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Traumatic events, but not post-traumatic stress disorder, common in childhood
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Potentially traumatic events are common in children but do not typically result in post-traumatic stress symptoms or disorder, according to a report in the May issue of Archives of General Psychiatry .

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Post-traumatic stress disorder (PTSD) is a unique psychiatric diagnosis because it requires an initiating event, such as war, rape, natural disaster or serious illness, according to background information in the article. In children, the list of events that could lead to PTSD includes a parent being sent to prison, sudden separation from a loved one and learning of a traumatic event occurring to a loved one.

William E. Copeland, Ph.D., and colleagues at Duke University Medical Center, Durham, N.C., conducted annual interviews with 1,420 children from age 9, 11 or 13 through age 16. Between 1993 and 2000, participants and their parents were interviewed in separate rooms and asked about traumatic events that may have occurred in the previous year. In addition, they reported any symptoms of post-traumatic stress that the children displayed, including compulsive behaviors to suppress memories, panic attacks and engaging in dangerous activities.

More than two-thirds of the children reportedly experienced at least one traumatic event by age 16, including 30.8 with exposure to one event and 37 percent to multiple events. The most common events were witnessing or learning about a trauma that affected others—known as "vicarious" events.

Of those, 13.4 percent of those developed some post-traumatic stress symptoms by age 16, but less than 0.5 percent met the criteria for PTSD. About 9.1 percent experienced painful recall, or distressing memories or images of the traumatic event, and 2.2 percent had a milder, sub-clinical form of PTSD. "Violent or sexual trauma were associated with the highest rates of symptoms," the authors write. "The post-traumatic stress symptoms were predicted by previous exposure to multiple traumas, anxiety disorders and family adversity." In addition, symptoms were more likely to occur among older children.

Children exposed to trauma had nearly double the rates of psychiatric disorders of those who were not (except for substance use disorders). "Across childhood, the children who experience trauma are often those with anxiety, depressive and disruptive behavior disorders, a finding supported in the present study," the authors write. "This likely reflects common liability conveyed from a limited set of family risk factors."

"In the general population of children, potentially traumatic events are fairly common and do not often result in post-traumatic stress symptoms, except after multiple traumas or a history of anxiety," they conclude. "The prognosis after the first lifetime trauma exposure was generally favorable. Apart from PTSD, traumatic events are related to many forms of psychopathology, with the strongest links being with anxiety and depressive disorders."
(Arch Gen Psychiatry. 2007;64:577-584)

Editor's Note: This study was supported by grants from the National Institute of Mental Health, National Institute on Drug Abuse and the William T. Grant Foundation.

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