Personality Traits and PTSD Resilience - Research Paper Example

?Personality Traits and Resilience to PTSD This work critically examines the relationship between personality traits and resilience to posttraumatic stress disorder or PTSD. I will examine literature and attempt to draw conclusions on the relationship between personality traits, personality types (particularly or especially intelligence and sensation-seeking personality) and their bearing on resilience to PTSD symptoms after exposure to ground combat or civilian-sector traumatic events). PTSD is not only rooted in personality factors and I make clear this point in the course of discussion. To avoid confusion in terminologies, this review focused on works from year 2000, the year of publication of DSM-IV-TR, the current diagnostic and statistical manual of the American Psychiatric Association for mental disorders. The TR in DSM-IV-TR refers to” text revision”s. Numeroff et al. (2009), a reprint of the work of Numeroff et al. (2006), reviewed the state of science in posttraumatic stress disorder (PTSD). The authors pointed out five key points. First, PTSD is frequent among women than among men. Second, the presence of group C symptoms after exposure to trauma can predict the development of PTSD. Third, increases in corticotrophin-releasing factor or CRF concentration associated with PTSD “may be reversed” with paroxetine treatment. Fourth, “hippocampal volume appears to be selectively decreased and hippocampal function impaired among PTSD patients.” Fifth, prolonged exposure therapy is effective in modifying negative cognitions that are frequent among PTSD patients. Note that in Numeroff et al. (2009) or state of science on the PTSD, there was no mention on the role of personality traits and resilience. In the 2000 guidelines of 50 pages for treating PTSD written by Foa et al., there was no mention on the role of personality traits in hastening or slowing down the treatment or management of PTSDs. The treatment guidelines were developed under the auspices of the PTSD Treatment Guidelines Task Force organized by the Board of Directors of the International Society for Trauma Stress Studies (ISTSS) in November 1997 (Foa et al., 2000, p. 539). The treatment guidelines described PTSD as a serious psychological condition resulting from an exposure to a traumatic event (Foa et al., 2000, p. 539). The 2000 guidelines mentioned that the symptoms associated with PTSDs are “reliving the traumatic events or frightening elements of it; avoidance of thoughts, memories, people, and places associated with the event; emotional numbing; and symptoms of elevated arousal” (Foa et al., 2000, p. 539). The treatment guidelines pointed out that PTSDs are “often accompanied by other psychological disorders” (Foa et al., 2000, p. 539). Further, the treatment guidelines elaborated that the “PTSD is a complex condition that can be associated with significant morbidity, disability, and impairment of life functions” (Foa et al., 2000, p. 539). The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association (1994) guided the guidelines. The guidelines recognized that research that shaped the guidelines came largely from western industrialized nations and little is known about the treatment of the PTSD in non-industrialized countries (Foa et al, 2000, p. 540). The guidelines also noted that there are limitations in the scientific literature on the PTSDs because most studies have used inclusion and exclusion criteria and, thus, each study may not fully represent the complete “spectrum” of patients (Foa et al., 2000, p. 541). In particular, it is customary in the studies of PTSD treatment to “exclude patients with active substance dependence, acute suicidal ideation, neuropsychological deficits, retardation, or cardiovascular disease” such that generalization of the findings to all populations may not be appropriate (Foa et al., 2000 p. 541). However, like Numeroff et al. (2009), Foa et al. (2000) did not mention anything on the association between personality or traits in hastening recovery or making the management of PTSDs easier. Lilly et al. (2009) studied the association between gender and PTSD among female police officers and INITIALLY echoed the point of view expressed in Numeroff et al. (2006) that was reprinted as Numeroff et al. (2009): women to suffer from PTSDs more frequently and more intensely than men (p. 767, citing the 2006 review of Tolin and Foa). Further, based on several studies from 1992 to 2001, Lilly et al. (2009, p. 767) pointed out that gender differences in PTSDs have been consistently found among ordinary citizens whether such differences are measured in terms of lifetime prevalence rates, current prevalence rates, conditional lifetime prevalence rates, conditional current prevalence rates, chronic prevalence rates, or PTSD symptom severity prevalence rates. However, Lilly et al. (2009, p. 767) pointed out that “interestingly, gender differences typically have not been found in military and police studies” and cited the studies of Pole et al. (2001) and Sutker et al. (1995) to support the point. Lilly et al. (2009, p. 767) bolstered their point further by pointing out that “a comprehensive meta-analysis found no correlation between gender and PTSD