Why some develop PTSD and others don’t?

How can two people experience the same traumatic event, and yet have a different response to it?

We all agree that war, for example, is horrific; and yet not everyone develops PTSD. The VA says that 11-20% of vets develop PTSD. Why is that?

In order to understand that we need to look a bit at complex trauma. As a reminder, complex trauma is a repeated event that takes place over a longer period of time, often of an invasive nature and which has an interpersonal element, and has long-term effects. The interpersonal element means that someone trustworthy, a caregiver usually is the perpetrator. In that situation, trust is first and foremost impacted. When this takes place over a longer period of time, it affects children’s ability to form a healthy attachment (white paper from Cook, Ph.D et al., 2003).

In absence of a caring adult, who is able to model emotional behavior, to respond appropriately to the child’s emotional needs, and nurture the child, the individual tends to: feel uncertainty about the reliability and predictability of the world; have problems with boundaries; show distrust and suspiciousness; isolate; they may have difficulty understanding other people’s emotional states, understand other points of view, and enlist others as allies (resource: Domains of Impairment in Children Exposed to Complex Trauma by NCTSN).

In simpler words, when in early childhood, the caregiver who is supposed to be the model of behavior and source of safety is absent or unable to help the child regulate emotionally, the child learns that the world is not safe. Therefore, as an adult, the impact of a traumatic event is more significant, with a high potential for that to result in PTSD.

On the other hand, when children feel safe, the impact of a traumatic event is not as significant. Having a support system is very important in processing the event and mitigating the impact of it. A study done on children during World War II showed that those separated from parents and sent away to be protected from German bombing were affected far more than those who stayed with their parents in bomb shelters (van der Kolk, 2014).

So why is support important? Support here refers not only to the immediate family, but also to extended family, peers, and the larger community. When the interaction with members of one’s support system are positive, when children (and adults) have role models and are able to learn healthy ways to interact and to cope with difficult situations, then their ability to replicate that increases, which leads to an increase in their resilience.