Traumatic stress symptoms - what to look for

Most health care providers are familiar with ways that children and family members may show stress. Traumatic stress reactions go beyond usual stress reactions, and can be triggered by thoughts about the traumatic event, or by reminders in the immediate environment.


Traumatic stress symptoms –what to look for
  • Thinking a lot about the illness, injury, or procedure (unwanted, intrusive thoughts)
  • Feeling distressed at thoughts or reminders of it
  • Having nightmares and "flashbacks"
Examples of Re-experiencing Symptoms
  • Intrusive thoughts / memories: "The image of my son getting a spinal tap frequently pops into my mind."
  • Feeling the event is recurring: "At least once a day, I have a flashback to the accident. It's like it's happening all over again."
  • Distress at reminders: "To this day, I still can't stand the antiseptic smell of hospitals" OR "My heart races every time I hear a siren."
  • Distressing dreams: "The other day I dreamed that I was in the woods lost, and the doctors and nurses were hiding behind some trees."


Traumatic stress symptoms – what to look for
  • Avoiding thinking or talking about the illness, injury, or hospital experience, or things associated with it
  • Avoiding places or activities that are reminders of the illness/ injury/ hospital experience
Examples of Avoidance Symptoms
  • Avoidance thinking: "I block it out, try not to think about when I was in the hospital."
  • Avoidance of places/activities: "I try to stay away from things that remind me of the time I was sick."


Traumatic stress symptoms – what to look for
  • Increased irritability
  • Trouble concentrating or sleeping
  • Exaggerated startle response
  • "Hypervigilance" - always expecting danger
Examples of Hyper-arousal Symptoms
  • Hypervigilance: "I know the doctors say we are in the clear, but I take my daughter's temperature every day. I am always afraid something bad will happen."
  • Exaggerated Startle: "I jump at any loud noise."
  • Difficulty Sleeping / Concentrating: "At night, it takes me more than an hour to fall asleep. During the day, it's just impossible to keep my mind on things."

Other reactions

Examples of Other Traumatic Stress Symptoms
  • New fears related to the medical event
  • New somatic complaints (bellyaches, headaches) not explained by medical condition
  • Dissociation: Feeling in a daze or "spacey"
Examples of Traumatic Stress Symptoms
  • New fears: "Ever since my son was in the hospital, he is terrified to be left alone -- he never used to be like that."
  • Dissociation: "It still feels unreal -- like I was dreaming." OR "I just feel spacey and not in touch with the world around me."

While having a few of these reactions is common, persistent symptoms that cause distress warrant greater clinical attention.

The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV) provides criteria for diagnosing traumatic stress disorders.


Acute stress disorder
  • a traumatic stressor
  • at least 9 of 14 different symptoms – including dissociation, re-experiencing, avoidance, anxiety and arousal
  • duration of symptoms: at least 3 days and up to 1 month
Posttraumatic stress disorder
  • a traumatic stressor and subjective emotional experience of fear, helplessness, or horror/li>
  • at least 1 re-experiencing symptom
  • at least 1 avoidance symptom
  • at least 2 symptoms that indicate negative alterations of cognition or mood
  • at least 2 hyper-arousal symptoms
  • significant impairment in functioning
  • duration of symptoms: 1 month or more


PTSD Criteria are slightly different for children under 6 years old. Individuals who do not meet full diagnostic criteria for a traumatic stress disorder can still be functionally impaired and may still need assistance in coping with and resolving these traumatic stress reactions.