Being Vulnerable to PTSD is Key to Developing PTSD
One of these studies (focusing on lineages containing holocaust survivors) shows that there are two essential elements that play a role in developing PTSD. The first is a severe traumatic event. The second is personal vulnerability.1
If a person is not vulnerable, even a severe trauma may not result in PTSD. However, a person who is vulnerable will likely develop posttraumatic stress symptoms when exposed to a traumatic event that is not usually severe enough to trigger PTSD.2,3 So, the obvious question is, “What things make us vulnerable to developing PTSD?”


Two Types of Vulnerability to Trauma – Psychological Versus Biological…
Our vulnerability is shaped by two major causative factors. One is psychological vulnerabilitywhich refers to personality traits such as strength of ego, beliefs and coping strategies. The other is biological vulnerability which refers to internal biological systems such as the autonomic nervous system, hormonal patterns and neurotransmitter patterns.4 The group of studies referenced here that examine the generational impact of trauma focus on the biological category of factors. 5-7


The Importance of Cortisol – A Biological Marker of Vulnerability to PTSD
One of the core biological features that contributes to the transmission of PTSD vulnerability to offspring is cortisol.8,9
Cortisol is a hormone produced in the adrenal glands. It is often called “the stress hormone” but may be more accurately thought of as the “anti-stress hormone” because cortisol actually helps counteract the biological effects of stress.
Cortisol has many functions. Cortisol reduces the duration of emotional distress. It increases the availability of the body’s fuel supply (carbohydrate, fat and glucose) which is needed to respond to stress. It promotes proper functioning of the immune system and helps create memories of emotional events that should be avoided in the future. Cortisol levels can be affected by many conditions, such as physical or emotional stress, strenuous activity, infection or injury.10-12
If our cortisol reserve is low due to being used up when handling previous stressful events, then subsequent stressful events have a greater biological impact on us. Thus, low cortisol levels make us more vulnerable to developing posttraumatic stress symptoms.13,14


What does this mean in terms of transmitting PTSD from one generation to the next?
When mothers who were Holocaust survivors had PTSD and low cortisol levels, the low cortisol levels were significantly associated with lifetime PTSD vulnerability in their biological children (both first and second generations). These children had lower cortisol levels than children with PTSD whose mothers did not have PTSD.15 It was also found that greater severity of PTSD symptoms in parents correlated with greater severity of PTSD symptoms in children.16


Childhood Trauma…
The role of childhood trauma was also examined in this group. The adult children of Holocaust survivors reported high levels of childhood trauma, particularly emotional abuse and neglect.17 Their cortisol levels were lower than in those without a history of emotional abuse.
It was also found that traumatized parents are more likely to express improper (abusive or neglecting) behavior toward their offspring during a critical developmental window, and that such behavior may have long-lived effects on cortisol regulation in the offspring.18
Hence, the experience of childhood trauma could be a key factor in the biological transmission of PTSD vulnerability from parent to child.19


The World Trade Center Attack…
The attack on the World Trade Center in New York City also allowed researchers to study the relationship between PTSD in mothers and PTSD in their infant offspring.
Cortisol levels were measured in infants and their mothers who had been directly exposed to the World Trade Center attack during pregnancy. At nine months old, the levels of cortisol in the infants of women with PTSD were significantly lower than in those infants whose mothers had not developed PTSD.
Interestingly, lower cortisol levels were most apparent in babies born to mothers with PTSD who were exposed to the World Trade Center attack in their third trimesters. The authors also suggested that exposure to traumatic experience during pregnancy is a stronger vulnerability factor than abusive parenting.20


Early-Life Sexual and Physical Abuse (of Mothers)
A similar study was conducted that found that infants whose mothers had a history of early-life sexual and physical abuse showed significantly lower baseline cortisol levels and therefore greater vulnerability to developing PTSD.21
Other similar studies have indicated that PTSD in mothers may be due to their genetics. The mother’s genetics can be altered by early life sexual and physical abuse. Those genetic alterations can account for the low cortisol levels in the mother, which can be transmitted to her offspring.22
Fortunately, other studies show that even if the mother has PTSD, and her offspring has low levels of cortisol, it does not mean that her offspring will certainly develop PTSD.23


