The tragedy recently occurring at Marjory Stoneman Douglas High School is likely to lead to a number of students developing a host of mental health (psychiatric) symptoms. Some may develop mood symptoms or disorders, anxiety symptoms or disorders, etc. Some may develop Post-traumatic stress disorder (PTSD).
In PTSD, the traumatic events experienced are severe enough to be either life-threatening or threatening physical harm. Examples of traumatic events are sexual abuse, physical abuse, violent crimes such as school shootings, motor vehicle accidents, or natural disasters.
Three Categories of PTSD
Symptoms of PTSD fall into 3 main categories including avoidance/numbness, re-experiencing, and hyperarousal. Re-experiencing symptoms are either recurrent, intrusive distressing memories of the traumatic event or recurrent distressing dreams of the event or “flashbacks” in which the individual feels as if the event is occurring again. Avoidance involves behaving in a way that the individual attempts to avoid memories, thoughts, or feelings related to the event. The individual’s thoughts may become distorted with negative beliefs and some memory impairment. He/she may experience persistent negative emotions such as fear, anger, shame, or guilt, and may develop less interest in participating in activities. In addition, irritability, reckless or self-destructive behavior, a wariness of the environment or increased vigilance, exaggerated startle response, concentration impairment, and insomnia are all common symptoms.
Who is more likely to develop PTSD?
The National Comorbidity Survey Replication-Adolescent Supplement found that 5% of adolescents developed PTSD and that the prevalence was higher in girls than in boys. Of those individuals experiencing or witnessing violence, who goes on to develop PTSD? It depends upon the type of event and the intensity of exposure. Other characteristics that play a role include whether the individual has been exposed to a traumatic event in the past and whether there exist any other psychiatric illnesses. In children, negative interpretations (or negative appraisals as opposed to adaptive appraisals) of their reactions to the trauma increase the risk of developing PTSD. An example of a negative interpretation is “this is likely to happen again” while a positive one might be “everything will be alright”. Likewise, the interpretations of one’s parents will affect the children’s interpretation. In addition, the mental health of the parents and the degree of social support serve as factors that predict risk.
On the other hand, there may be factors which play a protective role. For example, the degree of parental support may decrease the likelihood of the development of PTSD.
How Adolescents Cope with PTSD
Children, adolescents, and adults may all experience PTSD differently. Children may experience difficulty accurately remembering a sequence of events and they may develop the belief that they can identify future signs that enable them to predict future trauma. They may also display a reenactment of the trauma in their play. Further, children’s performance in school may start to decline or they may develop problems in relationships with others.
Adolescents may become more impulsive or aggressive as the expression of experiencing PTSD. It is common to develop symptoms of other psychiatric disorders as well such as major depressive disorder, panic disorder, or a substance use disorder.
Finding Psychiatric Help for PTSD
Treatment can be very effective. There are evidence-based psychotherapies including trauma-focused cognitive-behavioral therapy and eye movement desensitization and reprocessing (EMDR) as well as medicines proven to be helpful.
With the recent tragedy, it is important to be aware of the potential for the onset of PTSD in the affected students and pay attention to symptoms that would suggest a psychiatric evaluation may be in order. Like most illnesses, it is easier to treat PTSD very early on in its development.
Robert A Moran, M.D., F.A.P.A., F.A.S.A.M.
CEO and Medical Director, Family Center For Recovery
Diplomate, American Board of Psychiatry and Neurology
Certified in General Psychiatry and Addiction Psychiatry
Diplomate, American Board of Addiction Medicine
Certified in Addiction Medicine
Clinical Instructor in Psychiatry, Weill Cornell Medical College