What Is Trauma?
Trauma is any injury, physically or emotionally inflicted upon a person. Trauma has both a medical and a psychiatric definition. For the purposes of this site, we will focus primarily upon psychological trauma and its effects.
Emotional, or Psychological, Trauma is an intense, emotional reaction to a traumatic or severe situation. Trauma may be caused by stressful events such as natural disasters, incidences of abuse, assault, or death. Trauma can also be caused by more minor events, like a car accident or sports injuries.
A traumatic event involves a single event, or a repeating pattern of events that completely overwhelm an individual’s ability to cope or integrate the emotions involved in that experience. That feeling of being overwhelmed can last days, weeks, even years as the person struggles to cope.
Trauma can be caused by a number of events, but there are a few common aspects. There’s often a violation of the person’s familiar ideas about the world and of their rights, which puts the person into a state of extreme confusion and insecurity.
Psychological trauma may be accompanied by physical trauma or exist independently.
Trauma, while often involving a threat to life or safety, can also involve any situation that leaves you feeling stressed or alone, even if it didn’t involve physical harm. It’s not the objective facts that determine if an event is traumatic, but the subjective emotional experience of the event. The more frightened and helpless you felt at the time, the more likely that you will feel traumatized afterwards.
A traumatic event or situation creates psychological trauma when it overwhelms the individual’s ability to cope, and leaves that person fearing death, annihilation, mutilation, or psychosis. The individual may feel emotionally, cognitively, and physically overwhelmed. The circumstances of the event commonly include abuse of power, betrayal of trust, entrapment, helplessness, pain, confusion, and/or loss.
This definition of trauma is fairly broad. It includes responses to powerful one-time incidents like accidents, natural disasters, crimes, surgeries, deaths, and other violent events. It also includes responses to chronic or repetitive experiences such as child abuse, neglect, combat, urban violence, concentration camps, battering relationships, and enduring deprivation. This definition intentionally does not allow us to determine whether a particular event is traumatic; that is up to each survivor. This definition provides a guideline for our understanding of a survivor’s experience of the events and conditions of their life.
There are two components to a traumatic experience: the objective and the subjective:
It’s is the subjective experience of the objective events that constitutes the trauma. The more you believe you are endangered, the more traumatized you will be. Psychologically, the bottom line of trauma is overwhelming emotion and a feeling of utter helplessness. There may or may not be bodily injury, but psychological trauma is coupled with physiological upheaval that plays a leading role in the long-range effects.
In other words, trauma is defined by the experience of the survivor.
Two people could undergo the same noxious event and one person might be traumatized while the other person remained relatively unscathed. It is not possible to make blanket generalizations such that “X is traumatic for all who go through it” or “event Y was not traumatic because no one was physically injured.” In addition, the specific aspects of an event that are traumatic will be different from one individual to the next. You cannot assume that the details or meaning of an event, such as a violent assault or rape, that are most distressing for one person will be same for another person.
Trauma comes in many forms, and there are vast differences among people who experience trauma. But the similarities and patterns of response cut across the variety of stressors and victims, so it is very useful to think broadly about trauma.
What Conditions Co-Occur in Children And Adults Who Have Experienced Childhood Trauma?
Adults who experienced childhood trauma are at a greater risk for a number of complications and co-occurring disorders that may require diagnosis and treatment:
- Chronic pain and physical illnesses like diabetes or heart disease
- Depression
- Anxiety disorders
- Obsessive-compulsive disorder
- Substance use disorders
- Post-traumatic stress disorder and other trauma-related mental illnesses
- Dissociative disorders
- Self-harm
- Suicide
What Are Some Statistics About Childhood Trauma?
60% of adults report experiencing abuse or other difficult family circumstances during childhood.
26% of children in the United States will witness or experience a traumatic event before they turn four.
Four of every 10 children in American say they experienced a physical assault during the past year, with one in 10 receiving an assault-related injury.
2% of all children experienced sexual assault or sexual abuse during the past year, with the rate at nearly 11% for girls aged 14 to 17.
Nearly 14% of children repeatedly experienced maltreatment by a caregiver, including nearly 4% who experienced physical abuse.
1 in 4 children was the victim of robbery, vandalism, or theft during the previous year.
More than 13% of children reported being physically bullied, while more than 1 in 3 said they had been emotionally bullied.
1 in 5 children witnessed violence in their family or the neighborhood during the previous year.
In one year, 39% of children between the ages of 12 and 17 reported witnessing violence, 17% reported being a victim of physical assault and 8% reported being the victim of sexual assault.
More than 60% of youth age 17 and younger have been exposed to crime, violence and abuse either directly or indirectly.
More than 10% of youth age 17 and younger reported five or more exposures to violence.
About 10% of children suffered from child maltreatment, were injured in an assault, or witnessed a family member assault another family member.
About 25% of youth age 17 and younger were victims of robbery or witnessed a violent act.
Nearly half of children and adolescents were assaulted at least once in the past year.
Among 536 elementary and middle school children surveyed in an inner city community, 30% had witnessed a stabbing and 26% had witnessed a shooting.
Young children exposed to five or more significant adverse experiences in the first three years of childhood face a 76% likelihood of having one or more delays in their language, emotional or brain development.
As the number of traumatic events experienced during childhood increases, the risk for the following health problems in adulthood increases: depression; alcoholism; drug abuse; suicide attempts; heart and liver diseases; pregnancy problems; high stress; uncontrollable anger; and family, financial, and job problems.
People who have experienced trauma are:
- 15 times more likely to attempt suicide
- 4 times more likely to become an alcoholic
- 4 times more likely to develop a sexually transmitted disease
- 4 times more likely to inject drugs
- 3 times more likely to use antidepressant medication
- 3 times more likely to be absent from work
- 3 times more likely to experience depression
- 3 times more likely to have serious job problems
- 2.5 times more likely to smoke
- 2 times more likely to develop chronic obstructive pulmonary disease
- 2 times more likely to have a serious financial problem
What Is a Traumatic Event?
A traumatic event is a frightening, dangerous, or violent event that poses a threat to a child’s life or bodily integrity. Witnessing a traumatic event that threatens life or security of a loved one can also be traumatic, particularly for young children as their sense of safety depends on the safety of their guardians.
Traumatic experiences can lead to strong emotions and physical reactions that may persist long after the event is over. Children may feel terror, helplessness, or fear, as well as physiological reactions such as heart pounding, vomiting, or loss of bowel or bladder control. Children who experience an inability to protect themselves or who lacked protection from others to avoid the consequences of the traumatic experience may also feel overwhelmed by the intensity of their physical and emotional responses.
Who Is At Greater Risk For Childhood Trauma?
