Childhood Trauma: We Reap What We Sew

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Fear in Hawaii: The Biology of Stress

Residents and visitors in Hawaii were sent into a panic after officials accidentally sent an emergency alert warning of a "ballistic missile threat." It took officials 30 minutes to send a correction.

What happens in your brain...in clear, concise language.

What could people have been feeling?

From Healing the Brain: "Wounds that Time Alone Won’t Heal The Biology of Stress."

Imagine you are a zebra grazing on the plains of Africa. It's midday. The sun is bright, the food is plentiful.

Suddenly you sense an attack. A lion is chasing you. Its fight or flight in action.

Your brain tells your body to prepare for a fight or take flight. The body responds by preparing extra hormones to create more energy and by increasing the rate the heart pumps blood to the muscles. For most animals, this stress reaction lasts for just a short time and it saves lives.  

As a body is preparing for fight or flight, however, practically all systems, such as digestion, physical growth, and warding off diseases are placed on hold. This means that people for whom stress has become a way of life are endangering their overall health. Researchers have learned by studying primates whose systems are similar to human beings that those who learn to have control over their lives and are able to reduce or avoid stress live longer and healthier lives.

Are zebras better equipped to deal with stress than humans? No. However, according to Dr. Robert Sapolsky, author of ​Why Zebras Don't Get Ulcers, "For a zebra, stress is three minutes of some screaming terror running from a lion. After the chase, either it's over or they are." On the other hand humans, he says, have constructed a network of social stressors. Since we are obliged to live in this framework, stress builds up.

How do the brain and the body react to stress? Stress, such as the threat of attack, forces various changes in the body. First, adrenaline causes an increase in heart rate and blood pressure so that blood can be sent to muscles faster. Second, the brain’s hypothalamus signals the pituitary gland to stimulate the adrenal gland (specifically the adrenal cortex) to produce cortisol.

This stress hormone, a longer-acting steroid, helps the body to mobilize energy. However, prolonged exposure to cortisol can damage virtually every part of the body. Chronic high blood pressure can cause blood vessel damage and the long-term shutdown of digestion can lead to ulcers.  

Supporting our Vets: Relationships and PTSD

How does trauma affect relationships?

Trauma survivors with PTSD may have trouble with their close family relationships or friendships. The symptoms of PTSD can cause problems with trust, closeness, communication, and problem solving. These problems may affect the way the survivor acts with others. In turn, the way a loved one responds to him or her affects the trauma survivor. A circular pattern can develop that may sometimes harm relationships.

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How might trauma survivors react?

In the first weeks and months following a trauma, survivors may feel angry, detached, tense or worried in their relationships. In time, most are able to resume their prior level of closeness in relationships. Yet the 5% to 10% of survivors who develop PTSD may have lasting relationship problems.

Survivors with PTSD may feel distant from others and feel numb. They may have less interest in social or sexual activities. Because survivors feel irritable, on guard, jumpy, worried, or nervous, they may not be able to relax or be intimate. They may also feel an increased need to protect their loved ones. They may come across as tense or demanding.

The trauma survivor may often have trauma memories or flashbacks. He or she might go to great lengths to avoid such memories. Survivors may avoid any activity that could trigger a memory. If the survivor has trouble sleeping or has nightmares, both the survivor and partner may not be able to get enough rest. This may make sleeping together harder.

Survivors often struggle with intense anger and impulses. In order to suppress angry feelings and actions, they may avoid closeness. They may push away or find fault with loved ones and friends. Also, drinking and drug problems, which can be an attempt to cope with PTSD, can destroy intimacy and friendships. Verbal or physical violence can occur.

In other cases, survivors may depend too much on their partners, family members, and friends. This could also include support persons such as health care providers or therapists.

Dealing with these symptoms can take up a lot of the survivor's attention. He or she may not be able to focus on the partner. It may be hard to listen carefully and make decisions together with someone else. Partners may come to feel that talking together and working as a team are not possible.

How might loved ones react?

Partners, friends, or family members may feel hurt, cut off, or down because the survivor has not been able to get over the trauma. Loved ones may become angry or distant toward the survivor. They may feel pressured, tense, and controlled. The survivor's symptoms can make a loved one feel like he or she is living in a war zone or in constant threat of danger. Living with someone who has PTSD can sometimes lead the partner to have some of the same feelings of having been through trauma.

