Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a trauma-related disorder that can develop after a child or adolescent is exposed to actual or threatened death, serious injury, or other severe trauma. It is characterised by persistent re-experiencing of the event, avoidance of reminders, negative changes in mood and thinking, and heightened arousal that continue well beyond the time of the trauma. In young people these features are shaped by developmental stage, so the presentation can differ from that seen in adults.

Definition

Post-traumatic stress disorder is a mental disorder that follows exposure to a traumatic event and is defined by persistent intrusion (re-experiencing), avoidance of trauma reminders, negative alterations in cognition and mood, and marked changes in arousal and reactivity that last more than one month and cause significant distress or impairment.

Scope

This entry covers PTSD as it presents in childhood and adolescence: the required trauma exposure, the symptom clusters that define the disorder, how presentation varies with age, and how it is positioned within trauma- and stressor-related disorders. It is a reference description of the condition and its evidence base, not clinical or treatment guidance.

Key concepts

• Traumatic exposure criterion
• Intrusion and re-experiencing
• Avoidance of trauma reminders
• Negative alterations in cognition and mood
• Hyperarousal and reactivity
• One-month duration threshold
• Developmentally modified presentation in young children
• Re-experiencing expressed through play in early childhood

Mechanisms

PTSD is conceptualised as a failure of the normal recovery process that follows most traumatic exposures: rather than fear and distress subsiding, trauma memories remain easily triggered and intrusive, reminders are avoided, and the body's arousal systems stay elevated. Contemporary accounts describe disturbances in fear learning and extinction, in the processing and contextualisation of trauma memories, and in threat-detection circuitry, against a background of genetic and environmental vulnerability. In young children, these processes are expressed in developmentally specific ways: re-experiencing may appear as repetitive trauma-themed play, and distress may show as regression, new fears, or behavioural change rather than verbal report, which is why developmentally sensitive diagnostic approaches were proposed for early childhood.

Clinical relevance

PTSD is one of the central diagnoses considered when a child shows persistent distress after trauma, and recognising its developmentally varied presentation is important for accurate assessment. Because exposure is part of the definition, trauma history is integral to how the disorder is identified. This entry describes the condition and its evidence base; it does not provide diagnostic criteria for individual use or treatment recommendations.

Epidemiology

Most children and adolescents exposed to a potentially traumatic event do not develop PTSD; risk rises with the severity, chronicity, and interpersonal nature of the trauma. Maltreatment, assault, and repeated exposures carry higher risk than single-incident events, and PTSD frequently co-occurs with depression and other anxiety conditions.

History

PTSD entered formal psychiatric classification in DSM-III in 1980, drawing together earlier observations of post-combat and post-disaster syndromes. Recognition that young children express trauma differently grew through the 1990s, exemplified by Scheeringa and colleagues' proposals for developmentally sensitive criteria, and later classifications such as DSM-5 and ICD-11 incorporated developmental considerations and grouped PTSD among disorders specifically associated with stress.

Debates

How should PTSD be diagnosed in very young children?

Standard adult criteria rely on verbal report of internal experiences that young children cannot easily give; developmentally modified, behaviourally anchored approaches were proposed to capture trauma reactions in infancy and early childhood, and how best to define the disorder at these ages remains an active question.

Seminal works

• shalev-2017
• scheeringa-1995
• cohen-2010

Frequently asked questions

How is PTSD different from a normal reaction to a frightening event?

Brief distress after trauma is common and usually subsides; PTSD is diagnosed when re-experiencing, avoidance, negative mood changes, and hyperarousal persist for more than a month and cause significant distress or impairment.

Can young children have PTSD even if they cannot describe what happened?

Yes. In early childhood, trauma reactions are often expressed through repetitive trauma-themed play, regression, new fears, or behavioural changes rather than spoken report, which is why developmentally sensitive diagnostic approaches were developed.