Has Billy been exposed to trauma? Could his symptom pattern be indicative of PTSD?

Question

What will be an ideal response?

Answer 1

The presenting problem for treatment is the sexual abuse. Although Mrs. Bronksy insists that his behaviors started long before the sexual abuse, witnessing family violence can be a traumatic event for children. Billy, like most children his age, may not be able to detail his internal experience about the violence. For this reason, parents are an important source of information for PTSD symptoms in children, although they may tend to minimize symptoms. Mrs. Bronksy denied that the sexual abuse or the family violence has had an impact on her children, although she is willing to seek counseling at the recommendation of the child advocacy workers. In terms of re-experiencing, both Billy and his mother say he does not have nightmares, but it would be important to hear from him what he dreams of and if particular dreams are associated with his bedwetting. She says he does not report flashbacks. In the therapist’s sessions with Billy, it will be important to see if re-experiencing of the abuse occurs through drawings, stories, or play. The child’s re-experiencing the event can be facilitated through its re-enactment with drawings, stories, and play.
The hyperarousal criterion for PTSD could be manifested by his inattention symptoms (forgetfulness, lack of concentration, inability to sit still) and his bursts of irritability and anger. His incontinence could further be construed as indicative of PTSD, and one could speculate that the sexual abuse by his cousin could have resulted from possible decreased arousal to threat. Avoidance symptoms could be seen in his tendency to avoid discussions about the sexual abuse, although other motivations could be responsible, such as embarrassment, threats from the abuser, a desire to please adults by not discussing negative events, and the belief that he is at fault (James, 1989).
In a conversation with the therapist, Billy was positive about his father and his girlfriend and didn’t mention the family violence. Again, this could be avoidance due to PTSD, or it could be embarrassment, pressure from the family, his wanting to preserve a good image of his father for himself and people outside the family, and possibly other reasons. Numbing could have been signified by Billy’s refusal to talk or respond to the therapist when she first met with him, although this could also have stemmed from his oppositionality.