Signs of Trauma in Teenagers: Young People After an Accident, Earthquake or Violence

What are the signs of trauma in teenagers? Changes seen after an accident, earthquake or violence, what families can do and the path followed in therapy.

Two months after the accident, your sixteen-year-old daughter does not want to get into a car. She walks to school, even though it takes half an hour. At night she sleeps with the light on and jumps at the sound of a car horn. When you ask about the accident she says, "I'm fine, don't make a fuss", and closes the subject. Or perhaps your situation is a different one: in your family, which moved to another city after the 6 February 2023 earthquakes, your son is quiet and absent-minded at his new school and sits at the desk nearest the classroom door. The signs of trauma in teenagers do not always appear as tears or fear; sometimes they take the form of anger, sometimes indifference, sometimes a sudden maturity. In this article I look at what may be seen in young people after a traumatic event, which reactions are to be expected, which call for support, and what the family can do during this process.

What Is Trauma, and Which Events Can Be Traumatic?

Psychological trauma is the emotional impact that follows events in which a person's own life or physical integrity, or that of a loved one, was in serious danger, and in which they felt intense fear and helplessness. Events that may be traumatic for young people include:

• A traffic accident, an accident at home, a fire or a serious injury
• Natural disasters such as earthquakes and floods
• Being subjected to, or witnessing, physical or emotional violence, including domestic violence
• Being attacked in the street, mugging, threats, knife fights around the school
• Witnessing the sudden or violent death of a loved one
• A serious illness, a long hospital stay or a major medical procedure
• Digital abuse, such as blackmail, threats or the sharing of private images online

Of two young people who go through the same event, one may be deeply affected while the other recovers relatively quickly. What determines this is, as much as the event itself, the young person's earlier experiences, what they felt during the event, the support they received afterwards and the reactions of the adults around them. If you are curious about the general framework of trauma, the article on post-traumatic stress disorder offers detailed information.

What Are the Signs of Trauma in Teenagers?

In the first days and weeks after a traumatic event, a range of reactions is seen in most young people. These are normal reactions to an abnormal event and they usually ease over time. Symptoms lasting longer than a month, steadily increasing or markedly restricting the young person's life, however, indicate that a closer assessment is needed.

Reliving the event

The young person may relive the event in their mind again and again against their will. Sudden images, nightmares about the event, and feeling as if they are back in that moment in response to a sound or smell may occur. A young person who has been through an earthquake may freeze when a door slams in the building or a noise comes from the flat upstairs.

Avoidance

Avoiding places, people, conversations and feelings that are reminders of the event is very common. A young person who has been in an accident does not want to get into a car; a young person who has been attacked does not walk down that street and does not go out after dark. Some young people distance themselves from their family so as never to talk about the event. Avoidance brings relief in the short term, but lays the ground for the fear to become entrenched.

Changes in thoughts and feelings

The young person may begin to believe that the world is a dangerous place, that no one can be trusted, or that what happened was their own fault. Shame and guilt are particularly intense after violence and assault. Some young people stop making plans for the future: "Everything could end in a moment anyway." Being unable to enjoy activities they love, feeling cut off from people and being unable to feel their emotions also fall into this group.

Hyperarousal

Being constantly on guard, startling easily, difficulty falling asleep or waking often, being unable to concentrate, irritability and outbursts of anger are common. A young person may keep watching the door in class, or feel short of breath in crowded places.

Signs particular to adolescence

Unlike in adults, trauma in teenagers can also show itself through certain behavioural signs:

• Risky behaviour: Driving fast, staying out until late at night, using alcohol or drugs
• Self-harm: Behaviour such as cutting or burning themselves to cope with intense emotions
• Sudden maturity or regression: Taking on responsibilities beyond their age, or conversely returning to behaviour typical of younger ages
• Decline at school: Lack of interest in lessons, absences, falling grades
• Changes in relationships: Drifting away from friends, turning to new and risky circles of friends

These signs do not in themselves amount to a diagnosis. But several of them appearing together, and not easing as the weeks pass, indicate that it would be advisable to see a specialist.

Why Do Teenagers Hide Trauma?

The signs of trauma in teenagers can easily escape families' notice. There are several reasons for this.

Young people often do not want to appear weak. Saying "I'm scared like a little kid" contradicts the independence they are trying to gain. Boys in particular may hide their feelings behind anger or indifference because of cultural messages such as "A real man isn't afraid."

Some young people try to protect their families. In events such as an earthquake, which affect the whole family, the young person sees that their parents are already worn down and does not want to burden them with their own fear.

In events such as violence and assault, shame, guilt and the fear that "They won't believe me" are the main reasons for silence. Young people who are blackmailed or harassed online may hide what they are going through for months, afraid that their parents will take their phones away or blame them.

What helps a young person who has been through trauma most is not being asked the right questions, but knowing that whatever they tell, they will not be judged.

Young People After the Earthquake: Turkey's Shared Wound

The 6 February 2023 earthquakes were, for thousands of young people, an experience in which life was turned upside down overnight. Young people who lost their homes, their schools, their friends and sometimes members of their family had to start a new life in other cities. Many young people who did not experience the earthquake directly were also exposed to intense images through the news and social media.

Reactions commonly seen in young people after the earthquake include restlessness in enclosed spaces, panic at the slightest tremor felt in a building, sleeping with shoes on or fully dressed, keeping their phone with them at all times and being unable to bear being apart from their family. Some young people, on the contrary, display excessive indifference. For young people who have moved away from the earthquake zone, adjusting to a new school, being labelled "earthquake survivors" and the bond with friends left behind being broken create additional burdens.

