Journal of Social and Clinical Psychology, Vol. 30, No. 6, 2011, pp. 583-598

PHILIPPE ET AL.
Ego-Resiliency as a Mediator

Ego-Resiliency as a Mediator
Between Childhood Trauma
and Psychological Symptoms
Frederick L. Philippe
McGill University
Samuel Laventure, Genevieve Beaulieu-Pelletier,and Serge Lecours
Université de Montréal
Natasha Lekes
McGill University

Clinical research has firmly established that individuals who experience psychological trauma during their childhood are likely to display psychological or functional disorders in adulthood. However, a significant number of adults with ahistory of trauma remain psychologically healthy. These individuals have been
described as resilient. Although there has been much research on resilience in thepast decades, the psychological processes involved are still debated. An important issue is whether resilience develops as a consequence of trauma (resilience
as an outcome) or if resilience is a relatively common characteristic of many people that can emerge with or without traumatic experiences (resilience as a trait or
ego-resiliency). In the present research, we propose an integration of these two
perspectives by showing that ego-resiliency can play an important mediating rolein the relationship between childhood trauma and psychological symptoms. A total of 118 outpatients at a psychology clinic completed questionnaires measuring
their level of childhood trauma, ego-resiliency, anxiety, depression, and self-harmbehaviors. Results revealed that ego-resiliency was a significant mediator of therelationship between childhood trauma and these three types of symptoms. Implications for the conceptualization of resilience as a trait are discussed.
Correspondence concerning this article should be addressed to Frederick L. Philippe,
Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal,
Quebec, H3A 1B1, Canada. E-mail: frederick.philippe@mail.mcgill.ca.
© 2011 Guilford Publications, Inc.

583

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The personal cost of child abuse is extensive (Thomas, 2003). Substantial research has shown that child abuse is associated with a variety of short- and long-term psychological disturbances (McGloin& Widom, 2001; National Research Council, 1993; Wekerle & Wolfe,
1996) and with some of the most severe psychological symptoms
and psychiatric problems (Herman, Perry, & van der Kolk, 1989;
Johnson, Cohen, Brown, Smailes, & Bernstein, 1999; Kluft, 1996). Although childhood trauma clearly has an impact on people’s mental
health, it has also been found that a significant number of those whohave experienced childhood trauma remain psychologically healthyin adulthood. These people have been defined as being resilient orsometimes ego-resilient. The purpose of the present research was
to investigate the role of ego-resiliency as a central psychologicalprocess in the relationship between childhood trauma and psychological symptoms in adulthood.

On Resilience
The term resilience is usually used to refer to a positive adaptation
despite a context of adversity (Luthar, Cicchetti, & Becker, 2000; Rutter, 1987). One approach to study resilience is to look at the personaland social outcomes of people with a history of trauma. This conceptualization of resilience will be termed resilience as an outcome,which is assessed by observing and measuring the quality of one orseveral outcomes (e.g., attachment indices, academic performance,
mental health) in an individual’s development following adversity.
According to this definition, two conditions are required to attest
that an individual is resilient: (1) exposure to a significant threat oradversity and (2) the manifestation of a positive adaptation or theabsence of indices of poor adaptation in spite of adversity (Luthar
et al., 2000).
A second approach that resilience researchers have taken is to examine the factors that protect people from developing psychological symptoms despite trauma and adversity. A number of protective factors have been identified such as social bonding, a positiveand supportive caregiver–child relationship, competent parenting,caregiver’s mental health, child’s temperament, and child’s higher cognitive ability (Masten et al., 1999; Tiet et al., 1998; Wyman etal., 1999). However, this research has often investigated how thesefactors moderate the relationship between childhood trauma andEGO-RESILIENCY AS A MEDIATOR

