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How common is PTSD, Who is more likely to get PTSD?

Q: Dear Frank, We have support pals who have been through domestic violence, child abuse, ritual abuse and rape. Becoming survivors and thrivers are our goals. I have been asked just how common is PTSD? Who is more likely to get it and why? And how do normal post-trauma symptoms differ from PTSD symptoms? What role does resiliency play in healing and recovery? Why do some take longer to heal than others?

A: Dear Joyce,There are several important but different questions in this month's list. The first one, "How common is PTSD?" comes up whenever large groups are exposed to very dangerous circumstances, such as combat, and we need to anticipate the specific emotional outcomes. In that regard, PTSD is not as common as some other consequences of trauma, tragedy and abuse. For example, the British Ministry of Defense reports more depression and alcoholism than PTSD in its returning veterans from Iraq. This is true of women as well as men.

Among adult survivors of incest, I find PTSD to be relatively rare, but concerns about trust and intimacy quite common. The chances of developing PTSD after rape at gunpoint are quite high (one study found 80%). Among Vietnam vets exposed to combat, 15 % developed PTSD. The factors that increase the risk of PTSD include the suddenness and severity of the traumatic event, the intensity of exposure, the presence of complicating conditions (physical, emotional and interpersonal), and both genetic and personality factors. A readable but technical article in the latest PTSD Research Quarterly by Mark Miller is titled, "Personality and the Development and Expression of PTSD." A personality that tends toward "negative mood and adversarial interactions" is, according to Dr. Miller, more prone to PTSD. Moreover, one's personality predicts the way someone with PTSD will feel and act. Some are more introverted and self-destructive; some more aggressive and harmful to others.

Therefore, the answer to the question, "How common is PTSD?" depends upon the traumatic event and the person who is exposed to the event.
"Who is more likely to get PTSD and why?" There is more than one factor determining the answer to this question. But in my opinion, most of the reasons do come down to the way your brain is structured. Some of us have a pattern, from our earliest years, that makes us more likely than others to respond to a significant trauma with "hot memories." These memories are connected to the fear center of the brain and they turn themselves on when we do not choose to remember. They come with feelings that vary from minimal (vague dis-ease) to maximal (sheer terror). Recent brain imaging studies show that identical twins are similar in this regard.

Environmental factors, such as effective or abusive parenting, have more to do with the way we handle PTSD. As troubling as PTSD symptoms are, some cope relatively well while others find the symptoms overwhelming. But the presence or absence of PTSD symptoms after a traumatic event is, in my opinion, related to our genetic map and our brain structure.

Normal post-trauma symptoms include feeling shocked and stunned (which often includes a fast pulse and difficulty standing), having thoughts that return to the event, wanting to talk or to be silent (depending upon personality) and trouble sleeping. There actually is a long list of common reactions. But these are all proportional to the traumatic event and they clear up in days or weeks.

By definition, resilient people cope well with trauma and with most other life circumstances. They have an optimistic, yet realistic view of themselves and the world; they have a good sense of humor; they engage others effectively; they have skills that lead to productive and valued work. In my opinion, they are candidates for PTSD when extreme trauma befalls them, but they find accurate information and they make good use of it. I've had several such persons in my care. One is the mother of a murdered boy. She still has PTSD symptoms. But she is a terrific Mom to her other kids, and she copes. She helps other survivors.

Some of us take a long time to heal. That Mom may take a lifetime. PTSD is a group of symptoms that include "hot memories" (flashbacks and nightmares and images that burst into awareness when you wish you could forget); reduced or numb feelings (diminished joy and hope and love); and easily triggered anxiety. All of these symptoms fade with time, but they often reappear and when they do, it is easy to feel overwhelmed and demoralized.

It is no sign of danger or of weakness to take a long time healing. PTSD can be "tamed" and managed. It helps to learn as much as possible about the condition, and to take comfort from the others out there who are also enduring the long struggle.

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