In the modern world, people are constantly exposed to various environmental influences. In our lives, there are many sources of psychological trauma and symptoms of post-traumatic disorders are not rare among people.
Traumatic life events often entail the occurrence of stress, worsening of mental health, and even the emergence of various mental disorders and diseases. Therefore, it is very important to consider the topic of mental trauma.
This paper examines the post-traumatic stress disorders (PTSD) in children and adolescents through the prism of lifespan theories. It explores various aspects and factors which explain the causes, effects, and treatments of PTSD. The aim of this work is to provide the most complete study of cognitive and psychosocial models of lifespan development and their relationship to PTSD.
It is difficult to say who the first person was to draw attention to the phenomenon of psychic trauma and to introduce this concept in the scientific literature. Back in 1859, Brigitte put forward the idea that hysterical symptoms were a result of a traumatic event that affected the brain`s ability to process emotions. However, Freud drew public attention to the phenomena of psychic trauma. Developing the ideas of his time, he believed that the psyche is deprived of the soil.
According to the International Classification of Diseases PTSD can be developed after traumatic events that go beyond the usual human experience. Such events as bereavement, which occurred due to natural causes, severe chronic illness, job loss, family conflicts, etc., constitute the so-called "normal" human experience.
The events that can injure the psyche of almost any healthy person: natural disasters, manmade disasters, and events that are caused by deliberate, often criminal activity (sabotage, terrorism, torture, mass violence, fighting, being a "hostage", destruction of one`s house, etc.) refer to the stressors that go beyond normal human experience.
PTSD represents a complex of human psychophysiological reactions to physical and/or psychological trauma where the injury is defined as an experience, which leads to the feeling of fear, terror, and helplessness.
It is assumed that PTSD can manifest itself in humans immediately after exposure to a traumatic event, for example, the threat of their own life, death or injury of another person (especially - a loved one), but it can also occur a few months or even years later. It is the trickiest feature of PTSD. The intensity of a traumatic situation is a priority risk factor for developing PTSD. Other risk factors include low levels of education, low social status, chronic stress, mental health problems, the presence of close relatives who suffer from psychiatric disorders, etc.
It is necessary to attribute other important risk factors for developing PTSD related to such personal characteristics of a person as the accentuation of character, sociopathic disorder, low intellectual development, and alcohol or drug dependence.
In the case when a person is prone to exteriorization ("imposition of outside") of stress, he/she is less susceptible to PTSD. Genetic predisposition (availability of a history of psychiatric disorders) may increase the risk of developing PTSD after trauma.
At present, there is no single universally accepted theory that explains the etiology and mechanisms of occurrence and development of PTSD. However, there are several theoretical models, among which are psychodynamic, cognitive, psychosocial and psychobiological approaches.
Cognitive and psychosocial theories are the most interesting and effective models. They were developed through the analysis of the basic laws of the adaptation process when people were trying to return to normal life after traumatic events. The research has shown that there is a close connection between the ways out of the crisis, ways to overcome the PTSD state (elimination and avoidance of any reminders of the trauma, immersion in work, alcohol, drugs, desire to enter into the mutual-help group, etc.) and the subsequent success of adaptation.
It has been found that, perhaps, two following strategies are the most effective: a purposeful return to the memories of the traumatic event in order to analyze it and the full awareness of all the circumstances of the traumatic event; and an awareness of values of the carrier of the traumatic experience of the event. In its turn, the cognitive psychotherapeutic model reflects two aspects of the individual characteristics of overcoming PTSD - the cognitive evaluation and the re-evaluation of the traumatic experience.
Jean Piaget, the author of this direction, states that cognitive assessment of a traumatic situation, being a primary factor in adaptation after trauma, will be the greatest help in overcoming its consequences, if the cause of trauma in the minds of its victims will acquire the external character and it will be outside the personal characteristics of a person (a commonly known principle: "I am not bad", but "I made a bad thing").
In this case, faith in the reality of being in the existing rationality of the world and the ability to save one`s own control over the situation still remains and increases. The main task, in this case, is the restoration of harmony of the existing world, the integrity of a person`s cognitive model: justice, values of the person`s personality and kindness of others. These estimates are most distorted in victims of traumatic stress.