Some groups of children and families are disproportionately represented among those experiencing trauma, which means that they may be exposed to trauma at particularly high rates or be at increased risk for repeated victimization and traumatic experiences. For some populations, co-occurring issues and unique adversities can complicate recovery from trauma.
Others may face major challenges related to access to services or require services that are specially adapted for their needs.
Trauma and Substance Abuse:
There is a strong connection between traumatic stress and substance abuse that has implications for children and families, whether the user is an adolescent or a parent or caregiver.
Research studies have shown that adolescents who engage in problematic substance use are more likely to experience traumatic events and develop PTSD, depression, violent behavior, suicide, and other mental health problems compared to those who do not use substances. Additionally, adolescents exposed to traumatic events are more vulnerable to problematic substance use. Psychoactive substances can both dull the effects of stress and place teens at increased risk for experiencing trauma.
Caregiver substance use carries many risks for child and adolescent development. Starting even before children are born, parental substance use increases children’s risk for later mental health problems and victimization. Children and adolescents with substance-using parents may be exposed to other high-risk situations, such as violence in the home and community.
Economic Stress:
Whether living in urban, suburban, or rural settings, people face the reality of economic downturns: being laid off, being unable to find a job, having difficulty supporting a family, or the closing of community organizations or local services upon which they depend. Economic challenges can affect feelings of safety, the ability to remain calm, relationships with others, and hope and belief that things will improve. When times are uncertain, people feel frustrated, angry, scared, or hopeless; they may have to plan new ways to overcome obstacles.
As children hear, see, and read about what is happening in their homes, communities, and the world, they experience economic stress alongside their parents; when their parents are worried, children begin to worry too.
Military and Veteran Families:
Children of military and veteran families experience unique challenges related to military life and culture. These include deployment-related stresses such as parental separation, family reunification, and reintegration; disruption of relationships with friends and neighbors due to frequent moves; and adaptation to new schools and new community resources.
Added to this, some children face the trauma of a parent returning home from combat with injuries or illness; others must face their parent’s death. Research indicates that although most military children are healthy and resilient and have positive outcomes, certain deployment stresses put some groups at risk: young children; children with preexisting health and mental health problems; children whose parents serve in the National Guard, are reserve personnel, or have had multiple deployments; children who do not live close to military communities; children who live in places with limited resources; children in single-parent families with that parent deployed; and children in dual-military parent families with one or both parents deployed.
Intellectual and Developmental Disabilities:
Research indicates that youth living with intellectual and developmental disability (IDD) experience exposure to trauma at a higher rate than their non-disabled peers. Children with IDD appear to be at an increased risk for physical abuse, physical restraint, seclusion, sexual abuse, and emotional neglect. Additionally, this psychological distress comes second to medical problems and procedures and is more common among children living with IDD than their typically developing peers, as they also may have chronic medical problems that necessitate surgeries and other invasive procedures.
When trauma occurs with children and families with IDD, it is challenging to effectively address the psychological impact of the event.
Homeless Youth:
As many as 2.5 million youth per year are homeless. Along with losing their homes, community, friends, and routines – and their sense of stability and safety – many homeless youth are also victims of violence or other traumatic events. While coming from a variety of backgrounds, research suggests that most of these youth have experienced early and multiple traumas. Their responses to these events have been shaped—at least in part—by age, gender, ethnicity, and sexual orientation.
This history of trauma in turn can cause significant mental health problems, including depression, anxiety disorders, PTSD, suicidal ideation, attachment issues, and substance abuse disorders. Once they arrive on the street, many youths are re-traumatized. Then they struggle to recover from earlier traumatic events at the same time that they are trying to survive in a hostile street environment replete with countless dangers, including an increased likelihood of substance abuse and a vulnerability to being trafficked.
LGBTQ Children and Teens:
Lesbian, gay, bisexual, transgender, and queer, or questioning (LGBTQ) youth experience trauma at higher rates than their straight peers. Common traumas experienced by these youth include bullying, harassment, traumatic loss, intimate partner violence, physical and sexual abuse, and traumatic forms of societal stigma, bias, and rejection. Historically, professionals have failed to recognize and meet the needs of traumatized LGBTQ youth, leading to poor engagement and ineffective treatments that, in some cases, perpetuate the youth’s traumatic experiences.
What Experiences Might Be Traumatic?
- Physical, sexual, or psychological abuse and neglect (including human trafficking)
- Bullying is a deliberate and unsolicited action that occurs with the intent of inflicting social, emotional, physical, and/or psychological harm to someone who often is perceived as being less powerful.
- Natural and technological disasters or terrorism
- Family or community violence
- Sudden or violent loss of a loved one
- Substance use disorder (personal or familial)
- Refugee and war experiences (including torture)
- Serious accidents or life-threatening illness
- Military family-related stressors (e.g., deployment, parental loss or injury)
When children have been in situations where they feared for their lives, believed that they would be injured, witnessed violence, or tragically lost a loved one, they may show signs of child traumatic stress.
How Does Trauma Affect Children?
While adults work hard to keep children safe, dangerous events still happen. This danger can come from outside of the family (such as a natural disaster, car accident, school shooting, or community violence) or from within the family, such as domestic violence, physical or sexual abuse, or the unexpected death of a loved one.
Traumatic experiences are often shattering and life-altering for children. These experiences may effect all levels of functioning and result in an array of distressing symptoms:
Physical Symptoms of Exposure to Trauma Can Include:
- nervousness,
- tiredness
- headaches
- stomach aches
- nausea
- palpitations
- pain
- difficulty sleeping
- nightmares
- worsening of existing medical problems
Emotional Symptoms of Exposure to Trauma Can Include:
- fear
- anxiety
- panic
- irritability
- anger
- withdrawal
- numbness
- depression
- confusion
- hopelessness
- helplessness
Academic Symptoms of Exposure to Trauma Can Include:
- inability to concentrate or remember
- missing school
- poor academic performance.
Relational Symptoms of Exposure to Trauma Can Include:
- emotional barriers between caregivers and children
- distrust and feelings of betrayal
- attachment problems
Nearly all trauma survivors have acute symptoms following a traumatic event, but these generally decrease over time.
Factors That Impede Processing Childhood Trauma:
- Previous exposure to trauma: This may include neglect, physical abuse, sexual abuse, or abrupt separation from a caregiver.
- Duration of exposure to trauma: A one-time exposure, such as a car accident, results in very different responses than exposure over several years, such as domestic violence.
- The longer the exposure, the more difficult the healing process.
- Severity of exposure: An incident that happens directly to a child or in front of a child will have different impacts than an incident that happened to someone else or one a child was told about later. The more severe the exposure, the more difficult it will be to heal.
- Prior emotional and behavioral problems: Pre-existing problems with being able to pay attention, being hyperactive, fighting or not following rules, or a prior history of depression or anxiety may complicate a child’s response to a traumatic event.
