Pathogenesis (development of the disease)
The basic prerequisite for the diagnosis of post-traumatic stress disorder (PTSD) is the presence of a trauma/stress that is objectively considered life-threatening and subjectively causes fear, helplessness, and horror.
Studies show that reduced hippocampal volume and polymorphisms of receptors or neurotransmitter transporters influence responses. In addition, there is a disturbance in emotion regulation, evidenced by hypoactivity in the prefrontal cortex (part of the frontal lobe of the cerebral cortex) and corresponding hyperactivity in the amygdala (“amygdala complex”; brain complex in the limbic system; influences emotion and memory).
Trauma, poor sleep, and the development of post-traumatic stress disorder (PTSD) appear to be closely related: Sleep duration was reduced in the trauma group in one study, non-Rem sleep was significantly reduced, and waking periods at night were longer.
The likelihood of developing post-traumatic stress disorder (PTSD) is 8-15%, meaning that out of every 100 traumatized individuals, 8 to 15 have a PTSD diagnosis.
The risk for PTSD increases if the trauma was intentional. After rape, approximately 50% develop post-traumatic stress disorder.
Etiology (causes)
Biographical causes
- Trauma or traumas (see under “Classification”).
- Previous traumatization
- Early separation experiences
- Lower resources (intelligence, educational status, socioeconomic status).
- Professions: physicians working in gynecology/obstetrics (esp. obstetrics) – in a survey of over 1,000 clinicians, 30% were shown to have symptoms of PTSD; 18% each of residents and specialists with traumatic experiences had these symptoms clinically manifest (according to the Impact of Event Scale).Limitation: low response survey (18%).
Disease-related causes (trauma due to illness).
- Anxiety disorders
- Alcohol disorders
- Bipolar disorder
- Depression
- Cancer
- Psychosis
Other causes
- Long-term cognitive, psychological, and physical sequelae after intensive care treatment (“Post-Intensive Care Syndrome” and “Post-Intensive Care Syndrome – Family”): approximately 20% of patients in an intensive therapy unit (ITS) develop PTSD in the first year after treatment; up to 69% of family members develop PTSD symptoms after ITS treatment.
