Complex PTSD in children and young adults
Any form of early trauma can have a substantial impact on a child or young adult, and complex trauma, even more so.
‘Complex trauma describes both children’s exposure to multiple traumatic events—often of an invasive, interpersonal nature—and the wide-ranging, long-term effects of this exposure’. These events might be severe and pervasive, such as abuse or profound neglect. Often, they occur ‘early in life and can disrupt many aspects of the child’s development and the formation of a sense of self. Since these events often occur with a caregiver, they interfere with the child’s ability to form a secure attachment. Many aspects of a child’s healthy physical and mental development rely on this primary source of safety and stability.’
Traumatic experiences in general, are quite common in the young. Studies that by the end of adolescence, about 75% of young people will have experienced some kind of traumatic event.
However, unlike many adults, children can struggle to explain what they have been through. In cases of sexual, mental or physical abuse, they may even normalise what is happening to them.
Similarly, if they live in a household with domestic abuse or substance addiction, they may push down the effects on them, to avoid further conflict, as part of the ‘fawn’ trauma response or avoid being taken into care.
These are among the reasons that some PTSD and C-PTSD in some people goes undetected for many years and only results in symptoms later in life.
Clearly, the sooner any form of PTSD is identified the earlier treatment can begin. This is essential to underpin sustainable recovery.
This article will look more closely at the way C-PTSD affects childhood development, including how to spot the signs of C-PTSD in children and young adults.
Childhood C-PTSD, the brain and attachment
Any trauma can cause PTSD – and any repeated, continuous or multiple traumas can cause C-PTSD in children too.
There is a common assumption that abuse is the primary reason that figures for C-PTSD in children are so tragically high. However, it is important to understand that neglect can be an equally damaging form of maltreatment. Also, trauma can be a fear of something happening (to yourself or other people) and believing loved ones are in danger.
Perhaps the keyword is ‘safe’. Children need to feel safe, as well as loved and to benefit from a consistency of care.
Any form of maltreatment – or substantial interference with their feelings of safety – can also create a poor attachment to caregivers. As well as creating low self-worth and development issues.
Children need healthy attachments to thrive and develop, with their caregiver in control, while they navigate fundamental cognitive and emotional milestones. Without those healthy attachments, they only have themselves to rely on.
The frontal lobes of their limbic system – that deal with behavioural and emotional responses – get poor stimulation. Creating reduced reasoning skills and emotional control.
Instead, they have a highly active amygdala, the clump of cells at the base of the brain that processes memories and defines emotional responses. They learn to use their fight, flight or freeze instincts for self-preservation and ‘survival’.
You can see how C-PTSD in children becomes a deeply ingrained issue.
Signs and symptoms of C-PTSD in children
It is important to know how to identify C-PTSD as early as possible, to prevent some of the lasting effects outlined above. As with adult C-PTSD, the effects of trauma can sometimes be misdiagnosed as general depression or anxiety, as some of the symptoms overlap.
Childhood C-PTSD signs and symptoms generally fall into physical and mental health indicators.
One of the clearest ways to spot C-PTSD in a child or young adult can be summed up with the umbrella term ‘failure to thrive’. PTSD and C-PTSD involves being constantly in ‘alarm’ mode. This is exhausting. Partly as the damage done to their brain redirects nutrition to bodily functions connected to being alert and ready for action.
Also, they may sleep poorly, often due to nightmares.
This often means they have poor concentration, lethargy and fall asleep at inappropriate times.
Children with C-PTSD may also suffer from constant headaches and other aches and pains. This too can be a result of hormonal imbalances created by the physical effects of trauma and being ‘switched on’ alarm mode for large amounts of time.
Mental and emotional health
Alongside these physical signs a child has C-PTSD, they could be emotionally withdrawn and unwilling to engage, preferring to self-soothe.
This can be a coping mechanism – called dissociation – in which children learn to switch off sensory input to distance themselves from traumatic experiences. Emotional detachment and a refusal to acknowledge things can also be a natural outcome of poor caregiving, as children develop their interactions by mirroring others.
As their ability to master their own emotions has been limited by their lived experience, the opposite may also be true. A child with complex post-traumatic stress disorder could be easily triggered to anger, outbursts and oppositional behaviours. They are using these extreme reactions as their only available defence mechanism to feeling under threat.
Also, C-PTSD in a child can be apparent in how sensitive and jumpy they are. Hypervigilance can result in being distressed or frightened out of proportion to a situation. For example, when a noise, sight or even smell reminds them of their traumatic experience and heightens their feelings of being unsafe.
Poor mental stimulation in childhood can also limit a child’s cognitive development and ability to access learning opportunities. Resulting in poor performance at school.
Signs and symptoms of C-PTSD in young adults
Much of the above applies to pre-teens and early-teens too, but some of the behaviours can advance and become more serious. For example, self-harming may be a default system of self-soothing. Including substance misuse.
Young people with C-PTSD can start to engage in risk-taking behaviours, with limited ability to understand cause and effect due to their attachment issues. They may also have poor impulse control, and get angry or aggressive very quickly.
The deficits in their ability to self-regulate, develop healthy relationships and understand cause and effect can also lead them into illegal activities.
All of this reduces their ability to be employed and have long-term relationships.
One of the most unexpected indicators that a young person (or child) has C-PTSD is a deficiency in their ability to feel pain. This is because prolonged physical and mental stress desensitises them. They can be unaware of their own injuries or illnesses.
However, body dysregulation can also appear as being over-responsive to having their senses stimulated, resulting in the extreme and out of proportion reactions mentioned above. This can include feeling intense pain, without there being a physical cause.
You can read more about PTSD and C-PTSD symptoms here.
Self worth and C-PTSD
One of the biggest deficits that C-PTSD creates in the young, is a sense of self-worth. Shame, guilt and low self-esteem are closely interwoven with prolonged traumatic experiences.
Their sense of self, understanding of the world and problem-solving abilities have all been badly compromised. Making them feel unworthy and powerless, relying on negative behaviours to gain some ‘control’.
When you are constantly in survival mode, it can be difficult to think about normal childhood hopes and dreams, too.
Getting help for a child or young adult with C-PTSD
Support and treatment for PTSD in the young is vital and needs to be provided by professionals in this field. That is especially true of C-PTSD, as sustained recovery is a long and complex process, and involves learning to manage some of the damage done to their brain’s development and process the memories of the traumas they have experienced. Find out more about treatment for PTSD and C-PTSD for children and Young Adults here.
You can read more about Complex PTSD here.
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Treatments for PTSD
It is possible for PTSD to be successfully treated many years after the traumatic event occurred, which means it is never too late to seek help. For some, the first step may be watchful waiting, then exploring therapeutic options such as individual or group therapy – but the main treatment options in the UK are psychological treatments such as Eye Movement Desensitisation Reprogramming (EMDR) and Cognitive Behavioural Therapy (CBT).
Traumatic events can be very difficult to come to terms with, but confronting and understanding your feelings and seeking professional help is often the only way of effectively treating PTSD. You can find out more in the links below, or here.