Comprehensive Care Of The Child With Posttraumatic Stress Disorder

The essential feature of posttraumatic stress disorder (PTSD) is the development of characteristic symptoms following exposure to a traumatic event that arouses - intense fear, helplessness, or horror, or in children - disorganized or agitated behaviour. Symptoms are categorized into three clusters: persistent re-experiencing of the stressor, persistent avoidance of reminders and emotional numbing, and persistent symptoms of increased arousal. Childhood PTSD confers increased risk for a number of problems in later childhood, adolescence and adulthood. Among psychotherapies there is convincing evidence that trauma-focused therapies, that is that specifically address the child's traumatic experiences, are superior to nonspecific or nondirective therapies in resolving PTSD symptoms. Among the trauma-focused psychotherapies, TF-CBT has received the most empirical support for the treatment of childhood PTSD. The first step in the psychotherapy for posttraumatic stress disorder in children is helping the child gain a sense of mastery over the trauma and helping the child to feel safe again. In older children, gaining a sense of mastery includes the ability to recall, relate, narrate, and reconsider the trauma without feeling overwhelmed and without dissociating. Relaxation training and medication may be helpful in enabling the child to do this. In younger children, play provides an opportunity to work through the trauma. The victims of domestic violence especially required long-term psychological and psychiatric treatment.