The Effect of
Combat-Related P.T.S.D. on Children
The
Tran generational effects of combat-related P.T.S.D. have critical
implications for a veteran’s interpersonal and family life and may be a
factor in his children’s development of low self-esteem, poor reality
testing, hyperactivity, and aggressive behavior.
Children of combat veterans with P.T.S.D. generally exhibit one of three
response patterns. The most destructive pattern is that of the
over-identified child. Through a process it has been determined that in
secondary trauma, children come to experience an emotional distancing
similar to the veteran with P.T.S.D.. Children with secondary trauma are
often their father’s closest companion and are at risk for "reliving" their
father’s trauma, experiencing his flashbacks, and sharing his nightmares. In
general, these children fail to develop their own friendships because their
lives revolve around their father. In school, they often have difficulty
with concentration because they are distracted by their concern for their
father’s well being.
Another common pattern of children is becoming "rescuers," whereby they take
on parental roles and responsibilities. They often feel guilty about trouble
at home and blame themselves. They assume that if they are good, life at
home will go well. They believe it is their responsibility to keep their
parents happy and to insure nothing goes wrong. These children often lose
spontaneity and interest in daily activities. Similar to children of
alcoholics, these children are at risk for continuing this pattern into
adult life.
A
third pattern centers on children who are emotionally uninvolved in family
life. They often know about their father's war experience and need for
support, but generally receive little emotional support themselves from
their parents. In an effort to gain recognition, they are apt to perform
well academically, yet their emotional and social constriction may cause
symptoms of depression and anxiety, and later cause problems in their
adulthood efforts to form intimate relationships.
Not
all children develop emotional problems in response to a parent with
P.T.S.D.. A study of Holocaust survivors indicated that some children are
relatively unaffected by the impact of traumatic experience upon the family
(Krell, 1982). These children appeared to have the capacity to elicit
positive responses from parents, friends and teachers.
Effective intervention begins with a comprehensive assessment of individual
and family dynamics, including the presence of violence. A history of the
family of origin is taken to determine the level of premarital and
pre-morbid functioning of each spouse. Problems for these families
frequently include difficulties with communication, intimacy and problem
solving, as well as substance abuse and/or violence.
Although these families may be dysfunctional, they have adopted roles and
patterns that maintain homeostasis. It is critical not to disrupt the
homeostasis until there is something to put in its place. In general, these
families require family therapy interventions, however, treatment is more
effective after trauma issues have been addressed and therapeutic
improvement in the father’s self-image is achieved. The therapist must
provide the family with a safe environment before intervening to disrupt the
homeostasis. In the early stages of treatment, a family will have a low
tolerance for affect expression. Initial sessions that suddenly produce a
perceived loss of control may result in premature and harmful termination.
Establishing and enforcing ground rules, (e.g. no threats, no yelling) serve
to contain affect. An effort is made to improve family members’
communication and problem solving skills.
The
focus of children’s treatment is the strengthening of ego functions (i.e.
reality testing, frustration tolerance, and verbalization). Children are
encouraged to recognize their separateness, address their own developmental
needs, and not assume responsibility for their parents’ behavior and pain.
A
combat veteran with P.T.S.D. must learn to place his war experience in the
context of his entire life. There will be periods that require dealing with
war-related issues; however, he must primarily direct his efforts toward
improving the present and future quality of his life. The veteran's concern
for his family may serve as an impetus to change.
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