve them without imposing strict rules
about how and when to address them. Utilize skills that address the
issues without blaming or judging each other. Have identified
others they turn to for support Slide 28 In reaction to the
research that has identified the impact of PTSD on family members
of Vietnam Veterans, the military, VA, other organizations (SAMSHA,
NAMI, etc.) are addressing issues related to children and families
of the current returning veterans through education and treatment.
Slide 29 Interventions: 1. Development and/or incorporation of
evidence- based practices for the treatment of PTSD. 2. Early
screening for returning veterans with free treatment for a period
of five years. 3. Preparing families for mobilization, deployment,
and return. 4. Availability of treatments for veterans that
incorporates family interventions. 5. Efforts to reduce stigma
associated with treatment. Slide 30 Psycho-education: PTSD and its
effects A Strength-based approach Creating a support network
Instilling hope Tools to help families manage crises. Slide 31 Do
not confuse the secondary symptoms with primary symptoms and
provide treatment only to the child. Assess for domestic violence,
child abuse, overdisclosure, or other forms of exposure of the
child to violence. Examine assessment tools for exploring trauma
issues i.e., International Society for Traumatic Stress Studies
(ISTSS) Resources for Clinicians list (ISTSS, 2007). Educate the
parent(s) about the potential influence of PTSD symptoms on
children. Slide 32 Encourage the parent to explain the reason for
the parents difficulties without providing graphic details.
(children should see that symptoms are in no way related to them).
Provide information on resources to help the parent know how to
prevent transferring their symptoms or the consequences of their
symptoms to their children. Veteran Centers
(www.va.gov/rcs/)www.va.gov/rcs/ Veterans Affairs (www.va.gov)
National Center for PTSD (www.ncptsd.va.gov)www.ncptsd.va.gov Slide
33 Encourage the veteran to seek treatment first so that other
family members involvement should be viewed as an adjunct therapy
that provides support and education. Depending on the degree of
symptoms and age, individual therapy with the child may be
indicated. Regardless of treatment suggestions, it is important
that each person in the family have a voice in expressing his or
her concerns. Slide 34 Slide 35 Slide 36