- Caregiver’s response after the exposure: It matters whether a caregiver validates the child’s experience or blames the child, or if the caregiver is able to provide comfort and reassurance instead of having difficulty responding to the child. When a caregiver experiences a high level of distress, a child often responds similarly. Caregiver’s support is one of the most important factors in a child’s recovery from trauma.
What Is Childhood Traumatic Stress?
Children who suffer from childhood traumatic stress have been exposed to one or more traumas over their lifetime and develop a reaction that lasts longer than the traumatic event; this reaction affects their everyday life.
Traumatic reactions can include a variety of responses, such as intense and ongoing emotional upset, depressive symptoms or anxiety, behavioral changes, difficulties with self-regulation, problems relating to others or forming attachments, regression or loss of previously acquired skills, attention and academic difficulties, nightmares, difficulty sleeping and eating, and physical symptoms, such as aches and pains.
Older children may use drugs or alcohol, behave in risky ways, or engage in unhealthy sexual activity.
Children who suffer from traumatic stress often have these types of symptoms when reminded in some way of the traumatic event.
While many of us may experience reactions to stress some of the time, when a child is experiencing traumatic stress, these reactions interfere with the child’s daily life and ability to function and interact with others. At no age are children immune to the effects of traumatic experiences. Even infants and toddlers can experience traumatic stress. The way that traumatic stress manifests will vary from child to child and will depend on the child’s age and developmental level.
Without treatment, repeated childhood exposure to traumatic events can affect the brain and nervous system and increase health-risk behaviors (such as smoking, eating disorders, substance use, and high-risk activities).
Research shows that child trauma survivors can be more likely to have long-term health problems (such as diabetes and heart disease) or to die much younger than average people. Traumatic stress can also lead to increased use of health and mental health services and increased involvement with the child welfare and juvenile justice systems.
Adult survivors of traumatic events may also have difficulty in establishing fulfilling relationships and maintaining employment.
Factors That May Increase The Likelihood Of Children’s Recovery From Trauma (Resilience Factors)
Individual Traits:
- Easy temperament
- Feeling of control over one’s life
- High self-esteem/self-confidence
- Sense of humor
- Optimism
- Sociable
- Intelligent
Family Traits:
- Safe, warm, caring, supportive environment
- High expectations for achievement
- Good communication
- Strong family cohesion
- Reasonable structure and limits
- Strong relationship with at least one caregiver
School-Based Traits
- Considers school a safe place to be
- Warm, caring, supportive environment
- High expectations for achievement
- Significant adult committed to child
- Academic achievement
- Models from peers of developmentally appropriate behavior
- Good relationships with peers
- Involvement and participation in school community/activities
Community Traits:
- Safe community (or safe places to go)
- Access to resources and supports (e.g., church, mentor, clubs)
- Involved in community activities
Factors That May Interfere With Children’s Recovery From Trauma (Risk Factors):
Individual Traits
- Difficult temperament (e.g., fussy, irritable, sensitive)
- Sense of a lack of control over life events
- Dependency beyond what is age-appropriate
- Low self-esteem/self-confidence
- Feeling of uncertain or poor future outcomes
- Shy/difficulty making friends
Family Traits:
- Physical or sexual abuse, neglect, domestic violence
- High levels of parental distress
- Lack of parental support
- Expectation that child will fail or act out
- Lack of structure, limit-setting
- Negative relationships with caregivers
School-Based Traits
- Exposure to school violence
- Lack of support from adults at school
- Poor academic performance
- Difficulty with peer relationships
- Lack of participation in school community/activities
Community Traits
- Violence in the community
- Unable to identify a safe place to go
- Unable to identify resources or supports in the community
- Disconnected from the community
Childhood Trauma: Reminders and Adversities
Traumatic experiences can set in motion a cascade of changes in children’s lives that can be challenging and difficult. These can include changes in where they live, where they attend school, who they’re living with, and their daily routines. They may now be living with injury or disability to themselves or others. There may be ongoing criminal or civil proceedings they must cope with.
Traumatic experiences leave a legacy of reminders that may persist for years. These reminders are linked to aspects of the traumatic experience, its circumstances, and its aftermath.
Children may be reminded and triggered by persons, places, things, situations, anniversaries, or by feelings such as renewed fear or sadness.
Physical reactions can also serve as reminders and triggers, for example, increased heart rate or bodily sensations.
Learning children’s responses to trauma and loss triggers is an important tool for understanding how and why children’s distress, behavior, and functioning often fluctuate over time. Trauma and loss reminders can reverberate within families, among friends, in schools, and across communities in ways that can powerfully influence the ability of children, families, and communities to recover.
Addressing trauma and loss triggers is critical to enhancing ongoing adjustment.
Childhood Trauma: Risk and Protective Factors
Fortunately, even when children experience a traumatic event, they don’t always develop traumatic stress. Many factors contribute to symptoms, including whether the child has experienced trauma in the past, and protective factors at the child, family, and community levels can reduce the adverse impact of trauma. These may include:
- Severity of the event. How serious was the event? How badly was the child or someone she loves physically hurt? Did they or someone they love need to go to the hospital? Were the police involved? Were children separated from their caregivers? Were they interviewed by a principal, police officer, or counselor? Did a friend or family member die?
- Proximity to the event. Was the child actually at the place where the event occurred? Did they see the event happen to someone else or were they a victim? Did the child watch the event on television? Did they hear a loved one talk about what happened?
- Caregivers’ reactions. Did the child’s family believe that he or she was telling the truth? Did caregivers take the child’s reactions seriously? How did caregivers respond to the child’s needs, and how did they cope with the event themselves?
- Prior history of trauma. Children continually exposed to traumatic events are more likely to develop traumatic stress reactions.
- Family and community factors. The culture, race, and ethnicity of children, their families, and their communities can be a protective factor, meaning that children and families have qualities and or resources that help buffer against the harmful effects of traumatic experiences and their aftermath. One of these protective factors can be the child’s cultural identity. Culture often has a positive impact on how children, their families, and their communities respond, recover, and heal from a traumatic experience. However, experiences of racism and discrimination can increase a child’s risk for traumatic stress symptoms.
What Are Some Effects Of Trauma Among Children?
Unexpectedly losing a loved one or being involved in a natural disaster, motor vehicle accident, plane crash, or violent attack can be overwhelmingly stressful for all of us – especially our children. A traumatic event can undermine their sense of security, leaving them feeling helpless and vulnerable, especially if the event stemmed from an act of violence, such as a physical assault, mass shooting, or terrorist attack. Even kids or teens not directly affected by a disaster can become traumatized when repeatedly exposed to horrific images of the event on the news or social media.
No matter the age of your child, it’s important to offer extra reassurance and support following a traumatic event. A child’s reaction to a disaster or trauma can be greatly influenced by their parents’ response, so it’s important to educate yourself about trauma and traumatic stress.
