Who gets PTSD and Why?

You may have heard about the new “positive psychology” approach to dealing with the psychological injuries endured by combat vets. The latest American Psychologist has a full edition devoted to “Comprehensive Soldier Fitness” (2011, 66, 1, 1-86).  I eagerly went to it, with an interest in their view of who gets PTSD and why? Results? Not a word!  Aren’t there predisposing factors in the development of combat PTSD?  Does everybody get PTSD who goes to a war zone? I communicated with M. Seligman, the positive psychology guy, and he brushed me off, referring me to an old, obscure citation in a British journal. I guess they didn’t read or didn’t want to know about the findings from the National Vietnam Veterans Readjustment Study commissioned by the VA in the early ’80’s.  Here is what it says:

“Several conclusions seem warranted from this set of analyses of the role of predisposing factors and Vietnam experience factors in current PTSD prevalence. First, the current prevalence of PTSD is much higher among Vietnam theater veterans [vets who actually served in Vietnam] than among era vets [vets in the service at the time of the Vietnam war] and civilian counterparts. Second, [here is where it gets interesting] theater veterans differed from era vets and civilian counterparts on some background characteristics that are related to current PTSD and that might have rendered theater veterans more vulnerable to the development of PTSD. Nevertheless the current PTSD prevalence rate is much higher among theater veterans even after these differences in potential predisposing factors are taken into account. Third, exposure to war-zone stress in Vietnam plays a significant role in determining who among theater veterans has PTSD today, even after a broad array of predisposibng factors have been controlled for.

Taken together, these results are consistent with a model of PTSD that posits a role for individual vulnerability (potentially including biological, psychological, and sociodemogrpahioc factors) and a role for exposure to environmental factors (specifically war zone stressors), in determining who among theater veterans gets PTSD. Howvere, it is clear that exposure to war-zone stress makes a substantial contribution to the development of PTSD in war veterans that is independent of a broad range of potential predisposing factors.

The variables that consistently contributed to these theater veteran subgroup predisposition adjustment models include four factors:  having grown up in a family  that had a hard time making ends meet, having had symprtoms of drug abuse or dependence before entering the military, having had symptoms of an affective diosorder before going to Vietnam, and problems behaviors in childhood.”



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