PTSD In Adolescent

Question 1

Possible effects of complex developmental trauma:

Answer 1

The neurobiology of PTSD includes:
 Neuroendocrine changes (HPA axis and cortisol secretion- findings regarding HPA axis dysregulation amongst maltreated children are not universal, however HPA axis dysregulation has been linked to anxiety and mood disorders as well as deficits in learning, memory and response inhibition. These changes have also been linked to hyper arousal symptoms and an impaired stress response).  Abnormalities in brain structure and function (including: limbic structures -amygdala and hippocampus, prefrontal cortex, smaller corpus callosum and disruptions to the anterior cingulate).
 Alterations in neurotransmitter systems (trauma early in life can increase sympathetic nervous system responsiveness and affect serotonergic, noradrenergic and dopaminergic systems)
HPA axis dysregulation, structural brain changes, and other biological diatheses in maltreated children may facilitate serious psychological effects. These psychological effects generally include disruption of key developmental achievements in motor, emotional, behavioural, language, social, academic, and cognitive skills (De Bellis 2001; Gilbert et al. 2009b). These widespread disruptions can produce a general inability to sufficiently integrate physical sensations, emotions, and cognitions and thus lead to disorganized methods for behavioural self-regulation and coping with stress. In essence, chronically maltreated youth have great difficulty understanding their surrounding environment and may not develop or execute appropriate methods for coping with stress or solving problems. Problems in emotional and behavioural self-regulation can then lead to excessive anxiety, depression, cognitive distortions, somatization, dissociation, aggression, impulsivity, suspiciousness, and other systemic maladaptive responses (Kaplow and Widom 2007; Putnam 2003; van der Kolk 2005).
These changes have been implicated in severe emotional dysregulation (De Bellis, 2005; Cicchetti & Toth, 1995). These changes may present with symptoms spanning a diverse array of symptom clusters (van der Kolk, 2005).
These symptom domains can include:
Affective and physiological dysregulation e.g.
 Inability to modulate, tolerate or recover from extreme affect states (e.g. fear, anger, shame).
 Disturbances in regulation of bodily functions (e.g. persistent disturbances in sleeping, eating and elimination).
 Diminished awareness/dissociation of sensations, emotions and bodily states.
 Impaired capacity to describe emotions or bodily states.
Attentional and behavioural dysregulation e.g.
 Preoccupation with threat or impaired capacity to perceive threat, including misreading of safety and
danger cues.
 Impaired capacity for self-protection, including extreme risk-taking or thrill-seeking.
 Maladaptive attempts at self-soothing (e.g. rocking and other rhythmical movements, compulsive masturbation).
 Habitual (intentional or automatic) or reactive self-harm.
 Inability to initiate or sustain goal-directed behaviour.
Self and relational dysregulation e.g.
 Persistent negative sense of self including self-loathing, helplessness, worthlessness, ineffectiveness or
defectiveness.
 Extreme and persistent distrust, defiance or lack of reciprocal behaviour in close relationships with adults or peers.
 Reactive physical or verbal aggression toward peers, caregivers or other adults.
 Inappropriate (excessive or promiscuous) attempts to achieve intimate contact (including but not limited
to sexual or physical intimacy) or excessive reliance on peers or adults for safety and reassurance.
 Impaired capacity to regulate empathic arousal as evidenced by lack of empathy for, or intolerance of, expressions of distress of others or excessive responsiveness to the distress of others.
PTSD symptoms e.g.
 The child exhibits at least one symptom in at least two of the three PTSD symptom clusters B, C, and D.  Re-experiencing of the traumatic event.
 Avoidance of the trauma.
 Hyper arousal.