PTSD in Teens: Symptoms, Causes, & Treatment

What Is Post Traumatic Stress Disorder (PTSD)?

Post-traumatic stress disorder (PTSD) is a disorder that can develop after an individual has experienced a direct or indirect life-threatening and/or horrifying experience. Trauma(s) are often constituted by a loss of power, control, and agency over ourselves. PTSD can occur at any point in a person’s life. Symptoms include severe anxiety, panic attacks and flashbacks of the traumatic event.

How Common Is PTSD in Teenagers?

According to the National Center for PTSD, about 5% of adolescents have met criteria for PTSD in their lifetime, with girls affected more often than boys (8.0% versus 2.3%), and an estimated 3.9% meeting criteria in the past month. Nearly half of adolescents ages 12 to 17 have experienced at least one serious trauma, which is why recognizing the signs early matters.¹

What Are the Symptoms of PTSD in Teens?

Teens with PTSD most often show irritability, hypervigilance, poor concentration, emotional numbness, and withdrawal, along with flashbacks and nightmares tied to the trauma. PTSD symptoms often manifest differently across the lifespan, and they will not look the same for every person. This contrasts with younger children, who may act out the behaviors in play and show increased impulsivity.

Some PTSD symptoms in teenagers include:²

• Intrusive thoughts surrounding the traumatic event
• Difficulty remembering the details of the traumatic event
• Flashbacks of the traumatic event
• Avoidance of situations or circumstances that could remind them of the traumatic event
• Nightmares
• Problems concentrating
• Depressed Mood
• Anxious Mood
• Hypervigilance
• Feeling “on edge”
• Emotional numbing
• Not feeling joyful or fulfilled
• Irritability and behavioral outbursts

What Are the Warning Signs of PTSD in a Teenager?

Signs of PTSD in teens are often behavioral. Therefore, they can easily be mistaken as a part of teen development. However, it is important to be aware of when shifts in behaviors are dramatic, seemingly from one day to the next.

Common signs of PTSD in teenagers are:

• Angry Outbursts
• Using drugs or alcohol, either new use or if used previously increased use
• Isolation and withdrawal from family and/or peers
• Lack of engagement in previously enjoyed activities, such as sports, clubs
• Decline in school performance
• School refusal
• Trouble falling asleep or staying asleep
• Night terrors regarding the traumatic event
• Changes in Appetite
• High-risk sexual behaviors
• Regression, such as talking more childlike
• Restlessness or appearing slowed down

What Causes PTSD in Teens?

PTSD in teens is triggered by exposure to trauma such as sexual or physical abuse, community or dating violence, a serious accident, or the sudden loss of a loved one. Certain factors put teens more at risk, including intergenerational trauma, living in a high-crime community, and a family history of substance misuse.

Some common causes of PTSD in teens include:²

• Sexual abuse, including parent and sibling sexual abuse
• Physical abuse and/or physical neglect
• Emotional abuse and/or emotional neglect
• Community violence
• Dating/Intimate partner violence
• Unexpected loss
• Violent loss of a loved one
• Natural disasters, including hurricanes, illnesses
• Violent crimes such as school shootings and terrorism
• Family violence, such as witnessing domestic violence
• Accidents such as a car crash

How Is PTSD Diagnosed in Teens?

PTSD in teens is diagnosed using the same DSM-5-TR criteria that apply to adults, because those criteria cover everyone age 6 and older. A clinician looks for symptoms in four clusters that persist for more than one month after a traumatic event: intrusion (flashbacks, nightmares, unwanted memories), avoidance of trauma reminders, negative shifts in mood and thinking, and heightened arousal such as irritability, hypervigilance, and sleep problems. The symptoms must cause real distress or interfere with school, relationships, or daily functioning (National Center for PTSD, U.S. Department of Veterans Affairs).

