Even Young Children can Experience PTSD

When you think of PTSD (posttraumatic stress disorder), soldiers returning from combat may come to mind.  But years of research suggest many others experience PTSD, too, even young children, though their symptoms may differ from those of older children, adolescents and adults.

PTSD in adults and children can occur after exposure to a traumatic event — living through one, witnessing one in person, or learning about a traumatic event that involved a family member. A traumatic event can include a violent experience in the home or community, a fire, a natural disaster, a car accident, or the sudden death of a family member. The younger a child is, the greater the impact. The loss of a parent or being removed from a parent, for example, feels like a threat to a child, according to child psychiatrist Judith Cohen, M.D., medical director of the Center for Traumatic Stress in Children & Adolescents at Allegheny General Hospital in Pittsburgh.

Many children experience trauma — an estimated 14 to 43 percent, according to the National Center for PTSD. Of those, as many as 15 percent of girls and 6 percent of boys develop PTSD. Children with PTSD may experience distressful thoughts, ­and memories of the trauma may occur without warning. They may also have trouble sleeping and nightmares (though they may not seem clearly tied to the event). Traumatized children may try to avoid people or objects that are reminders of the event and they may act more irritable, have angry outbursts, or be easily startled. They may regress, wet the bed or talk baby-talk, and they may experience physical symptoms, such as headaches and stomachaches. The symptoms can cause major distress and can impact how a child behaves or relates to family members.

To help a child heal from PTSD, treatment involves working with the child and parents and caregivers, creating a feeling of safety, helping the child to understand the condition, and encouraging the youngster to talk about his or her feelings (through art and play), to help develop relaxation and coping skills. Rehabilitation begins with building trust and it needs to be fun and engaging for young children, according to Dr. Cohen. Several different types of treatment are available for children with symptoms of PTSD and early intervention can be important in helping little ones cope with and heal from the effects of trauma.

For more information on understanding and helping children of all ages heal from traumatic events visit the National Child Traumatic Stress Network.

By Debbie Cohen, health writer, APA

Adult Bullying in the Workplace

By Brad Zehring, DO

I would rather be a little nobody, then to be an evil somebody - Abraham Lincoln

Typically, when bullying is talked about it is in the context of children or adolescents during some level of schooling. Rarely do we think about bullying as an adult issue. However, much more attention has been focused on adult bullying – more specifically, adult bullying in the workplace.

According to various sources, citing research and survey’s, it has been reported that as many as 1 in 4 adults will face some form of bullying in their career.  It is important to point out the differences between constructive criticism, workplace conflict, and bullying. Workplace bullying focuses on the person rather than the performance or task being completed by the person. In addition, the person being targeted feels powerless to stop it. Making the situation worse, is when the adult being bullied goes to management to report the offense and the abuse is minimized or discounted altogether. Complicating the issue further is the difficulty verbalizing what is taking place or being unaware that what is occurring is bullying, leading to worsening suffering.

What are some forms of workplace bullying?

As discussed earlier, workplace bullying can be described as an extreme pattern where the person is isolated apart from his/her performance or task. Some examples of workplace bullying are: being left-out of work-related social events, coworkers refusing to help when asked, coworkers leaving the room when you enter or routinely arriving to meetings late that when you call them, being yelled at, put down, or disciplined in front of your coworkers. These are some of the ways that workplace bullying presents, but it is not an exhaustive list.

How workplace bullying is harmful

For individuals who are being bullied in the workplace, their desire to go into work day after day is diminished and their satisfaction in their performance and with their employer decreases.  Many reports discuss the loss of productivity when job satisfaction decreases. Beyond the psychological stress (depression, anxiety, PTSD, etc) – which should not be minimized, stress from bullying can lead to physical illness such as stroke, heart attacks, chronic fatigue or dissatisfaction in an person’s personal life – including leading to suicide. There are many reports documenting poor job satisfaction negatively affecting all areas on one’s life. Feeling accomplished and satisfied in a career can lead to a happier personal life and vice versa.

How to prevent or deal with workplace bullying
While recognizing or speaking up about workplace bullying can be a difficult task - it is important not to be silent about bullying experiences, whether personal attacks or witnessed attacks on colleagues, or isolate from those that may be able to help. Currently, states are working on anti-bullying bills to encourage healthy workplace environments, but fostering a workplace for your coworkers that doesn’t tolerate bullying is key. Many organizations provide or contract with mental health professionals willing to discuss, advise, and help an individual navigate the process. It is important to document your concerns and be specific and concise with the message you are trying to convey if you feel you are being bullied. Despite how difficult it may be, it is important to approach the bully or go to your supervisor with a calm demeanor and discuss your concerns rationally. Lastly, it is important to have an open mind about the situation. Sometimes it may be that the “bully” does not realize how his/her actions have affected you. Approaching them, or the situation, calmly will provide an environment for understanding and increase the probability for change.

