Why Some Soldiers Develop PTSD While Others Don’t

Pre-war vulnerability is just as important as combat-related trauma in predicting whether veterans’ symptoms of post-traumatic stress disorder (PTSD) will be long-lasting, according to new research published in Clinical Psychological Science, a journal of the Association for Psychological Science.

Researcher Bruce Dohrenwend and colleagues at Columbia’s Mailman School of Public Health and the New York State Psychiatric Institute found that traumatic experiences during combat predicted the onset of the full complement of symptoms, known as the PTSD “syndrome,” in Vietnam veterans. But other factors — such as pre-war psychological vulnerabilities — were equally important for predicting whether the syndrome persisted.

The researchers re-examined data from a subsample of 260 male veterans from the National Vietnam Veterans Readjustment Study. All of the veterans in the subsample had received diagnostic examinations by experienced clinicians that included information about the onset of the disorder and whether it was still current 11 to 12 years after the war ended.

Dohrenwend and colleagues focused on the roles of three primary factors: severity of combat exposure (e.g., life-threatening experiences or traumatic events during combat), pre-war vulnerabilities (e.g., childhood physical abuse, family history of substance abuse), and involvement in harming civilians or prisoners.

The data indicated that stressful combat exposure was necessary for the onset of the PTSD syndrome, as 98% of the veterans who developed the PTSD syndrome had experienced one or more traumatic events.

But combat exposure alone was not sufficient to cause the PTSD syndrome.

Of the soldiers who experienced any potentially traumatic combat exposures, only 31.6% developed the PTSD syndrome. When the researchers limited their analysis to the soldiers who experienced the most severe traumatic exposures, there was still a substantial proportion — about 30% — that did not develop the syndrome. This suggests that there were other factors and vulnerabilities involved for the minority of exposed who did end up developing the PTSD syndrome.

Among these factors, childhood experiences of physical abuse or a pre-Vietnam psychiatric disorder other than PTSD were strong contributors to PTSD onset. Age also seemed to play an important role: Men who were younger than 25 when they entered the war were seven times more likely to develop PTSD compared to older men. The researchers also found that soldiers who inflicted harm on civilians or prisoners of war were much more likely to develop PTSD.

The combined data from all three primary factors — combat exposure, prewar vulnerability, and involvement in harming civilians or prisoners — revealed that PTSD syndrome onset reached an estimated 97% for veterans high on all three. While severity of combat exposure was the strongest predictor of whether the soldiers developed the syndrome, pre-war vulnerability was just as important in predicting the persistence of the syndrome over the long run.

The researchers conclude that these findings have important implications for policies aimed at preventing cases of war-related PTSD.

Given the seemingly potent interaction between combat exposure and pre-war vulnerability, these results emphasize the need to keep the more vulnerable soldiers out of the most severe combat situations.

Dohrenwend and colleagues also point out that the recent conflicts in Iraq and Afghanistan, like the Vietnam War, are “wars amongst the people,” and they underline the need for research examining the circumstances in which harm to civilians and prisoners is likely to occur. Such research could provide important clues for preventing such devastating violations of the rules of war.

In addition to Dohrenwend, co-authors on this research include Thomas Yager and Ben Adams at the Mailman School of Public Health at Columbia University; and Melanie Wall of the Mailman School of Public Health and Department of Psychiatry at Columbia University, and the New York State Psychiatric Institute.

The research was supported by the National Institute of Mental Health (Grant R01-MH059309) and by grants from the Spunk Fund, Inc. and a Ruth L. Kirschstein National Research Service Award from the National Institute of Mental Health.


I’ve read the article because I always wondered why some got it and some of us didn’t.
My only disagreement comes with making adjustments for keeping most vulnerable out of situations and abiding by rules of war. War must be ruthless with no excuses…if we are ever going to abolish it. Again I state this is my opinion right or wrong.
Thank you

you couldn’t be more right. how would world war 2 have gone down if we had all of these ridiculous rules of engagement.

I had a rough childhood joined the Infantry Army and ended up in a rifle co. With 10th mountain and was very good at my job. Our first month in country my three friends were killed by an IED. I had leterally just walked away from that position and was the first to respond. I continued on mission for months after but honestly wasn’t the same man. Eventually I was diagnosed PTSD and remember a Army shrinking my head with this same BS. The reasons are different for everyone, it is a very personal subject and this is not the whole story but It hit a never with me. To blame my childhood after my three friends blew to pieces in my face and was then engaged by the enemy in close range well it is insulting. To say I was pre desposed really only people who really experienced it will know their reasons for having a normal reaction to an Abnormal experience.

