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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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