Navigating the Labyrinth of Diagnosing PTSD in Teens and Young Adults

Dr. Wesley Sassaman, DNP, MSN-NE, MPH, MBA, FNP-C, CARN-AP

The diagnosis of PTSD in adolescents and young adults is a multifaceted process that involves considering diagnostic criteria, treatment methods, and individual patient characteristics. Therapists rely on recognized diagnostic guidelines like the DSM-5 and ICD-11 to detect PTSD symptoms, which can vary greatly from person to person. This process is further complicated by the presence of other conditions and the specific difficulties encountered by certain groups, such as young people in care or individuals with chronic illnesses. Through this blog post, I aim to assist parents in understanding the diagnostic procedures used by mental health professionals, the treatments they employ, and the challenges associated with diagnosing PTSD in this particular patient demographic.

Diagnostic Criteria and Challenges

Supporting parents in understanding their child's mental health is essential, especially when it comes to diagnosing post-traumatic stress disorder (PTSD) in young people. It's important to know that there are two main frameworks used by mental health professionals to diagnose PTSD: the DSM-5 and the ICD-11.

DSM-5 vs. ICD-11 in Diagnosing PTSD

The DSM-5 framework tends to identify PTSD in more young people than the ICD-11. This happens because the DSM-5 includes a wider range of symptoms that professionals look for when diagnosing PTSD. This broader spectrum can sometimes mean that children diagnosed using the DSM-5 might also have other conditions like depression and anxiety (Dodd et al., 2024).
On the other hand, the ICD-11 has a slightly different approach. However, there's something called the ICD-11+ criteria, which adds more symptoms related to reexperiencing traumatic events. This updated version seems to align more closely with the DSM-5. This alignment suggests that there might be ways to improve how we diagnose PTSD, making it more accurate and helpful for young people and their families (Dodd et al., 2024).

Understanding these differences and challenges can empower you as a parent to engage in informed discussions with healthcare providers about your child's mental health and the best ways to support their well-being.

A Deeper Look into the Specific Criteria

Understanding how PTSD is diagnosed in young people can be a crucial step in supporting your child's mental health. Let's explore the key criteria used by professionals, as outlined by the DSM-5 and ICD-11, which are two widely used diagnostic frameworks.

Exposure to a Traumatic Event

DSM-5: Symptoms must persist for at least one month after the traumatic event. This helps distinguish PTSD from acute stress disorder, which occurs within the first month following trauma.
ICD-11: Symptoms must persist for several weeks, though it doesn't specify an exact duration like DSM-5. The focus is on the presence of symptoms that cause significant impairment in functioning.

Re-experiencing Symptoms

DSM-5: These symptoms might manifest as recurrent, involuntary distressing memories, nightmares, flashbacks, intense emotional distress, or physical reactions.
ICD-11: Includes intrusive memories, nightmares, and flashbacks, along with intense emotional distress.

Avoidance

DSM-5: Identifies avoidance behaviors related to reminders of the traumatic event, which can include avoiding people, places, conversations, or activities.
ICD-11: Includes the avoidance of thoughts and feelings related to the trauma.

Arousal and Reactive Symptoms

Both frameworks recognize symptoms such as hypervigilance, irritability, difficulty concentrating, exaggerated startle response, and sleep disturbances as part of PTSD.

Duration of Symptoms

DSM-5: Requires symptoms to last for more than one month to diagnose PTSD.
ICD-11: Requires a duration of several weeks.

By understanding these criteria, you can better engage with healthcare providers to discuss your child's experiences and ensure they receive the appropriate care and support.

Memory Aid to Help Remember the Criteria

To help parents remember the five key criteria for diagnosing PTSD in youth, you can use the acronym "EARAD":

E for Exposure to a traumatic event
A for Avoidance of reminders and thoughts related to the trauma
R for Re-experiencing symptoms like memories and flashbacks
A for Arousal and reactive symptoms such as hypervigilance
D for Duration of symptoms (more than one month for DSM-5, several weeks for ICD-11)

Clinician's Assessment of an 18-Year-Old Girl Using DSM-5 and ICD-11

Encountering a traumatic incident can deeply impact young individuals, and it is vital to acknowledge these effects to offer effective assistance and support. Familiarizing oneself with the timelines linked to the diagnostic standards for Post-traumatic Stress Disorder (PTSD) can enable parents to take prompt action.

Meet Sara: An Actual Scenario

Undergoing a traumatic event can have long-lasting repercussions on young individuals. Utilizing the "EARAD" acronym can assist parents in recalling and recognizing the criteria for diagnosing Post-traumatic Stress Disorder (PTSD) in youth. Let's delve into how these criteria relate to Sara's narrative.

