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Introduction
Researchers have recently examined the impact of veterans'
posttraumatic stress disorder (PTSD) symptoms on family
relationships, and on children of veterans in particular.
Family members of individuals with PTSD may experience
numerous difficulties. This fact sheet explains the common
problems that children of veterans experience and provides
recommendations for how to cope with these difficulties.
Although much of the research described here has been
conducted with children of Vietnam veterans, it is likely
that much of the information applies to children of combat
veterans of other conflicts.
How might a veteran's PTSD symptoms affect his
or her children?
Re-experiencing symptoms
Individuals who have PTSD often 're-experience' traumatic
events through vivid daytime memories or dreams. Re-experiencing
can occur suddenly and without intention, and it is typically
accompanied by intense emotions, such as grief, guilt,
fear, or anger. Sometimes these intrusions can be so strong
or vivid that the individual believes the trauma is reoccurring.
These symptoms can be frightening not only for the individual
experiencing them but also for children who witness them.
Children may not understand what is happening or why it
is happening, and they may start to worry about their
parent's well-being. Children may also worry that their
parent cannot properly care for them.
Avoidance and numbing symptoms
Because the re-experiencing symptoms characteristic of
PTSD are so uncomfortable, people who have been traumatized
tend to try to avoid thinking about the traumatic event.
They may also attempt to avoid places and experiences
that could trigger upsetting memories. As a result, veterans
may not want to do things or go places, such as to the
store, to the movies, or out to dinner. Children may feel
that their parent does not care about them when really
it is that the parent is avoiding places that are just
too frightening. In addition to these active avoidance
strategies, traumatized individuals often struggle with
experiencing positive emotions and may feel 'cut off'
from other people, including family members. These avoidance
and numbing symptoms can have a direct impact on children.
For example, when a parent with PTSD withdraws from family
members and has trouble feeling positive emotions, children
can inaccurately interpret this as the parent not being
interested in them or loving them, even though the parent
may try to indicate otherwise
Hyperarousal symptoms
Individuals with PTSD tend to have a high level of anxiety
and arousal, which shows up as difficulty sleeping, impaired
concentration, and being easily startled. They tend to
have a high level of irritability and may experience an
exaggerated concern for their own safety and the safety
of their loved ones. It is easy to see how these hyperarousal
symptoms can influence family members. For instance, irritability
and low frustration tolerance can make a parent seem hostile
or distant, again making children question the parent's
love for them. This perception is simply a misunderstanding
of the reasons behind the symptoms.
What are the typical patterns of how children
respond to a parent with PTSD?
Researchers have observed a direct relationship between
each of the parent's PTSD symptoms and the children's
responses. Researchers also have noticed patterns in the
ways children respond to the parent's overall presentation
of PTSD. Harkness (1991) described three typical ways
these children respond: (1) the over-identified child:
the child experiences secondary traumatization and comes
to experience many of the symptoms the parent with PTSD
is having; (2) the rescuer: the child takes on parental
roles and responsibilities to compensate for the parent’s
difficulties; and (3) the emotionally uninvolved child:
this child receives little emotional support, which results
in problems at school, depression and anxiety, and relational
problems later in life.
These theories certainly do not represent every possible
reaction children may have to parents with combat-related
PTSD, but they offer some useful ways of understanding
how symptoms might develop for these children.
What are the common problems children of veterans
with PTSD face?
Social & behavioral problems
Research has shown that there is significantly more violence
in families of Vietnam veterans with PTSD than in families
of veterans without PTSD, including increased violent
behavior of the child. 1 Several studies have examined
the effect that fathers' combat-related PTSD and violent
behaviors have on their children. 2, 3, 4 Results have
generally revealed that children of veterans with PTSD
are at higher risk for behavioral, academic, and interpersonal
problems. Their parents tend to view them as more depressed,
anxious, aggressive, hyperactive, and delinquent compared
to children of non-combat Vietnam era veterans (who do
not have PTSD). In addition, the children are perceived
as having difficulty establishing and maintaining friendships.
Chaotic family experiences can make it difficult to establish
positive attachments to parents, which can make it difficult
for children to create healthy relationships outside the
family too. There is also research showing that children
may have particular behavioral disturbances if their parent
veteran participated in abusive violence (i.e., atrocities)
during combat service. 5
Emotional problems and secondary traumatization
Results have also shown that children of veterans with
PTSD are at higher risk for being depressed and anxious
than non-combat Vietnam era veteran's children. Children
may start to experience the parent's PTSD symptoms (e.g.,
start having nightmares about the parent's trauma) or
have PTSD symptoms related to witnessing their parent's
symptoms (e.g., having difficulty concentrating at school
because they're thinking about the parent's difficulties).
Some researchers describe the impact that a parents PTSD
symptoms have on a child as secondary traumatization.
2 However, because of the increased likelihood that violence
occurs in the home of a veteran with PTSD, it is also
possible that children develop PTSD symptoms of their
own. Having a seemingly unsupportive parent can compound
these symptoms.
Problems may continue into adolescence
Adolescent children of veterans with PTSD may also be
affected by their parent's symptoms. Compared to adolescent
children of non-veteran fathers, adolescent children of
Vietnam combat veteran fathers show poorer attitudes toward
school, more negative attitudes toward their fathers,
and higher levels of depression and anxiety. They also
receive lower scores on creativity 6 . Adolescent children
of Vietnam combat veterans may also have more problematic
behaviors as rated by their mothers, although their behavior
at school does not show evidence of disturbance. In spite
of these differences, the two groups of adolescents were
actually quite similar on a range of other measures of
social and personality adjustment. One of the potential
reasons for the limited impact on this group of adolescents
is that the fathers in this study experienced combat but
were not actually diagnosed with PTSD. It seems that children
of combat veterans may struggle with some psychological
and behavioral difficulties, but higher levels of impairment
are much more likely when the veteran is struggling with
mental health issues of his/her own, such as PTSD.
