Turn on the TV on any given day and it seems there’s news of yet another school shooting, deadly accident, or natural disaster somewhere in our country.  When you include the plethora of tragic stories regarding the physical or sexual abuse of youth, any caring parent can easily become consumed with fear regarding the safety of their own kids and worry about the potential impact of such horrific events. 

Post-traumatic stress disorder (PTSD) is a serious psychological disorder that develops in some individuals after they’ve been through something traumatic.  If left untreated, it can negatively impact all areas of a person’s life, making it difficult or even impossible to function, let alone experience any joy in life.  Flashbacks, nightmares, emotional numbing, and frequent anxiety are just a few of the painful symptoms of PTSD.  

This brief guide is designed to help you gain awareness regarding the signs to watch for and understand the steps to take if you believe your teen has or is developing post-traumatic stress disorder (PTSD).  

PTSD facts and statistics

Following are several facts and statistics regarding PTSD in teens

• As many as 5% of teens have met the criteria for a diagnosis of PTSD at some point
• The likeliness of developing PTSD increases with the severity of the trauma
• 1 in every 10 teens with PTSD attempts suicide, according to one study
• PTSD develops in more than 75% of youth who witness a school shooting
• An estimated 4% of teens (between 13 and 18 years of age) will develop PTSD at some point in their lifetime, with the percentage increasing for older teens
• Adolescent females are more likely to develop PTSD than their male counterparts (6.6% to 1.6% respectively)
• Girls with PTSD typically have symptoms for a longer period of time than boys who develop the disorder
• Nearly two-thirds of individuals with PTSD also have a substance use disorder

Three Types of PTSD

There are actually three types of PTSD, distinguished by when symptoms first appear and how long they last.  They are:

• Acute PTSD – symptoms last from 1 to 3 months following the trauma
• Chronic PTSD – symptoms first appear between 3 and 6 months following the trauma
• Delayed PTSD – more than 6 months go by (after a traumatic event) before symptoms appear

Trauma Events that can Trigger PTSD

Any traumatic event can trigger the development of PTSD symptoms, including (but not limited to):  

• Car accidents
• Physical or sexual abuse
• Domestic violence in the home
• Natural disasters, such as an earthquake, flood, or hurricane
• Severe neglect
• Any type of violence assault
• School shootings
• Having one’s life threatened
• Witnessing someone get killed or seriously injured

Psychiatric Disorders that often Co-Occur with PTSD

It’s not uncommon for a teen with PTSD to have other mental health issues as well.  Disorders that often co-occur with PTSD include:

• Depression
• Other anxiety disorders, such as panic disorder or social phobia
• Substance use disorders
• Eating disorders
• Oppositional defiant disorder
• Conduct disorder
• Borderline personality disorder

Teens with PTSD also have an increased risk for many emotional and behavioral issues including:

• Non-suicidal self-harm (such as cutting or burning)
• Suicidal thoughts and behaviors
• Aggressive behavior
• Out-of-place sexual behavior
• Impulsivity

Looking for and Recognizing the Signs

Not everyone who goes through something traumatic develops posttraumatic stress disorder.  However, if you know your teen has been through a recent trauma, pay close attention to any changes in his or her normal mood, personality, or behavior.  These changes may signal the onset of PTSD.  Keep in mind that:

• You may not be aware that your teen has experienced something traumatic. Some teens will strive to keep it a secret, often due to shame or embarrassment, or in an attempt to forget it happened at all
• The symptoms may not appear for many months following the trauma

Signs to watch for may include the following:

• Irritability or anger outbursts
• Difficulties concentrating
• Flashbacks of the traumatic event
• Nightmares or night terrors
• Denial that the trauma occurred (this is a serious red flag that help is needed)
• Being jumpy or easily startled; flinching
• Somatic complaints such as headaches or stomachaches
• Acting out at home or school
• Difficulty expressing themselves
• Anxiety or nervousness
• Not making plans for or talking about the future / an expectation of dying young
• Self-destructive or reckless behaviors (often related to the above expectation)
• Impulsivity
• Rehashing details of the trauma over and over
• Regressed behaviors
• Being hyperalert
• Difficulties sleeping
• Going to great lengths to avoid anything (people, places, anniversaries, etc.) that reminds them of the trauma
• Intense anxiety if exposed to reminders of the trauma
• Difficulties trusting others
• Emotional numbness
• Spending more time alone
• Decline in school performance
• Avoiding new activities or experiences
• Feelings of hopelessness or intense sadness
• Suicidal thoughts or behaviors*

*Suicidal thoughts or behaviors should never be ignored.  Don’t assume your teen is just being “dramatic” or manipulative.  There is an increased risk of suicide in individuals with PTSD.

