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Using the biopsychosocial model to examine risk factors in post-traumatic stress disorder

Given the multitude of factors potentially involved in PTSD, it seems useful to consider risk and recovery through a biopsychosocial lens
In 1977, Dr. George Engel argued that medicine ought to shift away from a biomedical perspective. He disputed the long-held held assumption that only the biological factors of health and disease are worthy of study and practise. Engel argued that psychological and social factors influence biological functioning and play a role in health and illness. He proposed the biopsychosocial model which asserts that the interactions between biological, psychological, and social factors determine the cause, manifestation, and outcome of disease. The biopsychosocial model is commonly discussed in relation to mental health. Biological factors contributing to mental illness include genetics, chemical imbalance, infection, brain injury, and toxins. Psychological factors contributing to mental illness include neglect or abuse and loss, poor coping skills, and low self-esteem.
Social factors contributing to mental illness include education, employment, income, and housing. You should be aware that there are other factors which have not yet been mentioned in this video. Another biological factor, for example, is epigenetics. Another psychological factor is personality. Another social factor is conflict. Be aware that there are other factors which have not been discussed here.

Given the multitude of factors potentially involved in post-traumatic stress disorder (PTSD), it seems useful to consider PTSD risk and recovery through a biopsychosocial lens.

Although the biopsychosocial framework is helpful when considering risk and protective factors, it is important to note that there can be overlap between the different domains. For example, epidemiological data suggest that being female puts one at an increased risk of PTSD.

The mechanisms behind those gender differences are not fully understood. Genetic and physiological factors likely play a significant role (Ford et al., 2015). Women are also at an increased risk of sexual assault, which could be a trigger for PTSD. This illustrates the possible overlap between biological and social factors.

Risk factors

Examples of risk factors are offered in the table below:

Biological factors An underlying genetic predisposition, gender, physical injury and associated pain, hyperreactive physiological responses to stress, sleep, structural and functional brain abnormalities (for example, as a result of brain injury or chronic stress).
Psychological factors A subjective experience of loss of control and perceived negative effect of the traumatic event on the individual (Hasto et al., 2013). Extreme anxiety and intrusive reexperiencing. Guilt. Subjective reactions to terrifying or horrifying events. Dissociation. Dysphoria. Social phobia. Anger. Trauma-related beliefs.
Social factors Multiple exposures to trauma, social isolation and being at an increased risk of experiencing a traumatic event, for example, due to gender or substance misuse.


Influencing factors

Social and cultural factors inevitably interact with biology to impact health. This confluence of factors shapes a person’s experience and definition of health and illness, their access to healthcare, their response to disease, pain and disability, their beliefs about healing, their treatment expectations and their health outcomes.

Some of these factors are indicated in the illustration below:

A diagram showing 'Social and Cultural Factors' interacting with 'Biology'. Surrounding this are six circles, containing the words 'experience of health and illness', 'access to healthcare', 'response to disease, pain, and disability', 'experience of pain and healing', 'treatment expectations and options', and 'health outcomes'.
click to see larger version


Ford, J. D., Grasso, D. J., Elhai, J. D., & Courtois, C. A. (2015). Posttraumatic Stress Disorder: Scientific and Professional Dimensions. New York: Academic Press. doi: 10.1016/B978-0-12-374462-3.X0001-9

Hasto, J., Vojtova, H., Hruby, R., & Tavel, P. (2013). Biopsychosocial approach to psychological trauma and possible health consequences. Neuro-Endocrinology Letters, 34(6), 464-481. Retrieved from

Rafla, M., Carson, N. J., & DeJong, S. M. (2014). Adolescents and the internet: What mental health clinicians need to know. Current Psychiatry Reports, 16(9), 1-10. doi:10.1007/s11920-014-0472-x

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Post-Traumatic Stress Disorder (PTSD) in the Global Context

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