Posttraumatic Stress Disorder (PTSD)
While serving his country in war, one soldier, Jesse, saw the killing “of children and women. It was just horrible for anyone to experience.” Back home, he suffered “real bad flashbacks” (Welch, 2005).
Jesse is not alone. In one study of 103,788 veterans returning from Iraq and Afghanistan, 25 percent were diagnosed with a psychological disorder (Seal et al., 2007). Some had traumatic brain injuries (TBI), but the most frequent diagnosis was posttraumatic stress disorder (PTSD). Survivors of accidents, disasters, and violent and sexual assaults (including an estimated two-thirds of prostitutes) have also experienced PTSD symptoms (Brewin et al., 1999; Guo et al., 2017; Farley et al., 1998). Typical symptoms include recurring haunting memories and nightmares, laser-focused attention to possible threats, social withdrawal, jumpy anxiety, and trouble sleeping (Germain, 2013; Hoge et al., 2007; Yuval et al., 2017).
About half of us will experience at least one traumatic event in our lifetime. And many people will display survivor resiliency—by recovering after severe stress (Bonanno, 2004, 2005; Infurna & Luthar, 2016). Although Friedrich Nietzsche’s (1889) surmise that “what does not kill me makes me stronger” is not true for all, some will even experience posttraumatic growth (see Unit XIII). Why do some 5 to 10 percent of people develop PTSD after a traumatic event, but others don’t (Bonanno et al., 2011)? One factor seems to be the amount of trauma-related emotional distress: The higher the distress, such as the level of physical torture suffered by prisoners of war, the greater the risk for posttraumatic symptoms (King et al., 2015; Ozer et al., 2003). Among American military personnel in Afghanistan, 7.6 percent of combatants developed PTSD, compared with 1.4 percent of noncombatants (McNally, 2012). Among survivors of the 9/11 terrorist attacks on New York’s World Trade Center, the rates of subsequent PTSD diagnoses for those who had been inside were double the rates of those who had been outside (Bonanno et al., 2006).
Bringing the war home Hundreds of thousands of Iraq and Afghanistan war veterans have been diagnosed with PTSD or traumatic brain injury (TBI) (VA, 2017). Many vets participate in an intensive recovery program using deep breathing, massage, and group and individual discussion techniques to treat their PTSD or TBI.
What else can influence PTSD development? Some people may have a more sensitive emotion-processing limbic system that floods their bodies with stress hormones, which explains why PTSD may coexist with another disorder (Duncan et al., 2017; Kosslyn, 2005; Ozer & Weiss, 2004). Genes and gender also matter. Twins, compared with nontwin siblings, more commonly share PTSD cognitive risk factors (Gilbertson et al., 2006). And the odds of experiencing PTSD after a traumatic event are about two times higher for women than for men (Olff et al., 2007; Ozer & Weiss, 2004).
Some psychologists believe that PTSD has been overdiagnosed (Dobbs, 2009; McNally, 2003). Too often, say critics, PTSD gets stretched to include normal stress-related bad memories and dreams. And some well-intentioned procedures—such as “debriefing” people by asking them to revisit the experience and vent their emotions—may worsen stress reactions (Bonanno et al., 2010; Wakefield & Spitzer, 2002). Other research shows that reliving traumas (such as 9/11 or the Boston Marathon bombing) through media coverage sustains the stress response (Holman et al., 2014).