How PTSD Becomes Self-Sustaining in Civilian Survivors of War

Research maps out how trauma takes on a life of its own

Grant H Brenner
7 min readMar 14, 2022


Photo Credit: Grant H Brenner

New research on Balkan war survivors sheds light on the persistence of PTSD.

As the war in Ukraine wages, and the world watches millions of refugees flee for their lives, we are reminded of countless prior wars. While media attention mobilizes our outrage and the outpouring of immediate help to affected civilian populations, what happens after the wars end?

We know that war takes a massive toll on the people, but our understanding of how the effects unfold for years after is still evolving. Do we forget to pay attention after the cameras stop rolling? What can we learn from past wars about post- traumatic stress?


Researchers Schlechter, Hellmann, McNally and Morina conducted a study of civilian survivors of 1990s Balkan wars, including those who had stayed in their countries of origin (including Bosnia-Herzegovina, Croatia, Kosovo, Macedonia and Serbia) and those who had settled in Germany, Italy and the UK. The results wee recently published in the Journal of Traumatic Stress (2022).

Study authors focused on PTSD among war survivors to understand how symptoms emerge and change over time, and specifically how earlier symptoms predict and maintain later symptoms. Common symptoms of PTSD, including avoidance of trauma and emotional numbing, get in the way of people getting treatment, as do systemic issues like stigma and lack of resources, including paucity of qualified clinicians and lack of screening in at-risk groups in primary care settings.

Up to 227 million adult war survivors are estimated to have PTSD. A systemic review of PTSD and Major Depressive Disorder (MDD) (2021) in countries affected by war in the last three decades suggests that 316 million people suffer from war-related PTSD and/or MDD. Half of the people in that study had both PTSD and depression, with about a quarter of people having one or the other, but not both.

PTSD can take on a life of its own, especially if left unchecked. Once trauma sets the brain off on a dysregulated pathway, it can become a…



Grant H Brenner

Psychiatrist, Psychoanalyst, Entrepreneur, Writer, Speaker, Disaster Responder, Advocate, Photographer