In sum, a person who goes through a trauma may have certain common reactions. These reactions affect the people around the survivor. Family, friends, and others then react to how the survivor is behaving. This in turn comes back to affect the person who went through the trauma.

Trauma types and relationships

Certain types of "man-made" traumas can have a more severe effect on relationships. These traumas include:

• Childhood sexual and physical abuse
• Rape
• Domestic violence
• Combat
• Terrorism
• Genocide
• Torture
• Kidnapping
• Prisoner of war

Survivors of man-made traumas often feel a lasting sense of terror, horror, endangerment, and betrayal. These feelings affect how they relate to others. They may feel like they are letting down their guard if they get close to someone else and trust them. This is not to say a survivor never feels a strong bond of love or friendship. However, a close relationship can also feel scary or dangerous to a trauma survivor.

Do all trauma survivors have relationship problems?

Many trauma survivors do not develop PTSD. Also, many people with PTSD do not have relationship problems. People with PTSD can create and maintain good relationships by:

• Building a personal support network to help cope with PTSD while working on family and friend relationships
• Sharing feelings honestly and openly, with respect and compassion
• Building skills at problem solving and connecting with others
• Including ways to play, be creative, relax, and enjoy others

What can be done to help someone who has PTSD?

Relations with others are very important for trauma survivors. Social support is one of the best things to protect against getting PTSD. Relationships can offset feelings of being alone. Relationships may also help the survivor's self-esteem. This may help reduce depression and guilt. A relationship can also give the survivor a way to help someone else. Helping others can reduce feelings of failure or feeling cut off from others. Lastly, relationships are a source of support when coping with stress.

If you need to seek professional help, try to find a therapist who has skills in treating PTSD as well as working with couples or families. 

Many treatment approaches may be helpful for dealing with relationship issues. Options include:

• One-to-one and group therapy
• Anger and stress management
• Assertiveness training
• Couples counseling
• Family education classes
• Family therapy

Source: Veterans Administration

Harvey Weinstein and the Biology of Trauma

Hollywood movie executive Harvey Weinstein has been accused of and alleged to have committed sexual assault over a number of years on a number of actresses. Such a story strikes an all-too-common nerve in America, perhaps revealing the depth and widespread nature of such abuse. In this excerpt from Healing the Brain: Depression, we look at the biology of stress and trauma experienced by the victims and why it is a pernicious wound.

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Wounds that Time Alone Won’t Heal

The Biology of Stress

How do the brain and the body react to stress? Stress, such as the threat of attack, forces various changes in the body. First, adrenaline causes an increase in heart rate and blood pressure so that blood can be sent to muscles faster. Second, the brain’s hypothalamus signals the pituitary gland to stimulate the adrenal gland (specifically the adrenal cortex) to produce cortisol.

This stress hormone, a longer-acting steroid, helps the body to mobilize energy. However, prolonged exposure to cortisol can damage virtually every part of the body. Chronic high blood pressure can cause blood vessel damage and the long-term shutdown of digestion can lead to ulcers.

SimplyPsychology.org

Stress, such as the threat of attack, forces changes in the body carried out by the hypothalamus-pituitary-adrenal axis (HPA).

Why do some people experience more stress than others? Individuals who feel they have control over their lives appear to experience less stress. It also depends on personality and temperament. Aggressive, competitive types are more likely to define a situation as stressful than a passive, accommodating personality. A universal stress producer seems to be social isolation.

PTSD: A Breakthrough in Diagnosis

In 1980 the mental health community established the diagnosis of Post Traumatic Stress Disorder, PTSD, and revolutionized the way the field views the effects of stress. This change acknowledged that many of the symptoms people experience after exposure to trauma can be long-lasting, if not permanent. Before that shift, the field tended to view stress-related symptoms as a transient, normal response to an adverse life event, not requiring intensive treatment.

Furthermore, before 1980, people who did develop long-term symptoms following trauma were viewed as implicitly vulnerable; the role of the actual event in precipitating their symptoms was minimized. For a while, in a reversal of previous thinking, experts expected most trauma survivors to develop PTSD. More recent research has confirmed that only about 25 per cent of individuals who are exposed to trauma develop PTSD.

