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.

The research states that there is direct correlation between three factors: childhood trauma, severity of combat, and what they did to civilian/POW. They are only stating that any combination of the three (or all three) greatly increase your chances of developing PTSD. Everyone is different, some soldiers have experienced all three, been POW, etc. and have not developed PTSD. Then there are people who develop PTSD from non-war related incidents like experiencing a bad car accident, witnessing a death (could’ve been seeing a loved one have a heart attack or even stumbling across someone who had committed suicide and not even seen the incident happen), being threatened to the point of truly fearing for your/loved ones lives, etc. They aren’t saying that if you had a great childhood and didn’t harm civilians/POWs that you should be good and have no chance of developing PTSD. It’s just a study that shows that many factors significantly increase a soldiers chances of developing PTSD after experiencing the many traumas of war. Believe me man, No one is discounting your PTSD. Thank you so much for your service and sacrifices. Hope all is well:

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.

He was diagnosed after returning from Syria, correct? You asked why they don’t discharge soldiers who suffer from PTSD instead of allowing them to continue deployment. Well a lot of the time, thing with PTSD is that the soldier usually doesn’t experience it much while deployed, they(as well as most soldiers deployed) are already in a constant state state of paranoia and fear. They’re always looking over there shoulder, they are worried, every civilian they came in contact with makes them paranoid because they don’t know if they can trust them or if they want to hurt them, especially in more recent wars. Recent wars like Iraq, Afghanistan, Syria, etc. where they are fighting against radical groups (aka terrorists) and not a military, make it hard to even know who your enemy is because anybody could be a threat so you can’t trust anyone. The true PTSD kicks in after they come back to civilian life. They feared for their life for however long they were deployed, possibly experienced being attacked by non-militants, had explosions go of near them, and much more traumatic experiences that terrified them. While back home they become much more sensitive to the loud and sudden noises we’re so use to hearing everyday like construction sites, train horns/sirens, a car near them has a loud sudden backfire (which is a explosion in the cylinder or exhaust of a vehicle or engine that can make a loud noise that sounds like a gunshot) etc. the paranoia/mistrust also doesn’t disappear for some soldiers. They might be driving and notice the person behind them has been traveling the exact same direction as them for some time now taking the same turns, they may start to feel like they’re in danger from their paranoia and panic.

A lot of the time soldiers may not experience symptoms of PTSD for quite some time after they come home, it be even months or years before they have any symptoms. My grandfather didn’t really have any issues with PTSD until ~50 years after WW2 and the Korean War (the two wars he fought in). It’s a very strange disease that manifests differently in everyone. Your son may have not had any issues until after he got home from his most recent deployment.

He also could’ve, like many soldiers, hid his symptoms and didn’t want to talk about it at all. He could’ve been struggling even after his first deployment but didn’t want to tell the military or about what he was experiencing because he may have been worried about losing his job, may have felt like he was failing to be strong for his country, maybe felt like he was weak, maybe thought it would pass eventually or he would get use to it on the next deployment, or multiple other reasons.

If he had been diagnosed before his last deployment, and the military knew he had suffered with PTSD, im not sure if they would have been able to stop him from going. They may have been able to stop him from going depending on: how bad his symptoms were at the time, if it was obvious it was affecting him emotionally, or other issues arising. It’s possible they asked if he felt okay enough to go and they made it up to him, and maybe he said yes because he felt just fine at the time and figured it passed or didn’t want to tell them no. In recent wars after Vietnam (the last time people were drafted) soldiers have not been forced to go to war. They make the decision to reenlist after each deployment so the issue is that if he wanted to go, they’ll let him because it was ultimately up to him. It would have been super messed up if it was back in the past and he was forced to go after he’d already developed mental health issues from the past deployments. I’m sure this happened to many with the Vietnam war when they were drafting and forcing people to go and fight. That would have just made his trauma much worse.

Mental health is a real issue, and I’m glad that people are starting to actually see that and truly care about it. A lot of people and even the medical community up until recent years use to not take mental health seriously. They use to think it was fake and that people should toughen up. They would tell men that they need to man up and just ‘get over it’, which doesn’t help the problem at all. Mental health can be just as debilitating as physical health issues, and even worse.

I’m replying to you comment about a year and a half after you left it. I really hope your son is doing better now. Your son and entire family are in my thoughts. I’m so sorry that he has to experience this trauma and hope that he can be happy and at peace. I’m thankful for his and all of our military’s services and sacrifices that they have made for all of us. I’m am forever indebted.

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.

