Adolescent Girls, Trauma, and PTSD

By Marylene Cloitre, Ph.D., NYU Child Study Center, Institute of Trauma & Stress, New York

Dr. Cloitre is a member of the ADAA Scientific Advisory Board. This is the fourth installment in a series of articles focusing on women and anxiety disorders.

In the past decade, several studies have revealed that anxiety disorders identified in the adult population are also present in children and adolescents and at rates much greater than previously suspected. This is particularly true of Posttraumatic Stress Disorder (PTSD), once viewed primarily as the disorder of combat veterans and adult rape survivors. The reality is that children are frequently exposed to violent traumatic events as much as or more often than adults (see "9/11: A Case Study").

One significant consequence of childhood trauma is PTSD, which can be clearly diagnosed in adolescence. Like many anxiety disorders, PTSD occurs twice as often in females as in males, regardless of the type of trauma1. The most common and powerful predictor of PTSD in adolescent girls is childhood sexual abuse and sexual assault, with 62% of forcible rapes occurring under the age 18 and about half of those occurring under the age of 112.

It is only in the last few years that the devastating consequences of trauma and PTSD in particular have been identified among adolescent girls. Adolescence is a life stage of heightened risk. Many of these risks are exacerbated among teens with a trauma history and the addition of a PTSD diagnosis produces further risk. The toll is painful to calculate. It includes:

In addition, trauma and PTSD in adolescent girls is associated with poor emotion management skills, and a lack of social competence, sense of self-efficacy and mastery.

Many women who have experienced sexual abuse or assault in childhood identify their adolescence as the turning point toward recovery or compounded life difficulties. Recovery seems to hinge on several factors with the most important being the presence of at least one person who cared about them, identified a talent, interest or skill, and helped them develop it. This type of positive influence can be a critical element during a time of life driven by questions concerning self-identity, self-worth, value among peers and an emerging independence that is repeatedly tested for recognition and competence.

Although childhood abuse has been associated with myriad negative outcomes, it alone is not the most potent factor in predicting mental and physical health status as an adult. Recent research has indicated that events during adolescence determine most powerfully the final outcome in adulthood. Accordingly, adolescence is a time of high risk but also a window of opportunity to intervene.

While successful PTSD treatments have been established for children and for adults, remarkably, there are no established treatments for PTSD among adolescents. Given our understanding of the critical role adolescence appears to play in mediating long term recovery from trauma, it is clearly time to attend to the needs of adolescents and develop programs that address PTSD symptoms and the life stage difficulties such a self-esteem and peer relationships through which the effects of trauma are expressed.

Additional Resources

References:
1 Kessler, R., Sonnega, A., Bromet E., Hughes M., & Nelson C. (1995) Posttraumatic Stress
Disorder in the national comorbidity survey. Archives of General Psychiatry, 52, 1048- 1060.
2 Kilpatrick, D. (1992). Rape in America: A report to the nation. Charleston, SC: Crime Victims
Research Center.
3 Hoven, CW, Duarte CS, Lucas CP et al. (2002). Effects of the World Trade Center Attack on NYC Public School Students-Initial Report the New York City Board of Education. New York: Columbia University Mailman School of Public Health-New York State Psychiatric Institute and Applied Research and Consulting, LLC.
4 Finkelhor, D. & Dzuiba-Leatherman, J. (1994). Victimization of Children. American Psychologist, 3, 173-183.