Chronic versus single trauma in children: An approach towards a new definition of trauma

Trauma crónico contra trauma episódico en niños: Un abordaje hacia una nueva definición de trauma

Over the last twenty years, the definition of trauma in the Diagnostic and Statistical Manual of the American Psychiatric Association has changed three times. In the definition of the last DSM, which is the 4th edition (1994), trauma is defined as one or more distressing events, which include specific kinds of reactions. Children are mentioned only in the way that their posttrauma reaction might be expressed by disorganized or agitated behaviour instead of showing fear, helplessness or horror. Simpson criticizes such a definition of trauma as single, unexpected events "a product of communities who experience traumata, if at all, only as brief intrusions into comfortable and ordered lives". He claims that many traumata are long-lasting, repeated and expected events, especially those kinds of traumata experienced by children and adults in crisis zones of the world.

This paper presents a study (1996) done by the author, on about 33 extremely traumatized children in Nicaragua. The study compares the clinical symptom picture of children who experienced single trauma with children who were victims of chronic trauma. Furthermore, the author will suggest an amplified definition for trauma in children, which includes both chronic and single trauma. As a consequence, conclusions for strengthening resilience in children will be drawn.

The children's symptoms were evaluated using the Child Behaviour Checklist by Achenbach and a trauma symptom list for children. Both were translated into Spanish.

The study shows an urgent need for differentiating single versus chronic trauma in children. Whereas reactions of children to single trauma can best be characterized by PTSD as it is defined in the DSM-IV, symptoms resulting from chronic traumatization are not as easy to categorize. Generalized or specific anxiety, depression, aggression and disturbance of moral and personality seem to be the major co-morbidities. These symptoms may cause severe and tenacious effects, which are difficult to cope with. Some of the coping strategies, for example political identification, may help adolescents to cope with the traumatic circumstances they live in. At the same time, such copingstrategies can add up to the never-ending spirals of violence, which can be observed in so many places of the world. Understanding the full symptom picture of chronic traumatization in children is a necessary asset in deriving efficient sociopolitical intervention strategies.