585

mental health (e.g., Johnson, Gooding, Wood, & Tarrier, 2010; Martinez-Torteya, Bogart, Von Eye, & Levendosky, 2009). While this approach is useful to highlight the differences between people witha history of trauma who thrive and those who do not, it does notallow researchers to examine variables that may be protective forpeople with or without a history of trauma. Indeed, recent research(Bonanno, 2004) has shown that most people recover successfully
from adverse events, including individuals with no prior historyof trauma. In addition, this line of research has found that thesepeople already possessed important personal attributes prior to theadverse event, which helped them to live through the traumatic
event and yet emerge psychologically healthy (Bonanno et al., 2002;
Fredrickson, Tugade, Waugh, & Larkin, 2003).
Thus, a third approach to the study of resilience has been to examine trait resilience. Resilience as a trait may be defined in terms of thecharacteristics that individuals possess that enable them to achieve
positive outcomes or to avoid negative ones. This conceptualizationof resilience is also known as psychological resilience (e.g., Tugade& Fredrickson, 2004) or ego-resiliency (Block & Kremen, 1996). Egoresiliency may be defined as a flexible and resourceful adaptation
to ever-changing situations, desires, and environmental demands(Block & Block, 1980; Block & Kremen, 1996), that is, the capacity to adapt one’s behavior to various situational contexts (Block,2002). This capacity is a personal attribute that is not establishedby the experience of a trauma, but acquired over time. The conceptof ego-resiliency is a high-level personality component of the self,
and for this reason, it can be viewed as a personality trait or as arelatively stable cognitive structure or schema. However, it is not
an unchanging set of behavioral manifestations that is geneticallydetermined and permanently fixed, as how the five-factor personality model is frequently envisioned (see McAdams & Pals, 2006, on
dispositional traits). Ego-resiliency conceptualizes these behavioral
manifestations as the dynamic product of the regulations that took
place between the self and the environmental demands and thathave stabilized over time as a general trait (Block, 2002; Stern, 1985).
Thus, ego-resiliency is a measure of the flexibility of the psychological processes in place that have been shaped over time and that may
lead to resilient manifestations.
Taken together, the main difference between the trait and outcome
conceptions of resilience is that the latter presupposes an exposure
to substantial adversity, whereas the former does not. However, as586	PHILIPPE ET AL.

mentioned above, this conceptualization of resilience necessitating
substantial adversity is at odds with recent research revealing thatpeople showing resilience in the face of adverse life events are much
more prevalent than initially expected (e.g., Bonanno, 2004) andthat these thriving people possess certain trait attributes that arepresent before an adverse event occurs (Bonanno et al., 2002; Fredrickson et al., 2003). These two conceptualizations have very often
been contrasted with one another (see Kaplan, 1999, for a discussionof this issue). In the present research, we seek to show how these
two approaches may be partially integrated by examining whether
ego-resiliency is a fundamental factor in the process of resilience asan outcome. In other words, ego-resiliency may be a critical ingredient allowing people who have experienced childhood trauma toremain psychologically healthy in adulthood.

The Present Research
The purpose of the present research was to examine the role of egoresiliency as a psychological process that might allow people whohave experienced trauma as a child, as well as those who did not,to thrive and be free of psychological symptoms in adulthood. In
the present research, we conceptualized the outcome of resilience as
an absence of psychological suffering, which is operationalized as
an absence of psychological symptoms. As highlighted in the introduction, childhood traumas, such as emotional and physical neglect
or physical and sexual abuse, commonly lead to different types ofpsychological maladjustment that include emotional and behavioral problems (e.g., Soffer, Gilboa-Schechtman, & Shahar, 2008).
Research has shown that childhood trauma is positively associatedwith anxiety (Safren, Gershuny, Marzol, Otto, & Pollack, 2002), depression (Brown, Cohen, Johnson, & Smailes, 1999; Kaplan, Pelcovitz, Salzinger, Mandel, & Weiner, 1997; Levitan, Rector, Sheldon, &Goering, 2003), and self-harm behavior (Brodsky et al., 2001; Evren& Evren, 2005; Van der Kolk, Perry, & Herman, 1991). Therefore, toassess the possible protective effect of ego-resiliency, these psychological symptoms were chosen as undesirable outcomes commonly
associated with maltreatment during childhood.
One point that needs to be clarified is that the present study relies on a trait definition of resilience, as defined by Block (2002),
which specifies that resilience may be present in all people, with

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587

or without prior experience of trauma. Therefore, ego-resiliency
was not expected to display a protective effect exclusively in people
who had experienced trauma—in concordance with a resilienceoutcome definition resulting in a moderation effect. Rather, we expected ego-resiliency to have the same protective effect for everyone—implying a mediation effect rather than a moderation effect.
If ego-resiliency is at play, statistically controlling for ego-resiliency
should reduce the positive relationship between childhood trauma
and these different psychological symptoms to a nonsignificant relationship. In addition, because ego-resiliency is posited to occur
not only in people who suffered from childhood trauma, but also inpeople who did not undergo such types of detrimental experience(Block, 2002; Bonanno et al., 2002), ego-resiliency was hypothesized
to reduce psychological symptoms at all levels of trauma experienced (from severe trauma to none). It was thus expected that egoresiliency would act as an important mediator in the relationshipbetween childhood trauma and undesirable psychological symptoms in adulthood.

