The Who What and Why of Post Traumatic Stress Disorder

Have you ever wondered why some people have traumatic experiences and recover uneventfully, while others go on to develop PTSD (Post Traumatic Stress Disorder)? The answer to this question is complex with several factors at play. Before we list these determinants, let’s describe PTSD.

What are the signs of PTSD?

PTSD is a condition of increased anxiety that develops after exposure to a traumatic event including serious injury, sexual violence, or a threat to life or death. This exposure can be in person, on television or even just hearing about it after the fact. After these experiences, some people go on to develop recurrent and intrusive memories, distressing dreams, overreactions to mundane stimuli, and psychological distress. They may avoid people, places or activities that remind them of what happened. Often, the individual has trouble sleeping and concentrating, is more angry, aggressive,  and acts self-destructively. Long term, PTSD can negatively affect the immune system and lead to poor physical health. Symptoms generally begin within 3 months of experiencing the trauma but can develop many years or even decades later. Half of adults who develop PTSD will have a full recovery within 1 year of the onset of symptoms.


How common is PTSD?

Although 60% of people experience a significant trauma in their lifetime, only 10% develop PTSD. Many European countries have rates below 1%. This begs the question of why some people develop PTSD while others do not.


What types of people are most susceptible to PTSD?

PTSD is found amongst all demographics. It is most commonly seen in those with other psychiatric disorders, prior traumas or among people who hold risky jobs such as soldiers and first responders. Females, minorities, younger people, and those with childhood adversity or self-blaming coping strategies are at increased risk. Further predictors include having lower socioeconomic status, less education, and lower intelligence. The most important risk factors are the severity and duration of the trauma as well as proximity to the traumatic exposure.


Protective factors include having a strong social support network and being able to attach meaning to the traumatic events. Those who have experienced trauma and have been able to grow from it have increased life satisfaction compared to before the trauma. Viewing the event in a religious framework increases the chances of achieving Post Traumatic Growth and emerging from the trauma better off. Prognosis is better in a shared traumatic experience since those affected can commiserate with each other. These factors not only reduce the risk of developing PTSD, but also decrease the severity and duration of the illness in someone who already has PTSD.



Is there a biological basis to PTSD?

Similar to other psychiatric disorders there is a strong biological basis to PTSD with multiple brain structure and hormonal differences observed in people who develop PTSD. Certain genes are known to be protective against PTSD and epigenetics play a role as well. Second generation holocaust survivors have an increased risk of PTSD, but this disappears by the third generation.


How is PTSD treated?

Seeking treatment as soon as possible is essential as the symptoms are often reinforced when people avoid discussing the trauma. Generally, psychotherapy is sufficient for treating the disorder, however, some people require medication management as well. The sooner a person seeks help and is able to reprocess the trauma, the better their outcome.


When medications are necessary Selective Serotonin Reuptake Inhibitors are the treatment of choice. Other medications that calm the nervous system have also been found to be effective in PTSD.


The most efficacious psychotherapy is Cognitive Behavioral using exposure techniques. The therapist helps the client revisit and talk through the trauma, however, difficult it may be. The individual learns to develop healthy coping skills and avoid negative defense mechanisms.


A newer therapy that has shown promise is Eye Movement Desensitization and Reprocessing (EMDR). the client envisions the trauma while focusing on an external stimulus. This therapy helps with accessing and processing the traumatic event while causing deep relaxation and removal of the associated deleterious sensations.


What can you do if you know someone who has PTSD

Providing emotional, physical or financial support have been clearly shown to improve outcomes for those experiencing a traumatic incident. The more a person is able to talk about their trauma the better outcome they are likely to have. It is important to keep in mind that even when you have no words of comfort for a person, just being there and listening is beneficial for them. Social support needs extend beyond the acute aftermath of the tragedy and is helpful for years after the event.


What are your thoughts? Have you or has someone you know experienced a traumatic event? What has helped in healing? What advice do you have for others? Please share your questions and comments below.


Ariel Mintz, MD
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