The National Institute of Mental Health has estimated that more than 60% of men and more than 50% of women in the United States have experienced some type of traumatic event. Fortunately, the vast majority of people who have had a traumatic experience do not develop post-traumatic stress disorder, also known as PTSD.
Research indicates that people who develop PTSD differ from those who don't in a number of ways unrelated to the nature of the traumatic experience itself. To begin with, women seem to be two to three times as susceptible as men. They may be more biologically vulnerable for genetic or hormonal reasons. They also tend to undergo different kinds of trauma. Men suffer more non-sexual physical violence, while women are more likely to be raped or sexually abused.
It is possible that female trauma is more often prolonged — as in the case of a battered wife. Such long-term stress can have more profound effects than a single event. But even when both sexes have suffered the same type of trauma, women are more likely to develop PTSD. Six months after the bombing of the federal building in Oklahoma City, 45% of women exposed to the bombing developed PTSD, while only 23% of the men did.
Differences in social support may be one factor that explains why women seem more vulnerable to PTSD. For example, wives may be better at soothing husbands than the other way around. Or maybe women are more willing to admit that they have PTSD symptoms and seek help, instead of retreating into solitary misery or disguising their problems with drinking and aggression.
Many other individual differences influence vulnerability. PTSD is more likely to arise in someone who has suffered previous traumatic experiences. Intentional injury — physical or sexual assault — creates a greater risk of PTSD than a natural disaster or an accident. The risk is even higher for victims who feel guilty because they believe that they bear some responsibility for the event. High IQ may blunt the impact of a traumatic experience on mental health, and low IQ may exacerbate it.
Depression, anxiety, alcohol and drug abuse, childhood behavior disorders and adolescent delinquency, antisocial personality, and other personality disorders also heighten vulnerability to PTSD.
Twin and adoption studies suggest that heredity is also a factor. In one study, researchers enrolled identical twins in which one member of each pair was a Vietnam combat veteran. About half of the veterans developed PTSD after their service ended. Tests revealed subtle deficiencies in cognitive functioning in veterans who developed PTSD and their identical twins, which were not present in veterans without PTSD and their twins. This finding suggests that the cognitive deficiencies were risk factors for PTSD rather than consequences of the traumatic experience.
Research into why some people are more vulnerable than others to developing PTSD continues. For now, it is important to remember that any trauma will affect different people differently, and that the effects can be lasting. People who develop PTSD, therefore, deserve help that is designed to meet their particular needs.
Are you or is someone you know suffering from PTSD? Did the condition develop as a result of military service, personal trauma, or a traumatic event? What has helped you or your friend to cope with PTSD?
Dr. Michael Miller has been on staff of the Beth Israel Deaconess Medical Center, a large teaching hospital in Boston, for more than 25 years. He is also an Assistant Professor of Psychiatry at Harvard Medical School.
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Comments: 13
Bert:
Thanks, too, for your comment. There are of course several disadvantages to aging, but one of the main ADVANTAGES is that there can be a reduction in the intensity of emotional reactions, especially as you gain perspective.
With regard to dealing with loss or traumatic experience, the goal -- I think -- is not to stop feeling, but to be able to tolerate painful feelings and go on with life. This is a little corny, I know. But if you can keep functioning, you have a better chance of bringing good things into your life.
Thanks for posting the article.
I've seen what seem to be some pretty wild estimates about the number of men and women coming home with PTSD, like-- as many as 500,000 troops.
What do you think it might cost, to treat that many people, and how long might treatment be required ? Is this something that could financially ruin the VA ??
To lose a child to suicide is about as traumatic an experience as I know of. It seems you're using several different resources to manage the pain of it. That is instructive to people who are following this stream. Especially after suffering such a traumatic loss, it is useful to come at the problem from several directions. I'm glad you're working so hard at moving on with your life.
Regarding current and future veterans of the Iraq war, I know the estimates are staggering, but I believe they are accurate. The type of treatment and the duration of treatment will vary a lot, depending on the type of traumatic experience and how the person reacts to it.
Remember, everybody reacts to traumatic experiences in a different way. Some develop a classic PTSD syndrome. Others get depressed. Still others develop an anxiety disorder, or some other disorder. Many, maybe even a majority, don't develop a diagnosable illness. Still others keep their suffering to themselves so they don't come to the attention of caregivers.
The expression "war is hell," has survived for a reason -- because it is. Thus everyone needs help adjusting after a wartime experience.
So I'm not surprised at the estimates.
Will it be expensive? Yes. But providing the help is the right thing to do. And the cost will only be a fraction of what is spent to keep our troops in Iraq.
Do you remember the WWII era biography movie named "Patton," with George C. Scott? Do you remember the scene when he was reviewing the troops in the hospital, and came across a soldier with "battle fatigue" or "exhaustion?"
Patton was disgusted by the cowardice of the soldier and slapped him.
Now I'm not suggesting he was justified in doing so, but the simple truth is, until the all volunteer military came into existence, these conditions were relegated to "unproven ideas" status, believing instead it was "all in their head" so to speak.
After WWI "shell shock" or "soldiers heart" was considered a mental illness. Sufferers were thought of as cowards, and there were even instances of hangings.
Here is an excerpt from a book written during WWI, debating the wisdom of giving British soldiers "benefits" as a consequence of the diagnosed "problem."
"There should be no excuse given for the establishment of a belief that a functional nervous disability constitutes a right to compensation. This is hard saying. It may seem cruel that those whose sufferings are real, whose illness has been brought on by enemy action and very likely in the course of patriotic service, should be treated with such apparent callousness.
But there can be no doubt that in an overwhelming proportion of cases, these patients succumb to 'shock' because they get something out of it. To give them this reward is not ultimately a benefit to them because it encourages the weaker tendencies in their character. The nation cannot call on its citizens for courage and sacrifice and, at the same time, state by implication that an unconscious cowardice or an unconscious dishonesty will be rewarded.
From A War of Nerves: Soldiers and Psychiatrists By Ben Shephard 1914
Things didn't get much better during WWII, or Vietnam. PTSD-- Since the number of people that actually serve, is much smaller than the number that do not serve, I doubt a large percentage of people know a vet from Iraq, personally.
I think for the most part, you really do have to experience this "problem" first hand, to fully appreciate the condition, otherwise, I think you'll get a lot of "patton" wanna be's rising to the surface.
But yes, I DO agree that personality or intelligence may play a part in who becomes resilient over these events and who may be less resilient.