The DSM-5-TR, published by the American Psychiatric Association in 2022, kept the PTSD criteria unchanged from DSM-5. One distinction matters for families with younger children: a separate developmental “preschool” subtype exists for children ages 6 and younger. That subtype uses three symptom clusters instead of four, lowers the avoidance and negative-cognition threshold, and leans on behavioral signs like trauma themes in play, because young children cannot always describe internal states. Teens do not fall under this subtype, but understanding it helps parents see why a younger sibling’s PTSD can look very different.

Because teenage PTSD symptoms overlap with depression, anxiety, and ordinary adolescent moodiness, misdiagnosis is common. A trauma-informed evaluation by a licensed clinician, often using structured tools such as the UCLA PTSD Reaction Index, is the reliable way to confirm the diagnosis.

10 Tips for How to Help a Teen With PTSD

When your teen is experiencing mental health difficulties, it can be alarming. This is especially true with PTSD, given the symptoms are prompted by a traumatic event. However, parents, guardians, and caregivers can do many different things to help their teen with PTSD.

Begin by finding a therapist for your teen who specializes in treatment for adolescents as well as PTSD. It is important to be supportive of your teen as they go through the therapy process. They may be struggling with the stigma of attending therapy or shame around their PTSD. Normalize their feelings and suggest alternative ways to think about the stigma and shame.

Additionally, getting support as a parent, guardian, and caregiver from a trained professional is a good step. Not only are you better equipped to support your teen, but it can also show the teen that asking for support is okay. The more comfortable with therapy you are, the more comfortable your teen will be.

Here are ten ways parents and caregivers can help teens with PTSD:³

1. Create a Safe Place for Them to Heal

The first and more important aspect of healing from trauma is establishing a sense of safety in the world again. As parents and caregivers, creating a safe enough place is essential. There is often shame attached to trauma; thus, talking about the experience is even more difficult. However, with a sense of safety, shame can start to dissipate.

2. Allow Them to Feel How They Feel

Many emotions come up following traumatic exposure. All of these feelings are valid and have a biological basis due to changes in our central nervous system following trauma. The emotion your teen is experiencing, such as extreme anger, may be uncomfortable for you. Recognize that experiencing these emotions, as opposed to suppressing them, is an important part of your teen healing.

3. Let Them Talk About Trauma at Their Own Pace

Any survivor of trauma must be granted a safe enough space that allows them to take their time in talking about it. As well-intentioned as parents and caregivers may be, bringing up certain details regarding the trauma can cause retraumatization, especially if it is talked about before the teen is ready. Additionally, allow the teen to express their feelings in their own way.⁴ If talking is too much, maybe they can journal about their trauma, draw the event that occurred, or practice trauma-informed yoga.

4. Manage Expectations

Managing expectations as a parent or caregiver is crucial. It is challenging to get back to “how things were” before a trauma occurred. A person who has survived trauma needs time, and with that time, they also need your patience.

5. Manage Your Own Emotions

Seeing your teen in pain is devastating. You are allowed to feel devastated. It is also important to manage your emotions in front of your teen. You do not want them to feel like they must also take care of you while trying to mend themselves.

6. Limit Exposure to Any Potential Reminders of the Trauma

Support your teen by limiting any exposure to potential reminders of trauma. This is especially important if the trauma occurred in or around the home/your community. This could look like finding a different route to walk or requesting changes to their class schedule if the trauma occurred with a fellow classmate in school.

7. Support Them in Sticking to Their Routine

As hard as it will be, routine will give your teen a sense of regularity. Of course, managing expectations around this is important. Start with supporting them in returning back to their self-care practices geared towards teens. Then moving toward sleep habits, amongst other areas. Regularity is ideal. Please remember this will take time and patience to resume and allow for changes that better support your teen.

8. Pay attention to any sudden changes in behavior and emotional state

Any and all sudden changes in behavior and emotional state can mean an emergent risk is developing that could result in hypersexuality, misuse of alcohol and substances, self-harming, or suicidality. All situations that could result in immediate harm should be assessed by a medical and psychiatric professional in the Emergency Room. If your teen is in crisis or at risk of suicide, call or text the 988 Suicide and Crisis Lifeline for free, confidential support available 24/7, and go to the nearest Emergency Room for any immediate danger.