The more you know about the symptoms, effects, and treatment options, the better equipped you’ll be to help your child recover. With your love and support, the unsettling thoughts and feelings of traumatic stress can start to fade and your child’s life can return to normal in the days or weeks following the event.
| Effects of Trauma on Kids and Teens |
| Children age 5 and under may: |
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| Children age 6 to 11 may: |
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| Adolescents age 12 to 17 may: |
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What is Acute Traumatic Stress?
Acute trauma is generally a onetime event, such as a car accident or a natural disaster. Because children’s responses to acute trauma vary, awareness of the wide array of possible responses allows caregivers to provide a sense of safety and security, and support healing.
We each have an “alarm system” in our brain that signals us when we might be in danger. When our brain perceives danger, it prepares our body to respond. Our response often depends on the nature of the danger, but we are likely to react in one of three ways:
- Fight
- Flight
- Freeze
Two parts of our brain respond to danger:
The “doing brain” signals the need for action, while the “thinking brain” tries to solve the problem and make a plan.
When the brain perceives danger, the “thinking brain” makes an assessment. If it’s a false alarm because there is no real danger, the “thinking brain” shuts the alarm off and we move on.
If there is actual danger, the “doing brain” signals the body to release chemicals, to provide energy for us to respond.
When this happens, the “thinking brain” shuts off to allow the “doing brain” to take over.
As a result of this alarm system, people often experience intense emotional responses after a traumatic event. These responses are generally short-lived and most people eventually return to their usual level of functioning after the event. To cope with traumatic exposure, people often need time and support to process the event. During this time, any reminder of the event may lead to a reactivation or increase in their responses.
Some people are unable to recover from acute trauma in a timely way. As a result, they are more likely to develop an Acute Stress Disorder or Post-Traumatic Stress Disorder. The type, severity, and duration of exposure to traumatic stress will influence the course of recovery. The situation is compounded for children by their developmental stages.
What Are Childhood Developmental Stages?
As children grow and mature, they are faced with age-specific challenges they must master before moving along to the next stage.
At each developmental stage, a child is faced with different tasks that build upon one another: a toddler learns to explore his world; school-aged children are interested in making friends; an adolescent tries to separate and become more independent.
When faced with traumatic stress, a child’s energy is diverted and she has less capacity to master developmental challenges.
Most children rebound from traumatic experiences and continue to achieve expected developmental milestones. One of the crucial ways children are able to heal is with support from caregivers to make them feel safe, secure, and protected. The level of support a child receives from a caregiver is the most significant factor in how well a child fares after a traumatic event.
Children’s Developmental Stages
Early Childhood (0 – 5 years) The tables below outline primary developmental tasks and how they may be impacted by exposure to an acute traumatic stressor. These tables include developmental tasks from birth to age twelve, and are not inclusive of every developmental task that may occur.
Histrionic Personality Disorder Subtypes (As Suggested by Million)
| Subtypes of HPD | Description | Personality Qualities |
|---|---|---|
| Infantile HPD | includes borderline PD symptoms | Labile, high-strung, volatile emotions; childlike hysteria and nascent pouting; demanding, overwrought; fastens and clutches to another; is excessively attached, hangs on, stays fused to and clinging. |
| Vivacious Histrionic | The seductiveness of the histrionic mixed with the energy typical of hypomania. Some narcissistic features may also be present | Vigorous, charming, bubbly, brisk, spirited, flippant, impulsive; seeks momentary cheerfulness and playful adventures; animated, energetic, ebullient. |
| Tempestuous histrionic | Includes passive aggressive PD | Impulsive, out of control; moody complaints, sulking; precipitous emotion, stormy, impassioned, easily wrought-up, periodically inflamed, turbulent. |
| Appeasing histrionic | Includes compulsive and depended PD | Seeks to placate, mend, patch up, smooth over troubles; knack for settling differences, moderating tempers by yielding, compromising, conceding; sacrifices self for commendation; fruitlessly placates the unplacatable. |
| Disingenuous histrionic | HPD and antisocial PD | Underhanded, double-dealing, scheming, contriving, plotting, crafty, false-hearted; egocentric, insincere, deceitful, calculating, guileful. |
| Theatrical histrionic | Variant of “pure” pattern | Affected, mannered, put-on; postures are striking, eyecatching, graphic; markets self-appearance; is synthesized, stagy; simulates desirable/dramatic poses. |
| Personality Disorder | Co-Morbidity Odds Ratio |
|---|---|
| Dependent Personality Disorder | .70 |
| Paranoid Personality Disorder | 0.70 |
| Obsessive-Compulsive Personality Disorder | 0.63 |
| Schizoid Personality Disorder | 0.55 |
| Borderline Personality Disorder | 0.54 |
| Schizotypal Personality Disorder | 0.53 |
| Antisocial Personality Disorder | 0.05 |
What Is Complex Trauma in Children?
Children experience complex traumatic stress when they have had prolonged exposure to trauma, (as would occur if the child suffers regular physical or sexual abuse), experience multiple traumatic events over time, or when different traumatic events occur at the same time (such as separation from a parent or caregiver that’s followed by physical abuse, neglect).
Complex trauma profoundly impacts children’s physical, emotional, behavioral, and cognitive development. It impairs their ability to feel safe in the world and to develop sustaining relationships.
Traumatic experiences change the way the brain functions. According to Judith Herman: “Traumatic events produce profound and lasting changes in physiological arousal, emotion, cognition, and memory. Moreover, traumatic events may sever these normally integrated functions from one another.”
The brain’s alarm system prepares the body to respond to danger. The “thinking brain” assesses the situation to determine if there is danger or not.
For children who have experienced multiple traumatic events, such as physical abuse, sexual abuse, or witnessing domestic violence, this danger alarm goes off too often. When faced with repeated alarms, the “thinking brain” gets tired of checking things out, and assumes that the signal always means real danger, which causes the “thinking brain” to shut down and allows the “doing brain” take over.
False alarms or “triggers” can be set off when children hear, see, or feel something that reminds them of previous traumatic events. In the brains of children who have complex trauma, are trained to recognize these triggers, because in the past when they heard, saw, or felt that way, it meant they had to react quickly to a dangerous situation.Triggers can range from loud sounds such as sirens or yelling to smells, subtle facial expressions, or hand gestures. Triggers vary from child to child and are unique to each child’s experience
These triggers may not seem alarming to others, they don’t always seem to make sense to an outsider, including other children. Most of the time, children do not understand why they are acting this way.
Whatever the trigger, it sets off the alarm and the body “fuels” itself to prepare to deal with danger. When the danger is real, this response is helpful. When the body prepares, but there isn’t any danger, the child is left with pent up energy and no outlet. As a result, children may feel angry, want to fight, or hide in a corner to get far away from what their body perceives as danger.
