In our digital age of minute-long headlines, it becomes easier and easier to dilute world crises, presuming that the proclaimed end of a tragedy also means a sudden end of its effect. Research on children who experience violent conflict has demonstrated that not all wars end with a ceasefire. Post-Traumatic Stress Disorder (PTSD) is a common disorder that develops after children witness or experience traumatic events, with some symptoms persisting for an entire lifetime. Children are of high concern when considering the effect of trauma exposure, due to the brain's sensitivity during stages of development (Herringa, 2017).
The Development of Trauma in War Zones
The most frequent forms of trauma exposure for war-zone children are witnessing violence, deaths, or loss of family members (Murthy & Lakshminarayana, 2006). Additionally, children are commonly displaced from family or experience disorienting situations while lacking the developed cognitive abilities to comprehend what they endure (Herringa, 2017). War bombings that destroy childhood homes lead to a loss of assurance, security, and memory. In the implication of PTSD development, a direct correlation is observed between the degree of exposed trauma and the corresponding severity of posttraumatic stress (Murthy & Lakshminarayana, 2006).
For decades, researchers have documented the impact of political conflict on the children who are forced to experience them.
A 2003 Gaza report detailed that among children between 10 and 19, only 2.5% had no PTSD symptoms. Nearly 50% of children in the study suffered moderate PTSD symptoms, and 32.7% had severe symptoms requiring psychological intervention (Murthy & Lakshminarayana, 2006).
A similar study considered children aged 11-15 in Israeli settlements who were exposed to high levels of conflict during the second Intifada, with 27.6% of the 307 teenagers reporting moderate to severe PTSD symptoms (Solomon & Lavi, 2005).
The long-term effect of traumatic stress symptoms in children was considered in a study of Iraqi children during the First Gulf War, which included a 10-year follow-up. This longitudinal study assessed children from the ages of 6-18 who were exposed to a severe shelter bombing and the chaotic aftermath. Approximately 80% of children were past the diagnosis point for PTSD at the first examination. After 10 years, the percentage had only decreased slightly (Dyregrov et al., 2002).
THE LONG-TERM IMPACT OF PTSD IN CHILDREN
From a distance, we can take comfort in seeing conflicts come to a ceasefire, or the migration of children to a more peaceful environment. However, this naivety undermines the significant impact that PTSD symptoms can have on a child's future, even after a war ends. Some battles run skin deep; some continue for an entire life. We can briefly consider the lifelong effects of post-war PTSD by considering three aspects of a child's life: somatic, social, and life outcomes.
Somatic Impacts
Somatic impact refers to one's body and the effect that daily terror or sudden trauma has on our physical regulatory abilities. Enduring long-term activation of our body's stress response can lead to dysregulation which might manifest in frequent triggers and hormonal imbalances (Grillon et al., 1996). Modern research on the impact of stress on the body demonstrates that holding traumatic memories in the body has a devastating effect on all aspects of functioning: sleep, fatigue, memory, movement, digestion, and self-regulation during future periods of stress. The ability to function "normally" is a privilege that we cannot overlook when discussing how the body copes with trauma (McFarlane, 2010). The development of PTSD also puts one at risk for developing other mental disorders such as depression or panic disorder, due to overlapping neurobiology and comorbidity (Brady et al., 2000).
Social Impacts
The hyperarousal of PTSD can heavily impact how a child perceives peers, adults, and future relationships. High vigilance for threats can lead to distrust of those around a trauma victim, creating self-isolation and high irritability (McFarlane, 2010).
Children who endure war frequently witness violence occurring to family and friends. Studies document that a major source of enduring anxiety is children fearing for the lives of their loved ones over their own (Solomon & Lavi, 2005). Long term, these children tend to struggle to form stable relationships due to the disrupted social setting in which they were raised.
Impact on Life Outcomes
Studies that focus on the life outcomes of children with PTSD demonstrate that daily traumatic stress during war leads to a lack of concern for one's future. Firstly, stress symptoms (such as panic, sleeplessness, and agitation) can highly impact one's ability to concentrate in school. Disruptions to education limit future opportunities for children, prohibiting future financial stability and provision. Furthermore, children raised in war zones develop a sense of a foreshortened future. Anticipating future trauma prevents one from developing ambition or ideals for their future, expressing pessimism towards unknowns (Solomon & Lavi, 2005).
THE OPTIMISM FOR CHILDREN OF WAR
We cannot discuss children in war zones without acknowledging the most vital symptom that is seen across war-impacted generations: Resilience. Children take from the same sources of healing that have long defined humanity's indomitable spirit. Studies show that routine, family cohesion, parental safety, and cultural significance positively impact a child's ability to re-regulate after experiencing war traumas. Many children demonstrate an unwavering ability to re-regulate themselves after trauma, returning to a completely normal life (Qouta et al., 2008).
Dupuy and Peters, in their book "War and Children", acknowledge the chord-striking determination of young children by stating: "Children should not be considered only as the passive victims deprived of agency upon whom the violence has been enacted, but rather as the active participants in the society that develop their own ways to cope and survive..." (Dupuy & Peters, 2010).
While a child’s neuroplasticity is often implicated in the development of PTSD, we must also recognize it as a weapon against the scars of war.
References used:
Brady, K. T., Killeen, T. K., Brewerton, T., & Lucerini, S. (2000). Comorbidity of psychiatric disorders and posttraumatic stress disorder. The Journal of clinical psychiatry. https://pubmed.ncbi.nlm.nih.gov/10795606/
Dupuy, K. E., & Peters, K. (2010). War and children: A reference handbook. Praeger Security International.
Dyregrov, A., Gjestad, R., & Raundalen, M. (2002). Children exposed to warfare: A longitudinal study. Journal of Traumatic Stress, 15(1), 59–68. https://doi.org/10.1023/a:1014335312219
Grillon, C., Southwick, S., & Charney, D. (1996). The psychobiological basis of posttraumatic stress disorder. Europe PMC. https://europepmc.org/article/med/9118351
Herringa, R. J. (2017). Trauma, PTSD, and the developing brain. Current Psychiatry Reports, 19(10). https://doi.org/10.1007/s11920-017-0825-3
Impact of war on children’s mental health. War Childhood Museum. (n.d.). https://warchildhood.org/impact-of-war-on-childrens-mental-health/
McFarlane, A. C. (2010, February). The long-term costs of traumatic stress: Intertwined physical and psychological consequences. World psychiatry : official journal of the World Psychiatric Association (WPA). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816923/
Murthy, R. S., & Lakshminarayana, R. (2006, February). Mental health consequences of war: A brief review of research findings. World psychiatry : official journal of the World Psychiatric Association (WPA). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472271/#B41
Qouta, S., Punamäki , R.-L., & El Sarraj, E. (2008). Child development and family mental health in war and military violence ... International Journal of Behavioral Development . https://www.researchgate.net/publication/247779844_Child_development_and_family_mental_health_in_war_and_military_violence_The_Palestinian_experience
Solomon, Z., & Lavi, T. (2005). Israeli youth in the Second intifada: PTSD and future orientation. Journal of the American Academy of Child & Adolescent Psychiatry, 44(11), 1167–1175. https://doi.org/10.1097/01.chi.0000161650.97643.e1
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