Within the frameworks of the cognitive model, the traumatic events are potential destroyers of basic beliefs about the world and about themselves. A pathological reaction to stress is a maladaptive response to the depreciation of these basic concepts. These representations are formed during ontogenesis. They are associated with addressing the need for security and makeup I-theory.
The collapse of the I-theory occurs in a situation of extreme stress. Although the collapse of the I-theory is a maladaptive consequence of a stressful situation, it may itself be adaptive because it provides the opportunity for a more efficient reorganization of the I-system. Maladaptive overcoming of the trauma includes the generalization of fear, anger, dissociation and permanent acting out of it. The reason for non-adaptive trauma overcoming lies in the inflexibility of the cognitive schemes.
This model most fully explains the etiology, pathogenesis, and symptoms of the disorder, and it includes genetic, cognitive, emotional and behavioral factors.
According to the psychosocial approach, the model of reaction to trauma is multifactorial, and it is necessary to take into account the weight of each factor in the development of the stress response.
It is based on a model developed by Horowitz, but the authors and supporters of the model emphasize the need to take into account environmental factors: factors of social support, stigmatization, the demographic factor, cultural features, and additional stresses.
The main social factors, which influence the success of the adaptation of victims of trauma, are the following: the absence of physical trauma, strong financial position, preservation of the former social status, presence of social support from the society and especially the loved ones. The latter is the most significant factor.
There are a great number of conditions, affecting the intensification of PTSD:
- The intensity of the perception of the situation as threatening;
- The objectivity of the threatening reality;
- The proximity of the subject to the place of the tragic events (a person could not physically suffer, but see consequences of the disaster, corpses of other victims, etc.;
- The involvement of people, close to a person, in tragic events (whether they suffered, what was their reaction, etc.).
This is especially important in the case of children. When parents are very sensitive to past events, which are reversible, and, as a result, panic, a child will not feel psychologically safe. Children are more susceptible and have fewer mental resources. They react to trauma by the disorganization of the behavior or agitation. Younger children have a tendency to the development of autism.
Older children use the obsession defense. They experience nonspecific nightmares, for example, they can see monsters. Sometimes children start to have pessimistic expectations about the future.
It must be emphasized that quite often the people with PTSD are experiencing secondary traumatization, which usually occurs as a result of the negative reactions of relatives, people around them, medical personnel and social workers to the problems faced by people who have had trauma.
Negative reactions of people to the mentally traumatized persons are manifested in the denial of the fact of trauma, denial of the connection between trauma and human suffering, negative attitude towards the victim, refusal to provide assistance, etc.
In other instances, secondary traumatization can appear as a result of overprotection (excessive care), since many people create an "invalid environment" and isolate themselves from the outside world. It can prevent rehabilitation and reintegration.
Thus, the so-called secondary factors are crucial to the development and course of PTSD; among them, a set of social (socio-psychological) factors takes, of course, a leading position, because, often, everything that happens to a person after the trauma affects him/her even stronger than the trauma itself.
It is possible to identify factors (conditions) that can prevent the development of PTSD or soften its course.
These include: immediate psychosocial therapy of victims, giving them the opportunity to share their experiences; early and long-term social support; socio-professional recovery (rehabilitation and re-adaptation) and reanimation of the feeling of psychological safety (sensations); participation of the victim in the psychotherapeutic work together with other psychologically traumatized individuals; absence of re-traumatization etc.
Children and adolescents with PTSD have some difficulties in drawing the line between relevant and irrelevant incentives. They are not able to ignore insignificantly and choose what is most relevant.
As a result, they lose the ability to adapt to the changing demands of the environment, which can be manifested in learning difficulties and seriously impair the ability to assimilate new information.
Pursued by intrusive memories and thoughts about the trauma, traumatized individuals begin to organize their lives in such a way as to avoid the emotions which provoke these invasions. The avoidance can take many forms such as distancing from the reminders of the event, alcohol and/or substance abuse, etc.
It weakens their relationship with other people and leads to disruption and, as a result, to the reduction of adaptive possibilities.
Some of the models explain the causes of these disorders, methods of their prevention and treatment. Cognitive and psycho-social models reveal the nature of PTSD in depth. This paper explores these models, viewing them through the prism of children with PTSD.