Ask the Expert, Brian Klassen, PhD: Why Do Some People Get PTSD While Others Do Not?

My friends deployed to the same places I did and are all fine while I am struggling with PTSD. What is wrong with me? Dr. Klassen answers your questions about mental health treatment.

Brian Klassen, PhD, is the Clinical Director of the Road Home Program, part of the Wounded Warrior Project's Warrior Care Network.

For information about treatments for PTSD please visit The Treatment Hub.

Hi, I’m Dr. Brian Klassen. I’m a psychologist and here’s our question: “Why do some people get PTSD and others don't? My friends deployed at the same places I did, but are fine, while I’m struggling. What’s wrong with me?”

I think this is a great question and it’s certainly one that as a psychologist and a scientist I think quite a bit about. And there has been a lot of research recently into why some people develop PTSD, so-called risk factors, and why some people don’t. And so, so-called like buffering or protective factors. And this is a very kind of hot topic, kind of hotly debated question in the scientific community regarding PTSD.

And I have to say, I don’t know that we know completely. I think there is still a degree of mystery around who gets PTSD and who does not. There are a couple risk factors and protective factors that have emerged from the literature. So, I’ll kind of cover those, and maybe kind of talk about how they might apply to your situation or they might not.

In terms of risk factors for PTSD, one of the largest ones we know about is having prior trauma exposure. Right? So, we know that a big individual difference in who develops PTSD and who does not is that repeated trauma exposure throughout one’s life can often result in developing PTSD later.

So we see this in military settings especially where if people grew up with childhood abuse in the home, or had a particularly kind of adverse childhood, maybe they were exposed to natural disasters or neglect when they were young, that that sort of primes them in a way to experience combat, military deployments, later traumas, in a certain way that predisposes them to develop PTSD. So that’s one way.

I think another way is that we know that there are certain kinds of traumas that are more likely to result in PTSD than others. I think a good way to think about this is, you know, the meaning of combat. Meaning that you’re sort of - other people are out there trying to kill you through bombs or bullets or some other kind of weapon - has a very different meaning than being involved in your neighborhood being flooded or a house fire. Right?

So that the meaning of combat, that other people are trying to kill me or maim me or cause me harm, just kind of results in a very different kind of mindset than sort of an act of God, if you will. So why this is important is we know that military members, service members, veterans, they’re often exposed to the more kind of riskier kinds of trauma for developing PTSD, than like the general public might be.

Another risk factor for PTSD is, we know that some degree of it is genetic so that PTSD runs in families, along with things like depression, anxiety, and kind of other sorts of mental health diagnoses can run in families as well. You know, just like heart disease or diabetes. Right? Like, if it runs in your family and you have a kind of genetic loading for having this condition or these symptoms, it’s you’re more likely to. Some other things that are interesting to think about is what’s called protective factors or buffers. And these are things that kind of mitigate the effects of trauma exposure.

Now, one interesting thing that we’ve found is that the degree of social support that you feel that you have, which is, to kind of translate that, is the degree you feel close to other people, that you have close friendships or partnerships with other people in your family, your neighborhood, or friends. That you have people that you feel that you can talk to, or kind of share things without judgement, or people that would help you if you needed it. That’s actually one of the biggest protective factors against developing PTSD.

And I think the great tragedy of trauma exposure and PTSD is that it can lead to people feeling very isolated and alienated. And so it kind of cuts people off from the very thing that they most need after a trauma exposure, is sort of that community to kind of come around you.

Now, interestingly, in the military this can be sort of a double-edged sword because there are some units that were sort of very well buffered against trauma exposure because they have such a good cohesive unit culture. It can cut the other way as well, though. If you don’t feel supported by your leadership, if you don’t feel supported by your peers, if you don’t feel like the people next to you have your back, that can actually be a pretty major risk factor for PTSD.

The other thing I’ll say too, is that how the trauma is reacted to is often a big sort of factor in the development of PTSD. And so, as a psychologist, one thing I’ll say from my perspective is that after a trauma exposure this kind of natural tendency to avoid, right? To sort of push the event out of your mind, just to not think about it anymore, to not experience the kind of grief, sadness, fear, disgust, you know, these very kind of painful, unpleasant emotions, the need to like push those away or suppress those can actually be a major factor in the development of PTSD as well.

So, I think the, what we always try to encourage people, is like, you know, talk with people you trust. Let yourself feel what you feel. Like, don’t push these events out of your mind, but let yourself think about them, let yourself process them. And it’s very unpleasant at first, but we do find that it runs its course and it does improve with time.

Of course, it’s important to know about the risk factors and why people develop PTSD and about the protective factors, about why some people don’t develop PTSD. But you know what? One thing I’d like to tell you is that there are a lot of people that develop PTSD after traumatic experiences.

And actually, in the mental health community we sort of think of PTSD as a normal response to an abnormal situation. And so, the kinds of symptoms that you’re experiencing, the sort of lack of sleep, the irritability, the intrusive thinking, being unable to get these thoughts out of your head, are in some ways the body’s and nervous system’s and the brain’s way of protecting itself from being traumatized again in the future. And so, a lot of these responses in the right context are good, are healthy, are adaptive and of course not your fault.

Another thing I’d like to say about this question is, you know, you say that your friends seem fine, which could certainly be the case. Right? I do want to raise the possibility, or at least just put it out there, that your friends might also be struggling with the same things that you are. It could be the same events, the same traumas, the same kind of combat scenarios that you’re struggling with.

And I’ve been doing this work long enough to know that that’s often the case. Is that often once somebody comes into treatment and kind of gets to the point at which they want to start sharing their story with people that were in their unit or people they served with, that they often find, upon reaching out, that a person that seems fine in their unit, or they’re just like crushing it at life, they’ve got a great job, great partner, that actually once you kind of peek below the surface they’ve actually been struggling as well.

And I just want to say, those moments I think are quite beautiful because you’ve got two people really kind of coming to terms with an event that has really shaped their life, and that they’ve had trouble processing, and that’s haunted them. That they finally sort of put the mask down and really kind of see each other.

And so, just to kind of summarize, I think it’s possible your friends might be fine, it’s just sort of this mysterious mix of kind of risk factors and genetics and protective factors, but the truth may be more complicated.

BrainLine is powered in part by Wounded Warrior Project, to honor and empower post-9/11 injured service members, veterans, and their families.

Posted on BrainLine October 12, 2021. Reviewed October 12, 2021.

About the author: Brian Klassen, PhD

Brian Klassen, Ph.D., is the Clinical Director for The Road Home Program: The National Center of Excellence for Veterans and Their Families at Rush University in Chicago, Illinois. Brian spent his formative years training at the Jesse Brown VA Medical Center, completing rotations in chronic pain management, residential substance use disorder treatment, and PTSD. Brian has special expertise in providing front-line treatments for PTSD, including Prolonged Exposure and Cognitive Processing Therapy.

Headshot of Dr. Brian Klassen