Predisposition To PTSD: Influencing Factors
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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.
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.
Takeaway
Several factors may contribute to a person’s predisposition to develop PTSD, such as genetic variations, a family history of mental illness, anxiety sensitivity, and a tendency to avoid negative emotions. Having other psychiatric disorders, such as schizophrenia or major depressive disorder, may also increase a person’s risk of developing PTSD. Support for trauma-related challenges like PTSD is available; you can connect with a therapist online or in person.
Does post-traumatic stress disorder have a genetic predisposition?
While some studies have suggested that PTSD is only a social construct, other research has found that PTSD may have genetic risk factors. For example, in 2019, some psychiatric research looked at data from more than 200,000 PTSD and control subjects from 12 countries. The diverse genetic study and analysis uncovered DNA variants at six loci strongly associated with PTSD risk, hinting at some of the common genetic variants and biological pathways involved, including inflammatory and immune mechanisms.
Researchers also looked at genetic correlations between PTSD and more than 200 other traits, behaviors, and medical and mental disorders, finding that PTSD correlates and has significant overlap with 21 of them, including schizophrenia, coronary artery disease, depression, and insomnia.
The research team ultimately concluded that genetics accounts for between 5 and 20% of PTSD risk after a traumatic event. The results of this study could be used to possibly predict one's risk of developing PTSD after traumatic experiences.
According to one of the senior authors of this psychiatric genetics study, Karestan Koenen, a professor of psychiatric epidemiology at the Harvard T.H. Chan School of Public Health, this large study reveals PTSD has “just as much of a genetic component to PTSD risk as major depression and other mental illnesses.” At the time, Keonen went on to say that further research with even larger team-based efforts may be needed to make even more robust genetic discoveries as it was inherently difficult to study the living human brain.
Koenen and colleagues went on to perform another study published in 2024 of more than 1.2 million people and validated the results of this research, this time identifying 95 locations in the genome linked to PTSD.
This research study was funded in part by the National Institutes of Health, One Mind, Cohen Veterans Bioscience, and Stanley Center for Psychiatric Genetics at the Broad Institute of MIT and Harvard.
How does a biological predisposition to PTSD originate?
Biological predisposition to PTSD may originate in how the brain processes fear and anxiety. For example, research has found that people with PTSD may process fear as a more permanent state. They may not be able to eliminate memories of fear, so they continue to have sensitive fear responses, abnormal stress responses, and other posttraumatic stress disorder symptoms.
Can you be predisposed to mental illness?
Experts do not know the exact causes of PTSD and other mental disorders. While some of the most common psychiatric disorders have multiple contributing factors, they may also have genetic influences. Having a family history of psychological disorders can lead to an increased risk, but this does not mean that someone will definitely develop a mental health condition if they have a genetic predisposition.
What happens when post-traumatic stress disorder is triggered?
Adult PTSD symptoms can include re-experiencing symptoms, avoidance symptoms, arousal and reactivity symptoms, and cognition and mood symptoms. Specifically, someone with PTSD may experience the following in response to a trigger:
- Experiencing flashbacks, memories, dreams, or distressing thoughts about the event
- Staying away from places and things that remind them of the event
- Feeling tense, irritable, angry, or on edge
- Having trouble remembering features of the event, losing interest in activities, or having difficulty feeling positive emotions.
What personality is a risk factor for posttraumatic stress disorder?
Researchers have identified multiple personality traits that may contribute to PTSD. These include deficits in identity, self-direction, intimacy, and empathy. Some studies have also determined that PTSD can be a risk factor for a personality disorder, with one researcher finding that PTSD in adolescence can increase the risk of a personality disorder in adulthood.
Other personality traits can also play a protective role in PTSD. For example, some research has shown that people who are optimistic about the future are less susceptible to developing PTSD.
What does high predisposition mean?
A high disposition means that someone is more likely to develop a particular condition. With a PTSD diagnosis, multiple factors can put someone at a higher disposition or disease risk, including childhood trauma, stress exposure, and poor stress response, as well as some mental health conditions, like depression or anxiety disorders. Some traumatic brain injury research shows that people with these injuries are more susceptible to PTSD.
Another risk of PTSD development is being in the military. Military exposures affect health in many ways, including an increased risk of PTSD. Statistics show that the lifetime prevalence of PTSD in veterans is about 7%.
What is a mental predisposition?
A mental predisposition is a set of values or beliefs that influence how a person makes decisions, interprets the world, and interacts with it. Mental predisposition can be a key factor in the diathesis-stress model of psychopathology, which has been examined in multiple studies and current psychiatry reports.
The diathesis-stress model is a theory that proposes how people develop psychological disorders. Generally, it states that everyone has some mental predisposition or vulnerability to developing a certain disorder and that the onset can be triggered by environmental stress. However, the amount of stress required to trigger a mental health disorder is determined by how inherently vulnerable someone is. In other words, the more someone is susceptible to developing a mental health condition, the less stress will be needed to trigger the disorder.
Can someone cause you to have PTSD?
It may be misleading to say that someone can cause you to have PTSD because there are a lot of factors involved, but the actions and experiences of other people can lead to trauma that can cause PTSD. For example, childhood abuse is a significant risk factor for complex or chronic PTSD, and some people may get PTSD from finding out that a loved one has experienced trauma.
Recent research in Molecular Psychiatry into how to mediate the effects of adverse childhood experiences has found that self-compassion can play a mediating role in the development of complex PTSD in some children. In this study, researchers state that self-compassion “provides an inner safe base where individuals can seek refuge and recover during times of distress, connect with others to recover.” While more research is needed, working with a therapist to improve self-compassion may be an effective area to target to manage an increased risk of lifetime PTSD.
Why do some traumatized people get PTSD while others don't?
Experts are unsure of exactly what causes PTSD but believe it to be a combination of factors, including previous mental health conditions, social support, brain function, and recent genetic findings.
Is PTSD curable?
The outlook for people with PTSD can vary, but appropriate treatment is key. PTSD symptom management can be challenging, but with treatment, about 30% recover, and about 40% improve but may still have some mild to moderate symptoms.
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