PTSD: My teenage son is on edge since he was attacked

Q. Two months ago, my 14-year-old son and his friend were attacked by a group of boys in town who stole their phones. Since that time, my son has been anxious and on edge and particularly nervous about going out. As a result, his mother or myself have started accompanying him to and from school. We expected this might happen because of the incident and hoped he would get better and recover, but his anxiety remains. My son does not like talking about what happened but you can see it is still on his mind. He has nightmares and last night he woke very upset, saying “he couldn’t run away”. We took him to his GP who said he might be suffering from post traumatic stress disorder and suggested we seek counselling for him. How can we help him?

A. I’m sorry that your son was the victim of such a violent crime which must have been upsetting and traumatic for all of you. Unfortunately, such attacks on teenage boys can be common, though this does not make them any less traumatic for the victim. It is great that you are taking active steps to support him.

Post traumatic stress disorder (PTSD)
While it is of course normal for someone to feel anxious or upset after experiencing a trauma or being put in danger, a person is only thought to be suffering from PTSD when these symptoms endure over an extended period and continue to interfere in the person’s life long after the traumatic event has passed.

The symptoms of PTSD include flashbacks and intrusive memories about the event, anxiety symptoms such as being on edge or nervous or not being able to sleep, and avoidance symptoms such as being unable to leave the house after an attack or stopping to engage in healthy life pursuits. While many people have PTSD traits following a traumatic incident, they usually only receive a formal diagnosis if they experience a significant number of symptoms for a least one month.

Getting help for your son

The good news is there is a lot you can do to help your son, whether he gains a formal diagnosis of PTSD or not. The ideal is to see a mental health professional who has particular experience in working with young people who have anxiety or PTSD- type symptoms. This could be a psychologist or psychiatrist or specialist social worker or therapist/counsellor. Your GP should have a list of local professionals and services. Additionally, you might find it useful to contact the support services for victims of crime – a good place to start is (Freephone 116 006).

Below are the specific elements of good therapeutic treatment for someone who may have PTSD that you would expect the mental health professional you meet to follow. As his father, these principles can also provide you with some guidance on how you can help your son.

Help him talk about the incident in a contained way

People with PTSD often “block out” the memory of the traumatic event or they ruminate about certain details in an unhelpful way. Generally, it helps if they can talk about what happened with some perspective and balance. It could be that your son finds it hard to talk about what happened because he feels overwhelmed by the feelings it brings up.

He could also have a false belief that he was somehow responsible for what happened (that he drew the attack upon himself or he should have fought back, and so on). Helping him talk about what happened in a contained way could help him greatly. Don’t put pressure on him to talk, but letting him know that you are ready to listen when he’s ready to talk is important.

Help him understand his symptoms of PTSD
It can help someone greatly to understand the specific symptoms and how they are affecting him. Putting names on what is going on (flashbacks, nightmares, and so on) and putting them in the context as normal reactions to what he went through will be helpful to your son.

Giving him the message that he can move on and recover is important: “A very bad thing happened to you, that you were in no way to blame for – understandably you are very traumatised – but you can recover and move on and I am here to help you.”

Learning to tackle symptoms
It is also important to empower your son to tackle and manage the symptoms of anxiety as they affect him. Learning to relax his body when he feels anxiety, either by using breathing techniques or by positive visualisation could be helpful. He could also learn principles of mindfulness, whereby he learns to experience and accept his feelings without letting them dominate, and this could reduce the potency of the feelings.

As a parent, a good strategy is to learn some of these techniques together with your son. For example, if he learns them from a therapist you could try them out with him at home (everyone can benefit from good relaxation) or you could attend a course together if he is open to the idea.

Take steps to get back to normal life
It is also important to discuss with your son how he can stop the anxiety interfering in his life so he can get back to normal as soon as possible. A gradual step-by-step approach that proceeds at his pace is usually the best way forward. For example, it is acceptable for you to accompany him to school for a period after a traumatic event. But then you might set a goal with him walking part of the way there by himself when he is ready.

Additionally, make a plan with him to take up any activities he might have dropped due to the trauma so he can get his life back on track.

John Sharry, Irish Times Newspaper, October 2013. John writes in The Irish Times Health+ every Tuesday.