symptom severity in military samples (r=.00) as compared to civilian samples (r=.13), a statistically significant difference.” Following this up, Lilly et al. (2009) tested the hypothesis whether PTSDs are gender-related. For the test, they compared 157 female police officers and 124 female civilians on many variables covering exposure to trauma, peritraumatic emotional distress, current somatization, and cumulative PTSD symptoms (Lilly et al., 2009, p. 767). Lilly et al. (2009, p. 767) found that despite the exposure of female police officers to “assaultive violence”, female civilians reported significantly more severe PTSD symptoms. Lilly et al. (2009, p. 767) attributed the elevated PTSD symptoms among the female civilian population to the “significantly more intense peritraumatic emotional distress among female civilians.” Lilly et al. (2009, p. 767) interpreted their empirical results to mean that “apparent gender differences in PTSD may result from differences in peritraumatic emotionality, which influence subsequent PTSD and somatization symptoms.” The researchers concluded that “emotionality may be more important than biological sex in understanding gender differences in PTSD” (Lilly et al., 2009, p. 767). Related to this point from Lilly et al. (2009, p. 767), it is plausible as well to extend the interpretation of the Lilly et al. (2009) findings to mean that the personality traits associated with gender could be important in understanding PTSDs. As pointed out by Lilly et al. (2009, p. 772), “our results indirectly imply that differences between men and women in PTSDs may result from gender disparities in the intensity of emotions that contribute much to PTSD.” As the ability to handle emotions also distinguishes one’s personality, it is also reasonable to interpret the findings of Lilly et al. (2009) to be indicative of the role of personality in influencing the acquisition of or resilience to the acquisition of PTSD. Adams and Boscarino (2009) sought to identify the factors associated with PTSD after the World Trade Center Disaster (WTCD) twin bombings on 11 September 2001. The Adams and Boscarino (2009) study examined the changes in PTSD status over time (p. 1). Their data came from two-wave prospective cohort of New York City adults who were living near New York City on 11 September 2001 (Adams and Boscarino, 2009, p. 1). For the study, Adams and Boscarino conducted a baseline survey one year after the attack followed up by another survey two years after the attack (2009, p. 1). In their analysis on the first survey, Adams and Boscarino (2009, p. 1) found that “being younger, being female, experiencing more WTCD events, reporting more traumatic events other than the WTCD, experiencing more negative life events, having low social support, and having low self-esteem increased the likelihood of PTSD.” In their analysis on the second survey, however, Adams and Boscarino (2009, p. 1) found that “being middle aged, being Latino, experiencing more negative life events and traumas since the WTCD, and having low self-esteem increased the likelihood of PTSD.” Thus, in the Adams and Boscarino (2009) study what has been shown is that a personality with a low self-esteem represents a vulnerability to acquiring PTSD. In Adams and Boscarino (2009) study, social support was the “sum of four questions about emotional, informational, and instrumental support currently available to the respondent” (p. 5). This implies that the role of personality factors may have been much more in the Adams and Boscarino (2009) study because one way of interpreting the Lilly et al. (2009) study is that people who are “emotional” or who have less control of their emotions are more vulnerable to acquiring PTSD. It is good to review further the work of Adams and Boscarino because as we will show later in the study of Daud et al. (2008), it may not be emotional control which is important for developing resilience to PTSD but that of acquiring ways of expressing emotions. Meanwhile, another interesting finding of Adams and Boscarino (2009, p. 7) is that “individuals with delayed PTSD reported experiencing more negative life events postdisaster and had a marked decline in self-esteem, whereas remitters reported fewer negative events and showed an increase in self-esteem during the same period.” This may indicate that working on a personality variable, particularly raising the self-esteem of victims exposed to traumatic events, may improve resilience to PTSD. Adams and Boscarino (2009, p. 7) categorically stated that their research results indicate that those who are Latinos, those experiencing more negative life events, and those with low-self esteem are most vulnerable to delayed PTSDs. The variable “being Latino” may be a genetic variable or it may represent a personality variable and, thus, again, the role of personality in producing resilience or vulnerability to PSTDs may be larger than what Adams and Boscarino (2009) had seen in their research. It must be mentioned, however, that Adams and Boscarino (2009, p. 7) pointed out that although DSM-IV included a discussion on the phenomenon of delayed PTSD, the theoretical and conceptual work on delayed PTSD has been in the shadows of the “larger discussion of causes and consequences