MethodParticipants
A total of 118 outpatients (82 females, 35 males, and one missing
gender value) from a psychology clinic at a Canadian university
participated in this study. These participants were assessed before
receiving a psychological treatment. Their age varied between 18
and 72 years (M = 32.82 years, SD = 12.65 years). Marital status was
distributed as follows: 66 single, 16 married, 25 common law union,nine separated or divorced, one widowed, and one missing value.
A total of 62 participants had a university educational level, 35 acollege one, 19 a high school level, and two participants reported tohave an elementary school level.
Measures
Ego-Resiliency. The level of ego-resiliency was assessed with the
Ego-Resiliency Scale (Block & Kremen, 1996). Ego-resiliency is theaptitude to adapt one’s responses to changing situation demands,

588	PHILIPPE ET AL.
Table 1. Means, Standard Deviations, and Correlations Among Childhood Trauma,
Ego-Resiliency, and Adults’ Psychological Symptoms
1. Childhood trauma

Mean

SD

Alpha

1

1.72

0.59

.92

—

2

3

4

2. Ego-resiliency

2.95

0.41

.80

-.22*

—

3. Anxiety

16.19

12.28

.92

.19*

-.28**

4. Depression

18.47

10.31

.89

.33**

-.44**.70**—

5. Self-harm behaviors

4.68

7.67

—

.22*

-.27**

.15

.27**

—

Note. n = 118. *p < .05; **p < .01.

especially frustrating and stressful encounters. This scale is composed of 14 items responded to on a 4-point Likert scale ranging
from 1 (does not apply at all) to 4 (applies very strongly). A sample
item includes “I enjoy dealing with new and unusual situations.”
Strong evidence of validity and reliability has been reported for thisscale. It has been shown to converge with behavioral descriptions as
rated by external judges blind to the participants’ responses to thescale (Block & Kremen, 1996), to be positively associated with psychological adjustment variables (Callahan, Roge, Cardenal, Cayrou,& Sztulman, 2001; Ong, Bergeman, Bisconti, & Wallace, 2006) and to
predict increases in positive emotions after a distressful encounter(Philippe, Lecours, & Beaulieu-Pelletier 2009; Tugade & Fredrickson, 2004), faster emotional recovery (Tugade & Fredrickson, 2004),
and lower depressive symptoms and increases in psychological resources in times of crisis (Fredrickson et al., 2003). The ego-resiliency scale was also shown to be negatively associated with internalizing behavior problems in children, over and beyond the five-factor
model of personality (Huey & Weisz, 1997). Table 1 presents the alpha coefficients of all the scales used in this study.
Childhood Trauma. The degree of childhood trauma was assessedwith the short form of the Childhood Trauma Questionnaire (CTQSF; Bernstein et al., 2003). This instrument assesses various typesof trauma (emotional, physical, and sexual abuse; emotional andphysical neglect) with 28 items using a 5-point Likert scale (1 = never, 5 = very often). The CTQ-SF has displayed adequate convergent
evidence of validity with therapists’ assessments of abuse histories(Bernstein et al., 2003).
Anxiety. The Beck Anxiety Inventory (BAI; Beck, Epstein, Brown,& Steer, 1988) is a 21-item scale used to assess clinical anxiety. Partic-

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589

ipants were asked to evaluate the extent to which they have been affected by different anxiety symptoms (i.e. “unable to relax” or “fearof losing control”) over the past week with a 4-point scale ranging
from 0 (not at all) to 3 (severely, I could barely stand it).
Depression. Depression was assessed with the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). The
BDI is a 21-item self-report questionnaire measuring the intensity ofdepressive symptoms over the past week on a 4-point Likert scaleranging from 0 to 3.
Self-Harm Behaviors. Self-harm behaviors were assessed with
the Self-Harm Behavior Questionnaire (SHBQ; Gutierrez, 1998).
The SHBQ is composed of four sections assessing self-harm, suicide threat, suicide ideation, and suicide attempts. Each responseis weighted by the seriousness of the behavior reported, in linewith the SHBQ manual. The total score is obtained by summing theweighted score of each section. The SHBQ has shown adequate evidence of validity (Gutierrez, Osman, Barrios, & Kopper, 2001).
Procedure
Participants were recruited while sitting in the waiting room of theuniversity’s clinic. A male experimenter introduced himself andasked if they were interested in participating in a study to learn
about people’s general psychological functioning. They were assured that their participation would be anonymous and confidential and that they could stop their participation at any time. They
were also told that their refusal to participate would not impact thecourse of their therapy or their position on the waiting list. Upon
their agreement, they were administered the questionnaire package. Participants returned the questionnaires to the experimenter
once completed.

