Resilience-enhancing relationships: what we can learn from those with a history of adverse childhood experiences

Adverse childhood experiences (ACE) have long been recognized as antecedents to negative physical and mental health outcomes. Felitti and his colleagues, in their landmark ACE study, (1) discovered child maltreatment and household dysfunction to be associated with many of the leading causes of death in adults. Further reports from the ACE study linked childhood adversity to psychosocial problems that included suicide attempts, (2) alcohol abuse, (3) intimate partner violence, (4) depressive disorders, (5) hallucinations, (6) and generally poorer mental health functioning. (7) Since the initial work of Felitti et al, others have contributed to the growing understanding of the long-term consequences of childhood trauma. A study of young adults from economically disadvantaged, urban communities revealed that those with a high rate of ACEs were more likely to experience depressive symptoms, use drugs and engage in antisocial behavior. (8) Since the advent of the all-volunteer service, increased percentages of service members, particularly males, have described personal ACEs. (9) This is reflected in the high prevalence of ACEs seen in Soldiers who sought treatment for a wide array of behavioral health disorders while deployed to a combat zone, with many reporting having experienced 3 or more types of adversity. (10) Similarly, active duty Marines who reported a history of ACEs appeared to be at an increased risk for developing posttraumatic stress disorder after returning from a combat deployment. (11) Additional studies have correlated childhood adversity with a lifetime onset of posttraumatic stress disorder, conduct disorder, substance use disorders, suicidal ideation, and anxiety. (12-14) Furthermore, ACEs are believed to exacerbate the physical and psychological symptoms experienced by those with severe mental health disorders. (15,16) Much of the research on ACEs has shown that the more adversity a child experiences, the more likely they will develop physical or psychosocial problems as an adult. Nevertheless, embedded in these findings is the revelation that not everyone who endures hardships early in life is destined to become psychosocially dysfunctional.

This evidence suggests that some people become resilient in the face of adversity and emerge from childhood trauma to lead psychologically healthy and highly successful professional lives. Thus resilience, characterized by achieving positive outcomes despite severe threats to growth or adaptation, (17) may mitigate the risk of developing the psychological distress and maladaptive behavior associated with ACEs. In fact, psychological resilience has been shown to protect against the risk of suicide related to childhood trauma and lessens the association between being emotionally neglected as a child and developing psychiatric symptoms as a young adult. (18,19) Furthermore, homeless adolescents with a history of ACEs who perceived themselves as resilient were found less likely to engage in risky behavior, were less lonely and more hopeful. (20) Becoming resilient can be achieved through various pathways. (21) While innate factors and environmental influences undoubtedly contribute to resilience, the Kauai longitudinal study on the resilience and recovery of at-risk children discovered that relationships with supportive adults mitigate the vulnerabilities of adversity and facilitate positive outcomes as adults. (22)

RESILIENCE AND RELATIONSHIPS

The power...