Parental Posttraumatic Stress Disorder
The birth of a critically ill infant and the intensive care that follows can cause a great deal of psychological distress. A traumatizing impact (Eriksson & Pehrsson, 2002; DeMier et al., 1996), as well as ongoing maternal symptoms of traumatization long after hospital discharge of the preterm infant is commonly observed in parents of preterms (Affleck et al., 1991). Research as well as clinical experience indicates that the results with regard to parental PTSD may be transferred to the situation of parents of critically ill infants in general.
Strong psychological reactions after the confrontation with a traumatic stimulus are common. Over the subsequent weeks, a coping process takes place and in many cases leads to sufficient psychological integration of the experience. If the psychological trauma remains unresolved, however, it may result in Post Traumatic Stress Disorder (PTSD). Symptoms of PTSD are re-experiencing of the traumatic event, avoidance of stimuli associated with the trauma, numbing of general responsiveness, and increased arousal. The full range of symptoms must be present for more than one month, and has to cause clinically significant distress/impairment in important areas of functioning.
Parental PTSD has a negative, long-term impact on parental well-being, attitudes, and behaviour. Emotional conditions determine parental self-confidence, which affects the parent-child relationship. The parent-child relationship influences the long-term development of the infant.
Feeding disorders are often linked to chronic medical conditions of the infant. In the majority of cases prolonged tube feeding is caused by a critical medical situation experienced by the infant. PTSD has a high prevalence in parents of tube-fed infants.
A psychological intervention program for parents of preterm babies during their NICU stay (Jotzo, et al., 2002; Jotzo, 2004; Jotzo & Poets, 2005, Jens bitte link einfügen for evaluation see “research”) was adapted for the needs and terms of parents of infants with feeding disorders and tube-fed infants. The intervention consists of general trauma-preventative measures as well as components specifically geared towards the medical history and current problems of the infant.
Depending on the degree of psychological distress/impairment experienced by the parents, the following components are used during the treatment of feeding disorders or the tube weaning program.
Focus of the intervention is the re-establishment of emotional self-regulation in the parents, i.e. integration of traumatic experiences and (re-building) parental self-esteem.
- Explanation of stress and trauma reactions to allow parents to understand their emotions as a normal response to a stressful or traumatizing event
- Provision of support during emotional outbursts
- Provision of simple relaxation and calming techniques
- Exploration of helpful coping strategies used by the parents in previous crisis situations, to enable the parents to make use of them in the current situation
- Discussion of personal resources and current social support facilities to determine those that could be used in the current situation as well as in the future
- Exploration of possible solutions for concrete problems
- Reconstruction of the critical medical and psychological events during the infant’s life
- Obtaining a detailed history of the course of the infant’s life to date with regard to traumatic events that have occurred
- Exploration of the parents’ perception of their infant’s/child’s current condition in order to detect and address discrepancies between parental perception and the actual strengths and abilities of the infant
- Exploration of parent-infant relationships and the perception of parental role, in order to identify problems and facilitate relationship development
- Discussion of the relationship between the parents as well as between the parents and the rest of the family to identify ways of improving the level of support given