For many years researchers have been trying to determine why a sizeable minority of people develop post-traumatic stress disorder (PTSD) after a traumatic event, while other people exposed to the same event recover without experiencing PTSD. It’s an important topic for society at large, and a subject of much interest to the military, where PTSD is a growing concern. Understanding who’s most at risk can help decision-makers be strategic in using their resources and target interventions to the people most likely to benefit.
Hormones and PTSD
One thing that’s clear is that stress hormones play a significant role in PTSD. During a traumatic event, fight-or-flight hormones like adrenaline are raised to help the body deal with the emergency. After the incident, hormone levels slowly return to normal. For those with PTSD, however, those levels tend to stay high.
Levels of hormones in the body when the event occurs also appear to be important. Since the 1980s, researchers have understood that abnormal levels of cortisol are associated with developing PTSD, but the exact nature of the link has been hard to determine. Recently, Science Daily reported on a study that found a relationship between PTSD, cortisol and testosterone.1
A healthy stress response involves an increase in cortisol, and the study tested soldiers’ stress responses before they were deployed. The researchers found that soldiers who had an abnormal cortisol response were more likely to later develop PTSD, but those who responded to the stress with high levels of testosterone weren’t likely to develop the condition, whether or not their cortisol response was normal. Because of hormonal differences, men and women may also develop PTSD in different ways. A hormone known as pituitary adenylate cyclase-activating polypeptide (PACAP) has been linked to the development of PTSD in women, but not in men.2
As with many health conditions, there appears to be a genetic component to PTSD, with gene expression affecting hormone levels and the way that memories are coded in the brain. The amygdala and hippocampus are the brain regions most involved. The amygdala controls fear levels, and the hippocampus, which is often smaller than normal in people with PTSD, relates new experiences to older ones. The way the amygdala and hippocampus process memories is linked to the way that parts of our cells called glucocorticoid receptors, which bind cortisol and other hormones, signal during a traumatic event.3
Screening for PTSD Risk
Genetic screening, testing hormone levels and performing brain scans may all be useful in helping to identify people at highest risk for PTSD, but risk analysis may also be done in a much less invasive and costly way. A simple questionnaire, already given to all members of the US Army annually, could help predict which soldiers may need help addressing depression or PTSD after deployment.
Recently, researchers took responses to the Global Assessment Tool (GAT) and combined them with demographic information such as age, education, marital status and military occupation to determine individual risk for mental health disorders. Soldiers whose scores were in the bottom 5 percent had much higher odds of being diagnosed with depression or PTSD after deployment.4
Some people fear that PTSD risk information, like information regarding the risk for other medical conditions, could be used to discriminate. Others stress that screening is important so people can get the resources they need to remain healthy. Identifying at-risk military members might enable them to access programs designed to build awareness and resilience. An increased understanding of the biological and genetic factors involved could eventually lead to the development of targeted medical treatments.
Because PTSD can significantly affect someone’s quality of life, it’s important to treat it as quickly as possible. Screening soldiers at higher risk more frequently may be one way to help do that. There are also mental health programs, such as the one at Del Amo, that are specifically designed to meet the needs of military patients. With the right medical expertise, PTSD can be addressed effectively. And maybe, in the not-too-distant future, it can also be prevented.
1 University of Texas at Austin. “PTSD risk can be predicted by hormone levels prior to deployment, study says.” Science Daily, March 7, 2017.
2 Eastman, Quinn. “Study: Stress hormone linked to PTSD found in women only.” Emory Report, February 23, 2011.
3 Tucker, Patrick. “Predicting PTSD.” The Atlantic, August 13, 2014.
4 BioMed Central. “Predicting depression and PTSD before deployment could help soldiers cope.” Science Daily, October 4, 2017.