Natureversus Nurture: Post Traumatic Stress Disorder
Natureversus Nurture: Post Traumatic Stress Disorder
Mentalillnesses are health conditions that affect all people, irrespectiveof their age or social status. Mental illnesses limit the ability ofthe affected individuals to function and relate with other people.PTSD is one of the most prevalent mental illnesses and it affectsabout 7-8 % of all U.S. citizens (U.S. Department of VeteransAffairs, 2015). Currently, there is no single factor that isassociated with the occurrence of PTSD. Scientists and scholars aredivided, where some of them uphold the “nature perspective” whileothers suggest that the “nurturing perspective” should be used toexplain the occurrence of PTSD. This paper will consider the riskfactors put forward in both perspectives.
Definitionof PTSD under DSM criteria
PTSDis a disorder that occurs following an exposure to an actual,threatened death, or a serious injury. This exposure must lead to atleast one of the following a direct experience of a traumatic event,learning about an event that affected a close relative or a friend,witnessing the event in person, and experiencing an extreme exposureor a first-hand repeat of a traumatic event (DVA, 2016).
Thetraumatic event has to be encountered in one of the following waystraumatic nightmares, prolonged distress, recurrent and intrusivememories, dissociative reactions, and marked psychological reactivity(DVA, 2016).
Itshould also be characterized by persistent effortful avoidance ofstimuli that is related to trauma, with at least one of the followingbeing experienced trauma-related feelings and external reminders.
Negativealterations in mood and cognition should be accompanied by at leasttwo of the following the lack of ability to recall significantcharacteristics of the underlying traumatic event, persistent anddistorted blame, persistent emotions that are related to trauma,feeling alienated, persistent negative expectations, diminishedinterest in important activities, and constricted effects (DVA,2016).
Atleast two of the following arousals should be demonstratedself-destruction, aggressive behavior, startled response,hyper-vigilance, problems in concentration, and sleep disturbance.The criteria should last for at least one month (DVA, 2016).
Thesymptoms should be accompanied by functional impairment. Disturbanceshould also be excluded from substance abuse, mediation, or otherillness.
Behaviorsassociated with PTSD include
Anger and frustration
Lack of communication
Strange reaction to normal situations
Expression of guilt for events that are out of one’s control
Pulling out of intimate relationships
Causalfactors advocating for “nurturing” perspective
Childabuse and PTSD
Anexposure to trauma during childhood increases the risk of contractingPTSD during adulthood or later stages of development. There are manyforms of child abuse that can increase one’s vulnerability to PTSD.However, sexual abuse is the most common type of maltreatment thanincreases one’s vulnerability by limited the ability to achievenormal cognitive and psychological development (Jaffee &Christian, 2014). Poor developmental progress limits the capacity ofthe affected persons to cope with subsequent traumas. For an instant,individuals who experienced child abuse are at a higher risk ofsuffering from PTSD following a subsequent exposure to another traumaduring adulthood than persons who had a healthy life duringchildhood.
Insecureparent-child attachment theory
Thetype of attachment between parents and their children determines theability of kids to achieve cognitive, social, and emotionaldevelopment. An insecure attachment reduces the ability of kids toachieve cognitive and social development. A study conducted byArmour, Elklit & Shevlin (2011) indicated that about 53.1 % ofthe study participants with PTSD suffered from insecure attachment,where 18.6 % and 34.5 % of all participants were characterized bybeing fearful and preoccupied, respectively. These children had alimited ability to establish social bonds and distinguish betweennormal and dangerous stimuli (Armour, Elklit & Shevlin, 2011). Inaddition, an insecure attachment disrupts the development ofself-calming and self-regulating system, which limits the ability tomanage the impact of traumatic events that people face duringadulthood.
