Sunday, July 13, 2014
PTSD in Domestic Violence
For this discussion, I will focus on PTSD in children of domestic violence. Domestic violence exposes children to chronic violence that is not precipitated by anything definitive, and it usually not life threatening (Margolin & Vickerman, 2011). These two factors change the way psychologists think about PTSD in experiences of domestic violence, and the traumatic events that cause it. Domestic violence is one of the most commonly experienced adverse events during childhood, occurring in 30% of families with two parents (McDonald, Jouriles, Ramisetty-Mikler, Caetano, & Green, 2006). Half of all children exposed to domestic violence continue to experience intrusive thoughts, such as the re-experiencing of the violence, 20% experienced emotional numbing or avoidance, and 40% of one group experienced physiological hyperarousal (Rossman, Hughes, & Rosenberg, 2000).
These children can be left feeling a sense of danger and uncertainty, and the effects of domestic violence can be similar in effect to severe child abuse (Huemer, Erhart, & Steiner, 2010). Children experiencing domestic violence are subjected to feelings of overwhelming fear and helplessness, which can be particularly intense when one parent is the aggressor. Additionally, they may develop disorganized attachment, since the aggressive parent is dangerous, yet the provider of safety Margolin & Vickerman, 2011).
Complex traumas, such as domestic violence contribute to the inability to regulate anger and being self-destructive, affect their ability to pay attention, concentrate, and may cause learning difficulties. It affects self-confidence, self-esteem, and causes feelings of guilt and shame; causes aggression and substance abuse; creates trust and intimacy issues and creates challenges in interpersonal relationships (Margolin & Vickerman, 2011).
A Successful Intervention
Various forms of cognitive behavioral therapy, such as prolonged exposure therapy have been successful for children and adolescents with PTSD. Aderka and colleagues (2011) found that with prolonged exposure therapy, half of the children experienced sudden gains in their symptoms (Aderka et al., 2011). Prolonged exposure therapy combines behavioral and cognitive behavioral interventions that involve remembering traumatic events rather than avoiding thoughts associated with the trauma. Trauma-focused cognitive behavioral interventions were effective as was Stepped care trauma-focused cognitive behavioral therapy (Salloum, Scheeringa, Cohen, & Storch, 2014; Scheeringa, Weems, Cohen, Amaya‐Jackson, & Guthrie, 2011). Cognitive behavioral therapies may work for children similar to the way they work for adults by assisting them in reframing the traumatic events, learning to think about it from a different perspective, and break the cycles of negative thoughts that cause the re-experience of the trauma. This therapy might be effective in decreasing the replaying of the violence. Early interventions are more effective because "the lack of attention to the mental health of children and adolescents may lead to mental disorders with lifelong consequences,... and reduces the capacity of societies to be safe and productive" (World Health Organization, 2003, p. 2).
The Importance of Early Intervention
Early intervention can lessen the likelihood of continued symptoms of PTSD, and prevent further emotional and behavioral problems and poor psychological adjustment (Kenardy, Cobham, Nixon, McDermott, & March, 2010). In addition to decreasing further psychological damage, early interventions effectively reduce anxiety disorders and other symptoms associated with PTSD (Kenardy et al., 2010). It is important to recognize, however, that some adolescents recover on their own and an intervention will not be necessary or appropriate.
Aderka, I. M., Appelbaum-Namdar, E., Shafran, N., & Gilboa-Schechtman, E. (2011). Sudden gains in prolonged exposure for children and adolescents with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 79(4), 441–446.
Huemer, J. J., Erhart, F. F., & Steiner, H. H. (2010). Posttraumatic stress disorder in children and adolescents: A review of psychopharmacological treatment. Child Psychiatry and Human Development, 41(6), 624–640.
Kenardy, J., Cobham, V., Nixon, R., McDermott, B., & March, S. (2010). Protocol for a randomised controlled trial of risk screening and early intervention comparing child- and family-focused cognitive-behavioural therapy for PTSD in children following accidental injury. BMC Psychiatry, 1092. doi:10.1186/1471-244X-10-92
Margolin, G., & Vickerman, K. A. (2011). Posttraumatic stress in children and adolescents exposed to family violence: I. Overview and issues. Couple and Family Psychology: Research and Practice, 1(S), 63–73.
Scheeringa, M. S., Weems, C. F., Cohen, J. A., Amaya‐Jackson, L., & Guthrie, D. (2011). Trauma‐focused cognitive‐behavioral therapy for posttraumatic stress disorder in three‐through six year‐old children: A randomized clinical trial. Journal of Child Psychology and Psychiatry, 52(8), 853–860. Doi: 10.1111/j.1469-7610.2010.02354.x
Salloum, A., Scheeringa, M. S., Cohen, J. A., & Storch, E. A. (2014). Development of Stepped Care Trauma-Focused Cognitive-Behavioral Therapy for Young Children. Cognitive And Behavioral Practice, 2197-108. doi:10.1016/j.cbpra.2013.07.004
World Health Organization. (2003). Caring for children and adolescents with mental disorders: Setting WHO directions. Geneva, Switzerland: Author. Retrieved from http://www.who.int/mental_health/media/en/785.pdf