Why Do Only Some People Develop PTSD?

Why Do Only Some People Develop PTSD?

Post-traumatic stress disorder, or PTSD, is a condition that sometimes develops after a traumatic experience. Although it’s normal to feel anxious or re-experience a traumatic event in the days or weeks following the event, these symptoms typically go away on their own in a relatively short time. However, people who develop PTSD continue to experience symptoms including nightmares or flashbacks about the event, avoiding things related to the event, negative changes in feelings and beliefs, insomnia, and feeling on edge, being easily startled, or quick to anger. People with PTSD often try to self-medicate with drugs or alcohol, which puts them at a much greater risk for developing a substance use disorder. About half of people seeking help for a substance use disorder also meet the criteria for PTSD; that’s about five times the rate of PTSD in the general public. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3466083/

One surprising thing about PTSD is how few people develop the condition. Experiencing trauma is actually not uncommon. An estimated 60 percent of men and 50 percent of women will experience a traumatic event at some point in their lives, yet only about 10 percent of women and about four percent of men will develop PTSD in their lives. [https://www.ptsd.va.gov/understand/common/common_adults.asp] It actually makes sense following a traumatic experience that someone would become hypervigilant, remember the event, and avoid situations related to the trauma but this appears to be the exception rather than the rule. Why is it that relatively few people develop PTSD? The following are factors that increase your risk of PTSD following trauma.

Severity of trauma

It should come as no surprise that the severity of trauma has a major impact on whether you develop PTSD. For example, being involved in a serious car accident is traumatic and may lead to PTSD but being involved in a car accident that kills your entire family is much more likely to lead to PTSD. One study of Vietnam War veterans found that the severity of trauma was the biggest predictor of whether someone developed PTSD. [https://www.psychologicalscience.org/news/releases/why-some-soldiers-develop-ptsd-while-others-dont.html] Ninety-eight percent of veterans who developed the condition were involved in combat but of all soldiers involved in potentially traumatic combat, just over 31 percent developed PTSD. Of the soldiers who experienced the worst combat trauma, around 70 percent developed PTSD. 

Age of trauma

The study of Vietnam War veterans mentioned above found that age was another significant risk factor in who developed PTSD and who didn’t. Men who were younger than 25 when they began serving in the war were seven times more likely than older men to develop PTSD. There are probably a number of reasons for this. First, our brains are not fully mature until age 25. In particular, the prefrontal cortex–the area of the brain responsible for attention, working memory, emotional regulation, self-control, and planning–is the last part of the brain to develop. In other words, younger people are less likely to have the physical ability to bounce back from trauma. Second, older people are more likely to have developed coping skills that younger people may not have. Much of our resilience depends on using deliberate strategies. Finally, younger people were more likely to be draftees, meaning they didn’t choose to be there. A feeling of helplessness in another aggravating factor in developing PTSD.

Pre-existing mental health issues

The final major factor identified in the study above was preexisting mental health issues. People who had experienced childhood abuse or who had experienced mental health issues before entering military service were more likely to develop PTSD. Preexisting depression or anxiety disorders may be especially relevant to developing PTSD. The study found that if a service member met three main factors–was under age 25, had a preexisting mental health vulnerability, and had been involved in harming civilians–he had a 97 percent chance of developing PTSD following potentially traumatic combat. 

Propensity for rumination

Rumination is the habit of obsessively turning over a situation in your mind. It comes from the word for the process cows use to regurgitate and chew their food. When you ruminate, you may obsess over mistakes you made years ago, you may replay conversations as you wish they had gone, or you may worry about possible problems for the future. When you ruminate, you feel like you’re solving a problem, but you’re really just going in circles, making yourself depressed, and making your problems harder to solve. Studies have linked rumination to a greater risk of developing depression and PTSD. One study of people who experienced the 1989 earthquake in the San Francisco Bay area found that residents prone to rumination were more likely to develop depression and PTSD. [https://www.apa.org/monitor/nov05/cycle] Since ruminating is essentially reliving the trauma repeatedly without actually processing it, perhaps it’s no surprise that it leads to PTSD.

Social support

Many studies have found that inadequate social support is associated with a higher risk of developing PTSD. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507582/] Social support is also important for the prevention and treatment of PTSD following trauma. It is also relevant to the risk of other problems associated with PTSD, including developing a substance use disorder and suicide. Greater social support reduces perceived stress around a traumatic event. People who have a lower general level of stress and greater resources for dealing with traumatic events tend to be more resilient. Unfortunately, the symptoms of PTSD can lead to greater social alienation, which only makes the problem worse. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656396/] It’s crucial for anyone dealing with trauma to reach out both for professional help and social connection in the form of support groups and therapy groups. Diverse forms of social support, including a supportive work environment, a supportive family life, and supportive friends add extra protection against developing PTSD.

At Hart Consultants, we provide a number of different services to fit the needs of each individual client. Among these, are helping you choose a treatment provider, helping you develop a treatment plan, helping you establish post-treatment support, and ensuring continuity among the different elements of treatment. Contact us today at 844-262-7970 or Info@PatrickHartConsultants.com or explore our website for more information.

AUTHOR: Hart Consultants