Why Some Soldiers Develop PTSD While Others Don’t

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Neuro_biol_PTSDPre-war vulnerability is just as important as combat-related trauma in predicting whether veterans’ symptoms of post-traumatic stress disorder (PTSD) will be long-lasting, according to new research published in Clinical Psychological Science, a journal of the Association for Psychological Science.

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Researcher Bruce Dohrenwend and colleagues at Columbia’s Mailman School of Public Health and the New York State Psychiatric Institute found that traumatic experiences during combat predicted the onset of the full complement of symptoms, known as the PTSD “syndrome,” in Vietnam veterans. But other factors — such as pre-war psychological vulnerabilities — were equally important for predicting whether the syndrome persisted.

The researchers re-examined data from a subsample of 260 male veterans from the National Vietnam Veterans Readjustment Study. All of the veterans in the subsample had received diagnostic examinations by experienced clinicians that included information about the onset of the disorder and whether it was still current 11 to 12 years after the war ended.

Dohrenwend and colleagues focused on the roles of three primary factors: severity of combat exposure (e.g., life-threatening experiences or traumatic events during combat), pre-war vulnerabilities (e.g., childhood physical abuse, family history of substance abuse), and involvement in harming civilians or prisoners.

The data indicated that stressful combat exposure was necessary for the onset of the PTSD syndrome, as 98% of the veterans who developed the PTSD syndrome had experienced one or more traumatic events.

But combat exposure alone was not sufficient to cause the PTSD syndrome.

Of the soldiers who experienced any potentially traumatic combat exposures, only 31.6% developed the PTSD syndrome. When the researchers limited their analysis to the soldiers who experienced the most severe traumatic exposures, there was still a substantial proportion — about 30% — that did not develop the syndrome. This suggests that there were other factors and vulnerabilities involved for the minority of exposed who did end up developing the PTSD syndrome.

Among these factors, childhood experiences of physical abuse or a pre-Vietnam psychiatric disorder other than PTSD were strong contributors to PTSD onset. Age also seemed to play an important role: Men who were younger than 25 when they entered the war were seven times more likely to develop PTSD compared to older men. The researchers also found that soldiers who inflicted harm on civilians or prisoners of war were much more likely to develop PTSD.

The combined data from all three primary factors — combat exposure, prewar vulnerability, and involvement in harming civilians or prisoners — revealed that PTSD syndrome onset reached an estimated 97% for veterans high on all three. While severity of combat exposure was the strongest predictor of whether the soldiers developed the syndrome, pre-war vulnerability was just as important in predicting the persistence of the syndrome over the long run.

The researchers conclude that these findings have important implications for policies aimed at preventing cases of war-related PTSD.

Given the seemingly potent interaction between combat exposure and pre-war vulnerability, these results emphasize the need to keep the more vulnerable soldiers out of the most severe combat situations.

Dohrenwend and colleagues also point out that the recent conflicts in Iraq and Afghanistan, like the Vietnam War, are “wars amongst the people,” and they underline the need for research examining the circumstances in which harm to civilians and prisoners is likely to occur. Such research could provide important clues for preventing such devastating violations of the rules of war.

In addition to Dohrenwend, co-authors on this research include Thomas Yager and Ben Adams at the Mailman School of Public Health at Columbia University; and Melanie Wall of the Mailman School of Public Health and Department of Psychiatry at Columbia University, and the New York State Psychiatric Institute.

The research was supported by the National Institute of Mental Health (Grant R01-MH059309) and by grants from the Spunk Fund, Inc. and a Ruth L. Kirschstein National Research Service Award from the National Institute of Mental Health.

4 Strategies to Cope with Anger in A Healthy Way

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Our world is in the midst of an emotional meltdown. People are restless, volatile, our tempers about to blow. Recently, a riveting Newsweek cover story, “Rage Goes Viral” described how from Tunisia to Egypt a wave of rage is rocking the world to create revolutions. Then there are the talk radio ranters, congressional incivility, and domestic terrorists such as the Arizona shooter. Rage is also prevalent in our daily lives: There’s road rage, office rage, supermarket rage, and even surfer’s rage. Why is rage so rampant? What is the solution?

In my book, “Emotional Freedom” I explore the differences between “good” and “bad” anger. Anger can be a healthy reaction to injustice such as cultures fighting to free themselves from repressive regimes. Anger rallies people. It creates energy and motivation to rebel against dysfunctional political or social systems. It also motivates groups to go on strike say, for higher, well-deserved wages or to defend human rights. On a personal level, anger can be good if it’s expressed in a focused, healthy way rather than using it as a weapon to punish or hurt others.