How to "Bully-Proof " Kids

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Williams’ death reminds us that a patient’s relief might be a warning sign

By H. Steven Moffic, MD

One of my favorite movie moments is when Robin Williams signs on as an edgy D.J. by exclaiming "Good Morning, Vietnam" from the 1987 movie of the same name. Sometimes, I played the audio over and over, as if it could promise a good day. As he did so often, he found a way to not only lighten the sadness, but to do it in such a way that might be constructively critical.

Surely, the real life mornings were not often happy ones, as so many of our troops died or ended up with post-traumatic stress disorder (PTSD) from that war. It is a lesson we are still learning, so that movie and his role is worth seeing again soon.

Now, after his reported suicide, that good morning seems more like a final good night.

Although he is probably best known for his manic comedy, he also played many serious roles. Most ironically now, he won an academy award in 1997 for playing an empathic therapist in the film “Good Will Hunting.”
Indeed, beloved entertainers like Robin Williams have a therapeutic role of sorts for society in the sense that they provide some relief—even if briefly—for the grief and stress of everyday life. For playing that societal role, such people become a repository for our hopes, dreams and demons. As we know for so many famous entertainers, it is not easy for them to have a successful private life—a private life that the public also tries to invade, as if they were related to us.

What we do know publicly is that Williams suffered from chronic depression and intermittent substance abuse. It is reported that he received treatment, including entering rehab just last month. Obviously, money to get the best treatment was not an issue, though how good the treatment was will remain unknown. We do know, however, that wealthy VIPs often receive treatment just as poor as low-income folks without resources. We also know that occasionally depression is a terminal illness, though that ending is not predictable.

Beyond the public information, and despite the understandable curiosity, this is not the time, nor should it ever be the time, to speculate about his diagnosis and reasons for committing suicide. In fact, the so-called "Goldwater Rule," called that for the inappropriate professional speculation about presidential candidate Barry Goldwater, ethically prohibits such speculations on the part of psychiatrists like myself.

Given this professional ethical principle, as well as the family's request for privacy, is there anything we can still learn from this apparent tragedy? The most intriguing detail that caught my attention was his last tweet and Instagram on July 31. Reportedly, he had wished his daughter a happy 25th birthday.

Why might this positive communication be of importance to us?

It reminded me of the only patient I ever had who committed suicide, long ago, when I was a resident in training. In the second session, the depression of this elderly man seemed to be less severe, but after that session he walked into Lake Michigan and drown. In the psychological autopsy, I never forgot the warning that when a depressed patient starts to seem better, they actually can be at higher risk for suicide.

Risky time

Why is that time of apparent improvement a risky time? The person can have more energy, then plan and complete a suicide. They may also feel relief at their decision, causing others to paradoxically feel relief. That is one of the reasons why it is so common to hear of the genuine surprise that the suicide occurred, as the person seemed to be happier.

What this means, not only for professionals, but for the public, is not to take at face value if a depressed person seems better. Be sure there is a sound explanation for the apparent improvement. 

Our only consolation must be that entertainers like Robin Williams keep on living in the form of their life’s work, like the movie “Good Morning, Vietnam,” that is so ubiquitously available nowadays. Even so, it would not be surprising if at the times we laugh once again at Robin William's humor, that the laughter will also be accompanied by some tears of grief.

Bio

H. Steven Moffic, MD, is a Life Fellow of the APA. Currently, he blogs regularly for Psychiatric Times, Behavioral Healthcare, and The Hastings Center's Over 65.

This blog was originally published in Behavioral Healthcare. Tweet

Helping Others Helps Your Mental Health: Why Volunteering Makes Us Happier

By Roberto Blanco, M.D.



I had just sat down for Dr. Norden’s Neuroanatomy class when one of my classmates, who had just walked into lecture late, announced he heard on the radio that a plane had crashed into one of the World Trade Center Towers.  As was her way, Dr. Norden showed immediate concern, and before I knew it, we were watching another plane fly into the second tower live on CNN in the front of the lecture hall.  It was a surreal scene in Light Hall on Vanderbilt’s Medical campus; one that I did not expect to experience.  The rest of the day was a blur of events and emotions – people in a state of shock, tears shed, classmates comforting each other, and Dr. Norden attempting to put things in perspective.  Class was dismissed for the day, and the rush to call loved ones in New York City and Washington, D.C. began.  My thoughts immediately turned to family members who lived in New York and worry when I was unable to reach them.

