Complicated Kids: Teasing Out the Effects of Trauma From Mental Illness


When are trauma-related conditions in kids and teens unrelated to, or exacerbated by, mental health disorders?

Welcome to today's installment of our series, Trauma and Kids…A Primer for Pastors, Church Staff and Parents. Today, we’ll look at some of the challenges clinicians face in separating the effects of trauma from the signs and symptoms of mental illness in children and teens.

One of the challenges we face in treating kids with trauma is sorting out the extent to which the symptoms leading to referral are trauma-related, or associated with some other mental health disorder in which the symptoms are totally unrelated to the trauma.

Kids with trauma histories frequently present with marked dysregulation of affect, mood and behavior…not surprising, when one considers the impact of trauma on brain development discussed earlier in this series. Children of parents with chronic mental illness are more likely to live in the types of chronically dysfunctional environments in which traumatic events are more likely to occur.

Some of the conditions that can mimic symptoms associated with trauma/PTSD include…

  • ADHD: Kids will often present with agitation, restlessness, decreased concentration, hyperactivity, hyperarousal and difficulty with sleep.
  • Oppositional Defiant Disorder: Some kids may manifest PTSD primarily through angry outbursts and/or irritability.
  • Panic Disorder: Kids and teens can manifest symptoms that mimic panic attacks when they encounter reminders that trigger distressing memories of traumatic events.
  • Social Anxiety Disorder: avoidance and social withdrawal are common coping mechanisms among children and teens who have experienced trauma.
  • Depression: Affective numbing associated with trauma, in conjunction with sleep disturbances, avoidance of people, self-injurious behavior can frequently be misdiagnosed as depression.
  • Bipolar Disorder/Disruptive Mood Dysregulation Disorder: Irritability and mood lability in in kids following traumatic events, in addition to hypersexualized behavior in kids exposed to sexual trauma may lead to a misdiagnosis of a mood disorder.

There was some discussion around the development of the DSM-5 regarding a condition referred to as chronic PTSD in kids and teens with exposure to early, severe or interpersonal trauma…or complex PTSD…a condition occurring in conjunction with other DSM conditions.

I find it helpful when kids appear to manifest symptoms of other psychiatric disorders following a traumatic event(s) to ascertain whether the. symptoms of other mental health disorders preceded the trauma. When possible, we would seek to treat the comorbid conditions in an integrated manner that helps “kill two birds with one stone.”

Dr. Steve Grcevich is a physician specializing in child and adolescent psychiatry who serves as President and Founder of Key Ministry. He blogs at church4everychild.org and may be reached at steve@keyministry.org.


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Are They Really Depressed, Or Do They Have Something Else?
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Are the Medications Prescribed to Kids & Teens with Mental Illness Safe?
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Cognitive-Behavioral Therapy for Kids with Depression: Pros and Cons
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