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Post-traumatic Stress Disorder (PDQ®)

Patient Version

Risk Factors, Protective Factors, and the Development of PTSD

As many as one third of people who experience an extremely upsetting event, including cancer, develop post-traumatic stress disorder (PTSD). The event alone does not explain why some people get PTSD and others don't. Although there is no clear answer as to which cancer survivors are at increased risk of developing PTSD, certain mental, physical, or social factors may make some people more likely to experience it.

Individual and social factors

Individual and social factors that have been associated with a higher incidence of PTSD include younger age, fewer years of formal education, and lower income.

Disease-related factors

Certain disease-related factors are associated with PTSD:

  • In patients who received a bone marrow transplant, PTSD occurs more often when there is advanced disease and a longer hospital stay.
  • In adult survivors of bone cancer and Hodgkin lymphoma, people for whom more time has passed since diagnosis and treatment tended to show fewer symptoms.
  • In survivors of childhood cancer, symptoms of PTSD occur more often when there was a longer treatment time. See the PDQ summary on Pediatric Supportive Care for more information.
  • Interfering thoughts occur more often in patients who experienced pain and other physical symptoms.
  • Cancer that has returned has been shown to increase stress symptoms in patients.

Mental factors

Mental factors may affect the development of PTSD in some patients:

Protective factors

Certain factors may decrease a person's chance of developing PTSD. These include increased social support, accurate information about the stage of the cancer, and a satisfactory relationship with the medical staff.

How PTSD may develop

PTSD symptoms develop by both conditioning and learning. Conditioning explains the fear responses caused by certain triggers that were first associated with the upsetting event. Neutral triggers (such as smells, sounds, and sights) that occurred at the same time as upsetting triggers (such as chemotherapy or painful treatments) later cause anxiety, stress, and fear even when they occur alone, after the trauma has ended. Once established, PTSD symptoms are continued through learning. The patient learns that avoiding the triggers prevents unpleasant feelings and thoughts, so coping by avoidance continues.

Although conditioning and learning are part of the process, many factors may explain why one person develops PTSD and another does not.

  • Updated: December 12, 2013