PTSD risk factor confirmation bias?

[siniang]

So, this is something I've been ruminating about on and off. I know it may have come up in discussions on here before, but I don't remember.

One of the sorta "mantras" surrounding PTSD is that "experiencing trauma" doesn't automatically lead to developing PTSD. As far as I know, we still don't really know *why* PTSD develops, but I think a few risk factors have been identified over the years:
- the amount and severity of trauma you've gone through in your life
- family history of mental health issues, diagnosed and undiagnosed, treated and untreated, pointing to a strong genetic component which is also considered/accepted for other Dx's such as anxiety and depression (both of which end up being within the PTSD symptomatic cluster)
- already having other mental health problems
- lack of a support system

(and I've seen "low income", "being female", and "low education" thrown around as well, but I'm not sure how well studied/accepted those are as there's a really good chance these aren't actually objective risk factors and more the result of a certain survey bias, as those tend to correlate stronger (though of course not exclusively) with certain social situations which themselves have higher incidences of trauma)

And while correlation does not always equal causation, there "gotta" be something differential among people who do and don't develop PTSD after having gone through the same trauma.

I was wondering whether an inherent or at least long-standing unexplained but very specific fear of something makes you more prone to develop PTSD if/when that specific fear does come true. In a sort of self-fullfilling prophecy/confirmation bias kind of way.

Is the person with aerophobia surviving a plane crash more likely to develop PTSD than the person without ~, for example?
Is the woman who's always been fearful/suspcious of men and who ends up getting assaulted/raped more likely to develop PTSD?

(can't think of better examples, sorry, head is very mushy)

Which I mean is essentially really just a step up from the "already having other mental health problems" risk factor, specifically certain anxieties/phobies, no?

I had an unexplainable fear of someone breaking in for as long as I can remember. I never knew why. I wasn't living in an unsafe neighborhood at all. I wasn't a particularly anxious child nor were my parents particularly anxious/hypervigilant. We lived on the 6th floor of a secure condominium with locked indoor stairs - yet, somehow I was always convinced that if someone was breakig in, they would go all the way up to our floor and then choose *our* condo out of multiples to break in ... as little rational sense as that made. Even after we moved, that fear stayed, and it moved with me even when spending time in other places (such as visiting grandparents).

And then, further down the road, this is exactly what happened ...

Have there been any studies into this? I know some of you are much deeper into the literature and up to date on PTSD research.

But also interested whether anyone else shares this... experience? Connection?

And even if it's not a risk factor, I think it definitely helps solidify PTSD core beliefs of unsafety. Again, as a sort of confirmation bias. And I really don't quite know how to actually tackle those. Because not only did it happen -- YOU WERE SPOT ON and RIGHT with your prior fears.

PS: Just want to make clear that I'm not saying PTSD only develops if this is the case, because very obviously it doesn't. I'm just wondering if that could be *one* additional risk factor.

 

[coraxxx]

Perhaps having a fearful temperament and a tendency to worry for things is a risk factor of itself. Could even be passed on genetically or epigenetically. For what I have read so far it makes sense. There are terrains that are more or less prone to develop chronic mental health issues. In that sense having a family with a history of oppression or traumas might be a risk factor even if the parents haven't developed the thing themselves.

Another explanation for your specific case that could have made your fear so certain and specific could actually to have overhead something that you forgot because it was for you insignificant or that you obliterated it--whatever reason. And then the sublatent fear existed and it realised, for a reason.

Another thing I've read about is that there are set of fears that develop more easily in certain species. By example, arachnophobia is easily developed in humans because we do have an innate distrust for spider like shapes. You can develop it at seeing one peer of your species getting scared at it just once. It has to be reinforced by experience but the inner thing is there. For certain tree monkeys it's the shape of a preybird that is easier to be an object of great fear. While the shape of a kangaroo would be neutral, and only rare individuals would develop a specific and intense fear of kangaroos. The fear of being invaded might be one of these "easily reinforced items" for humans, I don't know. It would make sense.

