9781422285756

MENTAL ILLNESSES AND DISORDERS Awareness and Understanding

POST-TRAUMATIC STRESS DISORDER SERIES CONSULTANT ANNE S. WALTERS, PhD Chief Psychologist, Emma Pendleton Bradley Hospital Clinical Associate Professor, Alpert Medical School/Brown University PTSD H.W. Poole

MENTAL ILLNESSES AND DISORDERS Awareness and Understanding

P O S T - T R A U M A T I C S T R E S S D I S O R D E R

MENTAL ILLNESSESAND DISORDERS

Alzheimer’s Disease Anxiety Disorders Attention-Deficit Hyperactivity Disorder Autism SpectrumDisorders Bipolar Disorder Depression

Disruptive Behavior Disorders Drug andAlcohol Dependence Eating Disorders Obsessive-Compulsive Disorder Post-Traumatic Stress Disorder Schizophrenia Sleep Disorders

MENTAL ILLNESSES AND DISORDERS Awareness and Understanding

POST-TRAUMATIC STRESS DISORDER PTSD

H.W. Poole

SERIES CONSULTANT ANNE S. WALTERS, PhD Chief Psychologist, Emma Pendleton Bradley Hospital Clinical Associate Professor, Alpert Medical School/Brown University

MASON CREST

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© 2016 by Mason Crest, an imprint of National Highlights, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, taping, or any information storage and retrieval system, without permission from the publisher.

MTM Publishing, Inc. 435 West 23rd Street, #8C New York, NY 10011 www.mtmpublishing.com

President: Valerie Tomaselli Vice President, Book Development: Hilary Poole Designer: Annemarie Redmond Copyeditor: Peter Jaskowiak Editorial Assistant: Andrea St. Aubin

Series ISBN: 978-1-4222-3364-1 ISBN: 978-1-4222-3374-0 Ebook ISBN: 978-1-4222-8575-6

Library of Congress Cataloging-in-Publication Data

Poole, Hilary W., author.   Post-traumatic stress disorder / by H.W. Poole.        pages cm. —  (Mental illnesses and disorders: awareness and understanding)   Includes bibliographical references and index.   ISBN 978-1-4222-3374-0 (hardback) — ISBN 978-1-4222-3364-1 (series) — ISBN 978-1-4222-8575-6 (ebook) 1.  Post-traumatic stress disorder—Juvenile literature.  I. Title.   RC552.P67P635 2016   616.85’21—dc23                                                             2015009147

Printed and bound in the United States of America.

First printing 9 8 7 6 5 4 3 2 1

TABLE OF CONTENTS

Introduction to the Series 7 Chapter One: What Is Trauma? 9 Chapter Two: The History of PTSD 16 Chapter Three: Symptoms of PTSD 26 Chapter Four: Treating PTSD 36 Further Reading 44 Series Glossary 45 Index 47 About the Author 48 Photo Credits 48

Key Icons to Look for:

Words to Understand: These words with their easy-to-understand definitions will increase the reader’s understanding of the text, while building vocabulary skills.

Sidebars: This boxed material within the main text allows readers to build knowledge, gain insights, explore possibilities, and broaden their perspectives by weaving together additional information to provide realistic and holistic perspectives. Research Projects: Readers are pointed toward areas of further inquiry connected to each chapter. Suggestions are provided for projects that encourage deeper research and analysis. Text-Dependent Questions: These questions send the reader back to the text for more careful attention to the evidence presented there.

Series Glossary of Key Terms: This back-of-the-book glossary contains terminology used throughout the series. Words found here increase the reader’s ability to read and comprehend higher-level books and articles in this field.

People who cope with mental illnesses and disorders deserve our empathy and respect.

(istockphoto/digitalskillet)

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Introduction to the Series

According to the National Institute of Mental Health, in 2012 there were an estimated 45 million people in the United States suffering from mental illness, or 19 percent of all US adults. A separate 2011 study found that among children, almost one in five suffer from some form of mental illness or disorder. The nature and level of impairment varies widely. For example, children and adults with anxiety disorders may struggle with a range of symptoms, from a constant state of worry about both real and imagined events to a complete inability to leave the house. Children or adults with schizophrenia might experience periods when the illness is well controlled by medication and therapies, but there may also be times when they must spend time in a hospital for their own safety and the safety of others. For every person with mental illness who makes the news, there are many more who do not, and these are the people that we must learn more about and help to feel accepted, and even welcomed, in this world of diversity. It is not easy to have a mental illness in this country. Access to mental health services remains a significant issue. Many states and some private insurers have “opted out” of providing sufficient coverage for mental health treatment. This translates to limits on the amount of sessions or frequency of treatment, inadequate rates for providers, and other problems that make it difficult for people to get the care they need. Meanwhile, stigma about mental illness remains widespread. There are still whispers about “bad parenting,” or “the other side of the tracks.” The whisperers imply that mental illness is something you bring upon yourself, or something that someone does to you. Obviously, mental illness can be exacerbated by an adverse event such as trauma or parental instability. But there is just as much truth to the biological bases of mental illness. No one is made schizophrenic by ineffective parenting, for example, or by engaging in “wild” behavior as an adolescent. Mental illness is a complex interplay of genes, biology, and the environment, much like many physical illnesses. People with mental illness are brave soldiers, really. They fight their illness every day, in all of the settings of their lives. When people with an anxiety disorder graduate from

