See Specific diagnoses and their corresponding mentalizing failures for a description of how exposure to trauma (that is, a dramatic, uninvited, apparently life-threatening or life-altering experience) can affect our capacity to mentalize

Post Traumatic Stress Disorder (PTSD) has a number of key features, and it is important to recognise it, as there are some fairly well evidenced ways of treating this condition. As a formal psychiatric diagnosis it may be necessary to clarify the diagnosis through an assessment by a qualified mental health professional, and complex PTSD may require specialist treatment. In those circumstances, the goal of an AMBIT team might be to alleviate symptoms, or to provide the first 'port of call' on a journey that would lead ultimately to a young person engaging with specialist treatment.

Key features

Key features that might suggest PTSD are:

• Flashbacks - these are very vivid memories of part of a trauma, that are uninvited, intrusive and occur quite suddenly. At their most severe the person afflicted may have an experience that is so severe they report feeling as though they are "back there, having it all happen again" (this is a form of Psychic equivalence)
• Hyper-vigilance - this refers to a heightened sense of threat and is often accompanied by an exaggerated "startle" reflex (the person may well be described as very "jumpy".) When they are calmer (ie when mentalizing can come back on stream) the individual will usually say that they know they are over-reacting, but can't stop themselves - this is a subtle but important difference from the kind of Paranoid symptoms that may be associated with Psychosis.
• Avoidance - this is the most insidious and in many ways the most damaging of the PTSD symptoms; over time the suffer starts to avoid situations that they assume might trigger further flashbacks. Instead of providing the relief that they intend, however, too often this response actually amplifies the fears; the sufferer never gets to test out the belief (a kind of Pretend mode) so the belief "If I go down that street it will all happen again" becomes increasingly firmly held (this can be another form of Psychic equivalence.) Severe sufferers find that their lives can become dramatically constricted so that they are housebound, for instance.

What to do

There are well-researched NICE Guidelines for PTSD

Cognitive Behavioural approaches are the most strongly supported by the research evidence. Trauma-focussed CBT is recommended as the first approach for children by NICE.

In some cases specialists might add Pharmacological interventions (i.e. medication) to augment the psychological approach.

Although FamilyWork alone has not been shown to be effective, there is good reason to focus some energy on ensuring that family members understand the nature of the problem, and the plan for treatment, as family members may well be able to reinforce some of the key therapy tasks and 'homework' (Training Challenges.)