E for Exposure to a Traumatic Event

Sara, an 18-year-old, was part of a tragic car accident where her friend lost their life. This traumatic exposure serves as the initial and critical phase in comprehending her PTSD symptoms.

A for Avoidance of Reminders and Thoughts

Following the accident, Sara started avoiding anything associated with the incident. She stopped driving, evaded entering cars, and steered clear of discussions about the accident. This avoidance conduct is a pivotal component of PTSD, as Sara attempts to distance herself from distressing reminders.

R for Re-experiencing Symptoms

Sara frequently relives distressing memories and has nightmares about the accident. These re-experiencing symptoms have persisted for more than a month, meeting the DSM-5 requirement that symptoms endure beyond one month. It is crucial for parents to track these timelines, as the ICD-11 also recognizes such symptoms that emerge over several weeks, even if the precise duration is unspecified.

A for Arousal and Reactive Symptoms

Since the accident, Sara has become easily startled, experiences sleep difficulties, and displays heightened vigilance. These arousal and reactive symptoms, like hypervigilance and sleep disturbances, underscore the lasting impact of the trauma on her nervous system.

D for Duration of Symptoms

The duration of Sara's symptoms surpasses the one-month threshold established by the DSM-5, and the substantial presence of symptoms over several weeks aligns with the criteria delineated in ICD-11. This duration is crucial in distinguishing PTSD from transient stress reactions.

Seeking Professional Assistance

Recognizing these symptoms and their duration, Sara's mother, Linda, sought the aid of a mental health counselor. The counselor verified that Sara's encounters correspond to the PTSD criteria, emphasizing the significance of timely intervention.

Support and Rehabilitation

With professional guidance, Linda understood the significance of early intervention. As guardians, fostering a supportive and empathetic environment is essential in assisting children in managing their symptoms and progressing towards recovery.

Throughout the evaluation, the clinician elucidates each stage to the girl and her parents, ensuring their comprehension of how the criteria relate to her experiences. This method aids in establishing a clear and comprehensive diagnosis, effectively guiding the treatment plan.

PTSD and Complex PTSD Overlap

Post-Traumatic Stress Disorder (PTSD) and Complex Post-Traumatic Stress Disorder (CPTSD) are both trauma-related disorders, and it’s for parents to understand how they differ in their symptoms and clinical presentations. People dealing with PTSD frequently endure experiences like revisiting the distressing incident, avoiding triggers associated with it, and finding themselves in a constant state of vigilance, while individuals suffering from CPTSD not only encounter these challenges but also struggle more significantly with emotional regulation, suffering from a diminished self-worth, and the inability to foster healthy connections with others. Recognizing this distinction is vital for effective diagnosis and compassionate treatment.

Symptomatology and Diagnosis

PTSD Symptoms:

Re-experiencing the traumatic event
Avoidance of reminders
Negative alterations in cognition and mood
Hyperarousal

(Schnyder, 2024)

CPTSD Symptoms:

Disturbances in self-organization (DSO)
- Affect dysregulation
- Negative self-concept
- Interpersonal difficulties

(Bachem et al., 2024; Biscoe, New, & Murphy, 2024)

Prevalence and Population Differences

Prevalence:

Studies indicate that CPTSD may be more prevalent than PTSD in certain populations, such as military veterans, which is a crucial finding. This is likely due to the complex nature of trauma experienced by these groups, often involving repeated or prolonged exposure (Grinsill, Kolandaisamy, Kerr, Varker, & Khoo, 2024).

Military Populations:

Research shows a higher prevalence of CPTSD in military and veteran populations compared to PTSD, suggesting that the nature of military service can contribute to the development of more complex trauma responses (Grinsill, Kolandaisamy, Kerr, Varker, & Khoo, 2024).

Treatment Implications

Treatment Challenges:

Patients with CPTSD may not respond as effectively to standard PTSD treatments due to the added complexity of their symptoms. This highlights the importance of tailored therapeutic approaches that compassionately address both PTSD symptoms and disturbances in self-organization (Zepeda Méndez, Nijdam, ter Heide, van der Aa, & Olff, 2024; Biscoe, New, & Murphy, 2024).

Executive Function:

CPTSD is associated with greater impairments in executive function, which can understandably affect treatment outcomes. This emphasizes the need for interventions that also lovingly target cognitive and emotional regulation skills (Biscoe, New, & Murphy, 2024).

Although the separation between PTSD and CPTSD is apparent regarding symptoms and therapeutic approaches, acknowledging that both issues can greatly influence an individual's existence is vital. The complexity of CPTSD calls for a nuanced and understanding approach to diagnosis and treatment, emphasizing the need for specialized therapeutic strategies that address the broader range of symptoms with care and compassion.