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college, you know that they worked very hard to get there—harder, perhaps, than those who did not struggle with a psychiatric issue. They got up every day with a pit in their stomach about facing the world, and they worried about their finals more than their classmates. When they had to give a presentation in class, they thought their world was going to end and that they would faint, or worse, in front of everyone. But they fought back, and they kept going. Every day. That’s bravery, and that is to be respected and congratulated. These books were written to help young people get the facts about mental illness. Facts go a long way to dispel stigma. Knowing the facts gives students the opportunity to help others to know and understand. If your student lives with someone with mental illness, these books can help students know a bit more about what to expect. If they are concerned about someone, or even about themselves, these books are meant to provide some answers and a place to start. The topics covered in this series are those that seem most relevant for middle schoolers—disorders that they are most likely to come into contact with or to be curious about. Schizophrenia is a rare illness, but it is an illness with many misconceptions and inaccurate portrayals in media. Anxiety and depressive disorders, on the other hand, are quite common. Most of our youth have likely had personal experience of anxiety or depression, or knowledge of someone who struggles with these symptoms. As a teacher or a librarian, thank you for taking part in dispelling myths and bringing facts to your children and students. Thank you for caring about the brave soldiers who live and work with mental illness. These reference books are for all of them, and also for those of us who have the good fortune to work with and know them.

—Anne S. Walters, PhD Chief Psychologist, Emma Pendleton Bradley Hospital Clinical Professor, Alpert Medical School/Brown University

CHAPTER ONE

W H A T I S T R A U M A ?

Words to Understand acute: intense or severe. anxiety: a feeling of worry or nervousness.

context: the larger situation in which an event occurs. integrate: combine separate things into a whole. stress: an emotion or condition involving tension and fear.

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Bill was a soldier in Iraq for 18 months. During his time there, he and his fellow soldiers were in danger almost constantly. They saw terrible things—things that no person should have to see. When Bill’s tour of duty ended, he was eager to get home to his wife and kids. He couldn’t wait to leave the ugliness of war behind. But once the joy of his homecoming wore off, Bill wasn’t the same person anymore. Before the war, he’d been a pretty patient guy. Now his temper was short and explosive.

After the joy of homecoming, veterans have to cope with the difficulties of civilian life.

? DID YOU KNOW? PTSD affects more than 7 million Americans. But in time—and often, with help—people can integrate traumas into their regular lives. They may not be exactly the same as they were before, but they can learn to move on.

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It seemed like anything could send him into a rage— his son’s toys on the floor, an overcooked steak, anything. Each night, he would have dreams about being in the middle of battle again. The nightmares got so bad that Bill tried to avoid going to sleep at all. Even when Bill wasn’t angry, he wasn’t happy. Nothing seemed to really matter to him anymore. His wife worried about him. His kids were often afraid. Bill had left the war, but the war hadn’t left him. Bill has a classic case of post-traumatic stress disorder (PTSD). PTSD is a mental disorder, but it’s different from most other disorders in at least one very important way. When someone suffers from anxiety or depression, we often don’t know exactly why. The cause may be physical, emotional, or some mix of the two. But with PTSD, the cause is clear: trauma . But what is trauma? A trauma is an upsetting event, but it’s more than that. A trauma is an event that is more extreme than what most people experience. The experiences that Bill had in Iraq are not “normal” human experiences. Constantly fearing for one’s life, killing people, seeing people killed— these are intense, horrifying experiences. They are often impossible to forget. For example, if your grandparent dies, that’s very upsetting. But the loss of an elderly person is an expected part of life. People might say it is the “natural order of things.” It’s Terrible Experiences, Traumatic Experiences

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important to understand that saying this does not mean your loss is “no big deal.” You might be extremely upset and miss your grandparent for a very long time. It’s just not what a doctor would describe as a trauma. But the death of your sister or brother probably would be described as a trauma. The death of a sibling is not part of the “natural order of things.” It is outside what we would call normal human experience. Another key difference is the level of stress the person experiences. You might feel stress before you take a test or if you get in trouble with your parents. But if you compare taking a test to fighting in a battle, your level of stress is actually fairly low. And it will pass once the test is over. On the

When people hear the term PTSD they often think of soldiers, but traumatic events can happen to anyone.

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other hand, the acute stress that people feel during a trauma can take a long time to go away. It can have long-term effects on the brain. This is why people who have experienced trauma sometimes re-experience that trauma again and again. What’s Normal, Anyway? Our explanation of the word trauma only raises another question. If trauma is outside of “normal” human experience, then what’s normal? In some instances, this is an easy question to answer. If someone is mugged on the way home from work, that’s not normal. Millions of people travel to and from work every day without getting mugged. But a lot of times, the definition of normal depends on context . Consider our example of the death of a sibling. If someone is 90 years old and her brother is 89, the death of either one is—although still sad—not unexpected. But if someone is 12 years old and her brother is 9, it’s not normal

TYPES OF TRAUMAS

It has been estimated that as many as 50 percent of Americans will experience some form of trauma in their lives. A few types are:

• military combat • a violent crime • a natural disaster • a serious car accident • the sudden death of a close family member or friend

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for either of them to die. So the death of a sibling could be a “normal” event or not, depending on the person. Now consider Bill, the soldier from the beginning of the chapter. Fighting in a war is not a “normal” experience. That is, it’s not normal in many parts of the world. In some parts of the world, it’s not uncommon at all. Warfare is the type of trauma most closely associated with PTSD. After the Civil War, soldiers like Bill were said to have “soldier’s heart.” But you don’t have to be a soldier to experience trauma. Unfortunately, lots of us have soldier’s hearts. In the next chapter, we’ll look at the history of PTSD, which was first identified in veterans. Later, we’ll talk about how modern doctors are finding signs of PTSD in people who have never been in an actual war.

People in law enforcement are also at risk of PTSD because they are exposed to trauma in their jobs.