Post-Traumatic Stress Disorder


Introduction

PTSD is a disabling disorder, affecting individuals who survived a traumatic event. The symptoms of PTSD include recalling the event, a depressed mood, panic attacks, flashbacks, and avoiding situations that may remind the individual of the trauma. The American Psychiatric Association estimates that 3.5% of the population currently suffers from PTSD. However, the American Psychiatric Association further estimates that the lifetime prevalence of PTSD is 8.5%. This estimate suggests nearly three times the amount of people currently suffering from PTSD will eventually experience this disorder in their lifetime. Despite the large prevalence of the population at risk or currently experiencing PTSD, little as to what causes the disorder. Although research has shown that a traumatic event is often associated with onset of PTSD, the type and severity of the event that the individual experienced tends to vary. Furthermore, some individuals live through traumatic events and do not develop PTSD. The incorporation of the diathesis stress model will be provided in order to determine what factors influence the likelihood an individual will develop PTSD.

Diathesis Stress Model

The diathesis stress model explores certain characteristics that may increase the likelihood that an individual develops PTSD. The diathesis stress model assumes that there is a predisposing factor that influences the development of PTSD. However, Yedhuda further argues that the predisposing factor may be biological, behavioral, or cognitive. Despite the differences, the predisposing factor present in the individual increase the likelihood that he or she will develop PTSD when exposed to traumatic conditions. In further demonstrating the application of the diathesis stress model to PTSD, Mceveer & Huff found in a literature review that most participants suffering from PTSD exhibited certain characteristics. In this specific literature review, Mceveer & Huff determined that a history of anxiety disorders, or the lack of a prosocial support system were two factors present in most participants in the study.

Trauma & PTSD

Experiencing a traumatic event is one of the main characteristics that sets post-traumatic stress apart from other anxiety disorders. However, the types of traumas individuals with PTSD have experienced tend to differ. Events that may trigger PTSD include the sudden death of a loved one or friend, being victimized, or experiencing combat. Yet not everyone that suffers from a traumatic experience develops PTSD. Only 4-17% of military veterans who engaged in conflict developed PTSD. However, Richardson acknowledges that this estimate was based on a meta-analysis of current literature, and therefore, the prevalence of individuals that develop PTSD after experiencing conflict may be higher than estimated.

The sudden loss of a close friend or family member is enough to lead some individuals to develop PTSD. In a 2013 study, Sanderson, Lobb, and Mowll sought to explore the symptoms of PTSDs in caregivers that had recently lost an individual they were caring for. All individuals in the study reported that the person they were caring for died suddenly. The results indicated that PTSD was common in this population. The researchers further concluded that the ‘shocked caregiver’ experience may lead some individuals to develop PTSD. However, the researchers further found that caregivers that had a person they were caring for die suddenly were significantly more likely to feel some type of guilt and question if there was anything they could have done to change the outcome. Sanderson et. al. further questions whether or not the guilt or unresolved questions involving the individual’s death may have contributed to the formation of PTSD in this population. Yet, future research is needed to assess the role of guilt or unresolved questions in caregivers experiencing PTSD after the individual they were caring for unexpectedly died.

Victimization is another traumatic incident that has been widely associated with PTSD. In a 2014 study, Brewin, Andrews, and Rose sought to explore the prevalence of PTSD among individuals who had been victimized within the past six months. The researchers found that 19% of the sample suffered from acute stress disorder, while an additional 20% of the sample suffered from PTSD. However, Brewin et. al. argues that individuals who suffered from an acute stress disorder are at a future risk of developing PTSD. Yet even in the absence of this finding, the research concluded 2 in 10 victims will experience PTSD.

Gender & Onset Age

Males and females tend to experience traumas differently. In a 2010 study, Ditlevsen and Elklit sought to explore the average onset of PTSD by age and gender. All participants in this study had been diagnosed with PTSD. However, the age in which participants developed PTSD tended to vary based on the individual’s gender. This was further evident as women in their 20’s were significantly more likely to suffer from PTSD than males. The researchers further found that females had a 3 to 1 ratio in terms of the likelihood of being diagnosed with PTSD during their 20’s when compared to males. This trend was further observed in elderly individuals. However, the researchers questioned whether or not this trend is accurate in the elderly, as females tend to live longer than males. In reviewing other age groups, Ditlevsen and Elklit found that the number of individuals suffering from PTSD drastically increased in 50 year olds in both males and females. In concluding, Ditlevsen and Elklit determined that females are more likely to be diagnosed and suffer from PTSD. Yet the researchers further questioned whether or not the social and gender roles ascribed to females adversely impact the likelihood that females will develop PTSD.

