Взгляд на травматический стресс через призму уязвимости и устойчивости

Человек. 2023. Т. 34. № 4. С. 181–191.

Shmarina T.

This article details two existing perspectives on traumatic stress: vulnerability and resilience. Traditionally, the issue has been considered in the narrow psychopathological context of risk factors and vulnerability, despite evidence indicating that most people exposed to potentially traumatic events will remain mentally healthy and continue to lead fulfilling lives, following a trajectory of resilience. We will examine both perspectives and try to relate them. The view of post-traumatic stress through a vulnerability lens focuses on the risk factors and mechanisms that lead to the development of the disorder, and the qualities that increase susceptibility to them. Predictors are well researched and a consensus has been reached here, so to add some novelty to the data we already know, we will list risk and vulnerability factors, dividing them into three groups: pre-, peri- and post-traumatic. Looking at post-traumatic stress through the lens of resilience is not as clear-cut — this area is poorly understood, so there are several competing theories, and consensus has yet to be reached. The trajectory of resilience is common among large numbers of people — two-thirds of the trauma survivor population — so isolating individual correlates of resilience has led to a paradox: While there are many variables that correlate reliably with resilience, it is impossible to predict with great accuracy who will be resilient to potential trauma and who will not. One solution to the resilience paradox is the not yet widely accepted, but widely discussed, Flexibility Sequence Theory proposed by George Bonanno. In examining the two perspectives, we conclude that vulnerability does not preclude resilience and that the focus of interventions can be not only on identifying and mitigating risk factors, but above all on maintaining effective use of natural internal protective factors and developing a sequential flexibility that ensures resilience.

Keywords: уязвимость, устойчивость, факторы риска, risk factors, vulnerability, посттравматическое стрессовое расстройство, травматический стресс, resilience, Резильентность, post-traumatic stress, посттравматический стресс, posttraumatic stress disorder, парадокс устойчивости, теория последовательной гибкости, предикторы ПТСР, traumatic stress, resilience paradox, Flexibility Sequence Theory