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Post-traumatic resilience

In U.S. veterans, social connectedness, optimism, and a sense of purpose are among the characteristics associated with bouncing back from trauma—sexual and otherwise.

Many think the biggest threat to military personnel is battlefield death or injury. While that is certainly true during wartime, the military spends much of its time training. And for U.S. veterans, sexual assault confers a greater risk of post-traumatic stress disorder (PTSD) than combat.

Robert Pietrzak, PhD, MPH, associate professor of psychiatry and director of the translational psychiatric epidemiology laboratory of the clinical neurosciences division of the National Center for PTSD in West Haven, studies veterans, PTSD, and resilience. According to his research, sexual assault comes with a 26 percent likelihood of developing PTSD if the trauma occurred during childhood and 36 percent if the trauma occurred during adulthood. About 10 percent of veterans have experienced sexual assault, the trauma most strongly associated with PTSD. In comparison, combat of any kind—which about 35 percent of veterans have experienced—comes with an approximately 19 percent risk of developing PTSD. However, this figure increases as a function of the intensity of the combat exposure—the most heavily exposed veterans have a 35 percent likelihood of developing PTSD.

These data about veterans, PTSD, and resilience come from the National Health and Resilience in Veterans Study (NHRVS), which Pietrzak and his colleagues have been conducting since 2011. In the NHRVS, nationally representative samples of thousands of veterans answer survey questions designed to learn about veterans’ experiences with trauma, PTSD symptoms, and other factors. Researchers then analyze the data to determine which factors are associated with PTSD and which with resilience, or the ability to “bounce back” from trauma.

In addition to having experienced such types of trauma as sexual and physical assault, other factors that increase the risk of PTSD include being of younger age and female.

Nevertheless, many veterans rebound from their ordeals. Among veterans exposed to high levels of trauma of any kind, 70 percent are psychologically resilient; in other words, they do not exhibit symptoms of PTSD, depression, or anxiety.

“They basically look as if they hadn’t been exposed to trauma at all,” says Pietrzak. His research investigates why it may be possible to use that knowledge to help others to bounce back.

Among veterans who participated in the NHRVS in 2011, those who felt they had strong social support and a sense of meaning and purpose in life were less likely to develop symptoms of PTSD, depression, or anxiety. Optimism and gratitude also correlated with greater ability to recover from these symptoms.