The Unique Role of the Mother
Another study was aimed at determining if the biological transmission of vulnerability to PTSD by the mother was more significant than transmission by the father. In this study, 284 communities recruited participants to identify their lifetime traumatic experiences and their psychiatric diagnoses. The analysis demonstrated that offspring who had fathers with PTSD (and mothers who did not have PTSD) were not significantly different from offspring with fathers who did not have PTSD.
The same study also found that offspring who have both parents with PTSD had low cortisol levels similar to offspring with only a mother with PTSD. The authors hypothesize that these findings provide evidence that PTSD in mothers may contribute in a unique (biological) manner to decreased cortisol levels in her offspring.24


How Does it Happen? Chemical Programming of the Fetal Brain and Altered Gene Expression
We have looked at biological evidence that vulnerability to PTSD can be transmitted from one generation to the next. A couple of studies explain how low cortisol levels can be transmitted biologically in a couple of ways:

1. Exposure of the fetus to the mother’s body chemistry that has been altered by her exposure to traumatic experiences during pregnancy may program the stress response pattern in the fetus’ brain (increasing its vulnerability to PTSD).25 (Note that her altered body chemistry may have been transferred to her from her own mother.)
2. Vulnerability may occur due to changes to the mother’s and fetus’ gene expression. Gene expression is “the flow of genetic information from gene to protein; the process, or the regulation of the process, by which the effects of a gene are manifested; the manifestation of a heritable trait in an individual carrying the gene or genes that determine it.”26 Severe environmental stressors are associated with gene expression that results in lower cortisol levels and therefore increased vulnerability to developing PTSD.27

As mentioned before, although there is evidence that both parents may contribute to vulnerability to PTSD in their offspring, the mother has a unique role in that contribution. This could be because of how chemical programming and gene expression are passed through the biology of pregnancy.28


More Research Needed
The studies referenced in this article had some limitations. The authors who presented this research noted the limitations of their studies as the following:

• Limited sample sizes in many of the studies
• Most samples comprised a specific type of patients with a particular trauma, namely, Jewish victims of the Holocaust.
• Not every subject exposed to early-life or in utero stressors developed PTSD

The authors also note that these findings should be studied in more detail in other types of trauma with different severities and other populations with a variety of genetic backgrounds. Survivors of the tsunami in Southeast Asia and of the earthquakes of Tabas (Iran), Japan, Pakistan, and Turkey seem to be reasonable cases for further investigation.

What is overwhelming and unnamable is passed on to those we are closest to. Our loved ones carry what we cannot. And we do the same.
This is the subject of Lost in Transmission: Studies of Trauma Across Generations, edited by M. Gerard Fromm (2012). This collection of essays on traumatic transmission builds on the idea that “what human beings cannot contain of their experience—what has been traumatically overwhelming, unbearable, unthinkable—falls out of social discourse, but very often on to and into the next generation as an affective sensitivity or a chaotic urgency.”
The transmission of trauma may be particular to a given family suffering a loss, such as the death of an infant, or it can be a shared response to societal trauma.
Maurice De Witt, a sidewalk Santa on Fifth Avenue noticed a marked change in behavior the holiday season following 9/11 when parents would not “let the hands of their children go. The kids sense that. It’s like water seeping down, and the kids can feel it... There is an anxiety, but the kids can’t make the connections.”
“This astute man was noticing a powerful double message in the parent’s action,” Fromm says. “Consciously and verbally, the message was 'Here’s Santa. Love him.' Unconsciously and physically, it was 'Here’s Santa. Fear him.' The unnamed trauma of 9/11 was communicated to the next generation by the squeeze of a hand.”
Psychic legacies are often passed on through unconscious cues or affective messages that flow between child and adult. Sometimes anxiety falls from one generation to the next through stories told.
Psychohistorian Peter Loewenberg recalls the oral tradition of his parents who lived through the hunger years in Germany during the First World War when the physical healthand stature of a generation was stunted due to prolonged malnutrition. According to their stories, a once-a-year indulgence was an orange segmented and apportioned among the entire family. Loewenberg further identifies a cause chain between physical privations of the German people during WWI, which culminated in the Great Depression (1929), and the Nazi appeal to children of Central Europe. To what extent did “the passive experiences of childhood starvation” lead to a reversal and fantasied “undoing” through the hunger regimen and cruelty of the concentration camps? (Lowenberg, 61)