Results
The correlations among the present study variables are presented
in Table 1. Structural equation modeling was used to assess the hypothesized mediational model. In light of the small sample size,
random item parceling was used; that is, observed index variables

590	PHILIPPE ET AL.

composed of three, four, or five items, were created for each latentconstruct (see Bandalos, 2002). There was only one observed variable for the self-harm behavior measure, since this measure is theresult of a weighted score. LISREL 8 (Jöreskog & Sörbom, 2003) wasused to estimate the model using Robust Maximum Likelihood.
This method of estimation was used in order to handle the nonnormality of the data. Ego-resiliency was modeled to fully mediate therelationships between childhood trauma and the three psychological symptoms. Covariances among the three latent variables representing the psychological symptoms were allowed to freely covary.
Fit indices for this model were satisfactory: Satorra-Bentler (SB)
χ2(113) 149.93, p = .01, NC = 1.33, RMSEA = .054 [.027; .075], CFI =.98, NNFI = .98, NFI = .93, SRMR = .086. As shown in Figure 1, childhood trauma was negatively associated with ego-resiliency, which
was in turn negatively related to depression, anxiety, and self-harmbehaviors. All indicators had high factor loadings. The inclusion ofgender and age in this model revealed that they were unrelated toall study variables and their inclusion did not alter the parameter
estimates of the above model.
Following Preacher and Hayes’s (2008) recommendations, bootstrapping analyses with 5,000 resamples were conducted to examine the significance of each of the mediations. Results revealed thatthe 99% confidence interval for the mediations of ego-resiliency between childhood trauma and depression [.035; .578], anxiety [.003;.155], and self-harm [.015; .342] did not include zero, thus suggesting that each mediation was significant at p < .01 (point estimates
were .241, .057, and .123, respectively). A partial mediation model
including the direct paths from childhood trauma to each psychological symptom was tested. Results revealed that adding each direct effect separately, all ∆SBχ2(1) =< 3.32, ps > .07, or including allof them at the same time, ∆SBχ2(3) = 5.41, p = .14, did not improvemodel fit indices (all Satorra-Bentler chi-squares were rescaled to becomparable, see Satorra & Bentler, 2001).
Although the parameter estimate of each direct path did not reachthe p < .05 significance level, we examined the range of values that
could have taken each direct path. Standardized 95% confidence intervals were computed for each direct path. Results revealed thatthe direct path from childhood trauma to depression was [-.02; .29]
with a point estimate of .13, from childhood trauma to anxiety was[-.23; .15], with a point estimate of -.04, and from childhood trauma
to self-harm behaviors was [-.04; .18], with a point estimate of .07.

Figure 1. Structural Equation Model Testing Ego-Resiliency as a Mediator in the
Relationship Between Childhood Trauma and Three Psychological Symptoms.

EGO-RESILIENCY AS A MEDIATOR
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592	PHILIPPE ET AL.

Thus, these results show that a direct effect as large as .29 could
be found between childhood trauma and depression, given another sample. Also, the upper bounds of the confidence intervals ofanxiety and self-harm behaviors show that a significant direct effect of childhood trauma on these variables might be found with alarger sample size. Thus, ego-resiliency may more realistically act
as a strong partial mediator between childhood trauma and psychological symptoms rather than as a full mediator. Importantly,
results also revealed that there were no significant interactions between ego-resiliency and childhood trauma predicting psychological symptoms (all ps > .45). Thus ego-resiliency appears to provide
a protective effect from psychological symptoms, whether trauma
has been severely experienced or not at all experienced.
Finally, the mediation analysis and the bootstrapping procedure
were conducted again with each type of childhood trauma separately in order to examine which ones were mediated by ego-resiliency. Results revealed that ego-resiliency significantly mediatedthe relationships between emotional abuse, physical neglect, andemotional neglect and all three psychological symptoms (all threebootstrap confidence intervals for each type of trauma did not include zero), but not between sexual and physical abuse and these
symptoms—although these two latter types of trauma were correlated with ego-resilience with a small and negative coefficient (-.08,ns). These results thus suggest that ego-resiliency is less implicatedas a protective factor when sexual and physical abuses are at play.

