Children of Veterans and Adults with PTSD
> 1/30/2006 11:50:23 AM

Researchers have recently examined the impact of veterans' posttraumatic stress disorder (PTSD) symptoms on family relationships, and on children of veterans in particular. Family members of individuals with PTSD may experience numerous difficulties. This fact sheet explains the common problems that children of veterans experience and provides recommendations for how to cope with these difficulties. Although much of the research described here has been conducted with children of Vietnam veterans, it is likely that much of the information applies to children of combat veterans of other conflicts.

How might a veteran's PTSD symptoms affect his or her children?

Re-experiencing symptoms

Individuals who have PTSD often 're-experience' traumaticevents through vivid daytime memories or dreams. Re-experiencing can occursuddenly and without intention, and it is typically accompanied by intenseemotions, such as grief, guilt, fear, or anger. Sometimes these intrusions canbe so strong or vivid that the individual believes the trauma is reoccurring.

These symptoms can be frightening not only for theindividual experiencing them but also for children who witness them. Children maynot understand what is happening or why it is happening, and they may start toworry about their parent's well-being. Children may also worry that theirparent cannot properly care for them.

Avoidance and numbing symptoms

Because the re-experiencing symptoms characteristic of PTSDare so uncomfortable, people who have been traumatized tend to try to avoidthinking about the traumatic event. They may also attempt to avoid places andexperiences that could trigger upsetting memories. As a result, veterans maynot want to do things or go places, such as to the store, to the movies, or outto dinner. Children may feel that their parent does not care about them whenreally it is that the parent is avoiding places that are just too frightening.In addition to these active avoidance strategies, traumatized individuals oftenstruggle with experiencing positive emotions and may feel 'cut off' from otherpeople, including family members. These avoidance and numbing symptoms can havea direct impact on children. For example, when a parent with PTSD withdrawsfrom family members and has trouble feeling positive emotions, children caninaccurately interpret this as the parent not being interested in them orloving them, even though the parent may try to indicate otherwise.

Hyperarousal symptoms

Individuals with PTSD tend to have a high level of anxietyand arousal, which shows up as difficulty sleeping, impaired concentration, andbeing easily startled. They tend to have a high level of irritability and mayexperience an exaggerated concern for their own safety and the safety of theirloved ones. It is easy to see how these hyperarousal symptoms can influencefamily members. For instance, irritability and low frustration tolerance canmake a parent seem hostile or distant, again making children question theparent's love for them. This perception is simply a misunderstanding of thereasons behind the symptoms.

What are the typical patterns of how children respond to a parent with PTSD?

Researchers have observed a direct relationship between eachof the parent's PTSD symptoms and the children's responses. Researchers alsohave noticed patterns in the ways children respond to the parent's overallpresentation of PTSD. Harkness(1991) described three typical ways these children respond: (1) theover-identified child: the child experiences secondary traumatization and comesto experience many of the symptoms the parent with PTSD is having; (2) the rescuer: thechild takes on parental roles and responsibilities to compensate for theparentís difficulties; and (3) the emotionally uninvolved child: this childreceives little emotional support, which results in problems at school,depression and anxiety, and relational problems later in life.

These theories certainly do not represent every possiblereaction children may have to parents with combat-related PTSD, but they offersome useful ways of understanding how symptoms might develop for thesechildren.

What are the common problems children of veterans with PTSD face?

Social & behavioral problems

Research has shown that there is significantlymore violence in families of Vietnam veterans with PTSD than infamilies of veterans without PTSD, including increased violent behaviorof the child.1 Several studies have examined the effect that fathers' combat-related PTSD and violent behaviors have on their children.2,3,4Results have generally revealed that children of veterans with PTSD areat higher risk for behavioral, academic, and interpersonal problems.Their parents tend to view them as more depressed, anxious, aggressive,hyperactive, and delinquent compared to children of non-combat Vietnamera veterans (who do not have PTSD). In addition, the children areperceived as having difficulty establishing and maintainingfriendships. Chaotic family experiences can make it difficult toestablish positive attachments to parents, which can make it difficultfor children to create healthy relationships outside the family too.There is also research showing that children may have particularbehavioral disturbances if their parent veteran participated in abusiveviolence (i.e., atrocities) during combat service.5

Emotional problems and secondary traumatization

Results have also shown that children of veterans with PTSDare at higher risk for being depressed and anxious than non-combat Vietnam eraveteran's children. Children may start to experience the parent's PTSD symptoms(e.g., start having nightmares about the parent's trauma) or have PTSD symptomsrelated to witnessing their parent's symptoms (e.g., having difficultyconcentrating at school because they're thinking about the parent'sdifficulties). Some researchers describe the impact that a parents PTSDsymptoms have on a child as secondarytraumatization.2However, because of the increased likelihood that violence occurs inthe home of a veteran with PTSD, it is also possible that childrendevelop PTSD symptoms of their own. Having a seemingly unsupportiveparent can compound these symptoms.

Problems may continue into adolescence

Adolescent children of veterans with PTSD may alsobe affected by their parent's symptoms. Compared to adolescent childrenof non-veteran fathers, adolescent children of Vietnam combat veteranfathers show poorer attitudes toward school, more negative attitudestoward their fathers, and higher levels of depression and anxiety. Theyalso receive lower scores on creativity6.Adolescent children of Vietnam combat veterans may also have moreproblematic behaviors as rated by their mothers, although theirbehavior at school does not show evidence of disturbance. In spite ofthese differences, the two groups of adolescents were actually quitesimilar on a range of other measures of social and personalityadjustment. One of the potential reasons for the limited impact on thisgroup of adolescents is that the fathers in this study experiencedcombat but were not actually diagnosed with PTSD. It seems thatchildren of combat veterans may struggle with some psychological andbehavioral difficulties, but higher levels of impairment are much morelikely when the veteran is struggling with mental health issues ofhis/her own, such as PTSD.

