Risk Factors for PTSD

Post-traumatic stress disorder (PTSD) has probably always been part of the human experience, but it didn’t become an official diagnosis until 1980. It was once thought of as something that only happened to military veterans exposed to the violence of war. In fact, there are stories of psychological effects from war trauma that go back to the Civil War. The term “shell shock” came from World War I and was used to describe soldiers experiencing PTSD symptoms after being exposed to explosions of artillery shells. (1)

The definition of PTSD has evolved over time as we’ve learned more about it. Now, we know the mental health condition can affect anyone at any age who has experienced some type of trauma. (3)

It’s more common than we might think, too. About 70 percent of American adults have experienced a traumatic event at some point in their lives, and about 20 percent of them go on to develop PTSD as a result. (4) That means around 6 percent of Americans will have PTSD at some point in their lives, and about 12 million adults have it in any given year. (5)

For those who do live with PTSD, symptoms can interfere with their daily lives. They can cause problems in a relationship, at work, during social situations, or when trying to accomplish everyday tasks. (6) If left untreated, PTSD can also increase chances of developing depression, anxiety, substance abuse, eating disorders, and suicidal thoughts or actions.

Although researchers and mental health professionals know much more about the condition, it’s still hard to predict exactly who will or won’t develop PTSD. Everyone is different, and there are a variety of factors that come into play. (6)

For some people, a history of trauma increases the risk of developing PTSD after another trauma, while other people go through multiple traumas and do not develop PTSD, says Gary Brown, PhD, a psychotherapist based in Los Angeles, who has been treating PTSD survivors for 25 years. It’s currently unclear why some appear to have resilience against PTSD, but researchers are exploring this topic.

The cause of PTSD is experiencing, witnessing, or learning about a traumatic event and how you’re able to mentally process it in the aftermath. That’s why it’s often seen in people who have been in military combat. They may have committed or watched a violent act, or learned about the death of someone they served with.

Sadly, life-altering trauma can also happen in everyday life. Although mental health professionals use a specific definition of “trauma” to diagnose PTSD, there are many different adverse experiences that can impact people in a variety of important ways. Regardless of whether you develop PTSD is mostly about how you as an individual process the experience. Not everyone who goes through a trauma goes on to develop PTSD. In fact, most people do not. (3)

“You have to have some sort of event or situation that occurred that you perceive as traumatic,” says Kathryn Moore, PhD, a psychologist at Providence Saint John’s Child and Family Development Center in Santa Monica, California.

Common types of traumatic events (other than active military combat) linked to PTSD include: (6,7,8)

• Sexual Abuse This includes rape, assault, sexual violence from a partner, and childhood abuse. Often, people who experience sexual abuse in a relationship setting have also been victims of childhood sexual abuse. Having a history of both could increase your chances of developing PTSD. (9)
• Childhood Abuse This may be either physical abuse or some forms of emotional abuse.
• Natural Disaster Those who live through hurricanes, earthquakes, wildfires, and other devastating natural disasters may experience trauma, like losing a loved one or their home.
• Physical Assault Being beaten, hit, or subjected to any physical violence can be traumatic.
• Violent Threats This includes being robbed or threatened with a gun or other type of weapon.
• An Accident Surviving a car or plane crash can be traumatic.
• Acts of Terror This includes mass shootings and bombings, for example.
• Medical Diagnosis Receiving a life-threatening diagnosis for you or a loved one can have a traumatic effect.
• Death The unexpected loss of a loved one can be traumatic.

These events and experiences trigger intense fear, causing our bodies to react in “fight or flight” survival mode. (7)

Researchers aren’t exactly sure what causes traumatic events to lead to PTSD in some people — the reasons seem to be complex and involve many factors. But one factor may be that trauma leads to a chronic stress response in some people, changing the way they are able to cope with that event and future stressors. (10)

Your genetics and social experiences, like how you were treated as a child, play a role in brain development. (11) Differences in brain development before a trauma might explain why certain people develop PTSD.

Researchers have identified several risk factors that might predict someone’s likelihood of developing PTSD. But just because you have some risk factors doesn’t mean you will definitely get PTSD — it just means your chances are higher than someone without risk factors.

It’s possible for two people to experience the same traumatic event with only one developing PTSD, says Vinita Mehta, PhD, a clinical psychologist based in Washington, D.C. That’s because people have different genetic and personality dispositions, as well as different psychological strengths.

A person’s risk factors can be divided into three different categories: before (pre), during (peri), and after (post). (12) These represent stages of the trauma.

Before

This is the history you have before going through a trauma. (12) Risk factors include:

• Genetics People with a family history of anxiety or PTSD might be more likely to experience one of these mental health conditions themselves. (13)
• Age The life stage you’re in at the time of the trauma can determine your risk for PTSD. For example, research shows that women may be at their highest risk between the ages of 51 to 55. (14)
• Sex Women are more likely to develop PTSD than men. (15)
• Mental Health History Having other mental health conditions, like anxiety disorders or depression, might make you more likely to develop PTSD. (15)
• Personality Traits Having poor coping skills, being neurotic or introverted, or possessing a negative worldview are traits linked to PTSD. (16)
• Prior Trauma (15) Experiencing a traumatic event or ongoing trauma (like childhood abuse) that resulted in PTSD puts you at a higher risk of getting PTSD after a second event.