Can children get PTSD from their parents?
It is possible for children to display symptoms of PTSD
because they are upset by their parent's symptoms (secondary
traumatization). Some researchers have also investigated
the notion that trauma and the symptoms associated with
it can be passed from one generation to the next. Researchers
describe this phenomenon as intergenerational
transmission of trauma. Much research has been
conducted with victims of the Holocaust and their families
(see Kellerman 7 for review), and some studies have expanded
on these ideas to include families of combat veterans
with PTSD.
Ancharoff, Munroe, and Fisher 8 described several ways
to understand the mechanisms of intergenerational transmission
of trauma. These mechanisms are silence, overdisclosure,
identification, and reenactment.
• When a family silences a child, or teaches him/her
to avoid discussions of events, situations, thoughts,
or emotions, the child's anxiety tends to increase. He
or she may start to worry about provoking the parent's
symptoms. Without understanding the reasons for their
parent's symptoms, children may create their own ideas
about what the parent experienced, which can be even more
horrifying than what actually occurred.
• Overdisclosure can be just as problematic. When
children are exposed to graphic details about their parent's
traumatic experiences, they can start to experience their
own set of PTSD symptoms in response to the horrific images
generated.
• Similarly, children who live with a traumatized
parent may start to identify with the parent such that
they begin to share in his or her symptoms as a way to
connect with the parent.
• Children may also be pulled to reenact some
aspect of the traumatic experience because the traumatized
parent has difficulty separating past experiences from
present.
What should I do if I feel my or my partner's
PTSD is affecting my children?
Parents can help children by using the information provided
in this fact sheet and in the resources identified below.
Preventive interventions can be helpful and include explaining
to family members the possible impact of intergenerational
transmission of trauma, before it happens. Education about
the potential impact on children can also be a useful
reactive response, when a child is already being affected
by his or her parent's trauma history.
An excellent first step in helping children cope with
a parent's PTSD is to explain the reasons for the traumatized
parent's difficulties, without burdening the child with
graphic details. It is important to help children see
that the symptoms are not related to them; children need
to know they are not to blame. How much a parent says
should be influenced by the child's age and maturity level.
Some parents may prefer to have help with what they say
to their children, and seeking assistance through therapy
or written materials can be helpful. The National Center
for PTSD's fact sheet below on "Children and disasters"
can help parents talk to children about trauma. This fact
sheet also describes how children may react differently,
depending on the child's age.
In addition to this basic first step, there are multiple
treatment options available for affected families. Treatment
can include individual treatment for the veteran (symptom
improvement for the person suffering from PTSD would indirectly
benefit the family) and family therapy (to support the
parent who is struggling with symptoms and teach family
members how to get their own needs met). Family therapy
is typically more effective if the veteran with PTSD has
first received some type of trauma therapy such that he
or she is better able to focus on helping the children
during family sessions 9 . Children may benefit from individual
therapy as well, with variations based on the child's
age (e.g., art or play therapy for younger children, supportive
talk therapy for older children and adolescents). Each
family is unique, and decisions about what kind of treatment
to seek, if any, can be complicated. The most important
thing is to help each member of the family, including
the children, have a voice in expressing what he or she
needs. In light of the recent research showing the negative
impact PTSD can have on families, Veterans Affairs PTSD
programs ( http://www.va.gov) and Vet Centers ( http://www.va.gov/rcs/)
across the country are beginning to offer group, couples,
and individual programs for families of veterans.
References
1. Jordan, B. K., Marmar, C. B., Fairbank, J. A., Schlenger,
W. E., Kulka, R. A., Hough, R. L., et al. (1992). Problems
in families of male Vietnam veterans with posttraumatic
stress disorder. Journal of Consulting and Clinical
Psychology, 60, 916-926.
2. Cosgrove, L., Brady, M. E., & Peck, P. (1995).
PTSD and the family: Secondary traumatization. In D. K.
Rhoades, M. R. Leaveck, & J. C. Hudson (Eds.), The
legacy of Vietnam veterans and their families: Survivors
of war: catalysts for change (pp. 38-49). Washington:
Agent Orange Class Assistance Program.
3. Harkness, L. (1993). Transgenerational transmission
of war-related trauma. In J. P. Wilson & B. Raphael
(Eds.), International handbook of traumatic stress
syndromes (pp. 635-643). New York: Plenum Press.
4. Parsons, J., Kehle, T. J., & Owen, S. V. (1990).
Incidence of behavior problems among children of Vietnam
War veterans. School Psychology International,
11, 253-259.
5. Rosenheck, R., & Fontana, A. (1998). Transgenerational
effects of abusive violence on the children of Vietnam
combat veterans. Journal of Traumatic Stress,
11, 731-742.
6. Dansby, V. S., & Marinelli, R. P. (1999). Adolescent
children of Vietnam combat veteran fathers: A population
at risk. Journal of Adolescence, 22, 329-340.
7. Kellerman, N. (2001). Psychopathology in children
of Holocaust survivors: A review of the research literature.
Israel Journal of Psychiatry and Related Sciences,
38, 36-46.
8. Ancharoff, M. R., Munroe, J. F., & Fisher, L.
M. (1998). The legacy of combat trauma: Clinical implications
of intergenerational transmission. In Y. Danieli (Ed.),
International handbook of multigenerational legacies of
trauma (pp. 257-275). New York: Plenum Press.
9. Harkness, L. (1991). The effect of combat-related
PTSD on children. National Center for PTSD Clinical
Quarterly, 2(1).
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