So who is likely to develop PTSD following a traumatic experience, and why? The answer is not yet clear, but it now appears that PTSD represents a failure of the body to extinguish or contain the normal nervous system response to stress. This failure is associated with many factors:

• the nature and severity of the traumatic event
• preexisting risk factors related to previous exposure to stress or trauma, particularly in childhood
• the individual’s history of psychological and behavioral problems, if any
• the person’s level of education, and other cognitive factors
• family history—whether parents or other relatives had anxiety, depression, or PTSD

People who develop PTSD are also more likely to develop other psychiatric disorders involving mood (depression, anxiety and panic, bipolar disorder), personality, eating, and substance dependence.

People also seek medical help for problems that may develop after the trauma that can mask or intensify PTSD symptoms. These symptoms include chronic pain, fatigue, headaches, muscle cramps, and self-destructive behavior, including alcohol or drug abuse and suicidal gestures. Often, survivors are not aware that their physical symptoms are related to their traumatic experiences. They may even fail to mention those disturbing events to their physicians, which can make PTSD difficult to diagnose accurately.

Some PTSD symptoms in teens may begin to look like those of adults. One difference is that teens are more likely than younger children or adults to show impulsive and aggressive behaviors.

School-aged children (ages 5-12)

These children may not have flashbacks or problems remembering parts of the trauma, the way adults with PTSD often do. Children, though, might put the events of the trauma in the wrong order. They might also think there were signs that the trauma was going to happen. As a result, they think that they will see these signs again before another trauma happens. They think that if they pay attention, they can avoid future traumas.

Children of this age might also show signs of PTSD in their play. They might keep repeating a part of the trauma. These games do not make their worry and distress go away. For example, a child might always want to play shooting games after he sees a school shooting. Children may also fit parts of the trauma into their daily lives. For example, a child might carry a gun to school after seeing a school shooting.

Teens (ages 12-18)

Some PTSD symptoms in teens may begin to look like those of adults. One difference is that teens are more likely than younger children or adults to show impulsive and aggressive behaviors.

Wikimedia Commons

Teen experience of PTSD can mimic those of adults and include re-experiencing a traumatic event, flashbacks, and nightmares.

Adult symptoms may include:

• Re-experiencing the traumatic event
• Increased anxiety and emotional arousal
• Intrusive, upsetting memories of the event
• Flashbacks (acting or feeling like the event is happening again)
• Nightmares (either of the event or of other frightening things)
• Feelings of intense distress when reminded of the trauma
• Loss of interest in activities and life in general
• Sense of a limited future (not expecting to live a normal lifespan, get married, have a career)

Below the surface, some children from deprived surroundings, have vastly different hormone levels than their parent-raised peers even beyond the baby years. Studies have shown that children who experienced early deprivation also had different levels of oxytocin and vasopressin (hormones that have been linked to emotion and social bonding), despite having had an average of three years in a family home.

It has been thought that these changes in hormones and neurotransmitters impair development of vulnerable brain regions. If we observe an association between a history of abuse and the presence of a physical abnormality, the abuse may have caused that abnormality. But it is also possible that the abnormality occurred first and elevated the likelihood of abuse, or that the abnormality ran in the family and led to more frequent abusive behavior by family members or other relatives.

People with PTSD actively avoid situations that might bring back memories of the trauma.

Stress & Money: Paying With our Health

Free Illustration

Money fears and worries rank high as America’s stressors.

Money doesn’t buy happiness. Just try living without it, though.

We use money every day. It runs our daily lives--pays for food, clothing, and shelter; educates our children; supports us in retirement; and everything in between.

Americans are extremely concerned over their finances. Surveys show money and personal finances to be the number one cause of stress in America.

In this book about the brain, we look at stress and trauma and how they affect the brain and subsequently our health. Insomnia, migraines, ulcers, and more are triggered by money stress, according to Corporate Wellness Magazine--and any doctor who sees patients every day.

The treatment and cure for money worries doesn’t come in a pill or physical therapy. Only basic knowledge about money and how it works can ease our fears and help build a sound financial house.

Think about it: We go to school. We get courses in English, Science, Math, History...what course don’t we get? Has anybody taken a course called My Money, Money 101, or Building Personal Wealth?

So do we learn about money at work? At home?

The answers are almost always no.

This information deficit has become more critical because over the past decade, culminating in the Great Recession, the economic world of middle-class Americans shifted under our feet.

In these pages you will find information on topics that have proven important in talking to people about their finances. Folks working two and three jobs to make ends meet. People working in what they call “their retirement job.” Those trying adjust to the “new economy.”