Editor's Note: The following is a report on the practical applications of Bob Phillips's new book, Overcoming Anxiety and Depression: Practical Tools to Help You Deal with Negative Emotions, 2007).
There’s no shortage of troubling circumstances in life that can make you feel anxious and depressed. Whether you’re anxious about the future or depressed about the past, your negative emotions will prevent you from living the healthy life God wants you to enjoy right now.
Here’s how you can overcome anxiety and depression:
Give up the illusion of control. Understand that both anxiety and depression stem from attempts to control either the future (through worrying) or the past (by trying to change what has already happened). Realize that all such attempts are futile and a complete waste of your time and energy. Acknowledge that only God has the power to control the future and bring transformation out of what happened in the past.
Let your emotions lead you to ask questions. Realize that negative emotions are meant to alert you to danger. Rather than ignoring the anxiety and depression you feel, face your feelings and ask: “What’s going on?”, “How do I feel about it?” and “Do I want to change?”


Turn worries into prayers. Whenever an anxious thought enters your mind, decide that instead of worrying about it, you’ll pray about it. Pray as often as you think about whatever is troubling you. Know that, unlike worry, prayer actually accomplishes something positive.
Discipline your mind. Pay attention to what you’re choosing to think about. Rather than dwelling on your troubles, decide to think about what’s true, good, right, pure, beautiful, and praiseworthy. Read and meditate on Scripture often to saturate your mind with the right kinds of thoughts. Pray for the Holy Spirit to renew your mind every day.
Don’t blame illness when the problem is poor choices. Know that most of the anxiety or depression people experience isn’t due to mental illness in the medical sense, but is due instead to emotional pain caused by poor choices they’ve made. Be honest with yourself about what choices you may have made that have contributed to your anxiety or depression. Consider such potential causes as: broken and conflicted relationships; unspoken, unfulfilled, or  unrealistic expectations of life; guilt over not doing what you should do; disobedience; lack of exercise; poor diet or overeating; too much television; not accepting responsibility; prolonged sleep loss; faulty reasoning; emptiness and loneliness; lack of meaning and purpose; alienation and separation; buildup of various stressful events; the death of a loved one; the inability to adjust to and accept hurtful experiences; the unwillingness to let go of the past and forgive others; and a low self-image or high standards of perfection. Pray for the courage you need to face your problems instead of running from them. Know that once you take responsibility for your own attitudes and actions, you’ll start to grow in maturity, which will lead to healing.  
​

