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.
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