The Lived Experience of PTSD in Teens and Young Adults

The lived experience of PTSD in teens and young adults is multifaceted, encompassing a range of psychological, social, and physiological challenges. This demographic often faces unique stressors and developmental considerations that influence the manifestation and impact of PTSD. The following sections I will help you, as parents , to explore various aspects of PTSD in young individuals, drawing insights from recent research.

Psychological and Emotional Impact

PTSD in young adults is often characterized by a range of symptoms including re-experiencing, hyperarousal, avoidance, and negative mood. These symptoms are significantly associated with sleep disturbances, which can exacerbate the severity of PTSD symptoms (Schenker, Cherian, Felmingham, & Jordan, 2024).

The experience of PTSD is also linked to adverse childhood experiences (ACEs), which increase the likelihood of depression, anxiety, and stress in young adults. Emotional abuse and bullying are particularly impactful, leading to poor mental health outcomes (Chaudhary, Walia, & Saraswathy, 2023)

In the context of mass violence incidents, young adults who have experienced such events may develop PTSD, with factors such as prior exposure to trauma and gender influencing the severity of symptoms (Moreland et al., 2024).

Social and Environmental Factors

Socioeconomic factors play a crucial role in the development and persistence of PTSD symptoms. Young adults with limited access to emotional and social support, particularly females and sexual minorities, are at higher risk of developing PTSD (Folayan et al., 2024).

Community trauma exposure, such as the sudden death of a relative or parental divorce, significantly impacts adolescents, leading to PTSD symptoms. The prevalence of PTSD in these contexts underscores the need for community-based psychological support (Yuan et al., 2023).

Coping Mechanisms and Resilience

Resilience and self-efficacy are critical in managing PTSD symptoms. Young adults who have grown up in challenging environments, such as with a mentally ill parent, often develop resilience as a coping mechanism, although they may still struggle with trust issues and mental health complications (Shestiperov et al., 2024).

The lived experience of grieving a significant loss, such as an intimate partner, can lead to PTSD-like symptoms. Supportive community environments and identity-restructuring activities can aid in coping and recovery (Economos, Kluemper, & Woods, 2023).

Academic and Developmental Challenges

PTSD symptoms can negatively affect academic performance, leading to academic burnout. This is particularly evident in post-disaster contexts, where PTSD symptoms are linked to depressive symptoms and academic challenges (Ying, Jia, & Lin, 2023).

The prevalence of complex PTSD (CPTSD) in adolescents suggests that this condition may be more common than previously thought, with significant implications for cognitive and emotional development (Chiu et al., 2023).

Broader Perspectives

While the research highlights the profound impact of PTSD on young individuals, it is important to consider the broader societal and cultural contexts that influence these experiences. For instance, the stigma surrounding mental health in certain cultures can hinder young adults from seeking help, exacerbating their symptoms (Al Omari et al., 2023). Additionally, the role of gender and socioeconomic status in shaping the experience of PTSD suggests that interventions need to be tailored to address these specific factors. Overall, understanding the lived experience of PTSD in teens and young adults requires a comprehensive approach that considers psychological, social, and cultural dimensions.

Conclusion

The complexities of PTSD, particularly in teens and young adults, underline the necessity for a tailored and compassionate approach to diagnosis and treatment. This demographic faces unique challenges shaped by their developmental stage and various psychological and social stressors, such as adverse childhood experiences and community trauma. The interplay between socioeconomic factors and mental health significantly influences the prevalence and severity of PTSD symptoms, highlighting the critical need for accessible support systems.

Furthermore, resilience and effective coping mechanisms play a key role in the management of PTSD, suggesting that fostering these attributes can empower young individuals in their recovery journey. Academic performance and developmental milestones are also impacted, necessitating interventions that integrate mental health support within educational frameworks. Ultimately, a multifaceted understanding of the lived experiences of these young people is essential for developing effective strategies that address and mitigate the effects of trauma, enabling them to thrive in their personal and academic lives.

As parents it is crucial to remain aware of these factors and provide necessary support and resources for those struggling with PTSD. By acknowledging the lived experience and its complexities, we can work towards creating a more compassionate and resilient environment for young individuals living with PTSD.

Note from Author

By exploring the diagnostic criteria, therapeutic approaches, and challenges in diagnosing PTSD in teens and young adults, I hope this Blog post has provided valuable insights for all parents, mental health professionals, and educators. For those looking to further their understanding and support young individuals, consider consulting with behavioral health professionals or joining support groups. The path to recovery is a collaborative effort, and together, we can make a significant difference in the lives of those affected by PTSD.

