Symptoms of traumatic pathologies, in the military field, have been described for a very long time before medical psychologists study them.
The German neurologist Hermann Oppenheim (1889) was the first to use the term “traumatic neurosis” to describe the symptoms presented by accident victims of railway construction.
The term "post-traumatic stress disorder" has subsequently been attributed to a whole range of symptoms and disorders resulting from industrial or technological accidents. With the two world wars that marked the last century, military psychiatry took hold of the expression, then the pacifists and feminists of the 1960s and 1970s broadened the meaning to include the problems engendered through family and social violence.
During the time of the construction of the railroads, Charcot noticed similar symptoms in his patients at the “ Salpêtrière” Hospital in Paris. He devoted himself, like Pierre Janet and Sigmund Freud, to the study of "hysterical neurosis".
Charcot was the first to describe suggestibility problems and the memorable dissociation crises resulting from the excruciating experiences of his patients. While Charcot urged Janet to study the nature of dissociation and traumatic memories, two of their students, Gilles de la Tourette and Joseph Babinski, focused on hysterical suggestibility.
When Babinski took over the management of the hospital after Charcot, the thesis defended by Charcot of the organic origin of hysteria was refused. Babinski instead insisted on the role of simulation and suggestibility in the etiology of hysteria.
The Interest in the notion of trauma increased during the First World War, which claimed millions of civilian and military victims. Military psychiatry was first interested in the "shock of the trenches" (Shellshock) (Myers, 1940; Southard, 1919) caused by the terror of artillery bombardments and the horror of the butchery of dislocated bodies or the " war neurosis ”(Grinker and Spiegel, 1943, 1945; Mott, 1919) or to“ traumatophobia ”(literally“ fear of injury ”, Hado, 1942) which is invoked to justify convictions and executions for“ cowardice in front of the enemy ”.
" According to a recent study, artificial intelligence can limit interview interpretation bias, and help diagnose a state of PTS in veteran soldiers just by analyzing their voice (89% success rate). "
Post-traumatic stress disorder refers to a psychological illness that develops after an extremely traumatic event following a severe experience with a confrontation with ideas of death, a situation during which the physical or psychological integrity of the patient, or that of his entourage, has been threatened or actually harmed, for example, torture, rape, serious accident, violent death, and war.
The adaptation mechanism (how to cope) is overwhelmed, the patient feels an intense fear (dread), helplessness, or horror. It should not be confused with the acute stress response, it is another entity.
According to epidemiology studies, about 70% of adults have experienced a traumatic event in their lifetime and 12% of them suffer from post-traumatic stress disorder.
And thus, PTSD is much less common than the acute stress response but can cause clinical alteration in important areas of function.
The patient with PTSD systematically avoids any event or discussion leading to their emotions. Despite this, the event keeps coming back as flashbacks or nightmares. The severity of PTSD differs depending on how long the patient has these symptoms, if it is less than 3 months it is said to be a severe case and if it is longer: the PTSD is chronic .
The doctor recognizes the syndrome with its pathognomonic triad:
Intrusion, hyperstimulation, and avoidance.
• intrusion: the inability to prevent these memories from coming back to haunt the patient. Some patients even speak of reviviscence to say how it is more real pervasive flashbacks than just “ some memories “ .
Nightmares are another manifestation of this type of symptom.
• hyperstimulation: the patient suffers from hypervigilance which leads to concentration troubles, insomnia, nervousness, a tendency to be easily frightened, a constant feeling of danger or an imminent disaster, huge irritability, or even violent behavior. In children, disorganized or restless behavior may be perceived. An intense feeling of psychic distress can arise when the individual is exposed to elements that evoke the traumatic event.
• avoidance: the patient tries to avoid situations and triggers that could remind him of the traumatic event and this is totally beyond his control, often mistakenly confused with schizophrenia, he will also tend to avoid talking about it to avoid being directly confronted with it. This can lead to partial or total amnesia of the event; this behavior is the main response to psychological trauma. So, avoiding thinking about it becomes imperative in traumatized patients.
For Carlson, post-traumatic stress avoidance can manifest emotionally, cognitively, behaviorally, and physiologically.
• Emotional avoidance: an emotional indifference , a form of detachment from others. It can take the form of isolation from effects and social isolation.