Discussion
The purpose of the present research was to investigate the role ofego-resiliency in mediating between childhood trauma and various psychological symptoms. Mediation analyses showed thatego-resiliency mediated the relationship between childhood trauma and three different types of psychological symptoms—anxiety,depression, and self-harm behaviors. These findings indicate thatego-resiliency may play a protective role in preventing psychological symptoms, and that this beneficial effect seems to exist for all
levels of trauma. Indeed, results showed that when ego-resiliency
was modeled as a mediator, all the relationships between childhood
trauma and psychological symptoms were significantly reduced. In
addition, there were no interactions between childhood trauma andEGO-RESILIENCY AS A MEDIATOR

593

ego-resiliency, thus suggesting that this mediation effect existed at
all levels of trauma. These results indicate that, in line with otherauthors (Bonanno, 2004; Fredrickson et al., 2003; Ong et al., 2006),
ego-resiliency may be present in all individuals, with prior experiences of trauma or not, and that it protects against the emergence of
psychological symptoms at all levels of trauma. However, further
analyses also showed that ego-resiliency was a significant mediator
between childhood trauma and psychological symptoms as long as
emotional abuse, physical neglect, and emotional neglect were concerned. The mediation appeared to be much weaker when childhood trauma involves physical and sexual abuse.
The present research has implications with respect to the difference between the resilience as an outcome and the ego-resiliency
perspectives and their integration in a common framework. Recently, some authors have underlined the importance of disentanglingthese two constructs in scientific writings, and some have further
argued against using terms that suggest a personality trait in the
study of resilience, such as resiliency or ego-resiliency (Luthar etal., 2000; Reynolds, 1998). Although resilience as an outcome andego-resiliency can address separate aspects of resilience (see Luthar
et al., 2000 on the differences between a protective effect and othertypes of effect), the mediation analyses from the present researchsuggest that ego-resiliency, which describes people’s psychological processes in terms of a dynamic trait, plays a significant rolein the process of resilience as an outcome by protecting one fromdeveloping subsequent psychological symptoms after a traumatic
event. This is the first empirical combination of these two processes
in the relationship between childhood trauma and mental health inadulthood, supporting the thesis put forward by several authorsthat ego-resiliency is involved in the dynamic process of resilience
as an outcome (Block, 2002; Cicchetti & Rogosch, 1997; Cicchetti,
Rogosh, Lynch, & Holt, 1993). However, one important differencewith the resilience as an outcome perspective is that the experience of a trauma is not a sine qua non condition to benefit fromthe protective effect of ego-resiliency on mental health. The present
findings also extend previous research (Cicchetti & Rogosch, 1997;
Cicchetti et al., 1993) showing that ego-resiliency was positively associated with adaptive functioning in children, by highlighting thatego-resiliency also provides a long-term protective effect lasting
into adulthood. In addition, the present findings suggest that theprotective role of ego-resiliency is the same when no severe trauma

594	PHILIPPE ET AL.

has been experienced in childhood. However, it remains unclear ifother types of resilient markers that have been used in past researchsuch as social functioning and academic achievement might yield
the same results. Future research is needed to clarify this issue.
Relatedly, it would be interesting for future research to examine
whether other personal attributes or environmental factors may
moderate the mediation Childhood trauma → Ego-resiliency →Psychological symptoms, or some part of it. For example, the relationship between childhood trauma and ego-resiliency may be lessnegatively correlated for certain people possessing certain attributes
or living in some type of protective environment, which allowed
them to develop higher levels of ego-resiliency. Such types of moderation would provide an even larger integrative framework for thedefinitions of resilience presented in this article. Furthermore, otherfactors may increase ego-resiliency and thus reveal other mediating effects on psychological symptoms. These other mediating andmoderating factors may provide a base for interventions seeking toincrease people’s ego-resilience.
Limitations
Some limitations of the present study need to be underscored. First,
the present research was cross-sectional. Therefore, nothing canbe inferred with respect to the causality of the relationships in thisstudy. Future research should use longitudinal designs to confirm
the mediating role of ego-resiliency between childhood trauma andpsychological symptoms. A second limitation is that the present
study used a clinical sample composed of outpatients with moderate levels of psychological symptoms. It is unknown if the mediations highlighted in the present study would also hold in a sample
of inpatients with higher levels of psychological symptoms. Similarly, it might even be argued that the most resilient people would
not need to consult for psychological treatment (although one
should be cautious not to treat resilience as a state of invulnerability). Therefore, there is a need to replicate the present findings witha nonclinical population and with a clinical population of patientswith more severe psychological symptoms. A third limitation is that
only self-report measures were used. Although all measures usedin the present research have been shown to highly correlate with

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interview-based assessments, future research is needed to replicate
the present findings using psychiatric evaluations and diagnoses.
Despite these limitations, the present research provides evidence
for the protective role of ego-resiliency in preventing long-term psychological symptoms at all levels of trauma intensity. It further suggests that ego-resiliency is involved in the developmental processof resilience as an outcome. However, when physical and sexual
abuses have been experienced, ego-resiliency seems to be a weakerprotective factor. Future investigations of these issues appear promising.

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