PTSD And Depression Comorbidity Increase Risk Of Mortality In Women

PTSD And Depression Comorbidity Increase Risk Of Mortality In Women

POST-TRAUMATIC STRESS DISORDER and major depression comorbidity is linked to psychobiological changes in women that can lead to chronic disease and death. When these two conditions occur in tandem, a comprehensive approach to treatment must be taken to counteract their dangerous and complex emotional, psychological, and physical impact.

This article discusses:

Increased Mortality In Women With PTSD and Depression

A new study shows that post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) comorbidity can lead to physiological changes that cause serious illness and mortality in women.

An estimated 50% of women with PTSD also suffer from MDD. 1 out of every 2 women with this dual diagnosis have an increased risk of mortality.

A study of over 50,000 women were was conducted over 9 years period showed that women who suffer from symptoms of post-traumatic stress disorder (PTSD) and depression have more than twice as likely to die from complications compared to women who had not experienced trauma or depression.

Furthermore, research suggests that the biological impact of PTSD and MDD comorbidity may represent a subtype of PTSD.

Adverse Childhood Experiences Linked To Inflammation In The Body

Adverse childhood experiences (ACEs) are linked to an increased risk of developing PTSD in adulthood. The psychobiology of ACEs can make some adults predisposed to inflammation in the body, putting them at greater risk for certain health conditions.

PTSD Connected To Metabolic Dysfunction

PTSD is linked to physiological changes associated with metabolic dysfunction connected with the development of various diseases, specifically:

  • Changes in hypothalamic-pituitary-adrenal–axis
  • Immune system dysfunction
  • Oxidative stress
  • Sleep disturbances, and
  • Premature aging.

Researchers theorize that an increased discharge of cortisol by the hypothalamic-pituitary-adrenal axis in tandem with disruptions in the sympathetic nervous system can lead to irregularities in neurological and metabolic functioning.

Health Conditions Linked To PTSD

Numerous studies have shown that PTSD is linked to a range of adverse health outcomes, including:

  • Hypertension
  • Cardiovascular Disease
  • Metabolic Syndrome
  • Type 2 Diabetes
  • Obesity
  • Substance Use Disorders

PTSD and Depression Increase Risk of Suicide

Another health risk for women who experience PTSD and MDD is suicide. A 2009 study from Florida State University showed that women who experience both disorders are at greater risk for suicidal ideation and death by suicide.

Prevention Of Health Risks Associated With PTSD and Depression

It is imperative that women with PTSD and depression implement lifestyle changes to decrease the risk of mortality associated with their condition. Some effective actions include:

  • Regular exercise
  • Weight management
  • Smoking abstinence
  • Companionship


1 out of ever 2 women who suffer from cooccurring PTSD and MDD can experience psychobiological changes that cause 380% increase of death. Adverse childhood experiences can lead to inflammation in the body, which makes some people predisposed to illness and disease later in life. PTSD can cause metabolic dysfunction and systemic changes that lead to serious health conditions. Lifestyle changes are an important part of treatment.


  1. Roberts AL, Kubzansky LD, Chibnik LB, Rimm EB, Koenen KC. Association of Posttraumatic Stress and Depressive Symptoms With Mortality in WomenJAMA Netw Open. 2020;3(12):e2027935. doi:10.1001/jamanetworkopen.2020.27935
  2. Flory JD, Yehuda R. Comorbidity between post-traumatic stress disorder and major depressive disorder: alternative explanations and treatment considerations. Dialogues Clin Neurosci. 2015 Jun;17(2):141-50. doi: 10.31887/DCNS.2015.17.2/jflory. PMID: 26246789; PMCID: PMC4518698
  3. Masodkar K, Johnson J, Peterson MJ. A Review of Posttraumatic Stress Disorder and Obesity: Exploring the Link. Prim Care Companion CNS Disord. 2016 Jan 7;18(1):10.4088/PCC.15r01848. doi: 10.4088/PCC.15r01848. PMID: 27247845; PMCID: PMC4874765.
  4. Farr OM, Sloan DM, Keane TM, Mantzoros CS. Stress- and PTSD-associated obesity and metabolic dysfunction: a growing problem requiring further research and novel treatments. Metabolism. 2014 Dec;63(12):1463-8. doi: 10.1016/j.metabol.2014.08.009. Epub 2014 Aug 28. PMID: 25267015; PMCID: PMC4459590.
  5. Brown, P. J., Stout, R. L., & Mueller, T. (1999). Substance use disorder and posttraumatic stress disorder comorbidity: Addiction and psychiatric treatment rates. Psychology of Addictive Behaviors, 13(2), 115–122.
  6. Cougle JR, Resnick H, Kilpatrick DG. PTSD, depression, and their comorbidity in relation to suicidality: cross-sectional and prospective analyses of a national probability sample of women. Depress Anxiety. 2009;26(12):1151-7. doi: 10.1002/da.20621. PMID: 19842171.

