Risk Factors for PTSD

Not everyone exposed to trauma develops PTSD. Risk is shaped by a combination of:

• Trauma characteristics: severity, duration, repeated exposure, and whether the trauma involved intentional harm by other people (often higher risk than natural disasters)
• Immediate aftermath: low social support, ongoing stressors, barriers to safety or recovery
• Individual factors: prior mental health conditions, history of childhood adversity, and certain personality factors (like high neuroticism)
• Biopsychosocial vulnerability: PTSD is often explained through a diathesis-stress lens—risk reflects an interaction between predispositions (biological and/or psychological) and stressors (Brewin et al., 2000; APA, 2013)

Traumatic Experiences

Traumatic events that involve harm by others (e.g., combat, rape, and sexual molestation) carry greater risk than do other traumas (e.g., natural disasters) (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). Nearly 21% of residents of areas affected by Hurricane Katrina suffered from PTSD one year following the hurricane (Kessler et al., 2008), and 12.6% of Manhattan residents were observed as having PTSD 2–3 years after the 9/11 attacks (DiGrande et al., 2008).

Women are more likely to have been traumatized because of sexual trauma, childhood neglect, and childhood physical abuse. Men are more likely to have been traumatized by natural disaster, life-threatening accident, and physical violence, either witnessed or directed at them. Adolescent boys are more likely to experience accident, physical assault, and witness death/injury; adolescent girls are more likely to experience rape/sexual assault, intimate partner violence, or unexpected death or injury of a loved one.

Assaultive violence and witnessing trauma to others is more prevalent among non-White individuals when compared to White individuals. Black males are more likely to be exposed to and victims of violence than males of other races (Kilpatrick, Badour, & Resnick, 2017). A 2012 study found that 27% of corrections officers reported experiencing symptoms of PTSD in the past 30 days. Rates were higher for males (31%) than females (22%) (Spinaris, Denhof, & Kellaway, 2012).

A study conducted by Jaegers et al (2019) found that 53.4% of jail correctional officers screened positively for PTSD. PTSD is more prevalent in prison populations than in the general public, with prevalence estimates of 6% in male prisoners and 21% in female prisoners (Facer-Irwin et al, 2019).

Factors that increase the risk of PTSD include female gender, low socioeconomic status, low intelligence, personal history of mental disorders, history of childhood adversity (abuse or other trauma during childhood), and family history of mental disorders (Brewin et al., 2000). Personality characteristics such as neuroticism and somatization (the tendency to experience physical symptoms when one encounters stress) have been shown to elevate the risk of PTSD (Bramsen, Dirkzwager, & van der Ploeg, 2000).

People who experience childhood adversity and/or traumatic experiences during adulthood are at significantly higher risk of developing PTSD if they possess one or two short versions of a gene that regulates the neurotransmitter serotonin (Xie et al., 2009). This suggests a possible diathesis-stress interpretation of PTSD: its development is influenced by the interaction of psychosocial and biological factors.

Learning and cognitive models of PTSD

PTSD symptoms can also be understood through learning and cognitive frameworks:

• Conditioning: cues present during the trauma (sounds, smells, places) can become powerful reminders that trigger fear and physiological arousal later, even when the person is objectively safe.

  • The traumatic event may act as an unconditioned stimulus that elicits an unconditioned response characterized by extreme fear and anxiety.

• Cognitive appraisal and memory: PTSD is more likely when the trauma is encoded in a fragmented, “here-and-now” way and when interpretations of the event (or its aftermath) become rigid and self-blaming (e.g., “I should have prevented it,” “I can’t trust anyone,” “I’m permanently unsafe”).

  • According to this theory, some people who experience traumas do not form coherent memories of the trauma; memories of the traumatic event are poorly encoded and, thus, are fragmented, disorganized, and lacking in detail. Therefore, these individuals are unable to remember the event in a way that gives it meaning and context. A rape victim who cannot coherently remember the event may remember only bits and pieces (e.g., the attacker repeatedly telling her she is stupid); because she was unable to develop a fully integrated memory, the fragmentary memory tends to stand out. Although unable to retrieve a complete memory of the event, she may be haunted by intrusive fragments involuntarily triggered by stimuli associated with the event (e.g., memories of the attacker’s comments when encountering a person who resembles the attacker).

  • The model also proposes that negative appraisals of the event (“I deserved to be raped because I’m stupid”) may lead to dysfunctional behavioral strategies (e.g., avoiding social activities where men are likely to be present) that maintain PTSD symptoms by preventing both a change in the nature of the memory and a change in the problematic appraisals.

These models help explain why PTSD isn’t simply “remembering something bad.” It’s a pattern of memory, meaning-making, and threat detection that can stay stuck in high alert—long after the danger has passed.