Why Do Some Individuals Get PTSD While Others Do Not?

It is normal to experience fear and stress when experiencing a traumatic event.1

Fear and stress are vital to a person’s safety; they trigger physiological “fight-or-flight” responses that help people protect themselves from harm  to their own lives or those of others. In most cases, fear and stress will resolve naturally, but for some people, the emotional distress persists long after the traumatic event has passed. When this happens, the person may be diagnosed with a condition known as post-traumatic stress disorder, or PTSD.1

Events that may precipitate PTSD include, but aren’t limited to:

  • Sexual assault.
  • Natural disasters.
  • Combat.
  • Physical injury.
  • Serious medical illness.

Anywhere from 6% to 9% of the U.S. population experiences PTSD at some point in their lives. While traumatic events may certainly trigger PTSD, not everyone emerges from trauma with this disorder.1 A large portion of those who experience trauma do not develop PTSD. World Mental Health Surveys show that of the nearly 83% of U.S. respondents were exposed to severe and potentially traumatic events, just over 8% were diagnosed with lifetime PTSD.2

One study showed that, among soldiers who experienced potentially traumatic events in combat, about 32% developed PTSD. Amongst those who experienced the most significant trauma, approximately 70% developed PTSD.3 This shows that it is not just traumatic events but other factors, such as an individual’s personal history, that influence whether they will get PTSD.

What Is PTSD?

PTSD is a condition in which the stress and fear associated with a traumatic event do not fade over time.

For a diagnosis of PTSD to be made, an adult, adolescent or child older than 6 years old must experience all of the following symptoms for at least one month after exposure to actual or threatened death, serious injury, or sexual violence to themselves, a loved one or others:1

  • Symptoms in which the traumatic event is reexperienced, such as flashbacks, intrusive memories or bad dreams.
  • Avoidance symptoms, like staying away from places that are reminders of the trauma.
  • Reactivity/arousal symptoms, such as hypervigilance, emotional/angry outbursts, or insomnia.
  • Mood/cognition symptoms, such as guilt, depression, memory problems, or inability to experience happiness.

For PTSD to be diagnosed, symptoms must cause significant distress to a person or interfere with their day-to-day functioning and must not be the result of drug or alcohol use.4

PTSD can happen to anyone at any age. Children may display symptoms differently than adults. The National Institute of Mental Health provides information on trauma in young children.1

Risk Factors for PTSD

As only a fraction of people who experience trauma develop PTSD, there are other variables apart from the traumatic event itself that influence who gets PTSD. Of course, those who live through a trauma such as a natural disaster, assault, or war are at risk, but additional risk factors for PTSD include:1, 4

  • Experiencing childhood trauma or having emotional problems such as anxiety by age 6 years.
  • Lower education level.
  • Having a personal or family history of mental illness.
  • Having maladaptive coping strategies such as self-blame.
  • Having a history of drug or alcohol abuse.
  • Being a woman. According to the National Institute of Mental Health, women are more likely than men to suffer from PTSD.
  • Having a vocation with a high risk of traumatic exposure: police, firefighters, paramedics and other emergency medical personnel.
  • For military personnel, being a perpetrator of violence or witnessing atrocities.

There are also characteristics related to the event or experienced at time of the event or after the event that heighten the risk of developing PTSD:

  • Dissociation during and after the traumatic event.
  • Not having strong support after the trauma occurs.
  • Experiencing an additional loss after the events, such as a death, the loss of a home, etc.

People with PTSD are more likely to have problems with substance abuse. The American Society for Addiction Medicine estimates that anywhere from between approximately 22% to 43% of civilians suffering from PTSD also have a substance use disorder at some point in their life (versus prevalence rates of about 8% to 25% for individuals without PTSD). While taking drugs or drinking may seem like an effective coping strategy at first, it will usually worsen the symptoms of PTSD. And PTSD may, likewise, worsen the substance abuse.5 This makes integrated treatment for each vital.

Protective Factors

Many people who go through a trauma will not develop PTSD. It’s not easy to say why, but the National Institute of Mental Health lists some protective, or “resilience,” factors that may keep people from being impacted by this disorder. These protective factors include:1,4

  • Support from friends and family and/or a support group after the trauma.
  • Being able to act quickly and effectively despite feeling intense fear.
  • Accepting how one acted/reacted when faced with significant danger.
  • Coping in a positive way/learning from the event.

Treating PTSD

It is possible to treat PTSD using a combination of medical treatment and therapy. People who engage in PTSD treatment can learn how to manage the symptoms of the disorder and function in daily life again. These tools can be developed and strengthened through:6

  • Cognitive Behavioral Therapy. You can learn to recognize and alter thought patterns that make the PTSD worse. You can’t change what happened to you, but you can learn to think differently about it, which may help you feel better.
  • Eye Movement Desensitization and Reprocessing (EMDR). This therapy uses eye movements to help the brain reprocess traumatic events.
  • Group therapy. Support from others is a resilience factor, and group therapy can be a wonderful place to share with and receive support from others who have similar struggles.
  • Medications to manage depression or anxiety.
  • Alternative therapies, such as massage, acupuncture, or yoga.

All of these therapies can be used and combined in various ways, based on the individual’s needs and specific challenges. For example, a person who is dealing with PTSD and a co-occurring substance use disorder may need to take extra caution when using certain medications to treat anxiety, such as those with a high addictive potential like benzodiazepines.7

Ideally, ongoing research will help us better understand the reason some people who go through trauma get PTSD while others don’t. In the meantime, getting treatment can make it easier to live with PTSD and find better ways to manage symptoms than using drugs or alcohol. Desert Hope’s integrated, comprehensive treatment incorporates all of the treatment types mentioned above. Discover more about how our program treats co-occurring substance use and PTSD and how we can help you or a loved one find long-term recovery.


  1. National Institute of Mental Health. (2019). Post-Traumatic Stress Disorder.
  2. Koenen, K. C., Ratanatharathorn, A., Ng, L., McLaughlin, K. A., Bromet, E. J., Stein, D. J., … Kessler, R. C. (2017). Posttraumatic stress disorder in the World Mental Health Surveys. Psychological medicine47(13), 2260–2274.
  3. Association for Psychological Science. (2013). Why Some Soldiers Develop PTSD While Others Don’t.
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
  5. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The Asam principles of addiction medicine. Philadelphia: Wolters Kluwer.
  6. Royal College of Psychiatrists. (n.d.). Post Traumatic Stress Disorder (PTSD).
  7. Stein, Murray B. (n.d.). Pharmacotherapy for posttraumatic stress disorder in adults.


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