PTSD and depression have been shown to have high rates of co-occurrence.  It is estimated that 70% of the population in the United States has been exposed to a traumatic experience. Of those who’ve been exposed to trauma, about 24% develop posttraumatic stress disorder (PTSD). When someone has experienced repeated traumatic events, the outcome seems to be more severe than if they had only had one traumatic incident, at least that’s the hypothesis. If there is a history of traumatic events occurring before the most recent traumatic event, it is predicted that the individual is more likely to develop PTSD. When someone has had from an early age, ongoing or repeated exposure to trauma, this detrimentally affects his or her development. These experiences and the after affects could interfere with them being able to acquire adaptive emotion regulation and interpersonal skills, which means their functioning is impaired beyond them having PTSD. However, it is fairly common for people to experience multiple traumatic incidents, and over half the people who claim they’ve had one traumatic event have in fact had multiple traumas.

The association between type of trauma and its severity may also be easily explained by the depression that comes along with it. Symptoms of depression frequently occur after a child has had a traumatic event and in fact PTSD and depression commonly go hand-in-hand for children and adults. There have been very large studies that show that from 51% to 87% of people with PTSD have co-occurring symptoms of depression. When PTSD and depression co-occur this may be a complicating factor affecting individuals diagnosed with PTSD, no matter what type of trauma they’ve endured. Therefore, their depression may be more influential in causing their symptoms to be more severe as well as their impaired functioning, rather than their history of trauma.

When you consider the overlapping diagnoses that may be co-occurring, including major depressive disorder (MDD), multiple traumatic events and add in a history of childhood abuse, it makes sense to understand who might present with increased severity of symptoms of PTSD. In a group of patients who were enrolled in a clinical trial for treating chronic PTSD, researchers1 looked at the relationship existing between their childhood abuse as the index trauma, the history of the childhood abuse, their high levels of experiencing multiple traumatic events, and the co-occurring symptoms of depression, along with indices of how they were functioning more broadly.

The hypothesis going in was that these various factors would be linked with greater severity of symptoms, poorer functioning, higher degrees of dissociation, a more prolonged treatment history, and additional co-occurring symptoms and diagnoses. Additionally, they also looked at the commonality of subjects presenting with pure PTSD, which would result from a single traumatic incident and no comorbidity, in an attempt to see whether this PTSD clinical trial had subjects with a preponderance of “pure” or “simple” PTSD.

This study included 200 women and men who were seeking to be treated for chronic PTSD. They were in a clinical trial and had been evaluated for both PTSD and depression. They were compared as to severity of symptoms, dissociation, psychosocial functioning, treatment history and the extent of their diagnostic co-occurrences.

The results showed that overall their childhood abuse didn’t consistently predict the severity of symptoms. But, co-occurring PTSD and depression, and (to a somewhat lesser degree) a high level of exposure to trauma, were predictive of greater severity of symptoms, greater degree of dissociation, worse functioning, a more expansive treatment history, and more co-occurring disorders.

These findings imply that the presence of co-occurring PTSD and depression may cause more severity of symptoms and impairment than the subject’s history of repeated exposure to trauma and of childhood abuse. Additionally, it was emphasized that it is very important to assess for the the co-occurrence of PTSD and depression and to treat both disorders.

If you are suffering from the co-occurrence of PTSD and depression and are interested in an intensive outpatient program, please give us a call!

  1. An Investigation of Depression, Trauma History, and Symptom Severity in Individuals Enrolled in a Treatment Trial for Chronic PTSD. Bedard-Gilligan M, Duax Jakob JM, Doane LS, Jaeger J, Eftekhari A, Feeny N, Zoellner LA. J Clin Psychol. 71(7):725-40.

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