For airplanes, I don't know. But apart from bird, no species is especially enchanted with the idea of taking off the first time. PTSD might then be the next step when the brain wires in total certitude that the disaster not only is real, but is systemic rather than punctual. This is the main thing.

Could having an inclination of generalising thoughts or over generalising them a risk factor for PTSD? Can be certain kinds of cultural habits or philosophies tend to be more PTSD inducing than others? I don't have the beginning of an idea.

If you have time to watch interesting stutf I'd really recommend to watch Stanford's Sapolsky's lessons about endocrinology, neurology and human behaviour, if you don't already know them. It's freely available on YouTube.

 

[joeylittle]

If you want to do a deep dive, @siniang - I'd recommend this chapter: Risk Pathways for PTSD (subtitled 'making sense of the literature'), from The Handbook of PTSD (science and Practice), 2nd ed.

Spoiler alert: You're right, science doesn't know why PTSD develops in some and not others. But, the risk factors that have been discussed over the years are - to greater or lesser degree - flawed. So, things like having been exposed to additional trauma, or genetic history of mental illness, etc. - as far as I'm aware, no-one truly agrees on any of these. The studies often contradict each other. Individuals who are more regularly engaged in activities that have a higher risk of trauma (people in active military service, for example) - those individuals are more at risk for PTSD. That's the only empirical data that is fairly incontrovertible.

Which I mean is essentially really just a step up from the "already having other mental health problems" risk factor, specifically certain anxieties/phobies, no?

It's a smart question. From everything I've read, this kind of cognitive connection - a sort of confirmation bias - this isn't related to whether or not the individual will develop PTSD. IN other words - I've never seen anything where anyone is studying whether one's own thoughts can leave them more open to developing PTSD. It's ONLY connected insofar as we're talking about anxiety and stress - which some have argued, is a risk factor.

The stuff that's always resonated with me has to do with what happens following the trauma - whether or not a person has social support, whether they receive care. Basically, how they are re-engaging with the present, in the aftermath of the trauma.

I've also read interesting things about the individual who experiences dissociation during the trauma possibly having more risk of developing PTSD, than the person who does not dissociate during the traumatic event. There's a certain logic to that - but, until PTSD is more fully understood, I don't know that any of these things can become clearer.

And even if it's not a risk factor, I think it definitely helps solidify PTSD core beliefs of unsafety. Again, as a sort of confirmation bias. And I really don't quite know how to actually tackle those. Because not only did it happen -- YOU WERE SPOT ON and RIGHT with your prior fears.

I think this is a really interesting question. I challenge the idea that (in fact) you were right with your prior fears. To me, that's selective reasoning. If I'm afraid of heights - specifically, of falling from a height - and I have recurring nightmares about that, and then eventually I fall off the edge of a cliff...was my nightmare correct? In order to accept that, I'd also have to accept that anything I have strong thoughts about is likely to come true. Something like that.

Hindsight is 20-20. Foresight doesn't really exist in that way. (at least, not in my cosmology).

 

[siniang]

Thank you @ruborcoraxxx and @joeylittle !! I'll reply in some more in-depth after my system's seen some sleep.

But one thing that kind of "ting-a-ling"-ed right now when reading your reply... vvv

The stuff that's always resonated with me has to do with what happens following the trauma - whether or not a person has social support, whether they receive care. Basically, how they are re-engaging with the present, in the aftermath of the trauma.

I have more events that - at least I think, but of course could be totally wrong - technically qualify as Cat A. And both are very similar in what happened after. The only difference is the prior existing/non-existing fear.

1) Almost drowning in the ocean, having been caught in an undercurrent and big crushing waves during a storm, sincerely terrified for my life, to the point of waking up at the beach not knowing how I actually got back there and how long I was out. I don't think all-together it wasn't a long event (yahah, I know, doesn't matter) and there was no lasting damage (aside from a soar throat for a couple days from the swallowed water).

2) Waking up to home intruder. The whole thing lasted maybe 30s.