During

These risk factors relate to the event as you experience them: (12)

• Level of Exposure How long did the trauma last? Were you directly involved, watching it unfold, or hearing about it?
• Intensity What was your emotional experience during the trauma? Did you feel extreme fear? Were you trapped? Was death or extreme injury involved?
• Perception How did you view the event as it was happening?

After

These risk factors deal with what’s available to you immediately or soon after the experience: (12)

• Access to Resources Being able to process what happened with a trained therapist or in a group setting with others who have gone through the same thing — if this is something you’re interested in and comfortable with — can be helpful. In the case of a natural disaster, for example, resources to help relocate or ease financial stress are also important.
• Social Support A social network, whether it’s family members and friends, or a therapy group, can help you feel more secure and less isolated. Suddenly losing your social network — which often happens when people are forced to relocate after natural disasters — can raise your risk of PTSD.

Coping after a trauma really comes down to making meaning of it and regaining anything that was lost, says Dr. Moore.

The good news is that developing PTSD might be preventable by knowing your risk profile and getting proper support immediately after a traumatic event.

Researchers found that in the case of women who sought care after being raped — a common cause of PTSD — identifying those with PTSD risk factors, such as other mental health conditions and a significant acute stress response, could help healthcare providers offer the correct support after the event. (17)

“The sooner people get help, the better their chances are of recovering and getting back to their normal level of functioning, Dr. Brown says.

Although it’s not a cure-all, improving coping skills can help everyone deal with stressors — big and small. “Practice a lifestyle that incorporates a lot of balance,” says Lisa Skalla, LCSW, a social worker practicing at Enteave Counseling in Austin, Texas. She suggests engaging in self-care strategies, which can make it easier to heal and process trauma after the fact.

Skalla recommends selecting self-care activities from the four categories below, and mixing and matching to meet your needs:

• Physical Eating healthy, exercising, taking time to do fun activities, getting away from technology, and unplugging regularly are all important.
• Psychological Helpful strategies include journaling, taking time for self-reflection, talking to a therapist, taking time to notice your thoughts and feelings, practicing mindfulness, and learning and engaging your brain in new ways, such as going to a museum, taking a class, or learning an instrument.
• Emotional Some ideas for self-care include spending time with others whose company you enjoy, staying in contact with important people in your life, taking time to give yourself affirmations that help increase your self-worth, rereading a favorite book or watching a favorite movie, and finding out what makes you feel good and safe.
• Spiritual Taking time for quiet reflection, spending time in nature, connecting with a community where you feel safe and comfortable, meditating, and praying are all good strategies for self-care.

Most people who experience or witness a traumatic event are going to have some type of distress afterward. Having a reaction to trauma is normal, but it usually fades with time and proper coping strategies. That’s why experts have come up with specific rules for finding out if you have PTSD.

PTSD symptoms are divided into four categories. (3,6) To be diagnosed, you must have at least one symptom each from categories one and two and two each from categories three and four. You also have to experience these symptoms for more than 30 days, Moore says.

Here are the four categories of PTSD symptoms:

1. Reexperiencing

• Experiencing flashbacks or reliving the event as if it were happening again
• Tapping into unwanted memories of the event
• Having dreams or nightmares about what happened
• Psychological distress with cues
• Physiological distress with cues

2. Avoidance

• Avoiding thoughts, feelings, and memories about the event
• Staying away from places, people, things or activities that remind you of the event

3. Stimulation or Reaction

• Getting startled easily or being “jumpy”
• Sleeping poorly
• Feeling like you’re always in danger or “on the lookout”
• Being prone to angry outbursts, and being aggressive or irritable
• Having reckless or self-destructive behavior
• Struggling to concentrate

4. Mood or Thinking

• Having an inability to remember parts of the event
• Carrying negative beliefs about the world and yourself
• Inappropriately blaming yourself or others for the trauma
• Struggling with persistent feelings of fear, horror, anger, shame, or guilt
• Losing interest in the things you once enjoyed
• Becoming detached from loved ones
• Being unable to experience positive feelings, like happiness and love

Although PTSD can’t officially be diagnosed until 30 days after a traumatic event, it’s a good idea to see a professional whenever you’re having any of the symptoms listed above. If your symptoms are negatively affecting your day-to-day life, it’s a sign you can benefit from help processing the trauma.

“Experiencing [PTSD symptoms] for more than two to three weeks is a general warning sign that, if left unresolved, you may develop PTSD,” says Brown.

Getting therapy at any point after a traumatic event can help you to start healing. Talk therapy and medication given after exposure to a trauma can be very effective in reducing the risk of developing PTSD, explains Dr. Mehta.

People who are open to getting help are more likely to recover faster from traumatic events than those who tend to keep it all inside, says Brown.