Racial Differences in PTSD

Although PTSD affects people regardless of race, some races are more likely to experience PTSD than others. African Americans were more likely than other races to experience PTSD. The rate of PTSD was similar for both whites and Hispanics. However, Asians were further shown to be significantly less likely than other races to suffer from PTSD. Yet, African Americans and Hispanics were more likely to attribute the trauma to childhood (witnessing a traumatic event, domestic violence in the home, etc.). In contrast, whites were more likely to report the onset of PTSD to occur after a close friend or relative had unexpectedly died. In terms of military related traumas, Hispanics, African Americans, and women in general were more likely to report developing PTSD after witnessing combat. This suggests that certain experiences may be more likely to trigger PTSD in certain races or genders. Despite these differences, Roberts et. al. concluded that minorities (regardless of gender) were significantly less likely to seek treatment to help manage the symptoms of PTSD than their white counterparts.

Socio-Economic Status & PTSD

Socio-economic status may influence whether or not an individual develops PTSD. Individuals with a low socio-economic status were significantly more likely to suffer from PTSD than other populations. This relationship was attributed to the lack of resources available to this population. However, individuals living in an inner-city neighborhood with a low socio-economic status were significantly more likely to suffer from PTSD. Multiple factors may increase the likelihood that individuals with a low socio-economic status experience PTSD.

Although PTSD may be more common in individuals with a lower socio-economic status, PTSD can affect anyone. In a 2014 study, Dorrington, Zavos, and Ball explored factors that resulted in individuals from a middle socio-economic class to develop PTSD. In exploring middle classed individuals who had been diagnosed with PTSD, the researchers found that it was common for participants to report having two traumatic experiences within a short period. This suggests that multiple traumatic experiences may be more likely to influence PTSD in the middle class. However, the researcher did not explore the types of trauma participant’s experienced. Therefore, it is unknown if certain types of traumas are more likely to result in PTSD in a middle classed population. Furthermore, the inability to access the severity of each trauma makes it difficult to determine whether or not all types of traumas influence individuals in a similar manner.

Biological Predispositions

Although individuals experience traumas, not all individuals who experience a traumatic event go on to develop PTSD. This has led scientists to question whether or not certain individuals are biologically predisposed to mental illnesses. Only 20-30% of individuals who experience a traumatic event will be diagnosed with PTSD.

In exploring the role of genetics in the development of PTSD, twin studies have demonstrated that genetic factors account for 30-40% of cases of PTSD. Specifically, individuals with certain genes may be more likely to report post-traumatic stress likely symptoms (eventually leading to a diagnosis) after experiencing a traumatic event. Yet, there is no confidence as to what specific genes or neurotransmitter result in a diagnosis of PTSD after the individual has been exposed to a trauma. Dopamine may play a role in regulating neurotransmitter, which leaves certain individuals more suspetable to developing PTSD. However, future research is needed to confirm whether or not dopamine plays a role in the development of PTSD, or whether or not a combination of imbalances in neurotransmitters increase the likelihood that an individual will develop PTSD.

In further exploring the role of genetics in developing PTSD, there have not been enough studies exploring the role of neurotransmitters in developing PTSD. Dopamine may play a critical role in influencing whether or not a trauma victim develops PTSD. However, genetic studies exploring the role of neurotransmitters affecting the onset of PTSD have produced mixed results. Specifically, genetic studies have demonstrated that multiple genes and neurotransmitters may be responsible for PTSD. Therefore, it is difficult to pinpoint one specific gene or chemical imbalance that leaves certain individuals more suspetable to PTSD after experiencing a trauma. Future research exploring the role of genetics in PTSD use similar tests and methodologies in order to establish an increased sense of validity across the different studies.

In another study, Breslau, Troost, and Bohner sought to determine whether or not individuals with a family history of PTSD or an anxiety disorder were more likely to develop PTSD after experiencing a traumatic event. All individuals who participated in this study had experienced an extreme trauma, as defined by the researchers as a severe accident, sexual assault, disaster, or survived the sudden loss of a loved one. However, only some of the participants in this study had been diagnosed with PTSD. In exploring family histories, Bresalu et. al. concluded that there was no relation in this study relating to a genetic predisposition (as defined by family history) and the development of PTSD. In contrast, Bresalu et. al. found that individuals were just as likely to develop PTSD after a traumatic event, even if there was no family history of an anxiety disorder or PTSD.

Conclusion

PTSD occurs after an individual experiences a traumatic experience. Estimates suggest that nearly 3.5% of the population currently suffer from PTSD However, researchers are unsure as to why some individuals experiencing a traumatic event develop PTSD, while others do not. In exploring the presence of PTSD in society, females are significantly more likely than males to develop PTSD Some research has further suggested that African Americans may be more likely than other races to develop PTSD. Yet, the causes of PTSD are less defined. Researchers have long questioned whether or not PTSD is influenced by genetics. Although researchers have suggested that certain neurotransmitters (dopamine) may increase the likelihood that an individual develops PTSD, the role of neurotransmitters in the brain and its effects on PTSD are not fully understood. Furthermore, some research has demonstrated that individuals without genetic tendencies are equally as likely to develop PTSD after experiencing a traumatic event. In reviewing these findings, the overall cause of PTSD as it relates to genetics is unknown.