Earthquake anniversaries, news of new earthquakes and debates about urban regeneration can also revive symptoms. The article on earthquake anxiety contains further suggestions for coping with anxiety in everyday life.

What Can You Do as a Family?

Re-establish safety. After trauma, the first need is for the young person to feel physically and emotionally safe. Tell them in a calm voice that the danger has passed and that they are now safe; if possible, back this up with concrete steps.

Keep routines going. Regular routines such as sleep, meals, school and social activities strengthen the feeling of regaining control. However, it may be necessary to relax expectations in the first weeks.

Do not force them to talk, but be ready to talk. Forcing young people to describe the event in detail can sometimes increase symptoms. Instead, give the message, "We can talk whenever you want." When the young person starts to tell you, listen without interrupting, correcting or judging.

Explain that their reactions are normal. Saying, "Having nightmares, jumping at noises, not wanting to get into a car: these are understandable reactions to what you've been through. You're not going mad" reduces the young person's fear of their own reactions.

Question the guilt. If the young person holds themselves responsible for what happened, listen to this, but do not close it down straight away by saying, "It's not your fault." Asking, "Why do you think that?" and talking it through together lets you reach the deeper layers of this thought.

Limit media exposure. Constantly watching news, images and videos about the event keeps symptoms alive. Talk with the young person about how much of this content they want to look at.

Gradually reduce avoidance. Avoidance brings relief in the short term but makes fear bigger in the long term. With a young person who does not want to get into a car, planning short, calm journeys first helps them gradually regain control. Take these steps at the young person's pace and together with them.

Look after sleep. After trauma, sleep is often the first area to be disrupted. Small steps such as putting screens away for a while before bed, keeping the room as light as the young person wants, and going to them when they wake from a nightmare and staying until they calm down help nights to feel less frightening.

Watch your own reactions. A parent's intense anxiety can feed the young person's fear. If you too were affected by the same event, getting support for yourself helps you offer the young person calmer ground.

A Young Person at School After Trauma

Young people spend a large part of their day at school; that is why the effects of trauma are often first noticed in the classroom. Distractibility, failing to keep up with homework, sudden moments of crying or anger, being alone at break time and panic during noisy activities such as fire drills are some of them. These behaviours are sometimes interpreted as laziness or a discipline problem.

Working with the school counsellor is very valuable at this point. With the young person's consent, sharing basic information about the event with the school helps teachers understand the young person's reactions correctly. If necessary, small adjustments such as extra time in exams, being told in advance about noisy activities, and being able to step out of class briefly and go to the counselling service at difficult moments make it easier for the young person to stay connected to school. In classes with young people who have come from the earthquake zone, peers avoiding labels such as "earthquake survivor" and including the new student in the group is also a process teachers can support.

When Should You Seek Professional Support?

It is advisable to see a specialist in these situations:

• Symptoms are still intense or increasing a month after the event
• The young person is struggling to go to school, see their friends or carry out everyday tasks
• Sleep problems and nightmares have been going on for a long time
• Alcohol or substance use or dangerous behaviour has begun
• The young person is harming themselves, says they do not want to live or talks about thoughts of suicide; in this case, call 112 (emergency services) urgently
• The trauma involved violence, abuse or assault; in these situations, support should also be sought for the young person's safety and for legal processes

How Are the Signs of Trauma in Teenagers Addressed in Therapy?

One of the research-supported approaches in working with young people who have experienced trauma is trauma-focused cognitive behavioural therapy. In this approach, the young person first learns about the effects of trauma on the body and mind; then emotion-regulation skills such as breathing, relaxation and grounding are worked on. When the young person feels strong enough, a process of making sense of the event begins, in which they recount what happened step by step in a safe setting. Thoughts such as "It was my fault" or "The world is completely dangerous" are examined and more balanced perspectives are developed.

Gradually facing avoided situations again is also part of therapy. A young person who cannot get into a car can slowly overcome this fear through steps prepared together with their therapist. Other trauma-focused methods, such as EMDR, are also used in some cases.

Parents' involvement in the process is important so that the young person is also supported at home. Where there are sleep problems, severe depressive symptoms or intense anxiety, an assessment by a psychiatrist can support the process. For detailed information about work with young people, you can take a look at the adolescent counselling page.

Frequently Asked Questions

Months have passed since the event; have the symptoms only started now?

The signs of trauma in teenagers sometimes appear not immediately after the event but weeks or months later. Feelings suppressed in the early period by shock, by moving house or by the rush to set up a new routine can surface once life has calmed down relatively. Symptoms with a delayed onset should also be taken seriously and assessed.

Should I talk about the event with my teenager, or never bring it up?

Never talking about the event can give the young person the message that it is too terrible to be spoken about. On the other hand, forcing them to talk about it can also do harm. The middle way is to keep the door open, to talk about the event briefly and honestly, and to let the young person share details at their own pace.

Does every young person who experiences trauma develop post-traumatic stress disorder?

No. Most young people who go through a traumatic event recover over time with appropriate support. A diagnosis of post-traumatic stress disorder can only be made through a specialist assessment, by looking at the duration and intensity of the symptoms and how much they affect the young person's life.

Will a young person who has been through trauma ever be the same again?

Trauma is an experience that leaves a mark on a young person's life, and some things may not be as they were before the event. But many young people, with the right support, manage to feel safe again and to reconnect with their relationships and their future. Some even describe discovering their own strength in this process and finding their priorities in life becoming clearer.

• #trauma
• #adolescent mental health
• #earthquake
• #post-traumatic stress

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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