123PSOCIAL2422-619XUniversidad de Buenos AiresArgentinapsocial@sociales.uba.ar1231854007ArtículosContributions of Centrality of Events and Personality to the relationship between Traumatic Events and Mental Disordershttp://orcid.org/0000-0003-1482-1400OliveraMercedesmercedes.olivera@uflo.edu.arhttp://orcid.org/0000-0001-5870-5271MatrángoloGiselamatrangolo.gisela@maimonides.eduhttp://orcid.org/0000-0001-7012-0188TravisDanieldtravis@alumnos.kennedy.edu.arhttp://orcid.org/0000-0002-6299-2231YaccariniCeciliayaccarini.cecilia@maimonides.eduUniversidad de FloresUniversidad de FloresArgentinaConsejo Nacional de Investigaciones Científicas y TécnicasConsejo Nacional de Investigaciones Científicas y TécnicasArgentinaUniversidad MaimónidesUniversidad MaimónidesArgentinaConsejo Nacional de Investigaciones Científicas y TécnicasConsejo Nacional de Investigaciones Científicas y TécnicasArgentinaUniversidad Argentina John F. KennedyUniversidad Argentina John F. KennedyArgentinaUniversidad MaimónidesUniversidad MaimónidesArgentinaConsejo Nacional de Investigaciones Científicas y TécnicasConsejo Nacional de Investigaciones Científicas y TécnicasArgentinaJuly-December20206272730910202001122020Abstract
At present, numerous studies research the integration of traumatic events to one´s identity, as well as their relationship with the development of mental disorders. Also, several investigations link this connection with centrality of events and with personality traits from the five-factor model. The aim of the present article is to conduct a literature review about explanations that underlie these theorized and empirically evidenced associations. The results of the review show that two of the events most frequently referred to as traumatic are the loss of a loved one and the experience of child maltreatment. At the same time, these are related to the subsequent development of complex bereavement and post-traumatic stress disorder (PTSD) respectively. Both centrality of events and personality traits have been shown to influence the development of mental disorders.
Resumen
En la actualidad, numerosos estudios se ocupan de investigar la
incorporación al self de los eventos traumáticos, así como tambien su vinculo
con el desarrollo de trastornos psicopatológicos. Además, se han identificado
diversos trabajos que vinculan esta conexión con la centralidad de los eventos
y con los rasgos de personalidad del modelo de los cinco factores. El presente
trabajo se propone realizar una revisión bibliográfica sobre las explicaciones
que subyacen a las asociaciones teorizadas y empíricamente evidenciadas. Los
resultados de la revisión indican que dos de los eventos más frecuentemente
referidos como traumáticos son la pérdida de un ser amado y la vivencia de
maltrato durante la infancia. A su vez, estos se vinculan con el desarrollo
posterior de duelo complejo y trastorno por estrés post traumático
respectivamente. Tanto la centralidad de los eventos como los rasgos de
personalidad han demostrado influenciar el desarrollo de trastornos
psicopatológicos.
Keywordstraumatic events centrality of traumatic events post-traumatic stress disorder (PTSD) complex bereavement personalityPalabras claveeventos traumáticoscentralidad de los eventos traumáticostrastorno de estrés postraumático (TEPT)duelo complejopersonalidadIntroduction
Personal memories give meaning and
structure our life narratives, informing conventional life scripts based on
vivid and accessible memories of positive and culturally expected events
(Blanco, 2011; Robinson & Taylor, 1998). Whereas unfavorable events, such
as a loss or those that determine a directional change in the course of our lives,
are subjectively considered traumatic (Fernández-Alcántara
et al., 2016).
The more relevant a traumatic event
is considered for the identity of a person, experiencing it as a salient point
in their life story, the greater their vulnerability for the development of
mental disorder symptoms (Berntsen & Rubin, 2006; Bryant, 2015; Groleau et al., 2013). The degree to which those events
become an inflection point in one's personal biography is known as centrality
of event (Berntsen & Rubin, 2007), and has been proposed as a mediating
variable of the relationship between life events and mental disorders (Berntsen
et al., 2011; Reiland & Clark, 2017).
