Palo Alto Weekly

Cover Story - March 28, 2014

'Trauma is normal and needs to be treated'

Stanford doctor advises intervention to stem effects of abuse

Post-traumatic stress disorder — universally known as PTSD — is a misnomer, according to a Stanford University physician who heads a trauma-research program at the School of Medicine.

"It's not a disorder," Victor G. Carrion, director of the Youth Anxiety Disorders Clinic and Early Life Stress and Pediatric Anxiety Program, multidisciplinary programs recognized internationally, said of post-traumatic stress reactions, speaking generally and not in relation to a specific case.

He said "disorder" is wrong for PTSD because it's completely normal for everyone who has undergone a traumatic experience to be affected by it.

"It's better referred to as 'post-traumatic injury,' or 'post-traumatic stress symptoms,'" he said.

And, he said, it's vitally important for such injuries to be treated, as the effects can last for years, or lifetimes, if unresolved.

Younger persons are especially vulnerable to traumatic situations, whether sexual, physical or emotional, he emphasized. Children can even experience "vicarious trauma," also known as "secondary traumatization," when they are not directly the target or recipient of the trauma.

"It's a misconception that children are resilient," he said in a telephone interview.

In terms of sexual abuse of children, "Everyone's experience of abuse is different," and it is the details of an experience that actually cause PTSD-type symptoms.

Most adults can often react to a traumatic situation using the "fly or fight" response, "but children can't fly or fight — they're too little," he said.

Symptoms in children can vary and include screaming, dissociating or extreme withdrawal, or even running away as adaptive responses. But even years later adults without treatment can experience "trigger" events that bring back similar responses, which no longer serve a purpose.

Symptoms can change lives and last a lifetime when not attended to, he said.

"Trauma can affect their physical, emotional and even reproductive lives."

There are "interventions that are very effective," even if a person receives treatment years after the trauma occurred.

"Post-traumatic symptoms can come up as a delayed response," when something happens that can bring back the memory of the trauma.

"A child at age 3 may not develop a symptom, but at puberty it can emerge" and can be powerful enough to alter areas of the brain, a "neurotoxic" reaction.

"Good, targeted intervention can protect or repair some of these changes," he said.

Yet the best treatment still is prevention, particularly in the case of young children and early teens.

Wrong thoughts about the abuse are a significant issue, such as when a young person feels he or she is responsible for the abuse, he said.

"The younger you are the more responsible you feel" in many cases. Such "cognitive distortions" need treatment to "help correct those wrong thoughts," he said. Treatment is essential because the trauma and one's reaction to it are usually more than a person can handle on their own.

"We need to have systems developed to prevent abuse, and to inform children about what to do if something occurs — whom should they talk to? Parents? Teachers?"

He praised the roles of national organizations such as the Child Advocacy Center for pediatric mental health and the Center for Youth Wellness.

But ultimately the responsibility for protection rests with adults, who need to be watchful and perceptive, and sometimes brave enough to overcome natural avoidance.

A person who perceives a situation that seems odd or inappropriate can call the county child-protective services department or the police.

Most police departments now take reports seriously but have a careful approach to assessing and investigating such reports, he said.

Dr. Carrion is a professor at the School of Medicine, director of the Stanford Early Life Stress Research and Anxiety Program, and medical director of the Pediatric Anxiety Clinic. He is on the faculty at the Lucile Packard Children's Hospital at Stanford and is associate editor for the Journal of Traumatic Stress.

In recent years, his work has taken on an international scope: He has met with Australian children after huge bushfires, Spanish youth in foster care, Haitian earthquake survivors, and children in New Orleans after Katrina. He has consulted with Middle Eastern health practitioners on how to increase resilience in children exposed to war.

— Jay Thorwaldson

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