How Does Complex Trauma Effect Children’s Developmental Milestones?
| Subtype | Features |
|---|---|
| Exploitable-Avoidant | Characterised by an inability to express anger towards others or to resist coercion from others. May be at risk for abuse by others. |
| Cold-Avoidant | Characterised by an inability to experience and express positive emotion towards others. |
| Mild Personality Disorder | Moderate Personality Disorder | Severe Personality Disorder |
|---|---|---|
| Disturbances affect some areas of personality functioning but not others (such as: problems with self-direction in the absence of problems with stability and coherence of identity or self-worth and may not be apparent in some contexts. | Disturbances affect multiple parts of personality functioning (examples are identity or sense of self, ability to form intimate relationships, ability to control impulses and modulate behavior. However, some areas of personality functioning may be relatively less affected. | There are severe disturbances in functioning of the self (such that their sense of self may be so unstable that people state they do not have a sense of who they are and/or so rigid that they refuse to participate in any but an extremely narrow range of situations. The internal self may be characterized by self-contempt and/or be grandiose or highly eccentric. |
| There are problems in many interpersonal relationships and/or in performance of expected occupational and social roles, but some relationships are maintained and/or some roles carried out. | There are marked problems in most interpersonal relationships and the performance of most expected social and occupational roles are compromised to some degree. Relationships are likely to be characterized by conflict, avoidance, withdrawal, or extreme dependency (e.g., few friendships maintained, persistent conflict in work relationships and consequent occupational problems, romantic relationships characterized by serious disruption or inappropriate submissiveness). | Problems in interpersonal functioning seriously affect virtually all relationships and the ability and willingness to perform expected social and occupational roles is absent or severely compromised. |
| Specific manifestations of personality disturbances are generally of mild severity | Specific manifestations of personality disturbance are generally of moderate severity | Specific manifestations of personality disturbance are severe and affects most, if not all, areas of personality functioning. |
| Is typically not associated with substantial harm to self or others. | Is sometimes associated with harm to self or others. | Is often associated with harm to self or others. |
| May be associated with substantial distress or with impairment in personal, family, social, educational, occupational or other important areas of functioning that is either limited to circumscribed areas (e.g., romantic relationships; employment) or present in more areas but milder. | Is associated with marked impairment in personal, family, social, educational, occupational or other important areas of functioning, although functioning in circumscribed areas may be maintained. | Is associated with severe impairment in all or nearly all areas of life, including personal, family, social, educational, occupational, and other important areas of functioning. |
Attachment and Complex Trauma In Children
Attachment is the long-enduring, emotional bond between a child and a primary caregiver, as their caregiver serves as the child’s source of safety, provides for the child’s needs, and guides them in understanding themselves and others. In turn, the child meets the caregiver’s need to provide nourishment and guidance. This is a natural and automatic process that begins from the moment a child is born and a caregiver looks into the infant’s eyes.
Healthy attachments provide the building blocks for later relationships and a child’s ability to master developmental tasks by:
Regulating Emotions And Self-Soothing: A child learns how to calm down when a caregiver uses soothing techniques such as rocking, holding, and cooing. Over time, the child learns how to calm down by himself.
Developing Trust In Others: When the caregiver and child are attuned to each other, the caregiver knows how to respond to the child’s needs and the child learns that he can depend on others, which leaves the child with a sense the world is predictable and safe.
Encouraging Children To Freely Explore Their Environment: As the child has already learned that they can rely on others, they feels safe to explore the world knowing that someone will be there if they are in distress or needs help. This exploration is the way children learn.
Helping Children Understand Themselves And Others: The caregiver-child relationship provides the child with a model for understanding who she is, who the caregiver is, and how the world works. Because the caregiver responds, the world is seen as a safe place where people can be trusted and depended upon.
Teaching Children That They Can Have An Impact On Their World: Through interactions with the caregiver, the child learns that he has an impact on others. The child smiles and the caregiver smiles back; the child laughs and the caregiver plays with her; the child cries and the caregiver picks her up.
This natural process of attachment may be eroded by complex trauma in various ways:
- The caregiver may be the source of the trauma.
- The availability, reliability, or predictability of the caregiver may be limited.
- The child may not learn to regulate his emotions or calm himself down when experiencing intense emotions.
- The child’s ability to learn by exploring the world may take a back seat to the child’s need for protection and safety.
- The child begins to see the world as dangerous, leading to a sense of vulnerability and distrust of others.
As the child has little sense of her impact on others, their lack of control over her life leads to a sense of hopelessness and helplessness.
Coping With Acute And Complex Traumatic Stress in Children:
Suddenly losing a loved one or being involved in a natural disaster, motor vehicle accident, plane crash, or violent attack can be overwhelmingly stressful for children. A traumatic event can undermine their sense of security, leaving them feeling helpless and vulnerable, especially if the event stemmed from an act of violence, such as a physical assault, mass shooting, or terrorist attack. Even kids or teens not directly affected by a disaster can become traumatized when repeatedly exposed to horrific images of the event on the news or social media.Whatever the age of your child, it’s important to offer extra reassurance and support following a traumatic event.
A child’s reaction to a disaster or trauma can be greatly influenced by their parents’ response, so it’s important to educate yourself about trauma and traumatic stress. The more you know about the symptoms, effects, and treatment options, the better equipped you’ll be to help your child recover. With your love and support, the unsettling thoughts and feelings of traumatic stress can start to fade and your child’s life can return to normal in the days or weeks following the event.
When caring for a child who has recently experienced an acute traumatic event, it is helpful to think about meeting the child’s needs for safety, stabilization, and support.
Safety
Acute traumatic experiences challenge children’s idea that the world is a safe and predictable place. When scary things happen, children rely on caregivers to keep them safe. These are some of the ways you can help children feel safe:
Help the child find safe places to go when they’re feeling overwhelmed. At school, perhaps a safe place is in the reading corner, where the child can sit comfortably, look at books, or listen to music until they feel calm again. Perhaps it’s the guidance counselor’s office, the nurses office, or an area of the room separate from the main activities of the class. Ask the child what would make them feel safe when they’re feeling afraid, overwhelmed, or sad. Make sure if the child shows signs of acute traumatic stress (acting up, crying, withdrawing) that you ask the child if they would want to go to the safe place to calm down.
Find safe people for the child to talk with when they feel overwhelmed, asking the child who they feel comfortable being with when they’re upset. Reduce unnecessary secondary exposures and separations.
Routines can be a lifesaver. Tell children what to expect throughout the day, leading them to understand when the routine changes, always helps children feel comforted and secure.
It’s important to note that these children need to feel safe everywhere they go. Some children may feel safe in the classroom, but become overwhelmed in other environments. Helping children throughout the day and beyond the classroom may require communicating with other school personnel about how to accomplish this.
