PTSD is an interaction between a subject, a traumatogenic factor and a social context. Gene-by-environment studies are needed to focus more on distinct endophenotypes and influences from environmental factors. According to the monoamine predominantly incriminated PTSD can take on a more hyper-vegetative clinical expression linked with noradrenergic overuse. Differently, avoidance behaviour and the depressive aspect invoke more a modification of the serotoninergic modulation whilst post-traumatic psychotic reactions question the role of dopaminergic pathways. No neurobiological study has yet found a biological marker which would apparently and inevitably destine a subject to structure a post-traumatic stress disorder in reaction to a stress. Differently, the psychopathological study finds afterwards that a particular subject has necessarily built a traumatic repetition syndrome according to the concordance of significant data relative to their history. A PTSD does not occur by chance: the conditions of possibility of the trauma are established by genetic and psychological determinants interactively integrated at the heart of a social context.

PTSD is a pathology which interacts with the societal context: on the one hand the trauma is established on the brutal reconsideration of social values which seem immutable and on the other hand, the clinical and nosographical concept of PTSD is changing with the evolution of society.

Whilst the confrontation with death resembled nonsense, the subject will question the psycho-traumatic determinants of his life history to reinstate this tragic event within a search for meaning.