Healing the Brain: Stress & Money gives readers a view of the remarkable human brain, its capabilities, and its vulnerabilities. A brain compromised by stress and trauma diminishes our health and yet the brain is slowly yielding its secrets to science and medicine.

Get the book: Healing the Brain: Stress & Money!

PTSD: Post-Trump Stress Disorder?

In our book, Healing the Brain, we give readers the history and biology of PTSD, Post-Traumatic Stress Disorder. Get your copy here, Healing the Brain. We present below a compelling article on widespread PTSD-type misery spreading across America and the world, from Alternet.

Anguishing yet again over election results in the middle of the night, I finally realized I’m experiencing something similar to PTSD. Check out this definition from the renowned Mayo Clinic:

“Post-traumatic stress disorder (PTSD) is a mental health condition that’s triggered by a terrifying event—either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.”

Let’s call this PTSD post-Trump stress disorder, triggered by the election, to the most powerful office in the world, of a man who’s espoused wholesale exclusion of Muslim immigrants, deporting millions of undocumented immigrants, repealing Roe v. Wade, abolishing the Environmental Protection Agency, and encouraging Japan, South Korea and Saudi Arabia to develop nuclear weapons, among other polarizing proposals. While post-Trump stress in no way equals the level of trauma experienced by combat veterans in Afghanistan, Iraq or Vietnam, this is an experience shared by tens of millions of Americans right now.

“Before the election, at least half of my psychotherapy clients in San Francisco were exhibiting enormous anxieties around the issues of bullying, sexual exploitation, racial and ethnic stereotyping and threats of violence associated with the Trump campaign,” observed San Francisco psychotherapist Deborah Cooper. “Now that he has actually been elected, my entire practice is experiencing this as a traumatic event.”

In addition to the classic PTSD symptoms listed above, the Mayo Clinic cites irritability, angry outbursts or aggressive behavior, overwhelming guilt or shame, depression, self-destructive behavior such as alcohol and substance abuse, trouble concentrating, trouble sleeping, and being easily startled or frightened. Sound familiar? You’re not alone. Calls to the San Francisco Suicide Prevention hotline shot up 30 percent in the first five days after Trump’s election. “Some are wondering if they’re going to have the same health care,” director Courtney Brown reported. “Others are wondering if they’re going to still be allowed to be in the country. The only comparable incidents have been 9/11 and the Loma Prieta earthquake,” she said.

For some, Trump’s threats of violence to protesters, admission of sexual assaults against women, and bullying and intimidation of political opponents and the press have raised the specter of past political traumas: the assassination of John F. Kennedy in 1963, and his brother Robert in 1968; The fact that more than a dozen Nixon campaign operatives served time in jail for campaign finance violations and political dirty tricks—and Nixon himself resigned in 1974—provided some solace, but the shock remained.

And then there was the 2000 electoral stalemate between Al Gore and George W. Bush, ultimately decided by a 5-4 majority of the U.S. Supreme Court rather than the will of the people. The epically misguided invasion of Iraq and subsequent horrors in the Middle East as well as Brussels, Paris, Madrid and other terrorist-targeted centers, followed.

The first step in treating PTSD, psychotherapist Cooper says, is to admit you are suffering from trauma. “This is a time to reach out, feel the validation that others are experiencing similar things, and then figure out what we each can do individually about it, both emotionally and with action. Some need to take to the streets, some to the couch.” One thing Cooper warns against is trying to cope with the election as something normal. “This is not normal.”

For those contending with suicidal thoughts, San Francisco Suicide Prevention suggests additional steps.

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• Take compassionate, caring actions to support others. Help a friend in crisis, or a stranger in need, or volunteer to assist others in a cause that you care about.
• Limit your interaction with things that might aggravate your stress. In its survey on stress and the 2016 election, the American Psychological Association found that adults who use social media are more likely to be stressed out by the election than those who don’t. Unplug for a while.
• Call the Lifeline: 1-800-273-TALK (8255). Available 24/7, it’s free and confidential.

For those seeking a more political solution, there’s labor songwriter Joe Hill’s exhortation, “Don’t mourn, organize!”

Learn more about PTSD in our book, Healing the Brain.

 

Ecstasy (Molly) for PTSD?

