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Analysis Toxic Stress and PTSD in Children

Psychopathology in children exposed to trauma: detection and intervention needed to reduce downstream burden

BMJ 2020; 371 doi: (Published 19 November 2020) Cite this as: BMJ 2020;371:m3073

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Psychopathology in children exposed to trauma: Don´t forget trauma and the COVID 19 pandemic!

Dear Editor

I agree with the authors [1] that the identification of psychopathology related to childhood trauma can help to break down barriers to access health services and improve knowledge about children's mental health through more intensive training of general practitioners. But we need a realistic and pragmatic strategy.

Apart from PTSD, traumatic events are associated with many forms of psychopathology, with the strongest links with anxiety and depressive disorders [2]. PTSD is a complex disorder with many psychiatric comorbidities (affective, substance use disorders, psychosis, other delusional states or autism [3]). PTSD can be difficult to diagnose (subjective nature of most diagnostic criteria with the potential for over- and under-recognition, overlap of symptoms with other psychiatric disorders).

Two newly revised conceptualisations (ICD-11, DSM-5) of post-traumatic stress disorder are currently available. It is not clear what this means in practice. DSM-5 pays more attention to the behavioural symptoms associated with PTSD and proposes new clear diagnostic clusters.

Early intervention is absolutely essential to reduce the psychopathology in trauma-exposed children, but in my view preventive measures are crucial.

Do not forget trauma and the COVID 19 pandemic! COVID-19 has become a global health emergency, leading to physical and mental health problems with social isolation, self quarantine, disruption of daily routines and physical discomfort. These exposures may increase the risk of developing PTSD. Guessoum SB and colleagues [4] noted that extensive domestic isolation, massive mourning, intra-family violence, overuse of the internet and social media are dramatic traumatic events and stress. At present, risks and consequences for the development or intensification of psychological problems and psychiatric disorders are not yet foreseeable.

1) BMJ 2020;371:m3073
2) Copeland WE et al. Traumatic events and posttraumatic stress in childhood. Arch Gen Psychiatry 2007; 64(5):577-84. doi: 10.1001/archpsyc.64.5.577.
3) R Brewin CR, Rumball F, Happé F. Neglected causes of post-traumatic stress disorder. BMJ 2019; 365:l2372 doi:
4) Guessoum SB et al. Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown. Psychiatry Res. 2020;291:113264. doi: 10.1016

Competing interests: No competing interests

23 November 2020
Detlef Degner
Associate Professor of Psychiatry, Medical School of University Goettingen, Germany
Department of Psychiatry, Medical School of Georg-August University, UMG, Goettingen, Germany
Von- Siebold- Str 5 , D -37075 Goettingen, Germany