Thetendency of victims to blame themselves for traumatic events thathappen to them is a common cultural factor that increases thevulnerability of members of the community to PTSD. A study of 151victims of childhood sexual abuse indicated that the association thatoccurs between PTSD and self-blame score was higher in all cases ofabuse (Cortes, Canon & Cortes, 2012). People who blame themselvesdecide to handle the trauma without seeking help from health careexperts or relatives, which results in chronic stress that eventuallydevelops to PTSD (Cortes, Canon & Cortes, 2012). An internallocus of control help this population of victims think that they hadan opportunity to act differently and avoid the occurrence of thetrauma. Therefore, self-blame increases the risk of PTSD by limitingthe ability of the victim to seek for help from external sources,which could lead to a successful recovery from trauma.
Therelationship between socioeconomic status and PTSD
Thesocioeconomic status influences the psychological as well as themental health of all human beings. Studies have shown that anextremely lower socioeconomic status is among the most significantrisk factors for several mental conditions, including PTSD. Accordingto Neria, DiGrande & Adams (2011) socioeconomic status accountsfor about nine percent of the variance that leads to the occurrenceof PTSD. The socioeconomic status increase vulnerability to thismental disorder, irrespective of the age of the patient. People witha lower socioeconomic status experience a lot of economic hardshipsthat limit their ability to cope with traumas that happen in theirlife. In most cases, a traumatic event leads to PTSD when it affectsthe psychological as well as the economic status of the victim. Forexample a study of the relationship between September 11, 2001 bombattack and the prevalence of PTSD among revealed that most of thesurvivors became vulnerable after losing their jobs and businesses(Neria, DiGrande & Adams, 2011). An incident that lowers theeconomic status of an individual affects their mental health in asignificant way and it could lead to the development of PTSD.
Manypeople turn to their families for social support, which is criticallyimportant in the process of recovering from post-trauma stress. However, a dysfunctional family environment denies victims theopportunity to get social support from the family members. In thecase of children, a dysfunctional family environment, which ischaracterized by conflict between parents, serves as an additionaltype of trauma (Neria, DiGrande & Adams, 2011). By spendingseveral years in such an environment, people suffer from emotionalnumbing, which hinders the healing process. This family environmentallows post-traumatic stresses to accumulate and advance to PTSDsince the affected members of the family are not able to handle anyof the traumas that happen in their life.
Causalfactors advocating for “nature” perspective
Theconcept of genetic predisposition holds that people who suffer fromPTSD have certain genes that increase their vulnerability.Researchers and scholars who uphold this perspective support theirargument by stating that PTSD runs in families, which is aconfirmation of the hereditary nature of the disorder. Research showsthat between 30 % and 40 % of all cases of PTSD occur in familieswith at least one person who suffered from the same condition before(Cornelis, Nugent, Amstadter & Koenen, 2010). A recent studyconducted by the University of California, Los Angeles attributed thehereditary nature of PTSD to two types of genes, namely TPH-2 andCOMT. COMT is responsible for degradation of dopamine, which is aneurotransmitter that controls the pleasure and reward centers(Schimidt, 2015). The PTSD occur when COMT facilitates over orunder-degradation of dopamine. TPH-2 controls production ofserotonin, which is also a neurotransmitter that regulates alertness,sleep, and mood. Production of less or more than the normalquantities of serotonin, which occurs under the control of the genecalled TPH-2, increases the risk of suffering from PTSD (Schimidt,2015). Therefore, the genetic composition of an individual determinesthe possibility of suffering from PTSD.
Thecognitive ability, which influences the level of intelligence,determines the vulnerability of an individual to the risk ofcontracting PTSD. The level of IQ is determined by nature, whichimplies that natural factors make a significant contribution towardsthe occurrence of PTSD. A longitudinal study of 713 subjectsindicated that people with a lower level of intelligence are likelyto suffer from PTSD compared to those with a higher level ofintelligence (Breslau, Chen & Luo, 2013). Although most of thescholars attribute the occurrence of PTSD to patient’s exposure totraumatic events, pre-exposure level of intelligence is always loweramong those who suffer from the disorder than those who go throughthe traumatizing incident without significant mental problems. Therelationship between the risk of contracting PTSD and the level ofintelligence is attributed to the fact that people who are morevulnerable have more neurological soft signs, which is an indicativeof high chances of nervous system dysfunction (Breslau, Chen &Luo, 2013). This relationship is also confirmed by the fact that onlya few of individuals who are exposed to a traumatic incident of thesame magnitude suffer from PTSD, which depends on the susceptibilityof their nervous system.