My late father joined the military when he was 31 years old. He fought in a bush war for seven years. When I asked him why he did it, he told me he couldn’t stay on the farm whilst his friends went to war. Years later he told me some of the things that happened to them and it wasn’t very nice. I asked him how he felt about it and he said “Well that’s war.” He was not a hard man. He had a kind and caring nature and helped everyone but for some reason he was able to compartmentalise war and never let it get him down.

I served in the British army 15 years, but I don’t think I can agree with all that this article has said, I myself had a few nightmares after getting blown up in northern Ireland, and shot a few people and dealt with death of others.

My thought process is that We reflect on the negative emotions, but positive emotions can out weigh the unhealthy thoughts, until we choose to do so, this is my own wisdom.

Yes I have been a very aggressive person but too me that was part of a job, now I teach conflict resolution and physical intervention training.

However I do think that some are using PTSD for financial gains, which is I feel is completely wrong but it’s a known fact but hard to prove.

I have no regrets what I have experienced or done to others that was pass this is today which I strongly believe that I myself do look at the positive, some of my friends think fucking hell browny is at it again but they think they know me, but honestly they’re only using their past thoughts and memories.
We are the true one’s who know us.

Good luck to those who are suffering but remember who is around you and that you are really safe now

I believe that the re-entry back to from Nam to USA did not help the soldiers coming back. One day you are in a combat zone and in 24 hours later you r back in non-combat zone. WWII veterans it took over a month to get back into USA because they where shipped in cargo ships. Plus the basic combat training during Nam era, mentally and physically that was input into you was that you where not coming back. Vietnam was jungle war type with no borders. Plus they used to move from one training area to another in trailers that where used to carry cows to slaughter. That is the before and after to Vietnam era soldiers in training. I was the lucky one that came back. 50,000 didn’t make it.

I wonder if there is also a link between putting trained soldiers, equipped for war, as much is possible, in the theater of constant danger and uncertainty and then tying their hands with ridiculous rules of engagement. Would that not increase fear in not being able to eliminate the enemy and constant threat of trauma? I think our politics may be a contributing factor. War is never a good option but if we must go, we must not tie our warriors hands and go to win.

That is a great possibility. Training men to kill then throwing them in a place where people are trying to blow them up from 300 meters away and telling them they can’t shoot until shot at is insane. The parinoia must be unbearable.

I suffer from severe PTSD. I saw considerable combat, including mortar and rocket attacks, while serving as an infantry platoon leader. I had a great childhood: no abuse. I did not harm civilians. I had never killed anything prior to Vietnam.

My adopted son is an army captain with 2 deployments to Iraq,1 to Kuwait, and just returned from deployment to Syria. He has been diagnosed with and is suffering from PTSD and has been suicidal. My question to the Veterans here is this: why are combat soldiers with diagnosed PTSD not discharged and sent home? Why do they have to continue to be deployed in wars where they are retraumatized? Thank you.

I developed PTSD and am learning that adoption has a lot to do with it. It was like a hole that was hidden was opened up by the fear and danger I could finally not control. Also we raise our soldiers to be good sons and daughters and they don’t experience much trauma in life, so when it happens all at once it is overwhelming. Sometimes I think nobody understands, that and worse the Gulf War Illnesses. My unit was exposed to Nerve Agent Sarin and also Mustard Gas. When they “lost” my records, bad treatment, slow service that constantly violated the Law, that ruined me.

My father was a conscript in 1965 at the age of twenty (his birthdate-September 23-was drawn out),but because he was working for a protected industry at the time (SEC in Australia) he was deferred,but the government reserved the right to call him up at any time (they never did, even though he left the SEC). He may not have passed the medical,due to having had rheumatic fever as a child (he’d also been in a bad car accident caused by a drunk driver which resulted in damage done to his back which he never really recovered from). He knew people who did go (some made it back,some didn’t).I didn’t know his story until I was a teenager. I was aware the war in Vietnam had happened,due to shows such as “China Beach” and “Tour Of Duty”,and the movies “Platoon”and “In Country” (they seemed to be everywhere during the 80s), but what really made me feel disgusted was the recent documentary series “Vietnam.” I told my dad that,and he told me that a lot of people were disgusted about what happened then. They actually spat on returning soldiers, threw pig’s blood on them, refused to acknowledge them for God knows how long. Apparently even those who were there to entertain the troops suffered from PTSD because they witnessed things they couldn’t forget.

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