Be aware of Mandated Reporter laws. Many caregivers are required to report suspected abuse to child welfare authorities. Be aware of the laws in your state and work with your team to determine when you should file a report to protect a child.
Stabilization
Children who have been traumatized require stabilization to provide a sense of predictability, consistency, and safety – the very things that are lost when a traumatic event occurs. Stabilization allows children to process their experience and be able to move on.
Create a routine. Structure and predictability help children feel safe and secure.
- Start and end each day in the same way.
- Write down a schedule to be posted next to the child’s bed, on a classroom bulletin board, or at the child’s desk.
- Provide support so that the child and family feel safe and secure
- Help the child to return to typical routines (such as school) as soon as possible
Create a support system for the child; when children are supported by the people around them, their feelings of distress often decrease.
- Maintain a connection with children’s support network. Teachers and primary caregivers should communicate consistently with each other.
- A support system can include a child’s teachers, primary caregivers, as well as family members, guidance counselor, friends/peers, clergy, pediatrician, and neighbors.
- Advocate a supportive role by caregivers and others
- Maintain healthy relationships with the child’s primary caregivers and other close relatives/friends
- Create a supportive milieu for the spectrum of reactions and different courses of recovery
- Encourage and support help-seeking behaviors
Ensure the child’s physical needs are met. Traumatic experiences often affect physical health and emotional health.
- During acute stress following trauma, children may experience headaches, stomach aches, and muscle aches. Determine first if there is a medical cause for these symptoms. If none are found, provide comfort and reassure the child that these feelings happen to many children after a traumatic event. Be matter-of-fact with the child and beware that non-medical complaints too much attention may increase them.
- At home, be sure children sleep nine to ten hours a night, eat well, drink plenty of water, and get regular exercise.
- At school, be sure children drink plenty of water, have a well-balanced lunch, and get exercise during the school day.
Recognize “triggers.”
Triggers are events/reminders/cues that cause children to become upset again (such as rain or thunder for children who experienced a hurricane). These reminders may seem harmless to other people, but they can be devastating to survivors. These triggers will vary from child to child.
- If a child becomes upset, it may be helpful to explain the difference between the event and reminders of the event.
- Protect children from reminders of the event as much as you can, particularly media coverage.
- Avoid secondary trauma by reducing the child’s exposure
Provide clear and honest answers.
- Be sure children understand the words you use. Find out what other explanations children have heard about the event and clarify inaccurate information. If the danger is far away, be sure to tell the child that it is not nearby. Avoid details that will scare the child.
- Use developmentally appropriately terms when talking about the event and the trauma
Practice relaxation techniques
Deep breathing, listening to soothing music, and muscle relaxation will help children relieve some of their stress.
Children may have trouble sleeping.
- Young children may be scared to be away from their caregivers, particularly at bed or nap times. Reassure the child that she is safe. Spend extra quiet time together at bed or nap time.
- Let the child sleep with a dim light on. Some young children may not understand the difference between dreams and real life, and will need reassurance and help in making this distinction.
- School age children may have sleeping problems due to nightmares. Ask the child to tell you about the bad dreams. Explain that many children have bad dreams after a traumatic event and the dreams will go away.
Self-Care is key
- It is important that caregivers take care of themselves.
- Dealing with traumatized children may trigger intense and difficult feelings in caregivers, leaving them feeling depleted and exhausted.
Minimize media impact:
Children who’ve experienced a traumatic event can often find relentless media coverage to be further traumatizing. Excessive exposure to images of a disturbing event—such as repeatedly viewing video clips on social media or news sites—can even create traumatic stress in children or teens who were not directly affected by the event.
- As much as you can, watch news reports of the traumatic event with your child. You can reassure your child as you’re watching and help place information in context.
- Limit your child’s media exposure to the traumatic event. Don’t let your child watch the news or check social media just before bed, and make use of parental controls on the TV, computer, and tablet to prevent your child from repeatedly viewing disturbing footage.
- Avoid exposing your child to graphic images and videos. It’s often less traumatizing for a child or teen to read the newspaper rather than watch television coverage or view video clips of the event.
Engagement:
You can’t force your child to recover from traumatic stress, but you can play a major role in the healing process by simply spending time together and talking face to face, free from TV, games, and other distractions. Do your best to create an environment where your kids feel safe to communicate what they’re feeling and to ask questions.
- Provide your child with ongoing opportunities to talk about what they went through or what they’re seeing in the media. Encourage them to ask questions and express their concerns but don’t force them to talk.
- Young children may have trouble expressing their feelings. Encourage them to put their feelings into words, such as anger, sadness, and worry about the safety of friends and family. Don’t force them to talk, but let them know that they can at any time.
- School age children may have concerns that they were to blame or should have been able to change what happened, and may hesitate to voice these concerns to others. Provide a safe place for them to express their fears, anger, sadness. Remind them that they can cry or be sad. Don’t expect them to be brave or tough. Offer reassurance and explain why it wasn’t their fault.
- Facilitate open but not forced communication with the child about his/her reactions to the traumatic event
- Focus on constructive responses
- Talk to child in developmentally appropriate terms
- Acknowledge and validate your child’s concerns. The traumatic event may bring up unrelated fears and issues in your child. Comfort for your child comes from feeling understood and accepted by you, so acknowledge their fears even if they don’t seem relevant to you.
- Young children may not have the words to express their fears, but may be able to process their emotions through play and drawing.
- School age children may retell or play out the traumatic event repeatedly. Allow the child to talk and act out these reactions. Let them know that many children respond to events like this in similar ways. Encourage positive problem-solving in play or drawings.
- Encourage children to write or draw. Suggest to children that they write about or make drawings of their experiences without forcing them to do so.
- Engage in positive distracting activities such as playing sports, games, reading, and hobbies
- Reassure your child. The event was not their fault, you love them, and it’s OK for them to feel upset, angry, or scared.
- Don’t pressure your child into talking. It can be very difficult for some kids to talk about a traumatic experience. A young child may find it easier to draw a picture illustrating their feelings rather than talk about them. You can then talk with your child about what they’ve drawn.
- Be honest. While you should tailor the information you share according to your child’s age, honesty is important. Don’t say nothing’s wrong if something is wrong.
- Do “normal” activities with your child that have nothing to do with the traumatic event. Encourage your child to seek out friends and pursue games, sports, and hobbies that they enjoyed before the incident. Go on family outings to the park or beach, enjoy a games night, or watch a funny or uplifting movie together.
Encourage physical activity:
Physical activity can burn off adrenaline, release mood-enhancing endorphins, and help your child sleep better at night.
- Find a sport that your child enjoys. Activities such as basketball, soccer, running, martial arts, or swimming that require moving both the arms and legs can help rouse your child’s nervous system from that “stuck” feeling that often follows a traumatic experience.