Hormonalimbalance as a biological risk factor for PTSD
Thereexist some biological abnormalities among survivors of PTSD evenbefore they suffer from this disorder. This is confirmed by the factthat these abnormalities are not observed in individuals who do notsuffer from PTSD even after being exposed to a traumatic incident ofthe same magnitude. Neurohormonal abnormality is one of thebiological factors that predispose some people to the risk ofcontracting a PTSD. For example, a low level of cortisol, which is aglucocortisol that is secreted in the HPA axis, is observed in themajority of survivors of PTSD (Porhomayon, Kolosnikov & Nader,2014). Biological abnormalities that result in a chronic shortage ofcortisol are closely related to pathophysiology of PTSD more than apost exposure to trauma. Therefore, PTSD can be considered as aproduct of some underlying biological abnormality.
Theproponents of the “nature perspective” and the “nurturingperspective” present reasonable arguments and facts that explainthe occurrence of PTSD. The studies and theories reviewed in thispaper indicate that there are biological, trait, and genetic factorsthat predispose the victims of PTSD, even before the occurrence oftraumatic incidents. In other words, victims of PTSD have someunderlying natural risk factor that limits their ability to handlepost-exposure stress. This stress finds an opportunity to develop toPTSD, while people without the natural risk factors recover and getback to their normal lives after being exposed to a traumatic eventof a similar magnitude. Therefore, the two perspectives complementeach other in explaining the occurrence of PTSD.
Armour,C., Elklit, A. & Shevlin, M. (2011). Attachment typologies andpost-traumatic stress disorder, depression and anxiety: A latentprofile analysis approach. EuropeanJournal of Psychotraumatology,2, 1-9.
Breslau,N., Chen, Q., & Luo, Z. (2013). The role of intelligence inpost-traumatic stress disorder: Does it vary by trauma severity?PlosOne,8 (6), 1-4.
Cornelis,C., Nugent, R. Amstadter, B. & Koenen, C. (2010). Genetics ofpost-traumatic stress disorder: Review and recommendations forgenome-wide association studies. CurrentPsychiatric Reports,12 (4), 313-326.
Cortes,C., Canon, J. & Cortes, M. (2012). The interactive effect ofblame attribution with characteristics of child sexual abuse onpost-traumatic stress disorder. TheJournal of Nervous and Mental Diseases,200 (4), 329-335.
Jaffee,R. & Christian, W. (2014). The biologically embedding of childabuse and neglect: Implications for policy and practice. SharingChild and youth Development Knowledge,28 (1), 1-36.
Neria,Y., DiGrande, L. & Adams, G. (2011). Posttraumatic stressdisorder following the September 22, 2001, terrorist attacks.AmericanPsychologist,66 (6), 429-446.
Porhomayon,J., Kolosnikov, S. & Nader, D. (2014). The impact of stresshormones on post-traumatic stress disorder symptoms and memory incardiac surgery patients. Journalof Cardiovascular and Thoracic Research,6 (2), 79-84.
Schimidt,E. (2015). UCLAstudy pinpoints two genes that increase risk for post-traumaticstress disorder.Los Angeles: University of California, Los Angeles.
U.S.Department of Veterans Affairs (2015, August 13). PTSD: Nationalcenter for PTSD. U.S.Department of Veterans Affairs.Retrieved July 5, 2016, fromhttp://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp
U.S.Department of Veterans Affairs (2016, February 23). PTSD: DSM-5criteria. U.S.Department of Veterans Affairs.Retrieved July 5, 2016, fromhttp://www.ptsd.va.gov/professional/PTSD-overview/dsm5_criteria_ptsd.asp