TRAUMA AND ADOLESCENCE II: THE IMPACT OF TRAUMA

Adolescent Psychiatry, 2003 by Becker, Daniel F, Daley, Melita, Green, Monica R, Hendren, Robert L, Et al

THE COMMITTEE ON ADOLESCENCE OF THE GROUP FOR THE ADVANCEMENT OF PSYCHIATRY

NORMAL ADOLESCENT DEVELOPMENT AND VULNERABILITY TO TRAUMA

An understanding of normal adolescent development is crucial to the understanding of the impact of trauma in this age group. The developmental tasks of adolescence include

1. Coping with the physical changes of puberty

2. Mastering an upsurge of sexual and aggressive impulses

3. Developing autonomy from parents

4. Forging sustaining ties with peers and adults outside the family

5. Developing the capacity for intimacy with a romantic other

6. Establishing a durable sense of personal values

7. Consolidating a coherent identity (including gender, vocational, and ethnic roles

8. Achieving a sense of competency and industry in work or school

9. Planning realistically for eventual economic self-sufficiency.

These normative developmental challenges also pose potential areas of vulnerability for the adolescent, especially for the adolescent exposed to trauma. Overwhelming physical danger (experienced or witnessed) undermines fantasies of physical omnipotence and the adolescent's tentative moves towards autonomy from parental care and supervision. Sexual or aggressive trauma may either overstimulate the adolescent's own aggression (through stimulating defensive sadistic retaliatory anger) or by rendering dangerous the whole arena of sexual arousal or assertiveness. Feelings of mistrust, self-doubt, guilt, shame, or anxiety erode self-esteem, impede peer relations, interfere with academic or vocational functioning, and corrode a stable sense of identity.

Not only are adolescents particularly vulnerable to trauma during this developmental phase, they can react at this time to earlier traumatic events. The meaning to the adolescent of trauma experienced earlier can change; in effect, the trauma may be experienced anew. As an adolescent realizes the meaning of incest experienced during childhood, the memories of such experiences may take on different qualities and produce different responses. A previous exposure to trauma during childhood can have a variety of significant effects on adolescents. Early childhood traumas are frequently reactivated in adolescence, leading to the reemergence of problems that were thought to have been resolved. Moreover, in North American societies, the period of early adolescence is particularly stressful, involving as it does a number of developmental transitions (puberty, entrance into high school) that are accompanied by increased expectations and for which social support is limited (Dryfoos, 1998). Finally, adolescents have a tendency to take risks that expose them to trauma, with dangerous risk-taking behavior during adolescence more likely if there is a history of early abuse (Trickett, 1997). On the positive side, adolescents have potentially greater resources for protecting themselves. They have increased physical strength and increased ability to anticipate consequences and to develop plans for avoiding or escaping the threat of danger. Compared to younger children, they also have the availability of peers and adults outside the family as sources of aid and support.

The more advanced cognitive and emotional development of adolescents enhances their ability to appreciate and understand what they experience and have previously experienced. This may have both protective and risk-enhancing effects.

Studies of the Impact of Trauma During the Adolescent Years

Adolescents' responses to trauma, compared with those of younger children and adults, have not been well studied. Many of the studies that have included adolescents have lumped together their responses with those of younger children. However, a few studies, including those of combat trauma, disasters, and rape, have shown differential effects on adolescents consistent with the existence of particular vulnerabilities of this age. Adolescents who fought in Vietnam were more prone to develop posttraumatic stress disorder (PTSD) than were older soldiers; van der Kolk (1985) hypothesized that this was due to the intensity of their attachment to their combat buddies and the consequent magnitude of the loss that the young soldiers experienced when their friends were killed.

Comparing older and younger victims of sexual assault, Davidson and colleagues (1996) found the greatest likelihood of later suicide attempts in those who were assaulted prior to age 16. Similarly, Breslau et al. (1997) found that women who experienced trauma of any kind prior to age 15 were more vulnerable to developing PTSD as a sequel than were those whose trauma occurred at a later age. Two years after the Buffalo Creek disaster, adolescents were found to have higher levels of distress than younger children (Green et al., 1991). A major component of this tragedy was a loss of community as well as a sense of betrayal by the mining company whose negligence led to the disaster. These may have been particularly traumatic stresses for the adolescents, for whom normative development meant a social orientation outside their families and a confrontation with the imperfections of adult authority.