- Offer to participate in sports, games, or physical activities with your child. If they seem resistant to get off the couch, play some of their favorite music and dance together. Once a child gets moving, they’ll start to feel more energetic.
- Encourage your child to go outside to play with friends or a pet and blow off steam.
- Schedule a family outing to a hiking trail, swimming pool, or park.
- Take younger children to a playground, activity center, or arrange play dates.
Eat Well:
The food your child eats can have a profound impact on their mood and ability to cope with traumatic stress. Processed and convenience food, refined carbohydrates, and sugary drinks and snacks can create mood swings and worsen symptoms of traumatic stress. Conversely, eating plenty of fresh fruit and vegetables, high-quality protein, and healthy fats, especially omega-3 fatty acids, can help your child better cope with the ups and downs that follow a disturbing experience.
- Focus on overall diet rather than specific foods. Kids should be eating whole, minimally processed food—food that is as close to its natural form as possible.
- Limit fried food, sweet desserts, sugary snacks and cereals, and refined flour. These can all exacerbate symptoms of traumatic stress in kids.
- Be a role model. The childhood impulse to imitate is strong so don’t ask your child to eat vegetables while you gorge on soda and French fries.
- Cook more meals at home. Restaurant and takeout meals have more added sugar and unhealthy fat so cooking at home can have a huge impact on your kids’ health. If you make large batches, cooking just a few times can be enough to feed your family for the whole week.
- Make mealtimes about more than just food. Gathering the family around a table for a meal is an ideal opportunity to talk and listen to your child without the distraction of TV, phones, or computers.
Rebuilding trust and safety:
Trauma can alter the way a child sees the world, making it suddenly seem a much more dangerous and frightening place. Your child may find it more difficult to trust both their environment and other people. You can help by rebuilding your child’s sense of safety and security.
As children look to their caregivers to provide safety and security. Try not to voice your own fears in front of the child. Remind the child that people are working to keep them safe. Help the child regain confidence that you aren’t leaving him and that you can protect him.
The child may need on-going support long after the traumatic experience has occurred.
- Create routines. Establishing a predictable structure and schedule to your child’s or teen’s life can help to make the world seem more stable again. Try to maintain regular times for meals, homework, and family activities.
- Minimize stress at home. Try to make sure your child has space and time for rest, play, and fun.
- Manage your own stress. The more calm, relaxed, and focused you are, the better you’ll be able to help your child.
- Speak of the future and make plans. This can help counteract the common feeling among traumatized children that the future is scary, bleak, and unpredictable.
- Keep your promises. You can help to rebuild your child’s trust by being trustworthy. Be consistent and follow through on what you say you’re going to do.
- If you don’t know the answer to a question, don’t be afraid to admit it. Don’t jeopardize your child’s trust in you by making something up.
- Remember that children often personalize situations. They may worry about their own safety even if the traumatic event occurred far away. Reassure your child and help place the situation in context.
When Do I Seek Help For Childhood Traumatic Stress?
Usually, your child’s feelings of anxiety, numbness, confusion, guilt, and despair following a traumatic event will start to fade within a relatively short time. However, if the traumatic stress reaction is so intense and persistent that it’s interfering with your child’s ability to function at school or home, they may need help from a doctor, preferably a trauma specialist.
Warning signs include:
- Six weeks have passed, and your child is not feeling any better
- Your child is having trouble functioning at school
- Your child is experiencing terrifying memories, nightmares, or flashbacks
- The symptoms of traumatic stress manifest as physical complaints such as headaches, stomach pains, or sleep disturbances
- Your child is having an increasingly difficult time relating to friends and family
- Your child or teen is experiencing suicidal thoughts
- Your child is avoiding more and more things that remind them of the traumatic event
How Is Childhood Traumatic Stress Treated?
Immediate support for a child who has experienced trauma can help prevent many of the negative consequences. In some cases, the nurturing and support of parents and other family or caregivers is enough to avoid long-term harm. For those children who need professional care, mental health professionals may use cognitive behavioral therapy or trauma-focused therapies to help them learn to cope in healthy ways.
Cognitive-behavioral therapies are still the leading choice by most therapists, especially as the available research tends to be far stronger than research looking at psychoanalytic or purely medication-based treatment, which doesn’t address the underlying issues related to the trauma.
Although there are other CBT approaches that are used to treat trauma in children and adolescents including exposure therapy, art therapy and EMDR, a CBT-type approaches seem to work best for dealing with post-traumatic symptoms. All CBT methods that have been developed specifically for younger clients, there are some common features:
- Education to teach children about traumatic stress and the effects it can have on them
- Relaxation techniques
- A trauma narrative that encourages children to describe their experience in detail
- Cognitive restructuring to correct thoughts about the traumatic experience.
For all of the recognized CBT approaches for treating traumatized children, it is vital that children be encouraged to face their traumatic experience gradually and only in a way that they can handle emotionally. Since all children do not develop emotionally at the same pace, a therapist must tailor the treatment to the child’s level of emotional and cognitive development. If not, the therapist could end up doing more harm than good by re-traumatizing and re-exposing their child patients.
While CBT was first developed for trauma in adults and later adapted to adolescents, the special needs that adolescent trauma patients have has inspired the development of treatment methods focusing on children and adolescents alone. These treatment approaches include:
Multi-modality trauma treatment (MMTT) – was developed in 1998, MMTT is based on the idea that trauma at a young age can disrupt normal physical and emotional development and uses age-appropriate CBT strategies to help children or adolescents cope with trauma. Usually seen in school settings, these programs have a format that can include education, narrative writing (writing about the traumatic experience), exposure, relaxation techniques, and cognitive restructuring. Empirical studies of MMTT have shown marked reduction in trauma symptoms with similar results for symptoms of depression, anger and anxiety. The advantage of using this type of therapy is that it was specifically developed for traumatized adolescents; however the nature of this therapy tends to focus on adolescents who have experienced only one traumatic event, but may be used in children who have experience many different traumas.
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) – developed in 2006, this type of treatment was developed specifically for children between the ages of three and eighteen who have experienced trauma. Treatment using TF-CBT can include a number of sessions involving the child alone or the child and a parent/caregiver. The goal of this type of therapy is to help children and adolescents learn coping skills that will help them deal with traumatic memories. In treatment, children receive education, are taught relaxation skills, as well as affective expression and modulation, and cognitive coping skills. Children are also encouraged to use trauma narration and to cognitively process the trauma, use exposure to master trauma reminders, have parent/child sessions, and increase their feelings of safety.