Your Body’s Reaction To Anger As a psychiatrist, I know that anger is intensely physical and can come from a primal place. Let’s say a colleague double-crosses you in a business deal. You feel angry. Your amygdala (the emotional center in the brain) stimulates adrenaline. You get an energy rush that rallies you to fight. Blood flows to your hands, making it easier to grasp a weapon. Your heart pumps faster. You breathe harder. Pupils dilate. You sweat. In this hyperadrenalized state, aggression mounts. You may raise your voice, point accusingly, stare him down, grimace, flail your arms around, verbally intimidate, barge into his personal space. Taken to an extreme, you could literally be driven to knock him out or beat him up. In a pure survival-oriented sense, you want to dominate and retaliate to protect yourself and prevent further exploitation. Anger is one of the hardest impulses to control because of its evolutionary value in defending against danger.

What factors make us susceptible to anger? One is an accumulation of built-up stresses. That’s why your temper can flare more easily after a frustrating day. The second is letting anger and resentments smolder. When anger becomes chronic, cortisol, the stress hormone, contributes to its slow burn. Remaining in this condition makes you edgy, quick to snap. Research has proven that anger feeds on itself. The effect is cumulative: each angry episode builds on the hormonal momentum of the time before. For example, even the most devoted, loving mothers may be horrified to find themselves screaming at their kids if they haven’t learned to constructively diffuse a backlog of irritations. Therefore, the powerful lesson our biology teaches us is the necessity of breaking the hostility cycle early on, and that brooding on the past is hazardous to your well-being.

For optimal health, you must address your anger. But the point isn’t to keep blowing up when you’re upset rather–it’s to develop strategies to express anger that are body-friendly. Otherwise, you’ll be set up for illnesses such as migraines, irritable bowel syndrome, or chronic pain, which can be exacerbated by tension. Or you’ll keep jacking up your blood pressure and constricting your blood vessels, which compromises flow to the heart. A Johns Hopkins study reports that young men who habitually react to stress with anger are more likely than their calmer counterparts to have an early heart attack, even without a family history of heart disease. Further, other studies have shown that hostile couples who hurl insults and roll their eyes when arguing physically heal more slowly than less antagonistic partners who have a “we’re in this together” attitude.

Still, repressing anger isn’t the answer either. Research also reveals that those who keep silent during marital disputes have a greater chance of dying from heart disease or suffering stress-related ailments than those who speak their minds.

Here are some strategies from “Emotional Freedom” to productively cope with anger in daily life.
4 Tips To Diffuse Anger

1. When you’re upset, pause, and slowly count to ten.
To offset the adrenaline surge of anger, train yourself not to lash back impulsively. Wait before you speak. Take a few deep breaths and VERY slowly, silently, count to ten (or to fifty if necessary). Use the lull of these moments to regroup before you decide what to do so you don’t say something you regret

2. Take a cooling-off period.
To further quiet your neurotransmitters, take an extended time-out, hours or even longer. When you’re steaming retreat to a calm setting to lower your stress level. Reduce external stimulation. Dim the lights. Listen to soothing music. Meditate. Do some aerobic exercise or yoga to expel anger from your system.

3. Don’t address anger when you’re rushed.
Make sure you have adequate time to identify what’s made you angry. A Princeton study found that even after theology students heard a lecture on the Good Samaritan, they still didn’t stop to help a distressed person on the street when they thought they’d be late for their next class. Thus, allotting unhurried time to resolve the conflict lets you tap into your most compassionate response.

4. Don’t try to address your anger when you’re tired or before sleep.
Since anger revs up your system, it can interfere with restful sleep and cause insomnia. The mind grinds. Better to examine your anger earlier in the day so your adrenaline can simmer down. Also being well rested makes you less prone to reacting with irritation, allows you to stay balanced.

The goal with anger is to own the moment so this emotion doesn’t own you. Then you can mindfully respond rather than simply react. You’ll have the lucidity to be solution oriented and therefore empower how you relate to others.

Judith Orloff
Judith Orloff MD, an Assistant Clinical Professor of Psychiatry at UCLA and intuition expert, is author of the New York Times Bestseller Emotional Freedom: Liberate Yourself From Negative Emotions and Transform Your Life (Three Rivers Press, 2011) Her other bestsellers are Positive Energy, Intuitive Healing, and Second Sight. Dr. Orloff synthesizes the pearls of traditional medicine with cutting edge knowledge of intuition and energy medicine. She passionately believes that the future of medicine involves integrating all this wisdom to achieve emotional freedom and total wellness. http://www.drjudithorloff.com

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