According to Bernsten & Rubin (2007), there are three fundamental aspects to centrality of events: first, the
event or group of events constitute themselves as a turning point in the course
of our life. Second, they involve greater memory accessibility that facilitates
them being re-experienced, and consequently their institution as a reference
point to judge and give meaning to other experiences. Finally, the event is
integrated into one´s identity presenting a tendency to causally explain other
aspects of one's identity.
Traumatic events and mental disorders
There is strong support, found in the
literature, regarding the idea that events that have become central to one's
own identity have a greater influence on mental health than those that don't
exhibit a special relevance (Reiland & Clark,
2017). However, few studies examine if some type of event is perceived as central
with greater probability than others (Ogle et al., 2014).
The loss of loved ones, in
particular, triggers a bereavement process that affects well-being and
potentially can involve the development of mental disorders (Boelen et al., 2018). Bereavement is an adaptive process of
psychological nature that is prompted by the loss of a loved one (Fernández-Alcántara et al., 2016). Most people count on adequate
resources for coping with this type of loss, while others, about 10% to 15%,
develop symptoms of complex bereavement (Boelen et
al., 2018; Girault & Dutemple,
2020). These include a strong longing for the deceased, difficulty in accepting
the lost, feelings of shock or disbelief, emotions such as rage, bitterness,
sorrow or guilt regarding the death, and significant problems in daily
functioning, during a prolonged period, at least 6 months after the loss
(First, 2013).
Although the development of complex
bereavement depends on a great number of factors and variables, recently an
emphasis has been put on biographical processes and those of identification, in
such a way that the perception of the deceased as a basic element to define
one's own identity would be a very significant risk factor (Fernández-Alcántara et al., 2016). It should be noted that, although
the loss of a loved one is usually reported as one of the most stressful
events, it is related to reports of low levels of post-traumatic stress
disorder PTSD (Fitzgerald et al., 2015).
Besides the loss of a loved one,
multiple studies affirm that child abuse, due to its characteristics, can be
considered as a traumatic event for an individual (Breslau et al., 2014; Rehan et al., 2017; Rosner et al., 2014; Simonelli, 2013).
Child maltreatment can be understood as those actions or omissions committed
generally by parents or caretakers that harm or threaten the physical and
emotional integrity of a child or teenager under the age of 18 (Gilbert et al.,
2009). Concerning this, it can be noted that, in certain cases, people who
undergo traumatic incidents of this type develop mental disorder symptoms, of
which those that correspond to PTSD are some of the most prevalent (Barboza et
al., 2017; Ogle et al., 2014).
Post-traumatic stress disorder (PTSD)
is defined as a mental disorder characterized by symptoms such as flashbacks
and dissociation, that emerge as a result of experiencing a traumatic event
(Beck & Sloan, 2012; Crespo & Gomez, 2012; Friedman et al., 2014). For
the description of PTSD, the DSM-5 Psychiatric Manual (American Psychiatric Association,
2013), proposes for criterion A a series of stressors
such as exposure to death, serious injury or sexual violence, whether actually
experienced or threatened, or learning that a close friend or relative was
exposed to such incidents. It takes into account, as well, four clusters of
symptoms: (1) re-experiencing, (2) cognitive/behavioral avoidance, (3) negative
cognitive and mood changes, (4) hyperarousal.
Although child maltreatment presents
itself as a vulnerability factor for the development of mental disorder
symptomatology, it is necessary to point out that not all individuals that
suffer an event of these characteristics will inevitably manifest PTSD
symptoms. It is considered that the emergence of these symptomatologies
can be modulated by different variables, such as centrality of traumatic
events, which would modulate how each individual integrates the traumatic
events into their own identity (Matrángolo &
Paz, 2017).
From this perspective the traumatic
event may become an inflection point in the life of an individual, in such a
way that everything that happens in their life tends to be evaluated in
relation to the undergone traumatic event, facilitating the emergence of mental
disorder symptoms such as PTSD (Berntsen et al., 2003; Berntsen & Rubin,
2007).
