A rare case of Post Traumatic Stress Disorder in a 13-year adolescent after a chance witnessing of an unusual event - case report

INTRODUCTION: PTSD develop following a stressful event or situation of an exceptionally threatening or catastrophic nature which is likely to cause pervasive distress in almost anyone. Of those children and adolescent exposed to trauma 8 to 9% will develop PTSD CASE REPORT: A 13yr old adolescent male who was quite normal until he witnessed his parents in a state of sexual activity in early hours of morning when he woke up for nature’s call. Immediately following the very distressing exposure, he was in shock, tearful and anxious. He was troubled with repetitive memories of this traumatic event and has sleep disturbances with frequent nightmares. The mere sight of his father makes him to have a disruptive emotional breakdown. The home atmosphere itself triggers his emotions. He thinks his father has wronged and he avoids interacting with him. He is watchful over his mother while she interacts with his father. He could not concentrate on his study or play, had a sense of anhedonia. Since then, he has been counselled by his mother and close relatives that it was an innocuous sexual union and no malintent was attached to it, he is inconsolable and cries throughout the day with anger outbursts, sometimes indulges in self-injurious behaviour like thumping on his chest. He presented to psychiatric OPD with his mother On MSE he has dysphoric and restricted affect with distorted cognition regarding normal sexual process and expresses hostility towards his father Psychometry assessment suggestive of normal intelligence Significant scores in child PTSD symptom Scale Nil significant score in childhood depression inventory scale Treatment started with SSRI and trauma focused CBT, parental psychoeducation and on regular follow up CONCLUSION: A lot of discussion has happened on this case whether such an event can cause trauma to the child´s psyche. The prognosis for children with untreated PTSD has become a matter of increasing concern. This emphasis the need for identification and effective intervention in symptomatic children early in the course of this disorder.