of PTSD.” Daud et al. (2008) investigated resilience and vulnerability to PTSD among refugee children of traumatized and non-traumatized parents. Specifically, the study was on 80 refugee children and the test group was composed of 40 refugee children whose parents had been tortured in Iraq before coming to Sweden (Daud et al., 2008, p. 1). DSM-IV criteria were used in identifying PTSD cases and symptoms. According to Daud et al. (2008, p. 1), the children without PTSD in the traumatized parents group “had more favorable values (ITIA and SDQ) with respect to total scores, emotionality, relation to family, peer relations and prosocial behavior than the children in the same group” with PTSD. Thus, the study of Daud et al. (2008) is consistent with the view that personality variables are associated with resilience to acquiring PTSD. In particular, children with favorable scores related to “emotionality” and prosocial behavior are associated with resilience to PTSD. Daud et al. (2008, p. 1) concluded that “adequate emotional expression, supportive family relations, good peer relations, and prosociality constituted the main indicators of resilience” to PTSD. The authors noted that their findings “are useful for treatment design in a holistic perspective, especially in planning the treatment for refugee children, adolescent and their families” (Daud et al., 2008, p. 1). Ahmed (2007) reviewed the “conceptualization, epidemiology, and comorbidities of PTSD and highlights the factors underlying vulnerability and conveying resilience” (p. 369). According to Ahmed (2008, p. 369), PTSD was recognized as a diagnostic entity since 1980 and was originally associated with combat or war experience. Later, PTSD came to be viewed as “prevalent in any population exposed to traumatic events” (Ahmed, 2008, p. 369). When a population is subjected to acute stress such as civil wars (resulting in atrocities, violence, forced migration, and mass fatalities) as well as instabilities such as natural and man-made calamities, “PTSD is associated with the highest morbidity and is often underdiagnosed” (Ahmed, 2008, p. 369). PTSD was introduced in the Diagnostic and Statistical Manual (DSM) for Mental Disorders III of the American Psychiatric Association in 1980 (Ahmed, 2008, p. 369). Epidemiologically, based on the National Comorbidity Survey conducted in the United States between September 1990 and February 1992 using DSM-III-R, PTSD has a “lifetime prevalence of 7.8% in the general population, with women (10.4%) twice as likely as men (5%) to develop the disorder at some point in their lives” (Ahmed, 2008, p. 369). According to Ahmed (2008, p. 369), the “trauma most likely to be associated with PTSD was rape, with a 65% prevalence of rape related PTSD in men and 45.9% in women” but “women were 17 times more likely to present with PTSD after rape”. Ahmed (2008, p. 369) explained further that the “other traumatic events associated with PTSD in women were physical abuse (48.5%), threat with weapon (32.6%), molestation (26.5%), and physical attack (21.3%).” Ahmed (2008, p. 369) explained further that among men, the “other common traumatic events were combat exposure (38.8%), childhood neglect (23.9%), physical abuse (22.3%) and molestation (12.2%).” Ahmed (2008, p. 369) pointed out that there is also gender specificity for certain types of PTSD. For example, according to Ahmed (2008, p. 369), combat exposure being associated with PTSD is commonly associated with men. Citing the work of Karukarana et al. (2004), Ahmed (2008, p. 369) pointed out that the “in community samples of populations affected by war and forced migration, the prevalence of PTSD ranges between 14 and 37%”. Citing another study, Ahmed (2008, p. 370) pointed out that the prevalence of PTSD in a population directly affected by a terrorist act can be as high as between 12 to 16% but the prevalence could decline by about 25% within a year. Ahmed (2008, p. 371) echoed Bonanno 2004’s definition of resilience to PTSD as “the ability to maintain a state of normal equilibrium in the face of extremely unfavorable circumstances.” For Ahmed (2008, p. 371), to enhance resilience, it is necessary to understand the determinants of PTSD. Related to this, according to Ahmed (2008, p. 371), various factors such as “beliefs, attitudes, coping strategies, behaviors, and psychosocial cohesion have been suggested as conveying protection or endorsing resilience in the face of trauma.” According to Ahmed (2008, p. 371), individuals resilient to PTSD “may show insight, initiative, humor, creativity and independence” but Ahmed did not offer any evidence for the assertion. While pointing out that vulnerability, unlike resilience, has been conceptualized in a comprehensive manner, Ahmed (2008, p. 371) cited the definition of Mitchell in 1989 that vulnerability is the potential for loss or potential for casualty when exposed to a hazard or threat. Ahmed (2008, p. 371) also cited the definition of the International Strategy for Disaster Reduction of vulnerability as the predisposition of individuals or societies to be affected and the predisposition of individuals and societies to manage a disaster. Ahmed (2004, p. 371) pointed out that there is a genetic dimension in vulnerability. For example, he