Exercise discernment when considering medication. Don’t just take medication for your anxiety or depression without considering alternatives. Understand that you don’t need medication unless you have a chemical imbalance in your brain, which is a relatively rare condition. Know that drugs can have serious side effects, and that they never provide a magic cure. Pray for the wisdom to discern emotional distress from a true medical condition.
Consider what circumstances may be causing your feelings. Ask yourself whether or not your anxiety or depression is tied to some circumstance in your life, such as: losing your job, recently retiring, experiencing financial losses, being involved in an accident, committing some criminal act, being violated by some criminal act, having marital problems, facing an important decision, having troubles with in-laws, having your home or possessions destroyed by a natural disaster, having a conflict you need to deal with but are afraid to face, or losing a loved one through a broken relationship or a death. Recognize how any of these events may have contributed to your feelings. In prayer, give your troubling circumstances to God and trust Him to handle them according to what’s best.  
Check out physical symptoms that may be tied to your feelings. Ask yourself whether or not your anxiety or depression is tied to some symptoms, like: trouble sleeping, difficulty breathing, stomach disorders, diarrhea or constipation, headaches, twitching, or shaking. Be sure to visit a doctor to check out any of these symptoms.  
Let go of what you can’t change, and change what you can. Recognize the difference between what you can’t change (facts of life in our fallen world) and what you can (problems you can solve). Stop trying to change what’s beyond your control; instead, pray about it all and trust it to God. But do whatever you can to solve problems in your life. If you’re worried about a lack of money to pay your bills, cut back on unnecessary purchases and work harder to bring in extra income. If you’re anxious about the quality of your relationship with someone, work to become more loving and giving, and devote more time and energy to that relationship. Direct your energy away from anxiety and depression and toward solutions to your problems. Don’t just think about it or talk about it; actually take action toward solutions and enjoy seeing the progress you make.  
Look for the meaning in your suffering. Ask God to show you how you can grow as a person from your suffering, and how you can use what you’ve learned to help others who are suffering in similar ways. Ask yourself: “How do I feel about what is happening to me?”, “How can I get some help?”, “How can I learn from this?”, “How can I make positive changes in my situation?” and “How can I change my attitude?”
Pray for the right perspective. Ask God to give you His perspective on the relationships and situations in your life that are troubling you. Correct your vision so you can see them with accuracy. Know that doing so will help you to think straight, which will lead to better choices, and then to a better life.  
Forget about suicide. If you’re thinking about committing suicide, talk with someone you trust right away and get those thoughts out of your mind. Realize that, if you were to commit suicide, it would cause great harm to everyone who loves you. Know that God offers you real hope. Turn to Him and trust that your life will get better.
Make time for rest and relaxation. Be sure to get plenty of sleep each night, since sleep heals the emotional and physical stress that can cause anxiety and depression. Remember that, according to many studies, at least seven hours of sleep each night is best. Practice deep breathing to help reduce tension. Exercise regularly; doing so will release hormones in your body that help your mood. Regularly engage in some activities that relax you, such as: watching a movie, reading a book, talking with friends, listening to music, taking a leisurely walk, going on a picnic, soaking in a hot tub or warm bath, playing sports, sitting in the sun, taking a nap, reading and meditating on the Bible, and writing to family and friends.
Change the way you talk to yourself. Reclaim your mind from negative thoughts you regularly tell yourself, and start talking to yourself through your thoughts in positive ways. Whenever a negative thought enters your mind, shock yourself into stopping it (such as yelling out loud or in your mind, or snapping a large rubber band that you wear around your wrist). Then replace each negative thought with a positive thought. Or, write your negative thoughts down as they occur to you, and refuse to think about them until a brief, designated time each day. Know that as you change your thoughts, your feelings will also change. Pay attention to your appearance and make an effort to look good; when you look better, you’ll feel better about yourself. Set goals for where you would like to be in your thinking, emotions, and behavior in the next three months, year, and five years. Stop procrastinating about things you have to do; once you finish them, you’ll feel better about yourself. Learn how to face the pain you’ll inevitably encounter in our fallen world, and grow through it. Believe that, with God’s help, you can make significant progress.
Tap into the power of forgiveness. Realize that your anxiety or depression may be caused in part by guilt over something you did that was wrong, or something you didn’t do that you should have done. If so, seek forgiveness from God and the people you’ve hurt. Take responsibility for your own thoughts, words, and behaviors. Express regret and remorse for them. Repent by deciding to go in a completely different direction in the future. Make restitution for all damages incurred, as best as you can. Enjoy the clear conscience of knowing you’ve done your best. Then reconcile with the people you’ve hurt if they’re still alive and willing to restore their relationships with you.  
Draw strength from Scripture. Read, study, and meditate on the Bible every day. Let its truths refresh your soul, and remind you of God’s great love for you and unlimited power to help you.
Adapted from Overcoming Anxiety and Depression: Practical Tools to Help You Deal with Negative Emotions, copyright 2007 by Bob Phillips. Published by Harvest House Publishers, Eugene, Or., www.harvesthousepublisherscom.  
Bob Phillips, master compiler of inspirational verses, Scripture references, and quotes on the lighter, humorous side of life, has written a hundred books with combined sales of more than 9 million copies. Bob also serves as director-at-large for Hume Lake Christian Camps and is a licensed family counselor in California.