Vulnerability, Posttraumatic

Vulnerability and Inoculation

One of the most widely documented expressions of posttraumatic vulnerability may be seen in instances where exposure to an early traumatic event heightens the risk of developing psychopathology following exposure to subsequent trauma. This pattern of events is best described by the “vulnerability perspective.” According to the latter, trauma often scars its victims; its residues leaving them permanently weakened in the face of future stress. In line with that perspective, studies have shown that prior trauma may increase the risk for retraumatization, as well as the risk for developing posttraumatic stress disorder (PTSD) following subsequent trauma. The latter finding was even more powerfully evident when PTSD was developed following the earlier traumatic event, as well as when the early and late traumas were perceived as similar by the survivor. Overall, the vulnerability perspective has been supported by studies of various traumatized populations, including Holocaust survivors, sexual abuse victims, and war veterans. A competing theoretical perspective, known as “stress inoculation,” or the “resilience perspective,” argues that prior stress may actually strengthen the individual. The idea of inoculation postulates that when one effectively copes with initial traumatic stress, one will benefit from that experience and will become more resilient to future stress. The idea of stress inoculation has also received empirical support, thus hinting at the strong possibility that posttraumatic vulnerability and inoculation are not mutually exclusive but, rather, may coexist in different psychological areas.

Posttraumatic vulnerability was also conceptualized in terms of the availability of psychological resources. According to Stevan E. Hobfoll's conservation of resources theory, trauma often entails the loss or “depletion” of psychological resources (e.g., social support, sense of safety, effective coping strategies). Furthermore, those who lack resources are most vulnerable to additional losses, or “loss spirals.” Thus, an early traumatic event may serve as the initial blow, following which the individual will be less able to effectively cope with subsequent stressors.

Exposure to traumatic events may also entail physical vulnerability. Studies have consistently shown that survivors of trauma, and particularly those diagnosed with formal acute or chronic post-traumatic disorders, face an increased risk of suffering from a variety of physical health problems, ranging from migraine headaches to more severe problems such as diabetes, heart disease, and cancer. Studies have also reported accelerated aging among trauma victims, as well as significantly higher death rates compared with nonvictims. As it seems, multiple pathways may lead to this posttraumatic physical vulnerability, including frequent engagement in risk behaviors and high levels of substance abuse. However, physical vulnerability following trauma is perhaps most clearly demonstrated by recent studies showing evidence of a weakened immune system among victims of trauma. Negative alterations in immune function occurring following exposure to trauma may leave the individual at a heightened risk for various physical illnesses.

Cognitive Changes

Increased vulnerability following trauma is often also seen in the cognitive sphere. Exposure to traumatic events often significantly modifies victims' cognitive schemata and cognitive processing, thereby creating the basis for future psychological difficulties. One of the most well known conceptualizations of these cognitive changes may be found in Ronnie Janoff-Bulman's theory of shattered assumptions. The theory makes an important argument regarding posttraumatic vulnerability because it depicts the negative changes that often occur in one's belief system following trauma. Previous beliefs regarding the good in humankind, the meaningfulness of the world and self-worth, are shattered as a result of the traumatic experience, thus leaving one feeling more vulnerable to the evils of this world. However, vulnerability in this case is subjectively experienced and may carry significant mental health implications. The negative, pessimistic outlook one embraces following trauma may serve as a risk factor for future difficulties. For example, diminished world assumptions following trauma exposure were found to mediate the relationship between trauma exposure and depression severity. In sum, world assumptions are vulnerable to traumatic stress, but once shattered, they themselves render the individual more vulnerable to further distress.

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