Name Here"Resilience or PTSD: Studying Combat & Special Forces Veterans"

Steven M. Southwick, M.D.
Yale School of Medicine

September 29, 2010
 

1. What is Post Traumatic Stress Disorder (PTSD)?

It's a disorder that follows overwhelming trauma leaving an individual feeling helpless and hopeless. Some people are left with a group of symptoms, including:

  • Re-experiencing symptoms where a person suffers from repeatedly reliving a traumatic event
  • Arousal symptoms where a person has difficulty modulating nervous system activation and are left feeling vigilant. These individuals may "sleep with one eye open" or be on guard all of the time.
  • Avoidance symptoms – the person avoids situations and people that remind them of trauma that may activate them or stimulate arousal symptoms, thus they live in avoidance to minimize reminders

Overall it can affect many areas of life. There is also a neurobiological aspect - the body's alarm system for survival that was adaptive during the traumatic situation is still responding as if the danger is still there

2. What are the most common traumatic events that lead to PTSD?

Epidemiological surveys show 70 - 90% of Americans will be exposed to some major traumatic experience during their lifetime. These numbers will differ as a result of different types of trauma, for example: Rape cases account for 45%, of PTSD Combat accounts for 30%, Natural disasters account for about 10% The strongest predictor is the level of trauma - how severe was the experience. Another predictor is the amount of social support.

3. Do women suffer from PTSD more often than men?

Yes, but it's complicated. Women are more likely to be exposed in civilian life to more severe trauma like rape. However, 65% of men and 45% women develop PTSD as a result of rape. Overall it differs by the type of trauma - domestic violence and physical assaults account for 10 - 20%.

4. Are the underlying causes of PTSD known?

There are genetic and developmental influences, but you have to be traumatized to get PTSD. It's not like other psychiatric disorders – it will not emerge at a certain age on its own like schizophrenia.

5. Why do some people develop PTSD, while others who witness or experience traumatic events do not?

Resilience involves looking at trauma, but a different outcome. Not all people who suffer trauma have PTSD. Some people don't have symptoms - some have symptoms and recover - some develop symptoms and don't recover, but function well anyhow. For the last 5 years we have been looking at factors that promote resilience:

  • Strong social support
  • Optimistic outlook
  • Strong religious or spiritual beliefs
  • Altruism
  • Physical well being, exercise
  • Humor
  • Cognitive flexibility – the capacity to reappraise adverse circumstances…look for an opportunity in adversity or failure – finding the "silver lining"
    • accepting of a situation when it cannot be changed
  • Having a strong purpose or mission in life

6. Does spirituality play a role...in what way?

It's interesting because people who are spiritual are more optimistic - they live their lives with purpose and meaning. Often with religious or spiritual practices, people congregate and derive social support which allows people to transcend many elements of a traumatic experience such as psychological and physical pain.

7. Can anything be done to make children more resilient?

One of the important things for children is to help them engage in situations that are challenging but not overwhelming. So for children to be more resilient they need to be out of their comfort zone, but not overwhelmed - this leads to stress inoculation. One can be resilient in many domains of life, [e.g.,] resilient in education but not interpersonal relationships. This is true for all the factors mentioned above. You can train people in each of these factors but you have to be rigorous - just like running a marathon; you have to train.

8. What percentage of veterans suffer from PTSD or other mental illness when they return?

30% of Vietnam veterans developed PTSD at some point after war. 20 years after war 15% still had PTSD.

9. Are prevention/treatment services provided to veterans?

There are lots of treatment services available, however, prevention is gray - we don't do as well as treatment. The military are experts at stress inoculation - in a way, they try to prepare soldiers, but sometimes traumas are so massive people develop psychopathology anyway. Researchers are trying to learn if there are additional ways that people in fields of trauma, [e.g.,] soldiers or police have ways to heighten resilience physically and psychologically.

10. You will be speaking about fostering resilience in mental health professional; could you tell me more about that?

Mental health professionals are no different than anyone else… Our jobs are often stressful - we deal with tragedy suffering, pain, we grapple with extremely difficult decisions, we make mistakes. You have to be resilient to be in this field - we imagine that many of the same principles that apply to soldiers apply to mental health professionals.

The 12 Steps to Becoming a Psychiatrist

  1. Find Resilient Role Models
  2. Moral Compass and Integrity
  3. Religion/Faith/Spirituality/Altruism
  4. Using Signature Strength and Skills
  5. Finding Purpose and Meaning
  6. Face Your Fears
  7. Acceptance
  8. Optimism and the Fighting Spirit
  9. Supportive Social Network
  10. Training-rigorously in Multiple Areas
  11. Humor – appreciate it
  12. Cognitive Reappraisal

 

 

McKnight Brain Institute

Univeristy of Florida

Editor in Chief
Mark S. Gold, M.D.

This interview, conducted by Noni Graham, MPH in the UF COM Department of Psychiatry's Public Health Research Group is intended to provide current and authoritative information in regard to the subject matter covered. It is distributed with the understanding that the publisher is not engaged in rendering professional services. If medical advice or other expertise is required, the services of a competent professional should be sought.