Most clinical discussions involving posttraumatic stress disorder (PTSD) and military personnel revolve around treatment and prognosis. One area that doesn’t garner as much discussion is what puts some service members at greater risk for developing the disorder. This emphasis is likely because of the fact that most clinicians are involved in tertiary care and spend relatively little time involved in prevention.
And although it is true that being well-versed in evidence-based interventions for PTSD is of great importance for the practitioner, possessing a robust understanding of the various risk factors of the disorder is key to making an accurate diagnosis and educating military leaders and policy makers in hopes of preventing the disorder from occurring in those most at risk.
Risk factors are those variables that contribute to a person developing a particular psychiatric disorder. These variables can be related to a person’s childhood such as how they were treated by their parents.
They can also be related to a person’s environment such as growing up in a middle class neighborhood or in a high crime area of an inner city.
Research has shown that there are several risk factors related to the development of PTSD. Some of the more significant and common ones are listed below:
Age. The age a person joins the military influences whether or not he or she will develop PTSD. In general, the younger a person is when he or she signs on the dotted line, the greater his or her risk.
This likelihood is because younger individuals have fewer life experiences. Life experience provides a strong buffer against traumatic events and it’s especially true if the person has been exposed to moderate levels of stress over his or her lifetime leading to psychological resilience.
There is one exception, however. If a person’s life experience is riddled with trauma, the person is at increased risk of PTSD.
Trauma history. One of the greatest predictors of emotional distress following a traumatic event is having suffered a traumatic event sometime in the past. Research clearly shows that veterans who were abused or neglected as children or previously suffered a life-threatening event are at greater risk for psychological problems.
A variant of this fact is when a service member or veteran did not suffer any pre-military trauma, but suffered multiple traumas during combat. Each successive trauma increases the individual’s risk.
Personality style. Individuals who are more rigid and inflexible in the way they look at themselves, others and the world are more likely to suffer from the effects of trauma. In contrast, those who are able to consider competing viewpoints about why bad things happen, tend to do better.
This situation is not unique to military personnel. But, it is of more importance for this unique cultural group as rigidity, adherence to explicitly laid out rules and plans and following orders without question is part and parcel of a successful military career.
Social support. One of the biggest protectors against developing PTSD is others. If a person is surrounded by supportive people, whether it’s family, friends or fellow comrades, the person will fare much better than those who tend to isolate themselves from other people or surround themselves with negative ones.
That’s right. Negative people can do as much or more damage to a person post-trauma than if a person isolates and withdraws. Fortunately, the military is built upon the premise of “watching your buddies six” (watching their back) and openly promotes the importance of unit cohesion and camaraderie.
Fostering these values in your military and veteran patients can lead to quicker and more robust clinical outcomes.
Injury severity. Physical injury by itself can be a predictor for PTSD. However, the severity of injury is more important. Although by no means universal, a person who loses a limb from a roadside explosion is more likely to develop PTSD than someone who suffers a shrapnel injury from an indirect mortar.
The civilian equivalent is a woman who suffers an attempted sexual assault versus one who is brutally raped. Both are at increased risk, but the latter is more likely to develop PTSD.
There are a number of risk factors associated with PTSD. Some you can help your patients change and others you can’t. For those that you can, such as social support and personality style, helping your military and veteran patients make minor changes can provide major benefits.
* This article was adapted from a previous article written by Dr. Moore for his column “Kevlar for the Mind.”
Soldier photo available from Shutterstock