From the New York times comes news of possible use of Ecstasy for Post-Traumatic Stress Disorder, PTSD. In our new book, Healing the Brain, we take a close look at PTSD, what it is and how it affects people of all ages. 

F.D.A. Agrees to New Trials for Ecstasy as Relief for PTSD Patients

By DAVE PHILIPPS NOV. 29, 2016

C.J. Hardin, a veteran who served three tours in Iraq and Afghanistan, at a memorial in North Charleston, S.C. He is a patient in the study of MDMA, also known as Ecstasy, as a treatment for post-traumatic stress disorder. Credit Travis Dove for The New York Times

CHARLESTON, S.C. — After three tours in Iraq and Afghanistan, C. J. Hardin wound up hiding from the world in a backwoods cabin in North Carolina. Divorced, alcoholic and at times suicidal, he had tried almost all the accepted treatments for post-traumatic stress disorder: psychotherapy, group therapy and nearly a dozen different medications.

“Nothing worked for me, so I put aside the idea that I could get better,” said Mr. Hardin, 37. “I just pretty much became a hermit in my cabin and never went out.”

Then, in 2013, he joined a small drug trial testing whether PTSD could be treated with MDMA, the illegal party drug better known as Ecstasy.

“It changed my life,” he said in a recent interview in the bright, airy living room of the suburban ranch house here, where he now lives while going to college and working as an airplane mechanic. “It allowed me to see my trauma without fear or hesitation and finally process things and move forward.”

 

Based on promising results like Mr. Hardin’s, the Food and Drug Administration gave permission Tuesday for large-scale, Phase 3 clinical trials of the drug — a final step before the possible approval of Ecstasy as a prescription drug.

If successful, the trials could turn an illicit street substance into a potent treatment for PTSD.

Through a spokeswoman, the F.D.A. declined to comment, citing regulations that prohibit disclosing information about drugs that are being developed.

“I’m cautious but hopeful,” said Dr. Charles R. Marmar, the head of psychiatry at New York University’s Langone School of Medicine, a leading PTSD researcher who was not involved in the study. “If they can keep getting good results, it will be of great use. PTSD can be very hard to treat. Our best therapies right now don’t help 30 to 40 percent of people. So we need more options.”

But he expressed concern about the potential for abuse. “It’s a feel-good drug, and we know people are prone to abuse it,” he said. “Prolonged use can lead to serious damage to the brain.”

The Multidisciplinary Association for Psychedelic Studies, a small nonprofit created in 1985 to advocate the legal medical use of MDMA, LSD, marijuana and other banned drugs, sponsored six Phase 2 studies treating a total of 130 PTSD patients with the stimulant. It will also fund the Phase 3 research, which will include at least 230 patients...

Read out book and learn about PTSD.

 

PTSD and Trump: How's Your Health?

After the nation- world-wide shock of Trump's election, many are having health problems. Stress is real and affects our brain and therefore our health. Learn from this excerpt in Healing the Brain.

A Harvest of Psychiatric Disorders

PTSD: A Breakthrough in Diagnosis

In 1980 the mental health community established the diagnosis of Post Traumatic Stress Disorder, PTSD, and revolutionized the way the field views the effects of stress. This change acknowledged that many of the symptoms people experience after exposure to trauma can be long-lasting, if not permanent. Before that shift, the field tended to view stress-related symptoms as a transient, normal response to an adverse life event, not requiring intensive treatment.

Furthermore, before 1980, people who did develop long-term symptoms following trauma were viewed as implicitly vulnerable; the role of the actual event in precipitating their symptoms was minimized. For a while, in a reversal of previous thinking, experts expected most trauma survivors to develop PTSD. More recent research has confirmed that only about 25 per cent of individuals who are exposed to trauma develop PTSD.

So who is likely to develop PTSD following a traumatic experience, and why? The answer is not yet clear, but it now appears that PTSD represents a failure of the body to extinguish or contain the normal nervous system response to stress. This failure is associated with many factors:

• the nature and severity of the traumatic event
• preexisting risk factors related to previous exposure to stress or trauma, particularly in childhood
• the individual’s history of psychological and behavioral problems, if any
• the person’s level of education, and other cognitive factors
• family history—whether parents or other relatives had anxiety, depression, or PTSD

People who develop PTSD are also more likely to develop other psychiatric disorders involving mood (depression, anxiety and panic, bipolar disorder), personality, eating, and substance dependence.

