As I understand it*, it’s not uncommon that, when two or more persons share undergo a traumatic experience together, for only some of them to experience post-traumatic stress disorder while others do not. Do psychologists know why this is? That is, is the difference between the mental architecture of the persons in question, or is something else involved?
*Weasel words because I realize I could be wrong,
Well for one thing, two people will perceive the whole event differently. One of them may be completely terrified, the other not. One may not even be scared or feel in danger in any way. The other person might be scared out of his mind and thinking he could die any second.
When two people are both being shot at, one of them may not mind as much because in his mind, he isn’t going to get hit anyway. Yet, the other person may feel that each of those bullets nearly killed him and he barely survived!!
I think it is obvious that one of these people will be more likely to develop PTSD than the other.
Interesting question. “Different mental architecture” is probably as good a guess as any, and maybe someday we’ll know more about it. But it happens a lot.
Two army buddies spend 40 years smoking unfiltered cigarettes. One gets lung cancer, the other lives to be 96.
Two frat brothers spend four years in college getting drunk together. One becomes an alcoholic and the other is just a social drinker for the rest of his days.
Two sisters lose their parents at an early age. One goes on to promiscuity, drug use, and prostitution. The other goes on to college and becomes a sociology professor.
There are people who are prone to depression, addiction, disease, and there are people who are less prone. The one who suffers PTDS is the one who’s more prone to it.
Mentally tough? Or just perceiving things differently? I read a book recently (and I wish I had written down the name of it) saying that different people perceived time differently, as there are many different ways of perceiving it, and this affected things like whether they were depressed, along with many other things. I will try to find it (a key concept was some study of children where they were left alone with a marshmallow for three minutes, and told that if they did not eat it, they would get TWO marshmallows that they could eat…later. Three minutes later. Most of them, once they were left alone with the marshmallow, ate it. As if they couldn’t help themselves.)
If you’re really interested in this question, get yourself a copy of “On Combar” by Col. David Grossman. It is, essentially, an entire treatise on performance under psychologically traumatic circumstances. (Bonus factoid: 1/4 of soldiers lose bladder continence on first combat, 1/8 soil themselves). It covers preparation, preception & performance during the event, and the aftermath, the part relevant to your question.
I dont’ have enough time and memory, frankly, to go into it in enough detail, but some factors stand out in my recolection:
If the subject felt powerless / helpless to change the situation, the probability of PTSD increases.
If the subject was passive, either by choosing not to act, or because there was nothing they could do (eg. passenger in a plane crash) there was a higher prob. of PTSD.
Victims of violent crime who did not resist had higher instances of PTSD.
He talks about a number of indicators that can suggest a greater / lesser pre-disposition to PTSD, but I don’t remember them.
Since attempts at erasing traumatic memories center around the amygdala, it has to be due at least in part to one’s brain chemistry. Certain beta blocker drugs like propranolol are already being used for this purpose.
Risk factors for developing PTSD include lack of social support at the time of the incident and presence of other stressors in the person’s life at the time of the incident. Those two factors are at least as strong as the severity of the trauma experienced. The likelihood increases significantly and is likely to be more severe if the trauma is interpersonal (interpersonal assault vs. an impersonal earthquake, for example) and if the trauma involves captivity or repetition.
Interestingly, soldiers who enter combat are more likely to develop combat-related PTSD if they were abused as children. There is evidence that cognitive reactions at the time of and immediate aftermath of the traumatic event are pretty significant - when distorted cognitions (’‘I could have stopped it/it was my fault/etc.’’) go unaddressed PTSD seems more likely. There are also small effect sizes for race, socioeconomic status, gender, prior history of trauma, and age at time of trauma, but the reality is risk factors have only moderate to small effect sizes.
The traumatic incident with the single highest rate of PTSD is rape. The statistic is crazy - something like 80% vs. 15-30% among other traumatic events including direct combat.
ETA: dzero is right, there is evidence that people with PTSD process traumatic memory differently than narrative memory, and that it’s possible to train the brain to recall the memory in a different way that is less distressing. That may be the principle at work with cognitive therapy for PTSD, EMDR and prolonged exposure, as all three of these evidence-based treatments apparently modify the way one thinks about what happened to them.
But developing PTSD or not has nothing to do with remembering what happened or not, it’s about how those memories affect you. Isn’t it?
The higher incidence of PTSD in rape cases vs combat seems to me to mesh with the factors trupa reported. A large amount of the people who find themselves in combat have been trained for it and are actively taking part in it; a large amount of rape victims are unable to do anything about it, and too often the only training they have received is “don’t fight back” (and then they are told it wasn’t rape because they didn’t fight back) or “submit to authority”. Does anybody have statistics for “non-combatants who found themselves in combat”? I think the figures for those would be much higher. I know the Spanish AVT reports that “many victims of terrorism are still in therapy years after the attack” but can’t recall having seen specific figures (can’t access their webpage at work, “political organization”).
IIRC time to decompress also plays a factor. I remember reading that troops who returned from the Falklands War by sea had lower rates of PTSD than those who were flown home.
That’s interesting. I’ve done three transatlantic crossings on sailboats and I remember my French captain saying something about the sea empties you, that you empty into the sea. Very therapeutic.
Similar to trupa, I would recommend Col. Grossman’s first book “On Killing: The Psychological Cost of Learning to Kill in War and Society”, which was a fascinating read, and talks quite a bit about PTSD.
Much of what was already said was in the book as well. One thing that others left out was that having a shared experience with the trauma (whether they were highly affected or not) and being around those individuals afterwards actually reduces PTSD. That may explain the Falklands War issue mentioned for those who flew home because there was no time to decompress and stay with the group. They returned right away to their families, which is actually not what you want to do.
This is apparently a well understood process with many militaries. When I was recently in the country of Cyprus, I was surprised at how many British soldiers were there. It turns out that they make a point of returning their soldiers from Afghanistan through Cyprus specifically for this needed decompression period with their fellow soldiers to specifically address this PTSD risk.