Predisposition To PTSD: Influencing Factors

Posttraumatic stress disorder (PTSD) refers to a mental illness that some people develop after experiencing or witnessing a traumatic event or series of events. Predisposition to PTSD may be linked to various factors, including genetic risk, additional stress, and environmental influences, such as insufficient social support following a traumatic event. The National Center for PTSD indicates that about 6% of people in the US will experience PTSD at some point.

Events associated with PTSD are usually severe enough to shock or scare someone or endanger their life. Examples of such events can include a natural disaster, an accident, or a physical/sexual assault. 

While some people recover over time, others develop symptoms of PTSD. So why do some people develop PTSD after a traumatic event while others don’t? There’s a growing body of research examining this very question. Below, we’ll explore factors that may affect predisposition and resilience to PTSD. 

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What gives someone a predisposition to PTSD?

According to the National Institute of Mental Health, risk factors for posttraumatic stress disorder include:

• Having had trauma exposure in the past, particularly during childhood
• Witnessing people getting hurt or being killed
• Lacking adequate social support after a traumatic event
• Experiencing additional stress following the event, such as an injury, financial difficulties, or loss of a home
• Having a personal or family history of substance use or mental illness

Research published in Nature suggests that one PTSD risk factor may be alcohol dependence, as nearly one-third of people with PTSD also experience such dependence. A family history of alcohol dependence has also been linked with a greater risk of experiencing trauma and developing PTSD. Research indicates this link may be partly attributed to common “psychosocial risk factors," such as challenging childhood experiences, as well as common genetic factors between PTSD, alcohol dependence, and substance use disorders. 

According to the Harvard T.H. Chan School of Public Health, research findings of the Psychiatric Genomics Consortium suggest that genetic variation may also play a role in PTSD. Also, having a genetic risk for other psychiatric disorders such as schizophrenia, major depressive disorder, or bipolar disorder may increase a person’s risk of developing PTSD. 

Older research suggests that pre-existing brain abnormalities within the circuitry of the amygdala and dorsal anterior cingulate cortex may lead to a predisposition to developing PTSD

Posttraumatic stress disorder and anxiety sensitivity

Research published in the Journal of Contextual Behavioral Science suggests that anxiety sensitivity (AS) and emotional avoidance may also increase a person’s risk of developing and maintaining PTSD. Anxiety sensitivity refers to a fear of experiencing sensations that may cause anxiety due to expectations of negative outcomes in one's psychological, physical, and social spheres. 

The study focused on individuals with substance use challenges and noted that anxiety sensitivity was associated with PTSD in individuals who scored high in emotional avoidance, suggesting a "significant interaction between negative emotional avoidance and AS in predicting PTSD status."

Symptoms of posttraumatic stress disorder

The timing of the onset of PTSD symptoms, their severity, and their presentation can vary widely among individuals. For example, while many people develop symptoms shortly after experiencing trauma, others may not experience symptoms until years after a traumatic event. Symptoms may also get better or worse over time, depending on various factors. 

In general, however, PTSD symptoms tend to fall into the following four categories:

• Intrusion: The traumatic event may be re-experienced through flashbacks, dreams and nightmares, and unwanted memories and images that can summon a range of intense feelings, including fear, anger, and guilt.
• Avoidance of reminders: Avoidance may involve avoiding people, places, and other reminders of the event. A person may not want to discuss the event or their feelings about it. 
• Changes in reactivity and arousal: A person with PTSD may tend toward feeling anxious, "on edge," or tense, expecting a threat or danger. Features of hyperarousal include proneness to anger, irritability, difficulty concentrating, and sleep disturbances.
• Changes in mood and cognition: Many people with PTSD may not be able to remember details about a traumatic event. They may experience inaccurate beliefs and blame themselves for the event. Some people may also experience detachment from others and seem unable to enjoy activities they previously enjoyed. 

Some individuals also experience symptoms of complex PTSD, which may result from long-term or recurring traumatic events. Complex PTSD may make it more challenging to manage emotions and relationships. Symptoms may include difficulty connecting with others, low self-esteem, and intense feelings of shame or guilt.  

The following criteria are associated with a PTSD diagnosis:

• At least one symptom of re-experiencing the traumatic event, such as flashbacks that elicit a physiological response and intrusive memories
• At least one symptom of avoidance, such as avoiding people and places that may act as reminders of the event
• At least two arousal and reactivity symptoms, such as experiencing sleep difficulties, being easily startled, having outbursts of anger, and/or demonstrating self-destructive behavior
• At least two mood and cognition symptoms, such as social isolation, ongoing negative emotions, and/or difficulty recalling important parts of the event

Factors associated with resilience to PTSD

Just as there are factors that may contribute to predisposition, some factors may help build resilience and reduce the risk of developing PTSD. Resilience may be defined as one's ability to recover after a certain time (weeks or months) of a major adverse life event.

Resilience factors against PTSD

Research has identified several of these factors that may increase resilience to PTSD after trauma. Some examples include:

• Less amygdala reactivity before trauma exposure, which is linked to less reactivity to threats 
• A secure attachment style, which has been linked with reducing the likelihood "of traumatic loss-related PTSD" 
• The ability to reframe, in a helpful way, what has occurred 
• The use of coping strategies that foster adaptive skills
• Social support

Therapy to address PTSD 

If you are experiencing PTSD symptoms, therapy may help with your recovery process. A therapist may be able to help you manage stress and build resilience by introducing coping strategies and cognitive restructuring skills. The latter may help you reframe your experience, which might alleviate the distress associated with it. 

Online therapy for PTSD

If there aren’t many therapists in your area or if your symptoms make it difficult to attend therapy in person, you might consider online therapy for PTSD. Online therapy through platforms like BetterHelp can be convenient for many people who would rather speak to a therapist without having to go to appointments. Online therapy allows you to have sessions with a licensed therapist from the comfort of your own home, where you can speak to a therapist by phone, video, or live chat. Also, you can contact your therapist in between sessions through in-app messaging, and they’ll respond as soon as they can, which may be helpful if you experience PTSD symptoms in between sessions.

Effectiveness of in-person and online therapy for posttraumatic stress disorder

A UK-based study employing either in-person or internet-based therapy in 196 people with mild-to-moderate PTSD symptoms suggests that PTSD symptoms improved for participants in both the online and in-person therapy groups after 16 weeks. The participants of both the in-person and online therapy groups experienced this improvement in symptoms at a one-year follow-up as well.