People also seek medical help for problems that may develop after the trauma that can mask or intensify PTSD symptoms. These symptoms include chronic pain, fatigue, headaches, muscle cramps, and self-destructive behavior, including alcohol or drug abuse and suicidal gestures. Often, survivors are not aware that their physical symptoms are related to their traumatic experiences. They may even fail to mention those disturbing events to their physicians, which can make PTSD difficult to diagnose accurately.

Get the book!

PTSD: Wounds that Time Won't Heal

With many Americans in shock after this election, it's good to take a look at our stress response. Excerpted from Healing the Brain.

The Biology of Stress

Imagine you are a zebra grazing on the plains of Africa. It's midday. The sun is bright, the food is plentiful.

Suddenly you sense an attack. A lion is chasing you. Its fight or flight in action.

Your brain tells your body to prepare for a fight or take flight. The body responds by preparing extra hormones to create more energy and by increasing the rate the heart pumps blood to the muscles. For most animals, this stress reaction lasts for just a short time and it saves lives.

Wikimedia Commons

Why don’t zebras get ulcers? According to Dr. Robert Sapolsky, their stress is decidedly short term, not long term.

As a body is preparing for fight or flight, however, practically all systems, such as digestion, physical growth, and warding off diseases are placed on hold. This means that people for whom stress has become a way of life are endangering their overall health. Researchers have learned by studying primates whose systems are similar to human beings that those who learn to have control over their lives and are able to reduce or avoid stress live longer and healthier lives.

Are zebras better equipped to deal with stress than humans? No. However, according to Dr. Robert Sapolsky, author of Why Zebras Don't Get Ulcers, "For a zebra, stress is three minutes of some screaming terror running from a lion. After the chase, either it's over or they are." On the other hand humans, he says, have constructed a network of social stressors. Since we are obliged to live in this framework, stress builds up.

Nature.com

While the stress response activates automatically, its duration and intensity relies on factors such as individual temperament.

How do the brain and the body react to stress? Stress, such as the threat of attack, forces various changes in the body. First, adrenaline causes an increase in heart rate and blood pressure so that blood can be sent to muscles faster. Second, the brain’s hypothalamus signals the pituitary gland to stimulate the adrenal gland (specifically the adrenal cortex) to produce cortisol.

This stress hormone, a longer-acting steroid, helps the body to mobilize energy. However, prolonged exposure to cortisol can damage virtually every part of the body. Chronic high blood pressure can cause blood vessel damage and the long-term shutdown of digestion can lead to ulcers.

SimplyPsychology.org

Stress, such as the threat of attack, forces changes in the body carried out by the hypothalamus-pituitary-adrenal axis (HPA).

Why do some people experience more stress than others? Individuals who feel they have control over their lives appear to experience less stress. It also depends on personality and temperament. Aggressive, competitive types are more likely to define a situation as stressful than a passive, accommodating personality. A universal stress producer seems to be social isolation.

PTSD: A Breakthrough in Diagnosis

In 1980 the mental health community established the diagnosis of Post Traumatic Stress Disorder, PTSD, and revolutionized the way the field views the effects of stress. This change acknowledged that many of the symptoms people experience after exposure to trauma can be long-lasting, if not permanent. Before that shift, the field tended to view stress-related symptoms as a transient, normal response to an adverse life event, not requiring intensive treatment.

Furthermore, before 1980, people who did develop long-term symptoms following trauma were viewed as implicitly vulnerable; the role of the actual event in precipitating their symptoms was minimized. For a while, in a reversal of previous thinking, experts expected most trauma survivors to develop PTSD. More recent research has confirmed that only about 25 per cent of individuals who are exposed to trauma develop PTSD.

So who is likely to develop PTSD following a traumatic experience, and why? The answer is not yet clear, but it now appears that PTSD represents a failure of the body to extinguish or contain the normal nervous system response to stress. This failure is associated with many factors:

• the nature and severity of the traumatic event
• preexisting risk factors related to previous exposure to stress or trauma, particularly in childhood
• the individual’s history of psychological and behavioral problems, if any
• the person’s level of education, and other cognitive factors
• family history—whether parents or other relatives had anxiety, depression, or PTSD

People who develop PTSD are also more likely to develop other psychiatric disorders involving mood (depression, anxiety and panic, bipolar disorder), personality, eating, and substance dependence.

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