9. Encourage Scheduling a Follow Up With Their Doctor

It can be very scary to go to a medical professional after a trauma. This is something that can be encouraged and also given time for the teen to agree to. An example of how to approach this would be, “I can imagine how scary it feels to be in a vulnerable state, I’ll be there, and it is to make sure you’re okay physically.”

10. Encourage and Schedule a Session with a Therapist

Similarly to seeing a medical professional, seeing a therapist can feel even more daunting. Therapy requires some level of vulnerability that a teen experiencing PTSD may not be ready for. Again, encouragement is what is important. Although your teen needs counseling, you do not want teens to feel pressured or pushed. The therapy won’t be effective if they are going against their will.

How Is PTSD in Teens Treated?

Finding a therapist who specializes in teenage PTSD is extremely important. A well-trained therapist knows the ins and outs of PTSD symptoms. There are many options for trauma therapy, and you should discuss with potential therapists their style of therapy to ensure you are matching with the right person. The most important component of therapy is your teen feeling safe with and connected to their therapist.

Treatment options for teen PTSD include:

• Cognitive behavior therapy (CBT): CBT for teens has been shown to be extremely beneficial. This modality can be tailored to a teen audience by focusing on the specific struggles teens experience. With trauma, mindful and self-soothing interventions support regulation along with cognitive restructuring.
• Trauma-focused cognitive behavior therapy (TF-CBT): TF-CBT is the first-line, best-evidenced treatment for adolescent PTSD, supported by international guidelines and more than 25 randomized controlled trials (Thielemann et al., Child Abuse & Neglect, 2022). It is a specific CBT model for trauma treatment. It takes a whole-person approach by engaging parents/guardians (as long as they are not the root cause of the trauma) in psychoeducation while also providing central nervous system regulation skills. Lastly, it supports adopting a more ego-syntonic view of the traumatic experience(s) through cognitive restructuring.
• Cognitive processing therapy (CPT): CPT is another form of CBT. It is a time-limited therapy, around 12 sessions. CPT is geared toward imaginal exposure of the trauma(s) in order to support desensitization so that trauma triggers/reminders do not impact the survivor as readily.
• Eye Movement Desensitization and Reprocessing (EMDR): EMDR for PTSD is a form of therapy that was specifically developed to treat trauma(s). EMDR utilizes bilateral stimulation while remembering trauma(s) and these two experiences together support a teen in releasing tension and dissipating the intensity of somatic experiences and emotions associated with trauma(s).
• Dialectical Behavior Therapy (DBT): DBT for PTSD was developed following the success of DBT treatment for borderline personality disorder (BPD). The practices with BPD clients are applicable to survivors of trauma as they holistically offer self-regulation, mindfulness, and building of distress tolerance skills.
• Narrative Exposure Therapy (NET): NET is a time-limited treatment approach that offers behavioral, narrative processing, and neuroscience-based interventions. The long-term goal is to reimage the story one has attached to the trauma(s) in a way that does not spark symptoms as readily.

Where Can You Find Help for a Teen With PTSD?

You can find help for a teen with PTSD by choosing a clinician who specializes in adolescents and trauma. A parent or guardian can look through an online therapist directory to connect with a therapist in their local area who specializes in PTSD. If your teen feels overwhelmed at the thought of attending therapy, online therapy options for teens can be effective. It allows the teen to be in their own safe environment when bringing up challenging thoughts and emotions.

In My Experience

Teenage PTSD, whether from childhood or a recent trauma, is treatable. I highly recommend seeking a therapist who has specialized in trauma treatment. It is also crucial for your teen to feel safe and comfortable with their therapist. The outlook for treatment of teen PTSD is bright when all factors can come together, from a supportive therapist to understanding adults in the teen’s life.

When clients come to my office with PTSD symptoms at any age, I ensure psychoeducation around their experience and how it is connected to current symptoms. One of the most important offerings is when I advise that there are no expectations for my client to trust me. I will continue to be there and be present as trustworthy. The client has the power and control to decide if and when I can be trusted.