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PTSD Questions & Answers
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Joyce Boaz & Dr. Frank Ochberg, M.D.

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PTSD: Delayed Onset of PTSD Symptoms.

Q: Dear Frank:

If a person has endured most of their trauma in childhood and has delayed onset PTSD as an adult, is it possible for them to display some of the symptoms that a child would verses an adult? Can you discuss what PTSD would be like in a child? Would having many types of trauma in childhood make one more prone to chronic PTSD as an adult?

A: Dear Joyce:

Many Gift From Within survivors were traumatized as children, so this is an excellent, thoughtful question. I'm thinking now of a woman who had sadistic, possibly psychopathic older brothers. One held her upside-down over a waterfall when she was three or four. Another arranged for someone else to abuse her when she was a few years older. Her parents were caring, but they posed other problems when she was an adult. In her case there were times when she would "regress" to a child-like personality and cry for "Daddy." But there were other times when she had a fierce, almost punishing personality and would intimidate others. I called this her Lady Macbeth mode. She was never a multiple personality, but she certainly had styles of behavior that went from one extreme to another. When you are traumatized in your family of origin, you do learn how to adapt as you go through the steps of maturation. In some cases that adaptation involves altered states of consciousness - trances or dissociative states. That can mean that the traumatic scenes are not remembered in a normal way. They can lurk inside, causing fearful withdrawal from others who resemble the tormentor, or they might be the source of anger and rage.

Freudian analysis is based on the theory that unconscious events cause anxious, irrational behavior later on. Exploring and mastering these repressed traumas is an essential step, according to these analysts, in reaching recovery. But PTSD is different. The theory and the treatment of PTSD, including childhood trauma, begins with conscious memory of terrifying events. In a way, these memories are the opposite of repressed. They are very much in ones awareness, causing uncontrolled and unwanted recollection. And, yes, these re-experiencings can bring child-like states of mind. An adult who is triggered to remember being held upside-down over Niagara Falls may curl up in a ball and whimper -- or may talk about the event as an adult, with a sense of distance and mastery. The mastery comes with being believed, being respected, and having months or years to overcome the habit of regressing. That, fortunately, is the case with my patient.

When a traumatized child comes to a therapist, they often have taken a few steps backward in the stages of development. They may fail to speak at the level they achieved. They may forget about toilet training. They act a year or more younger. Therapists learn to play with these children in a non-threatening way. Eventually, important truths are revealed in the sandlot or on a page of drawing paper.

Marla Handy's story, in her book, No Comfort Zone, and on the DVD produced by GFW, illustrates her childhood and adult traumas and the consequent PTSD. She does call her situation chronic PSTD -- meaning it fits the criteria of regular PTSD, but lasts many years. It is also accurate to call this Complex PTSD - meaning the trauma occurred over a long period of time or it occurred during formative years. In Marla's case, both of these were true - long duration of trauma during formative stages of early life. And this did result in long-term PTSD. But remember- Marla's story and the story of many others is hopeful and encouraging. The legacy of profound trauma includes wisdom, resilience and appreciation of true friends. To be a survivor of trauma, tragedy and even of cruelty is not an indelible curse. Many learn to prevail and to be the ultimate judges of virtue, loyalty and love.

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