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 disaasters" 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).