Contributions of personality and centrality of events
Currently, although different
approaches exist to the study of personality, the five-factor model developed
by Costa and McCrae (1980) is one that has involved some of the greatest
academic interest and development (Depaula & Azzollini, 2013; Simkin & Azzollini,
2015). This model views personality as composed of five big factors: openness
to experience, conscientiousness, agreeableness, extraversion, and neuroticism
or emotional instability (Laher, 2013).
It has been suggested that traits
such as neuroticism would be responsible for increasing the availability of the
memory of the traumatic event and it being re-experienced, facilitating in this
way the mnemic integration of the trauma to the autobiography narrative,
enlarging the possibility of experiencing it as a salient point in one's life
story (Berntsen & Rubin, 2007). This could be explained by the tendency to
interpret ambiguous or neutral stimuli in a negative or threatening manner, as
well as by the association of this trait with maladaptive coping strategies
(Ogle et al., 2014).
Other factors that have been found to
be related -although to a lesser extent- to the centrality of traumatic events
and a subsequent mental disorder development are openness to experience,
conscientiousness, and agreeableness (Fitzgerald et al., 2015; Rasmussen &
Berntsen, 2010; Rubin et al., 2008). The latter is inversely correlated to the
centrality observed by traumatic events; individuals with higher levels of
agreeableness generally experience higher levels of positive affect, which
influences their way of experiencing life, acting as a buffer against mental
disorder development (Ogle et al., 2014).
Openness to experience is generally
considered a positive characteristic of personality; nevertheless, it is
associated with high levels of centrality of traumatic events and PTSD symptoms
(Rasmussen & Berntsen, 2010). It could be anticipated that openness to
experience would promote adaptation to life events, but when the experience is
uncontrollable, repeated, and stressful, an individual may move too quickly to
alter their identity, in such a way that it is negatively affected (Fitzgerald
et al., 2015).
There is controversy in respect to
conscientiousness: some studies report, in the same manner as with
agreeableness, an inverse correlation with centrality of traumatic events (Ogle
et al., 2014; Rubin et al., 2008), while others report a direct association
(Fitzgerald et al., 2015). According to the latter, very conscientious
individuals may find themselves too willing to assume responsibility for
causing the negative events or may develop a maladaptive pattern in trying to
find a solution for events that are out of their control, compulsively,
creating negative changes in their narrative identity (Fitzgerald et al.,
2015).
Although the original personality
model is composed of the five aforementioned factors, different authors
consider it appropriate to incorporate other factors into the model;
spirituality is one such that has received greater interest (MacDonald, 2000;
Piedmont et al., 2012). However, little has been explored so far regarding its
possible relationship with centrality of events. According to Simkin (2020),
spirituality promotes strong connectivity with others, which can help in coping
with traumatic events, while those individuals that do not have a religious
framework to count on would be more vulnerable to the development of mental
disorders.
Conclusion
As has been observed, events such as
the loss of a loved one and child maltreatment are those that have been most
frequently referred to in their traumatic character (Fitzgerald et al., 2015;
Ogle et al., 2014). At the same time, the experience of these events has been
associated with the development of mental disorders related to complex
bereavement -depressive symptomatology- and PTSD, respectively (Boelen et al., 2018; Groleau et
al., 2013). The emergence of these symptomatologies
can be articulated by different variables, such as centrality of traumatic
events which would mediate how individuals integrate traumatic events into
their identity (Berntsen & Rubin, 2007).
Another variable of great relevance
for the study of the relationship between events and the development of
symptomatology is personality, which has evidenced its influence on the
integration of traumatic events to the self (Rasmussen & Berntsen, 2010).
However, further studies remain to be undertaken in respect to the relationship
between spirituality -as a sixth factor of personality- and its specific
influence on the centrality of traumatic events. Regarding the latter, new
lines of research affirm that the accumulated exposure to events subjectively
assessed as traumatic turns out to be the best predictor of subsequent mental
disorders, much more than the experience of a single event of great negative
intensity (Ogle et al., 2014).
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