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      Psycho-Emotional Abuse: The Essential Guide

      Psycho-Emotional Abuse | Narcissistic Abuse Rehab

      PSYCHO-EMOTIONAL ABUSE: THE ESSENTIAL GUIDE was made to provide you with greater knowledge of this fundamental component of narcissistic abuse.

      This information will give you a clear understanding of:

      Let’s get started.

      What is psycho-emotional abuse?

      Psycho-emotional abuse describes any non-physical pattern of behavior that intentionally harms an individual’s mental state and undermines their ability to reach their full potential. It is a portmanteau of psychological and emotional abuse.

      This kind of abuse can occur within a variety of contexts. For example, it can take place in intimate partner relationships, in family relationships, in friendships, in the workplace, etcetera.

      Above all it is used to manipulate and control another person or people.

      Neglect, hostility, sabotage, indifference, false concern

      Other definitions of psycho-emotional abuse

      Dr. Marti Tamm Loring defines psycho-emotional abuse as, “An ongoing process in which one individual systematically diminishes and destroys the inner self of another.”

      Professor Dorota Iwaniec describes it as hostile or indifferent behavior which:

      • Damages the individual’s self-esteem,
      • Debases their sense of achievement,
      • Diminishes their sense of belonging,
      • Prevents their healthy and vigorous development, and 
      • Takes away the individual’s well-being.
      Dorota Iwaniec

      Characteristics of psycho-emotional abuse

      Psycho-emotional abuse is subtle and can be tricky to spot – even by the person experiencing it!

      Abusers often disguise their malice as good intentions, which confuses the person they target and deceives most bystanders.

      At times, the aggression is overt and takes place in front of witnesses. However, in these instances most people do not understand the nature of this kind of aggression and so they fail to recognize that abuse is taking place. 

      Some of its characteristics are:

      1. It is a pattern of behavior.
      2. The harm it causes is deliberate and intentional.
      3. The target experiences the behavior as harmful.
      4. The abuse may be overt or covert.
      5. It may or may not occur in the context of conflict.
      6. It may not immediately seem aggressive.
      7. The aggressor may camouflage the abuse as caring, love, or humor.
      8. The targeted person’s vulnerabilities are exploited to cause them to feel confused, insecure, and unsure of themselves.
      9. It may manifest as neglect.
      10. The abuse causes harm to the targeted individual’s well-being.

      Abusers are cunning enough to understand that psychological abuse is a bloodless crime which usually enables them to escape accountability for the harm and devastation they cause.

      This is because the theatre of the abuser’s aggression is not visible to the naked eye.

      While the recipient of the abuse has no physical symptoms, the emotional wounds may be catastrophic.

      Pattern of behavior, malicious, deliberate, exploitative, camouflage

      What causes psycho-emotional abuse?

      There are many reasons why psycho-emotional abuse may occur. The abuser’s behavior is often rooted in envy, fragility, and aggression.

      A common occurrence is when an aggressive and/or narcissistic person feels intimidated by the presence of someone who they believe has qualities or privileges they do not. They may seek to resolve these painful feelings by asserting dominance over the person they regard as a threat. 

      In some instances, the abuser is externalizing their toxic shame and placing their burden on the victim. In this way, the abuse strips away the authentic identity of the target and assigns to them a new one that encompasses the parts of the abuser’s persona which they despise and reject.

      What are the effects of psycho-emotional abuse?

      The cumulative effect of psycho-emotional abuse is the erosion of the recipient’s self-worth and trust in their judgment.

