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What causes PTSD?

Vol. 6, No. 8 / August 2007

The article “6 keys to resilience for PTSD and everyday stress,” (Current Psychiatry, April 2007) makes only a small reference to post-traumatic stress disorder’s (PTSD) biologic factors. My knowledge of PTSD comes from my experience as a psychiatrist for Special Forces soldiers from 1964 to 1966 and follow-up studies by Peter Bourne, MD, and Colonel Lewellyn Legters, MD.

During the Vietnam War, Dr. Bourne noted that there was no rise in cortisol levels in the blood of Special Forces soldiers in battle. The casualty rate at that time was 1 in 10 wounded in a year. Pentagon or Special Operations soldiers placed in Special Forces had a casualty rate of 1 in 2 killed in Vietnam in 7 months.

Only 3% of the population will come through stressful experiences without some emotional sequelae. So what were the resilience factors in Special Forces troops that prevented combat fatigue, shell shock, or PTSD? Special Forces soldiers often had a long history of accepting and accomplishing challenges. This is different from mastering childhood adversity such as deaths, relocations, or family job loss.

Leonard R. Friedman, MD
Revere, MA

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