- I never talked about either event afterwards (I think to this day my parents don't know event 1 even happened). I just shrugged both off and returned to continue with my life business as usual. So whether or not there was social support, both received (or rather didn't) the same.
- I had no prior fear of 1 happening, ever. I did have prior fear of 2 happening for years before the event.
- I did not develop any PTSD symptoms from 1 (aside from maybe some healthy respect of waves). I very much developed PTSD from 2.

I very much realize this is purely anecdotal, but at least for me personally - besides a general scientific curiosity - I feel like it might hold some keys to healing. Maybe.

 

[coraxxx]

I have the impression it's more the case of paranoid "targeted" fear that is significant here. Oceans don't target precise individuals.

 

[katz]

So, this is something I've been ruminating about on and off. I know it may have come up in discussions on here before, but I don't remember.

One of the sorta "mantras" surrounding PTSD is that "experiencing trauma" doesn't automatically lead to developing PTSD. As far as I know, we still don't really know *why* PTSD develops, but I think a few risk factors have been identified over the years:
- the amount and severity of trauma you've gone through in your life
- family history of mental health issues, diagnosed and undiagnosed, treated and untreated, pointing to a strong genetic component which is also considered/accepted for other Dx's such as anxiety and depression (both of which end up being within the PTSD symptomatic cluster)
- already having other mental health problems
- lack of a support system

(and I've seen "low income", "being female", and "low education" thrown around as well, but I'm not sure how well studied/accepted those are as there's a really good chance these aren't actually objective risk factors and more the result of a certain survey bias, as those tend to correlate stronger (though of course not exclusively) with certain social situations which themselves have higher incidences of trauma)

And while correlation does not always equal causation, there "gotta" be something differential among people who do and don't develop PTSD after having gone through the same trauma.

I was wondering whether an inherent or at least long-standing unexplained but very specific fear of something makes you more prone to develop PTSD if/when that specific fear does come true. In a sort of self-fullfilling prophecy/confirmation bias kind of way.

Is the person with aerophobia surviving a plane crash more likely to develop PTSD than the person without ~, for example?
Is the woman who's always been fearful/suspcious of men and who ends up getting assaulted/raped more likely to develop PTSD?

(can't think of better examples, sorry, head is very mushy)

Which I mean is essentially really just a step up from the "already having other mental health problems" risk factor, specifically certain anxieties/phobies, no?

I had an unexplainable fear of someone breaking in for as long as I can remember. I never knew why. I wasn't living in an unsafe neighborhood at all. I wasn't a particularly anxious child nor were my parents particularly anxious/hypervigilant. We lived on the 6th floor of a secure condominium with locked indoor stairs - yet, somehow I was always convinced that if someone was breakig in, they would go all the way up to our floor and then choose *our* condo out of multiples to break in ... as little rational sense as that made. Even after we moved, that fear stayed, and it moved with me even when spending time in other places (such as visiting grandparents).

And then, further down the road, this is exactly what happened ...

Have there been any studies into this? I know some of you are much deeper into the literature and up to date on PTSD research.

But also interested whether anyone else shares this... experience? Connection?

And even if it's not a risk factor, I think it definitely helps solidify PTSD core beliefs of unsafety. Again, as a sort of confirmation bias. And I really don't quite know how to actually tackle those. Because not only did it happen -- YOU WERE SPOT ON and RIGHT with your prior fears.

PS: Just want to make clear that I'm not saying PTSD only develops if this is the case, because very obviously it doesn't. I'm just wondering if that could be *one* additional risk factor.

I had been told for many years that my "mental condition" was due to me "not having it all together". I even heard my mother telling my boyfriend that I "made up stories". It was not till I was in the hospital and hooked to wires and machines that a doctor explained to me that PTSD is a "physical condition". I was as much glad as I was sad. My outlook about myself did a huge flip as I realized that not only did I "have something", but that it had a name.

A lot of my symptoms changed and I began to understand myself a lot better. It was amazing to me to find out all the different things about myself that were due to all the abuse (by multiple people). I still see myself as damaged/unfixable, but I tend to put less blame on myself.

One of the most vivid of my adult memories is the look on my mom's face when the doctor told her that I had PTSD.