      Some of the specific consequences may include:

      • Confusion
      • Self-blame
      • Depression
      • Inability to concentrate
      • Lack of motivation
      • Procrastination
      • Low self-esteem
      • Fear of failure
      • Hopelessness
      • Worthlessness
      • Self-sabotage

      Abusers often compound the damage they do by refusing to recognize the right of the targeted person to feel hurt, wronged, or angry.

      They use a variety of tactics to convince the person they target that they brought the abuser’s aggression on themselves.

      They defend their aggression and escape accountability through the process of scapegoating. This is done by using the targeted individual’s vulnerability to excuse the abuse. By blaming the person they victimize, they absolve themselves of any wrongdoing.

      Abusers often silence targets by using threats and intimidation. They enlist agents to gang up on the target. The result is that the targeted individual may experience fearanxietydread, and panic

      Prolonged psycho-emotional abuse can lead to adverse health outcomes. It may cause chronic anxiety which can impact the targeted person’s physical and psychological well-being. Over time, this may cause depressioncomplex post-traumatic stress, and auto-immune disorders.

      Narcissistic Abuse Rehab

      Comparisons to Coercive Control

      Coercive Control and psycho-emotional abuse are both power- and control tactics.

      Psycho-emotional abuse may refer to harm inflicted on men, women, and children by abusive men, women, and children.

      Coercive Control originated as a descriptor, Dr. Evan Stark, used to describe the entrapment and subjugation of women. It points to a specific kind of gender-based violence, namely how abusive men prevent women from “freely developing their personhood, utilizing their capacities, or practicing citizenship.”

      Coercive Control may include isolation, monitoring, sexual abuse, financial abuse, and bodily harm.

      Dr.Stark underscores that Coercive Control is more akin to hostage-taking and kidnapping.

      “We must stop characterising Coercive Control as only psychological abuse,” Forensic criminologist Dr.Jane Monckton Smith of Gloucestershire University explains, “Psychological abuse is a method used by controlling people to exert and maintain control. Coercive Control is a campaign made up of any or all of these things which then trap people in a relationship, and make it impossible or dangerous to leave.”

      Gaslighting is the distortion of another person’s reality. It’s purpose is to undermine their sense of self-mastery. It is a feature of Coercive Control and psycho-emotional abuse.

      Psycho-emotional abuse has legal status in France and Canada as harcèlement moral and harcèlement psychologique ou sexuel. It was criminalized in 2010.

      The United Kingdom recognizes Coercive Control as criminal behavior. Laws prohibiting coercive and controlling behavior came in to force in 2015. The legislation is gender-neutral and applies to anyone experiencing entrapment and domination.

      The Kingdom of Sweden recognizes Coercive Control as the crime våld i nära relationer.

      Relationship to narcissistic abuse

      Psycho-emotional abuse is one of the two fundamental components of narcissistic abuse. The other is Coercive Control.

      Now It’s Your Turn 

      That wraps up Psycho-Emotional Abuse: The Definitive Guide.

      Now, it’s your turn to have your to say:

      What part of this guide resonated with your lived experience?

      Do you think you have a better understanding of this kind of abuse after reading this guide?

      Do you understand how it works in the context of narcissistic abuse?

      Share your insight by leaving a comment below.


      Loring, Marti Tamm. “Emotional Abuse: the Trauma and Treatment.” San Francisco, CA: Jossey Bass Publishers, 1998.

      Iwaniec, Dorota. “The Emotionally Abused and Neglected Child Identification, Assessment and Intervention; a Practice Handbook. Chichester: Wiley, 2008.

      Strecker, Peter John. “I Wish That He Hit Me: The Experiences of People Who Have Been Psychoemotionally Abused and Have Psychoemotionally Abused Others.” Victoria University, March 2012.

      Stark, Evan. “Coercive Control: How Men Entrap Women in Personal Life. New York: Oxford University Press, 2009.

      Monkcton Smith, Jane. “Coercive Control is Not Just Psychological Abuse.” Forensic Criminology: Working in Homicide Prevention, 2020.

      “C-PTSD Academic Research Material.” Out of the Storm. Accessed May 5, 2020.

      * Editor’s Note: This is article is an except from the book ‘Are You In An Emotionally Abusive Relationship.’ To download your FREE copy, subscribe to our Mailing List.

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