My father was a WWII combat veteran. He fought in the Pacific and had disturbing nightmares for the rest of his life. He didn’t talk much about his service as was customary for his generation. But I think time and dedication to something he loved saved him from the stress related effects of his service. He was a finish carpenter and seemed happiest when he was around his wood,(which he always was.) He cut his demons down to size over time, made them manageable and I think that’s how he made it through. He found inner peace but it did take time.

I’ve been home from the war for more than 10 years now. I also saw extreme levels of combat on many many occasions. From bullets snapping inches from my head, to mortars feet from me, to rockets, to IEDs, to dismembered bodies, dead children, taking the life of combatants, etc. This past January I passively attempted suicide. I was experiencing psychosis from isolation and sever depression as a result of withdrawal from society as a result of my PTSD sypmptoms. I still to this day believe sometimes that I’m dead already, that reality does not seem real, etc, but I can say this. I’m now a volunteer inpatient at the VA to stabilize those symptoms before entering in a PTSD treatment program. The first few weeks here were very intense for me just being around other veterans again and hearing some of their stories. Further, there is A LOT of stolen valor and benefit seekers here. What I will say is this, there are only 10 beds for the PTSD program of which only 5 are taken and the VA has given me EXTREME pushback of getting into the program thus far trying to put me in outpatient. Which I’ve failed to follow through with because of the symptoms and untimely social withdrawal. That said, I think they will take me after stabilizing, but it seems that our VA needs more resources and better outreach. Ive talked to the crisis line half a dozen times in the past decade or so and although they do reach out to you, they eventually stop trying to contact you and they definitely do not contact friends or family to check on you. It is very easy to fall down the rabbit hole. That’s to downside. The upside is that since being here, the psychosis and flashbacks have mellowed out – isolation can exaserbate those things. However, I feel like I have to experience life threatening things to feel whole, still. And my view of the world is still pretty wrecked. If you’re reading this and you’re a veteran with PTSD, I will say this… don’t wait like I did until your symptoms push you to the point of eating a bullet or accidentally hurting someone else when you’re only thinking of yourself – IE speeding down the highway, thrill seeking, etc etc. Come here and open up. Get these things off your chest. You’re not alone and albeit this sucks really bad to be in this situation, there may be hope for us if we open up.

Headhunter 9 Golf Out

PTSD needs to be addressed more frequently in our veterans that need it, but I tire of it being used as a handout to those in the military that never once saw conflict….

Did the study compare outcomes between conscripts and career soldiers?

This article rings true. Chances of PTSD are increased with bad prior military experiences, combat experiences, and harming of civilians and prisoners. Combat before and after age 25 is also a factor. PTSD has always interested me as an army infantryman.

Everyone has problems, but I don’t think my problems rose to the level of PTSD. Even if they did I would never admit it because you don’t admit problems in the army. I am concerned about people who use PTSD to get out of work or as an excuse to drink and use drugs, especially if they served in a rear area support position and saw no first hand combat action. For those who do have PTSD, no expense should be spared to help them find peace. I’m glad to see research such as this article.

For me once again, I was about 25 when I went to Vietnam. I had read a lot of history and knew what to expect and I remembered Mr. Spock’s detachment in the Star Trek series where he would say in the face of danger, “Interesting, very interesting.” For those who have PTSD I would say look to yourself, your God, your family for a cure and peace. Don’t expect the military, government, drugs, or anyone else to find the answers for you. Best wishes and best of luck for those who have PTSD. I hope you find peace and please don’t harm yourself or others.

I think we need to be careful saying what criteria is combat and what is not. I was a Combat Engineer in Iraq and had a relatively light tour.Mainly indirect fire, IEDS, mortars, and losing a fellow soldier. Our battalion medic then having to good buddies kill themselves upon returning. That was 12 years ago and to this day I still struggle..I don’t drink or do drugs other that what I am prescribed. Point is, you don’t have to shoot some kids face off or watch your buddies burn alive to get PTS. Hell, I hear some kids claim they have it from boot camp. Who knows why some do and some don’t. I am doing way better than I was, I was originally 50% and I only applied because the local veteran center convinced me I needed to. I am down to 30% and it’s fair. I am nowhere close to the disaster I once was. If you accuse one of stolen valor or simply looking for money or an excuse to drink and drug you best have your facts straight. To all those who have PTS all I can say is hang in there, in my experience it never goes away but IF you work at it you can have somewhat of a normal life again. God bless you all.

Tyler M

I’m a student studying criminal justice and criminology. I have a class called Victimization and had the project of discussing victimization pertaining to Veterans. I’ve read my book and listened to researchers. For what ever reason I stumbled across this site and read the comments. I want to thank you all who have posted over the years. I found truth and heart in what you’ve said. Thank you all for your service and God Bless you and America!

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