10 years ago, the world of every American changed.  In response, the country and the world came together in support of the victims of the terrible tragedy.  People from far and wide drove, some for thousands of miles, to reach New York City and care for complete strangers.  People sacrificed their time, sweat, and a good portion of their lives and livelihoods to help those in need.  Donations flooded in to support the victims’ families.  A rush of prayers, love, and aid from across the globe also streamed in for those affected.  It seemed that the world was one in giving to those who had lost.

I recently wrote a blog post here on happiness, human fulfillment, and flourishing.  In that posting, I discuss human fulfillment and flourishing as the real definition of happiness and the final aim of all of what we do.  A great way to help yourself and your own mental health is to help others.  Feeling useful and needed is a wonderful way to work towards human fulfillment and recognize all you have for which to be grateful.  Serving others is a sign of individual and community emotional health.  Volunteering your time and talents also leads you to finding the love within yourself that you didn’t know you had.  When faced with those who have lost and are truly in need, just like on September 11th, the true beauty of mankind comes out.  

For Sunday's 10th Anniversary of September 11th, President Obama is calling for a national day of giving in memory of those who passed during the attacks.  His goal is to have over 1 million Americans engaged in volunteer work on September 11th.  The American Psychiatric Association has joined "Give an Hour" in aid of military members, veterans of Iraq and Afghanistan, and their families as part of the “I will” campaign to encourage that same spirit of service that was felt in the days following the attacks.  So, think about joining us in giving by helping build a house for a needy family through an organization like Habitat for Humanity.  Volunteer to distribute food or give to your local food bank.  Help a friend move.  Donate time or resources to a homeless shelter, spend time with the elderly, or serve at a local hospital.  This September 11th, let’s honor those who died by helping a member of your community in need.
In photo: Dr. Blanco and another volunteer work together to build a home through Habitat for Humanity
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The Truth About Domestic Violence

By Roberto Blanco, M.D.

In my work with patients across the world, I can´t help but notice how many come to psychiatric clinics as a result of domestic violence. Despite its prevalence in other countries, domestic violence is also quite common in the United States. In the United States alone, 22 percent of women are physically assaulted by an intimate partner during their lifetimes and over 5 million are victims every year. Domestic violence touches all elements of society regardless of age, race, or socioeconomic status.

As a child psychiatrist, I can´t help but think of the smallest victims of domestic violence as I often see them in my clinical work. These are the children who are either involved secondarily by witnessing the abuse or become victims directly themselves. The effects of domestic violence on this population are far ranging and long lasting. As these children develop, they may struggle to deal with conflict. They may also become aggressive or experience severe depression, nightmares and other symptoms of post-traumatic stress, as well as other anxieties or fears.

The effects of domestic violence on children are dependent on the nature and severity of the abuse and on the developmental level of the child. Young babies and infants cannot understand why violence occurs in the home and so violence in this population can cause deep-seated changes in personality, self-esteem, and ways of interacting with others that can last for a lifetime. Often older children have a better understanding of what is going on, but still often blame themselves for the abuse and can have excessive guilt or anger as a result.

Domestic violence does not need to be only physical to qualify as a form of abuse. Abuse can also take the form of emotional, financial, or sexual control or disregard. Initially, characteristics of an abusive relationship can often be endearing such as wanting to be with you all of the time. Over time, this can become intense jealousy for no reason, excessive control over relationships and behaviors, and aggression or violence. Options for milder forms of emotional abuse can include family and/or individual therapy. For severe cases, there may be a need to get out of the situation or to a safe house. For more information on domestic violence, please see the American Pyschiatric Association's brochure  Let´s Talk Facts About Domestic Violence.
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Knowledge is Power

By Jeffrey Borenstein, M.D.

When it comes to mental health, knowledge is power. As host of the Healthy Minds public television series, my goal is to provide people with information about psychiatric conditions and treatment. I interview experts who provide cutting edge information and more importantly, I speak with people who have sought treatment for a mental health issue.

One of the most moving interviews was with Jennifer Crane, a veteran who served in Afghanistan. She spoke about her experiences with post-traumatic stress disorder (PTSD) and how treatment is helping her recover. She has received treatment through the Give an Hour program, which is sponsored by the American Psychiatric Foundation.

The combination of medical and scientific information with the real life experiences of individuals and their families provides our audience with new knowledge and insights about mental health. I hope the show will open up conversations in families and inspire people to seek help. In addition to PTSD, topics include autism, chemical dependency, depression, bipolar disorder, eating disorders and suicide prevention.

As we plan for future episodes of Healthy Minds, I would very much appreciate your comments, ideas and questions. And, remember, when it comes to mental health, knowledge is power.