Can children get PTSD from their parents?

It is possible for childrento display symptoms of PTSD because they are upset by their parent's symptoms(secondary traumatization). Some researchers have also investigated the notionthat trauma and the symptoms associated with it can be passed from onegeneration to the next. Researchers describe this phenomenon as intergenerational transmission of trauma. Much research has been conducted with victims of the Holocaust and their families (see Kellerman7 for review), and some studies have expanded on these ideas to include families of combat veterans with PTSD.

Ancharoff, Munroe, and Fisher8described several ways to understand the mechanisms ofintergenerational transmission of trauma. These mechanisms are silence,overdisclosure, identification, and reenactment. When a family silences a child, or teacheshim/her to avoid discussions of events, situations, thoughts, or emotions, thechild's anxiety tends to increase. He or she may start to worry about provokingthe parent's symptoms. Without understanding the reasons for their parent'ssymptoms, children may create their own ideas about what the parentexperienced, which can be even more horrifying than what actually occurred. Overdisclosure can be just asproblematic. When children are exposed to graphic details about their parent'straumatic experiences, they can start to experience their own set of PTSDsymptoms in response to the horrific images generated. Similarly, children wholive with a traumatized parent may start to identify with the parent such that they begin to share in his orher symptoms as a way to connect with the parent. Children may also be pulledto reenact some aspect of thetraumatic experience because the traumatized parent has difficulty separatingpast experiences from present.

What should I do if I feel my or my partner's PTSD is affecting my children?

Parents can help children by using the information providedin this fact sheet and in the resources identified below. Preventiveinterventions can be helpful and include explaining to family members thepossible impact of intergenerational transmission of trauma, before it happens.Education about the potential impact on children can also be a useful reactiveresponse, when a child is already being affected by his or her parentís traumahistory.

An excellent first step in helping children cope with a parent's PTSD is to explain the reasons for the traumatized parent's difficulties, without burdening the child with graphic details. It is important to help children see that the symptoms are not related to them; children need to know they are not to blame. How much a parent says should be influenced by the child's age and maturity level. Some parents may prefer to have help with what they say to their children, and seeking assistance through therapy or written materials can be helpful. The National Center for PTSD's fact sheet below on "Children and disaasters" can help parents talk to children about trauma. This fact sheet also describes how children may react differently, depending on the child's age.

Inaddition to this basic first step, there are multiple treatment optionsavailable for affected families. Treatment can include individualtreatment for the veteran (symptom improvement for the person sufferingfrom PTSD would indirectly benefit the family) and family therapy (tosupport the parent who is struggling with symptoms and teach familymembers how to get their own needs met). Family therapy is typicallymore effective if the veteran with PTSD has first received some type oftrauma therapy such that he or she is better able to focus on helpingthe children during family sessions9.Children may benefit from individual therapy as well, with variationsbased on the child's age (e.g., art or play therapy for youngerchildren, supportive talk therapy for older children and adolescents).Each family is unique, and decisions about what kind of treatment toseek, if any, can be complicated. The most important thing is to helpeach member of the family, including the children, have a voice inexpressing what he or she needs. In light of the recent researchshowing the negative impact PTSD can have on families, Veterans AffairsPTSD programs ( Vet Centers ( the country are beginning to offer group, couples, and individualprograms for families of veterans.


1. Jordan,B. K., Marmar, C. B., Fairbank, J. A., Schlenger, W. E., Kulka, R. A.,Hough, R. L., et al. (1992). Problems in families of male Vietnamveterans with posttraumatic stress disorder. Journal of Consultingand Clinical Psychology, 60, 916-926.

2. Cosgrove,L., Brady, M. E., & Peck, P. (1995). PTSD and the family: Secondarytraumatization. In D. K. Rhoades, M. R. Leaveck, & J. C. Hudson(Eds.), The legacy ofVietnam veterans and their families: Survivors of war: catalysts for change(pp. 38-49). Washington: Agent Orange Class Assistance Program.

3. Harkness, L. (1993). Transgenerational transmission of war-related trauma. In J. P. Wilson & B. Raphael (Eds.), Internationalhandbook of traumatic stress syndromes (pp. 635-643). New York: PlenumPress.

4. Parsons, J., Kehle, T. J., & Owen, S. V. (1990). Incidence of behavior problems among children of Vietnam War veterans. SchoolPsychology International, 11, 253-259.

5. Rosenheck,R., & Fontana, A. (1998). Transgenerational effects of abusiveviolence on the children of Vietnam combat veterans. Journalof Traumatic Stress, 11, 731-742.

6. Dansby, V. S., & Marinelli, R. P. (1999). Adolescent children of Vietnam combat veteran fathers: A population at risk. Journal ofAdolescence, 22, 329-340.

7. Kellerman, N. (2001). Psychopathology in children of Holocaust survivors: A review of the research literature. Israel Journal ofPsychiatry and Related Sciences, 38, 36-46.

8. Ancharoff,M. R., Munroe, J. F., & Fisher, L. M. (1998). The legacy of combattrauma: Clinical implications of intergenerational transmission. In Y.Danieli (Ed.), International handbook of multigenerationallegacies of trauma (pp. 257-275). New York: Plenum Press.

9. Harkness, L. (1991). The effect of combat-related PTSD on children. National Center for PTSD Clinical Quarterly, 2(1).

Excerpt from "Children of Veterans and Adults with PTSD," by Jennifer L. Price, Ph.D., National Center for PTSD

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