Knowing the First Steps to Take  

If you believe your teen has or may be developing PTSD, it’s vital that you don’t ignore it or just hope it will pass.  Instead, take the following initial steps:

1 – Talk to your teen.  Sit down with your teen and let him or her know that you’re really concerned about the things you’ve been observing.  Let our teen know that you want to help in any way you can, and that you’re there if he or she wants to talk – about anything. 

Be prepared for the possibility that your teen may deny there’s a problem, become defensive (e.g. accusing you of worrying too much or being over-protective), or push you away.  Talking about the impact of a trauma can be very difficult. 

2 – Have your teen evaluated.  Your teen’s pediatrician or your family doctor can do an initial evaluation.  This can help rule out any underlying medical issues that may be causing or contributing to your teen’s symptoms and also provide the basis for an initial diagnosis. 

With PTSD, however, it’s essential that you have your teen evaluated by a psychologist, psychiatrist, or other mental health professional as soon as possible.  Look for someone who not only specializes in treating children and adolescents, but who also has substantial experience in working with individuals who’ve experienced trauma.  These professionals have the specialized training to identify and understand the challenges, potential dangers, and nuances of PTSD in this age group.  Your family doctor may be able to give you a referral or recommendation.

3 – Get your teen into treatment.  Early intervention is really important when it comes to dealing with trauma.  It can help prevent PTSD from developing, and reduce the severity of symptoms if it already has. Like many psychiatric disorders, PTSD often becomes increasingly difficult to treat as time goes on.  

• Individual psychotherapy – Psychotherapy can help your teen process the traumatic experience and understand the various symptoms he or she is experiencing. Two types of psychotherapy that are often used to treat PTSD are:
  • Trauma-Focused Cognitive Behavioral Therapy – Research has found TF-CBT to one of the most effective types of psychotherapy for the treatment of trauma and PTSD in children and teens.
  • Eye Movement Desensitization Reprocessing – EMDR is a relatively short-term, specialized therapy that has helped countless individuals recover from the impact of trauma, including veterans suffering from combat-related PTSD. Backed by years of extensive research, it has been proven to be one of the most effective types of psychotherapy for trauma-based symptoms. 
• Medication – Medications, specifically SSRIs (selective serotonin reuptake inhibitors), are sometimes prescribed to help alleviate troubling symptoms or comorbid disorders (e.g. depression) in adolescents with PTSD. Research is limited regarding their use for adolescent PTSD, so medication should be used with caution and under the guidance of a psychiatrist who specializes in treating children and adolescents.
• Dual Diagnosis Treatment – This is usually necessary if there is a co-occurring substance use disorder – see more below
• Residential treatment – See below
• Hospitalization – See below

Supporting and Encouraging Your Teen   

As your teen goes through the healing process, two of the most important things you can do is provide amble encouragement and support.  Two things to keep in mind that will really help are that 1) PTSD isn’t a sign of emotional weakness and 2) this isn’t something your teen can simply overcome with determination or sheer willpower.

Following are several ways you can provide support and encouragement:

• Educate yourself about PTSD and the impact of trauma on children and teens; the more knowledge you have, the easier it will be to understand what your teen is going through
• Don’t try to control every aspect of your teen’s life; instead, allow your teen to have control over some decisions or areas of his or her life (appropriate to age and maturity level) in order to feel empowered
• Be willing and available to listen when your teen is ready to talk about the trauma; don’t pressure him or her to open up
• Validate your teen’s feelings
• Don’t minimize, shame, or ridicule your teen’s feelings or behaviors
• Be genuinely supportive in both your words and actions
• Keep your wits about you, even when you feel scared, helpless, or frustrated
• Don’t tell everyone you know; respect your teen’s privacy
• Check-in with your teen from time to time to see how things are going, whether treatment is helping, and to find out if is anything you can do that would be helpful
• Take an active role in your teen’s treatment
• Strive to create a low-stress, pleasant, nurturing home environment as much as possible
• Support your teen in finding healthy ways to cope with his or her stress and anxiety
• Avoid nagging or lecturing your teen; if you have concerns, talk to your teen in an open, honest, and respectful manner
• Talk to your teen’s therapist or treatment providers if you’re feeling stuck regarding how to handle a situation, and to learn additional ways to be supportive and helpful

