Helaina Hovitz is an editor, writer, and author of "After 9/11.”

The story has dominated headlines all week: on Monday night, as thousands of people were exiting an Ariana Grande concert in Manchester, England, a terrorist detonated a suicide bomb outside the arena. The blast claimed 22 lives—including those of teens and young children—and injured 120.

As difficult as it is to watch images of the bomb site thousands of miles away, I know that the young people who actually witnessed the explosion and carnage are experiencing real trauma. The heightened security, police blockades, wailing sirens, and vigil sites are probably intensifying their anxiety and fear.

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I understand this firsthand, because I lived through a terror attack as a child as well. I was 12 years old and in middle school a few blocks from the World Trade Center when two planes tore into the towers on September 11, 2001. The horror I experienced that day stayed with me and had a profound effect on my teen years, as it likely will for the kids who lived through the Manchester bombing.

Everything from that day remains seared in my mind. The first plane hit the North Tower of the World Trade Center while I was in class. We were rushed to the cafeteria, and soon after, the second plane hit the South Tower. A bomb squad burst in, and we had to evacuate.

My neighbor and her son appeared around the same time and offered to walk me home; we only lived a few blocks from school. When we stepped outside of the school building, it was like walking onto the set of a disaster film. Bleeding bodies were loaded into ambulances, random screams pierced the air, buildings vomited paper, and people packed shoulder to shoulder, making it nearly impossible to move.

And then, we saw people jumping from the burning towers.

After the towers collapsed, we spent an hour running, trying desperately to get home to my grandparents (who lived with us) while police blocked every street and the dust and debris whirled around us. We had no idea what was going on at the time, and when I finally arrived at my home and saw on TV what we had been running from, I understood. Out the window, there was only black smoke.

 

In the weeks, months, and years after 9/11, I struggled to live life as normally as possible. I wanted desperately to be a regular teen, but the trauma of that day seized me and wouldn't let go. I knew something was very wrong with me. The immediate symptoms, like stress and anxiety, were apparent.

But the long-term, complex effects of trauma came later in the form of Post Traumatic Stress Disorder, or PTSD. It shifted my brain into a constant state of alarm, of feeling that I was not safe. I struggled with depression and panic attacks.

PTSD puts you in a state of fight, flight, or freeze, where you feel completely out of control, says Gary Brown, PhD, a trauma specialist and psychotherapist who has worked with NASA and the Department of Defense. This is because the trauma that victims have experienced has activated the most basic part of the brain, the part that’s responsible for ensuring survival.

“In essence, you are now in a state of high alert, constantly surveying your environment for any additional threats to your well-being, and certainly any potential lethal threats,” says Brown. Needless to say, this is very painful and scary, he adds.

In my case, for years, anywhere that crowds gathered scared me and left me feeling overwhelmed—unable to concentrate on the song, the player at bat, or the aroma of food from the street fair. Planes flying overheard terrified me. I was stuck in fight, flight, or freeze without knowing what that was.

My parents and I tried a number of different therapies and medications that all led me in the wrong direction. I was misdiagnosed as having ADHD and being bipolar. It wasn’t until I was 19 that I learned what I was suffering from PTSD, and I began to understand the complex ways it changes how the brain, the body, and mind respond to everyday life. It’s what many victims of the Manchester attacks will have to face as well.

I’ve spent years learning and writing about PTSD, and this is what I know now, and hope people can use in light of this week’s heartbreaking events.

What PTSD looks like in young people

For adolescents who don’t have the words to describe what they’re feeling or are afraid to talk about it because they think nobody will understand, trauma is a subtle and sometimes deadly diagnosis that often goes overlooked. Children may be easily startled, irritable, and moody. They may not be able to sleep, feel restless, and have a hard time concentrating. They may not want to participate in things they once loved.

As time continues, they may experience extreme reactions to things that would not seem like a big deal. They may start having more fights with their friends or romantic partners or experiment with drugs and alcohol. Some may argue that these are typical teen behaviors, but they're not—their brains and their bodies are responding to a threat as though that threat is still happening, and their thoughts, behaviors, and even bodily experiences are following suit.

“For many people, one of the ways they try to cope is by withdrawing from typical sources of support, like family and friends, as the person is feeling a certain degree of social anxiety because they find it difficult to talk about the trauma,” says Brown. “Perhaps they feel embarrassed, afraid, or confused.”

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Victims may also start to avoid concert venues or crowded areas. They may hear one of Grande’s songs and suddenly feel afraid or anxious and not know why. They may start riding their bike too fast or skipping school for the adrenaline rush, or they may be too upset to get out of bed. They may want to spend all of their time in their room—any out-of-the-ordinary behavior can’t be trusted.  

“One of the most common themes associated with this phenomenon is the desire to avoid any people, places, or objects that cause us fear and pain. It’s really a very normal response to an abnormal experience,” Brown says. In addition, he says, it may be difficult for people with PTSD to acknowledge these feelings to others. The idea of self-disclosing what may be feelings and thoughts of extreme vulnerability can cause the survivor intense anxiety.

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How to support a teen with PTSD

I was lucky; my parents fully supported me and were able to get me the help I needed, even though a slew of doctors and therapists misdiagnosed me several times. I hope the young people who experienced the Manchester bombing will have that same support from their families and community. For me, what helped was being allowed to express my feelings openly and not challenged but validated.

I also had access to therapy, and I know other PTSD survivors cite getting the right therapy as life-saving. For teens and all trauma survivors, specialized therapy is crucial, because talk therapy alone can often do more harm than good. Cognitive behavioral therapy, dialectical behavioral therapy, and EMDR are incredibly effective methods that offer skills for coping with the challenges that trauma presents in every day life. 

Even tools like Crisis Text Line can help. A person can send any message to 741-741; the textline is an anonymous way to get expert support for any mental health or emotional issue. 

I also hope that all the adults in Manchester understand how important it is to remind young PTSD survivors that their families and communities will do everything they can to keep them safe. They need to know that help is always available if they need it—and while resilience is something that does have to be learned, it is also something we all have within us.