PTSD And The Youth Worker
Suicide, sexual abuse, drive by shootings, car accidents, date rape. These events and many other traumatic events occur on a seemingly regular basis and can impact the surviving student(s), families, or youth workers more deeply than imagined. If you work with kids long enough then you will experience a traumatic event and it will serve you well to understand the phenomenon of Post Traumatic Stress Syndrome that is often left in the wake of a horrible event.
The following is an overview of what PTSD might look like in your youth, their families, and those that serve them.
Many triggers in the present environment can activate traumatic memory material and stimulate intrusions. Triggers are cues – often harmless – that have become associated with the original trauma. In some way, they remind us of the trauma or recall traumatic memories. The association may be obvious or subtle. They may trigger most of the memory or just certain fragments of it. Often, they trigger intrusions against our will. Recognizing triggers, and realizing that their power to elicit intrusions is understandable, are steps towards controlling its effects on our thoughts, feelings, and behaviors.
Some people find it helpful to understand triggers by their twelve categories:
- Visual: seeing blood or road kill reminds one of wounded bodies; black garbage bags can remind us of body bags; a secretary sees her boss standing over her and is reminded of her abusive father.
- Sound (auditory): a backfiring car sounds like gunshot to a veteran or inner city youth exposed to street violence; sounds during lovemaking remind one of sexual abuse.
- Smell (olfactory): the smell of semen or another’s body during intercourse, or the smell of cologne or aftershave reminds one of sexual assault.
- Taste (gustatory): eating a hamburger reminds one of an automobile accident that occurred as one drove away from a fast food restaurant.
- Physical or Body
- Kinesthetic means the sensation of movement, tension, or body position. Thus, running when tense might be reminiscent of trying to flee a beating; trying to do progressive muscle relaxation (tensing muscles, lying on one’s back with eyes closed) might trigger memories of sexual abuse.
- Tactile or touch: pressure around wrists or waist, being gripped, held, or otherwise restrained (perhaps even a hug) reminds one of torture or rape; feeling someone on top of you; a man accidentally kicked in bed by his wife while sleeping recalls a midnight attack while in prison; being touch during sexual relations with a loved one in the same place or in the same way as occurred during abuse will likely trigger traumatic memories.
- Pain or other internal sensations; surgical pain, nausea, headaches, or back pain might trigger memories of torture or rape. Elevated heart rate from exercising at night might remind one of a similar sensation during a high stress encounter such as a drive by shooting.
6. Significant Dates or Seasons
- Anniversary dates of the trauma
- Seasons of the year with their accompanying stimuli (temperature, lighting, colors, sounds)
- Other dates (e.g., a mother becomes distressed on the date of her murdered son would have graduated)
7. Stressful Events/Arousal: Sometimes changes in the brain due to the trauma cause it to interpret any stress signals as a recurrence of the original trauma. At other times, seemingly unrelated events are actually triggers. Examples include:
- A woman visits her spouse in the hospital which triggers a flashback of grief and loss. As a young woman she has a late term miscarriage in the same hospital.
- An argument with a significant other triggers memories of parents arguing violently.
- Criticism from a teacher reminds a person of being abused by his father.
- A frightening dream with no apparent related theme activates the fear of a traumatic memory. (Of course, a nightmare of the trauma would understandably elicit strong feelings of distress.)
- Athletic competition reminds an athlete of a previous traumatic injury or of a being abused when she performed poorly in the past.
8. Strong Emotions: feeling lonely reminds one of abandonment; feeling happy reminds a woman of a rape that occurred after having dinner with her best friend; anything that makes one anxious, out of control, or generally stressed, such as PMS. Some memories are state-dependent, meaning that the brain activates them only when the emotional state is the same as the original memory. Thus, if one was drunk when raped, she may feel symptoms only when drinking; if raped when sober, then drinking might provide an escape from the symptoms.
9. Thoughts: rejection by a lover leads to the thought “I am worthless,” which triggers the same thoughts that occurred when one was abused as a child.
10. Behaviors: driving reminds a person of a serious accident.
11. Out of the Blue: Sometimes intrusions occur when you are tired, relaxing, or your defenses are down. Often a thought or something you’re not aware of will elicit symptoms; so might the habitual act of dissociating during stressful times.
12. Combinations: often triggers contain several memory aspects at once. For example:
- Walking to the parking lot on a dark summer’s night (visual+kinesthetic+seasons) triggers a memory of a violent crime.
- Fireworks (sound+flarelike sight) triggers combat memories.
- Intercourse (weight+touch+sounds+relaxing+the smell of aftershave+the pressure of a hug or a squeezing sensation or the wrists) trigger memories of rape.
This list is by no means exhaustive but hopefully it will shed some light on the problems some of your students face. There are some implications for our ministries too. If we know a student has been sexually assaulted then we should be cognizant to the fact that some games we play where there is physical contact (human knot) or close proximity to others (passing a Life Saver on a toothpick) may trigger a response to that stimulus. We can simply pull them aside and prep them ahead of time as to what the game will entail and give them an option to participate or not.
Students who suffer from trauma need therapeutic interventions. Often we operate outside of our expertise and we must realize that we are not trained counselor. A referral for the student and their family is often the best thing we can do for them. Be honest with yourself about your limitations and seek outside support if necessary.
Chris Schaffner is a veteran youth worker and certified counselor. He is also the founder of CONVERSATIONS ON THE FRINGE. CotF is an organization seeking creative and innovative ways to bridge the gap between the mental health community and those entities (particularly schools and churches) that serve youth in contemporary society.
Disclaimer: The views and opinions expressed in the YS Blog are those of the authors and do not necessarily reflect the opinion or position of YS.