What to Do When Things Escalate

Posttraumatic stress disorder can trigger erratic, aggressive, and / or self-destructive behaviors in adolescents.  These behaviors can be unpredictable and even dangerous.  If your teen is using alcohol or drugs as a way of coping, engaging in self-harm, or having thoughts of suicide, things can gradually or suddenly escalate.  Co-occurring disorders such as depression can also create a rapid downward spiral.

If your teen is becoming increasingly depressed, manic, actively suicidal, or becomes a danger to self or others in any way, don’t hesitate to reach out for help in the following ways:

• Contact your child’s treatment provider asap
• Enlist the help of a close family member or friend for support or assistance
• Call an emergency hotline
• Take your child to the nearest hospital emergency room (if you can do so safely) 
• Call 911   

When Individual Therapy isn’t Enough  

For some teens battling PTSD, individual therapy won’t be sufficient.  They may need a more intensive level of treatment, at least for a while.  A higher level of care is likely needed if your teen is:

• Refusing to cooperate with the therapy process
• Using alcohol or drugs, often to cope with emotional pain
• Experiencing severe depression, anxiety, or other psychiatric distress that require a higher level of care
• Actively suicidal – threatening or planning suicide, and / or engaging in suicide gestures or attempts
• Has symptoms that are seriously interfering with his or her ability to function at school or other areas of life

then it’s time to consider a more intensive level of treatment.  This may involve:

• Intensive outpatient treatment (IOP) / Psychiatric day treatment
• Dual diagnosis treatment (if substance abuse is occurring)
• Residential treatment
• Inpatient psychiatric treatment

Intensive outpatient treatment or psychiatric day treatment for PTSD can vary in terms of the amount of time spent in treatment and how many times a week your teen is required to go.  These programs are often the next step up from regular outpatient treatment.

Dual diagnosis treatment is often necessary if your teen has a substance use disorder in addition to PTSD.  The substance use problem will almost always hinder the effectiveness of individual therapy alone.  Enrolling your teen in a dual diagnosis program allows for both disorders to be treated simultaneously.   

Residential treatment requires having your teen live at a non-hospital treatment facility that specializes in treating teens with PTSD and other psychiatric disorders.  Residential treatment typically lasts between 30 to 180 days, depending on the severity of symptoms and how well your teen is progressing in treatment.  

Inpatient psychiatric treatment in a hospital setting is the highest and most intensive level of treatment for teens with PTSD.   Patients are monitored ‘round the clock.  Hospitalization is usually relatively brief.  It’s often used primarily to stabilize your teen and ensure safety.  

Each of these more intensive levels of treatment typically provides daily or bi-weekly visits with a psychiatrist and a variety of therapeutic activities.

Taking Care of Yourself 

Knowing that your teen is dealing with the aftermath of trauma can be gut-wrenching.  The treatment process may seem tedious at times, and many parents feel like they should be doing more – even though they’re already doing everything they can.  The toll can be significant, which is why it’s imperative to make self-care a priority.  Otherwise, you risk exhaustion and burn-out, both of which will hinder you from being there for your child. 

There are several things you can do to bolster your own well-being while your teen is healing, such as:

• Getting support from multiple sources such as close family and friends, a support group for parents going through something similar, therapy for yourself, and / or your church family if you have one
• Making sure you get plenty of rest (easier said than done, but essential!)
• Finding healthy ways to manage your stress, such as practicing yoga or regular aerobic exercise
• Holding on to hope and gratitude even when things seem especially difficult or bleak

Remember, with proper treatment, love, and support many individuals with PTSD do eventually work through and heal from the pain, and find joy once again.