cited that the literature on PTSD has suggested that “trauma victims who develop PTSD are more likely than those who do not to have parents and first-degree relatives with mood, anxiety and substance use disorders.” Further, he pointed that a study has shown that “children of Holocaust survivors who experienced PTSD were themselves more likely to develop the disorder than the children of survivors without PTSD.” Among Vietnam veterans, Ahmed (2008, p. 371) pointed out that “genetic factors account for as much as 34% of the PTSD symptoms” based on a study conducted in 1993. Ahmed (2008, p. 371) also touched on the neurobiology of PTSD. According to Ahmed (2008, p. 371), “in stressful and threatening situations, the sympathetic nervous system becomes activated and adrenaline and noradrenaline are released” and “unrestrained activation of the sympathetic nervous system, leading to hypervigilance, anxiety and intrusive memories, has been seen in people with PTSD”. In contrast, Ahmed (2008, p. 371) pointed out that, based on a study conducted in 2000, individuals resilient to PTSD “may be able to restrict sympathetic activation to only dangerous or stressful situations”. Some studies have linked resilience to PTSD with high levels of neuropeptide Y (Ahmed, 2008, p. 371). Ahmed (2008, p. 371) described neuropeptide Y as an amino acid released with noradrenaline on activation of the sympathetic system. Low levels of neuropeptide Y have been associated among combat veterans with chronic PTSD in a study conducted in 2000 (Ahmed, 2000, p. 371). Based on a study conducted in 2004, Ahmed (2008, p. 371) pointed out that the ability to restrain corticotrophin-releasing hormone or CRH has also been suggested with resilience to PTSD. According to Ahmed (2008, p. 371), during stressful situations, the CRH is released from the hypothalamus into the hypothalamic-pituitary circulation, resulting in the activation of the hypothalamic-pituitary axis and subsequent secretion of cortisol from the adrenal glands. Further, based on a study that was also conducted in 2004, Ahmed (2008, p. 371) pointed out that it has been suggested that individuals resilient to PTSD “are less likely to consolidate emotional memories and have a greater ability to extinguish traumatic memories.” Ahmed (2008, p. 371) identified psychosocial factors but many of these were also related to exposure to other forms of trauma. Based on a review of literature, Agaibi and Wilson (2005, p. 203) identified some of the personality factors associated with resilience to PTSD: 1) sense of efficacy and determination; 2) inclination to self-disclosure; 3) sense of group identity and “sense of self as a positive survivor”; 4) altruistic or pro-social behavior; and 5) capacity to find meaning in a traumatic experience. On the other hand, Bramsen et al. (2000, p. 115, 118) identified that personality factors like negativism and psychopathology have been associated with vulnerability to PTSD. Negativism refers to negative, dissatisfied, and hostile attitude towards others and life in general (Bramsen et al., 2000, p. 1116). In contrast, according to Bramsen et al. (2000, p. 118), psychopathology refers to “having paranoid ideas and psychotic experiences” although psychopathology does not seem to be a personality at all but a psychological condition. In summary, our review indicated that some of the most important determinants of vulnerability or resilience to PTSD included genetics, neurobiology, situational, and personality factors. The personality factors identified by the literature included self-esteem, emotionality, pro-social personality, ability to express emotions, inclination towards altruism, and the other factors identified by Agaibi and Wilson in the earlier paragraph. Intelligence does not seem to be a factor affecting vulnerability nor resilience to PTSD. However, the study closest to studying the relationship between intelligence and vulnerability to PTSD is Bonne et al. (2008). In Bonne (2008), however, hippocampal volume is reduced with the onset of PTSD and this may have an effect on intelligence but only when hippocampal volume and intelligence are correlated. Bonne et al. (2008), however, did not say that low intelligence will make one more vulnerable to PTSD. Sensation-seeking personality as a factor for vulnerability or resilience to PTSD is not discussed in the literature immediately available from 2000 to 2011. Solomon et al. (1995, p. 57) reported that “low-sensation seeking” ex-POWs or prisoners of war reported more PTSD symptoms than “high sensation-seeking” ex-POWs among 348 Israeli ex-POWs studied 18 years after the Yom Kippur War. Solomon et al. (1995, p. 59-60) defined “high-sensation seekers” as those that “tend to look for novel, non-conventional and sometimes illegal experience.” In studying the behavioral correlates of sensation-seeking personality, Roberti (2004) reported that “conflicting empirical findings in relation to reactivity to stressors and neuroendocrine responses in humans (cortisol) and animals (corticosterone) suggest that continued studies are warranted.” References Adams, R. and Boscarino, J. (2009). Predictors of PTSD and delayed PTSD after disaster. Authors Manuscript. 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