Reference

Al Omari, O., Amandu, G., Al-Adawi, S., Shebani, Z., Al Harthy, I., Obeidat, A., Al Dameery, K., Al Qadire, M., Al Hashmi, I., Al Khawldeh, A., AlBashtawy, M., & Aljezawi, M. (2023). The lived experience of Omani adolescents and young adults with mental illness: A qualitative study. PLOS ONE, 18.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
Bachem, R., Maercker, A., Levin, Y., Köhler, K., Willmund, G., Bohus, M., Koglin, S., Röepke, S., Schoofs, N., Priebe, K., Wülfing, F., Schmahl, C., Stadtmann, M. P., Rau, H., & Augsburger, M. (2024). Assessing complex PTSD and PTSD: Validation of the German version of the International Trauma Interview (ITI). European Journal of Psychotraumatology, 15(1).
Biscoe, N., New, E., & Murphy, D. (2024). Complex PTSD symptom clusters and executive function in UK Armed Forces veterans: A cross-sectional study. BMC Psychology, 12.
Chaudhary, V. K., Walia, G. K., & Saraswathy, K. N. (2023). Adverse childhood experiences in mental health of young adults: An exploratory study from Delhi-NCR, India. International Journal of Social Psychiatry.
Chiu, H. T. S., Alberici, A., Claxton, J., & Meiser-Stedman, R. (2023). The prevalence, latent structure, and psychosocial and cognitive correlates of complex post-traumatic stress disorder in an adolescent community sample. Journal of Affective Disorders.
Dodd, C. G., Kirk, C. L., Rathouz, P. J., Custer, J., Garrett, A. S., Taylor, L., Rousseau, J. F., Claasen, C., Morgan, M. M., Newport, D. J., Wagner, K. D., & Nemeroff, C. (2024). Comparing diagnostic criteria for posttraumatic stress disorder in a diverse sample of trauma-exposed youth. Journal of Traumatic Stress.
Economos, A. D., Kluemper, T., & Woods, R. (2023). The lived experiences of young adults grieving an intimate partner or spouse: A phenomenological pilot study. Death Studies, 1-9.
Folayan, M. O., Zuñiga, R. A. A., Ellakany, P., Yousaf, M. A., Osamika, B. E., Virtanen, J. I., Gaffar, B., Lawal, F. B., Khalid, Z., Aly, N. M., Lusher, J., & Nguyen, A. (2024). Socio-economic factors associated with post-traumatic stress symptoms among adolescents and young people during the first wave of the COVID-19 pandemic. Dental Science Reports, 14.
Grinsill, R., Kolandaisamy, M., Kerr, K., Varker, T., & Khoo, A. (2024). Prevalence of Complex Post-Traumatic Stress Disorder in Serving Military and Veteran Populations: A Systematic Review. Trauma, Violence, & Abuse, pp. 15248380241246996-15248380241246996.
Mordeno, I. G., & Luzano, J. G. C. (2023). Examining specific and non-specific symptoms of the best-fitting posttraumatic stress disorder model in conflict-exposed adolescents. BMC Psychology, 11.
Moreland, A. D., Rancher, C., Davies, F., Bottomley, J. S., Galea, S., Abba-Aji, M., Abdalla, S. M., Schmidt, M. G., Vena, J. E., & Kilpatrick, D. G. (2024). Posttraumatic stress disorder among adults in communities with mass violence incidents. JAMA Network Open, 7(7), e2423539-e2423539.
Schenker, M., Cherian, D., Felmingham, K., & Jordan, A. (2024). Associations between sleep disturbances and PTSD symptoms in young adults. Sleep.
Schnyder, U. (2024). Treating posttraumatic stress disorder: The complexities of the clinical realm. Psychotherapy and Psychosomatics, 1-5.
Shestiperov, A., Grinstein-Cohen, O., Lindell, D., Irani, E., & Kagan, I. (2024). Lived experiences: Growing up with a seriously mentally ill parent. Journal of Nursing Scholarship.
World Health Organization. (2018). International Classification of Diseases for Mortality and Morbidity Statistics (11th Revision). Retrieved from https://icd.who.int/browse11/l-m/en
Ying, L., Jia, X., & Lin, C. (2023). The longitudinal associations between PTSD symptoms, depressive symptoms, and academic burnout in adolescence and early adulthood in the postdisaster context. Acta Psychologica, 239, 104011-104011.
Yuan, T., Li, X.-D., Liu, H., Guo, L., Li, J., Xu, G., Li, X., Sun, L., Wang, C., Yang, L., Zhang, D., Hua, Y., Lei, Y., & Zhang, L. (2023). Community trauma exposure and post-traumatic stress disorder in Chinese children and adolescents. Frontiers in Psychiatry.
Zepeda Méndez, M., Nijdam, M. J., ter Heide, F. J. J., van der Aa, N., & Olff, M. (2024). Response of patients with complex forms of PTSD to highly intensive trauma treatment: A clinical cohort study. Psychological Trauma: Theory, Research, Practice, and Policy.