Stanford Cue-Centered Therapy (SCCT) – Developed Stanford School of Medicine’s Early Life Stress Research Program, this is a short-term treatment approach that uses one-on-one therapy for children and adolescents dealing with trauma. It was created to treat problems with a child’s cognitive, affective, behavioral, and physical functioning, and uses cognitive-behavioral techniques, relaxation training, narrative use, and parental coaching. The goal of this type of therapy is to reduce the child’s negative thoughts and beliefs as well as sensitivity to traumatic memory. This form of therapy encourages children to build coping skills including relaxation and self-empowerment, and helps children to learn how trauma affects them, while teaching them that they are able to control how they respond to traumatic triggers.
Seeking Safety was developed for use with substance abuse and trauma in adults and adolescents, Seeking Safety was specifically adapted for treating adolescents and, like the other treatment models, uses education, training in specific coping skills, and cognitive restructuring. Parental involvement is only needed in one Seeking Safety session.
Seeking Safety has five principles:
- Personal safety is a priority
- Integrated trauma and substance abuse therapy
- Focusing upon the child’s needs
- Attention to the therapeutic process
- Focuses on thoughts, behaviors, interpersonal interactions, as well as case management.
Tips For Caregivers Of Children Who Have Acute And Complex Trauma:
Caring for children after a traumatic event is incredibly stressful. Caregivers or parents work to make sure their children’s needs are met, which can be draining and rewarding at the same time. Many caregivers report that they become extremely frustrated with the things they cannot control.
To understand self-care, you must understand what self-care is not:
- Self-care is not an “emergency response plan” to be activated when stress becomes overwhelming.
- Self-care is not about acting selfishly (“It’s all about me!”).
- Self-care is not about doing more or adding more tasks to an already overflowing “to-do” list. Healthy self-care can renew our spirits and help us to become more resilient.
- Self-care is most effective when approached proactively, not reactively.
Think of self-care as having three basic aspects: awareness, balance, and connection — the “ABC’s” of self-care.
Awareness:
Self-care begins while being quiet. By quieting our busy lives and entering into a space of solitude, we can become awareness of our own needs, then act accordingly. This is the contemplative way of the desert, rather than the constant activity of the city. Too often we act first, without real understanding, then wonder why we feel more burdened rather than relieved.
Balance:
Self-care is a balancing act between action and mindfulness. Balance guides decisions about embracing or relinquishing certain activities, behaviors, or attitudes. It also informs the degree to which we give attention to the physical, emotional, psychological, spiritual, and social aspects of our being. In other words, how much time we spend working, playing, and resting. Think of this healthy prescription for balanced daily living: eight hours of work, eight hours of play, and eight hours of rest!
Connection:
Healthy self-care cannot take place solely within oneself. It involves being connected in meaningful ways with others and to something larger. We are interdependent and social beings. We grow and thrive through connections that occur in friendships, family, social groups, nature, recreational activities, spiritual practices, therapy, and a myriad of other ways.
There is no formula for self-care. Each of our “self-care plans” will be unique and change over time. As we seek renewal in our lives and work, we must listen well to our own bodies, hearts, and minds as well as to trusted friends. Caregivers should rely on other adults and support systems (such as a support group or church) to help meet their own emotional needs so they will have enough energy to support a child who is stressed.
Hotlines For Childhood Trauma:
Childhelp National Child Abuse Hotline
800-4-A-CHILD (800-422-4453)
The mission of the Childhelp hotline is to provide help or answer questions about child abuse or neglect 24 hours a day.
FEMA Disaster Aid Hotline
800-621-FEMA
This hotline is available to provide direct and financial assistance to individuals, families, and businesses in an area whose property has been damaged or destroyed by disaster.
National Center for Missing and Exploited Children
800-THE-LOST (800-843-5678)
The mission of the National Center for Missing and Exploited Children is to help prevent child abduction and sexual exploitation; provide assistance with finding missing children; and assist victims of child abduction and sexual exploitation, their families, and the professionals who serve them 24 hours a day.
Center For Victims of Crimes
800-FYI-CALL (800-394-2255)
The National Center for Victims of Crime provides information, education, and referrals to local resources across the country. The hotline is available Monday through Friday from 8:30 am to 8:30 pm and is offered in numerous languages.
National Domestic Violence Hotline
800-799-SAFE (800-799-7233) and 800-787-3224 (TDD)
The mission of the National Domestic Violence Hotline is to provide crisis intervention, safety planning, information, and referrals for individuals experiencing domestic violence. The hotline is available 24 hours a day, and assistance is offered in numerous languages.
Mental Health America
800-969-6MHA (6642)
The mission of MHA is to promote mental wellness for the health and well-being of the nation. MHA offers information and resources on numerous mental health topics.
National Organization for Victim Assistance
800-TRY-NOVA (800-879-6682)
NOVA’s mission is to promote rights and services for victims of crime and crisis. The hotline provides information and referrals and is available 24 hours a day.
Homelessness Resource Center
617-467-6014
The Center is focused on the effective organization and delivery of services for people who are homeless and who have serious mental illnesses by providing technical assistance and training.
National Sexual Assault Hotline
800-656-HOPE (800-656-4673)
This hotline is operated by the Rape, Abuse & Incest National Network (RAINN), which also carries out programs to help prevent sexual assault, assist victims, and ensure that perpetrators are brought to justice.
National Suicide Prevention Lifeline
800-273-TALK (800-273-8255)
This suicide prevention service is available to anyone in suicidal crisis and is available 24/7.
National Teen Dating Abuse Helpline
866-331-9474 and 866-331-8453 (TTY)
This hotline was created to help teens ages 13-18 that experience dating abuse and it is available 24/7.
SAMHSA’s National Clearinghouse for Alcohol and Drug Information
800-729-6686
The Clearinghouse is a one-stop resource for information about substance abuse prevention and addiction treatment.
SAMHSA’s Substance Abuse Treatment Facility Locator
800-662-HELP (4357); 800-487-4889 (TDD); 877-767-8432 (Español)
A searchable directory of drug and alcohol treatment programs that shows the location of facilities around the country that treat alcoholism, alcohol abuse, and drug abuse problems.
Witness Justice
800-4WJ-HELP (800-495-4357)
Witness Justice is a national grassroots organization that provides assistance, support, and advocacy for survivors of violence and trauma.
Additional Childhood Traumatic Stress Resources:
Center For Trauma, Assessment, Intervention Services, and Treatment: The purpose of our Center is to provide national expertise on interventions for the developmental effects of trauma across child-serving settings, including child welfare, behavioral health, educational and juvenile justice settings.
Child Mind Institute offers Free Trauma Resources in a number of languages, all of which can be used to help the child recover from the trauma and heal the family as well.
Child Welfare.Org offers a number of free programs for children and their families who are coping with different types of trauma.
Substance Abuse and Mental Health Services Administration: This US government site helps to identify a number of different types of trauma, including reading on military families, substance abuse, for families, and for educators.