创伤与治疗杂志

The Various Care Requirements of Psychotraumatized Subjects: From Linguistic Desert to Therapeutic Perspectives

Abstract

Yann Auxemery

Background: The cardinal symptoms of posttraumatic stress disorder, which is exhibited as intrusions, avoidance strategies and hypervigilance, are rarely highlighted by psycho traumatized patients when they seek care. Furthermore, the clinical features of posttraumatic stress disorder (PTSD) change over time and vary between patients; thus, a classical description of PTSD that can apply to all patients is more of the exception than the rule.
Clinical findings: Many comorbidities affect both the clinical presentation and the development of PTSD. The demand for care is generally expressed via addictive and somatic comorbidities in psycho traumatized subjects: physical bodily injuries are more socially acceptable than psychological injuries. Indeed, the multifaceted nature of PTSD can often mislead clinicians because they tend to focus on the somatic complaints. Psychological comorbidities can also be present, such as depressive and anxiety disorders, dissociative disorders, psychoactive substance use and suicidal behavior.
Literature findings: PTSD is favored by a polygenic vulnerability, and a preponderance of susceptibility to neuromodulation implicates various endophenotypes, which explain the different clinical dimensions that are encountered. But no neurobiological study has revealed a biological marker which would apparently and inevitably destine a subject to structure a PTSD in reaction to a stress. In contrast, the psychopathological study discovers afterwards that a particular subject has necessarily built a traumatic repetition syndrome according to the concordance of significant data relating to their history.
Conclusion: Although the only FDA-approved drugs for the treatment of PTSD are sertraline and paroxetine, numerous studies have evaluated the use of Serotonin-norepinephrine reuptake inhibitors and atypical antipsychotics. The psychotherapy will thus require active commitment of the subject who far from clearing themselves of the traumatic scene will produce meaning by breaking away from a purely passive position taken at the heart of the tragedy. If the trauma is in essence nonsense, the psychotherapeutic reconstruction will promote this search for a meaning enabling the subject to continue to produce rather than again returning to real death.