SPECIAL REPORT: EXPLORING RESILIENCY
In our psychiatric practices, we naturally focus on psychopathology and the negative effects that adverse and traumatic experiences have on our patients’ mental health. We assess disaster survivors’ maladjustment in order to develop policies for mental health recovery programs. However, the majority of individuals exposed to disasters or other traumatic events do not develop posttraumatic stress disorder (PTSD) or another lasting psychiatric disorder, although they may experience temporary ripples on the surface of their emotional lives and subclinical symptoms for a time.
Resiliency and Posttraumatic Growth: Cultural Implications for Psychiatrists
Resilience and Healthy Aging
Igor Linkov, PhD, MSc; Stephanie Galaitsi, MSEE; Katarzyna Klasa, MPH, BSN; Andrew Wister, PhD
In considering the patients seen by my residents and me, I am often in awe of the tremendous strength that many of them have developed despite experiencing horrific abuse, neglect, disasters, extreme poverty, major losses, and other traumatic events. Some who were severely abused or neglected as children become devoted parents or highly functional adults, albeit with effort. How do we understand this emotional hardiness?1
Resilience is a relatively neglected research topic. A Medline search for medical literature related to “psychological resilience” revealed only 6471 articles, whereas a search for articles related to “PTSD” and “posttraumatic stress” (which does not include other mental health problems associated with trauma) identified 36,682 and 18,823, respectively. In fact, in my own research on biological markers for symptoms and diagnoses of PTSD, depression, and anxiety after disaster, we explored heart rate and blood pressure responses, heart rate vulnerability, and levels of cortisol, interleukin-2, and interleukin-6—yet we did not explore those markers or personal characteristics associated with resilience.
Part of the problem is that resilience is difficult to define. Is it the absence of mental health diagnosis, or is it having temporary symptoms or symptom levels below a defined threshold of distress? Or is it having a fulfilled life and pursuing cherished life goals?
However we define resilience, what factors contribute to it? Are some individuals blessed with a fortunate genetic endowment or temperament? Some research has shown heritability of resilience to range between 33% and 52%. Research on resilience has implicated genetic variations in expression of neuropeptide Y and regulation of the HPA axis, as well as polymorphisms in noradrenergic and dopaminergic systems and serotonin transporter genes.2 Conversely, epigenetic factors involve methylation, demethylation, and histone changes after stress, especially early life stress, which can change gene expression but not DNA structure, for a variable amount of time, contributing to psychiatric vulnerability.3 Does this “hop on, hop off” epigenetic model for stress response inversely explain emotional hardiness? Recent research results point to an association between maternal resilience and increased cellular telomere length in newborns, with longer telomeres important in gene transcription, meiosis, and cellular longevity.4 Can promoting maternal adaptation to stress during pregnancy have protective factors in offspring?