1. The severity of the traumatic event.
2. Parental reaction to the traumatic event.
3. Physical proximity to the traumatic event.

As a general rule, most studies that have examined
the risk factors associated with PTSD emergence in children find that children and adolescents reporting experiences with severe trauma also report the greatest levels of PTSD- related symptoms.
The extent of family support as well as parental coping capacities also correlate with symptom development in pediatric populations. As such, children and adolescents with a supportive family structure that includes less distress between their parents have a less acute PTSD symptom profile.

Lastly, children and adolescents with a greater proximity from the traumatic event report less distress.

There are a number of other factors that affect the occurrence and severity of PTSD. Interpersonal traumatic events such as rape and direct physical assault are more likely to result in PTSD as opposed to witnessing a school shooting or experiencing a natural or man-made disaster. Gender specific studies tell us that girls are more likely than boys to develop PTSD. Finally, it is not yet clear in what way a child’s age at the time of traumatic event exposure influences the occurrence or severity of PTSD. While some studies allude to a correlation, others simply do not.

Of concern, has been a persistent expansion of what I refer to as “criteria creep.” Namely, an expansion of what constitutes a sufficiently serious enough trauma to categorize an individual’s symptoms as PTSD, as opposed to understandable feelings (anger, anxiety, agitation, irritability, frustration, etc.)  Examples include: watching a movie or a television show that is distressing, witnessing a real-time violent event, or hearing condescending comments about oneself.   

So does PTSD even exist? In a study conducted by researchers at McLean psychiatric hospital in Belmont, Massachusetts and reported on in the J. Anxiety Disord. 2007; 21: 176-82, one hundred and three subjects were asked if they had ever experienced a traumatic event. Even if they answered no, they were asked about symptoms of PTSD. Of those that had a traumatic experience, 78 percent also met symptomatic criteria for PTSD. Of those, who had never had a traumatic experience, 78 percent met symptomatic criteria for PTSD!

What does this mean? PTSD is not necessarily a post traumatic disorder, but instead a non-specific constellation of symptoms that often occur with or without trauma. It may therefore be inaccurate to assume that the symptoms are caused by trauma.

PTSD earned DSM diagnostic criteria after an analysis of the thoughts, feelings and behaviors of soldiers associated with the Vietnam War. Interestingly, reports indicated that approximately 33 percent of Vietnam veterans suffered PTSD at some point. Only 20 percent had ever seen combat.

Suggestions are being made that DSM V tighten up criteria such that only those that directly experience trauma can be assigned a diagnosis of PTSD; doing so will aid in demystifying what constitutes a sufficient trauma, and even more importantly, what doesn’t.