• Behavioral avoidance: it consists of moving away unintentionally from anything that may recall the tragedy. It can be intentional!
• Physiological avoidance: it's a "sensory indifference" . Traumatized people report having an attenuation of the sensations of pleasure or pain, it is also observed in the attenuation of the sensations associated with the experience of chronic trauma (Herman, 1992).
• The fear of being afraid: it can lead the patient to avoid an increasing number of activities in order to avoid emotions, feelings, and memories.
Another aspect of this avoidance symptom is emotional insensitivity; The individual loses interest in activities that once fascinated him, isolates himself, and flees his relatives, he can have serious relationship difficulties and be misunderstood by people around him because of it. It can even lead to a dissociative state when interpersonal, verbal, and mental abilities are impaired.
A particular form: The complex PTSD
It occurs when the individual has been exposed to physical, verbal, or psychological violence repeatedly during which he was unable to defend himself. It is manifested by the following symptoms:
- an alteration in the regulation of emotions, with marked impulsivity and disturbance of attention or consciousness, which can lead to dissociative episodes when the mind is disconnected: the patient has the impression of no longer existing (depersonalization) or no longer manages to take an interest in the world around him (derealization); permanent feelings of shame or guilt, and a feeling of emptiness;
- an alteration in the perception of the aggressor, which may for example be idealized. He may also experience unexpected gratitude towards his aggressor ( Stockholm Syndrome).
- disrupted interpersonal relationships, with an inability to trust or have an intimate relationship with others.
- cognitive impairment with loss of hope.
These disorders are sometimes accompanied by depression, alcohol dependence (or other drugs), suicidal ideas, Alzheimer's in the elderly ...
Alcohol dependence and other addictions can be aggravating factors for PTSD. However, addictions seem to be more of a consequence of PTSD (frequent comorbidity), the person thus seeking to anesthetize himself and to alleviate his very debilitating symptoms and sources of his wounds
The scale used for the diagnosis and monitoring of patients with PTSD is the CAPS, for the "Clinician-Administered PTSD Scale" 1990, this scale has become a measurement criterion commonly used in the field of post-traumatic stress. It has been used in over 200 studies. This scale would have excellent reliability, useful for diagnosis, and have good sensitivity to clinical change.
What's new:
According to Professor Jean-Michel Constantin, an anesthesiologist at the Pitié-Salpêtrière Hospital in Paris, after the end of their treatment, patients who were intubated during the COVID 19 epidemic undergo post-stress traumatic post-COVID 19.
A study carried out in 2000 of more than 1000 Filipino boys who underwent ritual circumcision (outside of a medical environment) showed that more than half of them suffered from PTSD after their circumcision.
Treatment :
Variable and has inconsistent and different results from patient to patient:
Recovery from post-traumatic stress disorder or other anxiety disorders may be limited or the condition may worsen, due to abuse or excessive medication. Solving these addiction problems allows a clear improvement in the mental health of the patient and his degree of anxiety.
- Psychotherapy: Psychotherapy treatments are offered as a first-line treatment regardless of the time elapsed since the traumatic event (s). They aim to eliminate all post-traumatic symptoms and thus allow the victim to regain the previous status. If there is no improvement or limited improvement, a reassessment of the diagnosis, or a change of therapy, or a change of practitioner, or even intensification of the therapy (drugs may then be offered in complement).
- Cognitive-behavioral therapy: involving breathing exercises, relaxation training, interrupting negative thoughts, "mental imagery" therapy (that is, imagery involving reliving the trauma), or brain therapy. repeated exposure also allows a significant reduction in symptoms.
- EMDR : its effectiveness is recognized by the WHO (2013). It therefore currently appears to be the best therapy for everything related to psychotraumatology because it is an integrative therapy: it seems to put into action the psychodynamic, cognitive, behavioral, emotional, physical and sensory aspects simultaneously. Its originality lies mainly in this last point. It would seem that the ocular sensory stimulation, tactile or sound, of dysfunctional information of traumatic origin makes it possible to restart its processing and its classification in an explicit / narrative memory rather than in an implicit / motor memory .
- Hypnosis : the NLP technique or the hypnotic treatment of phobias are particularly indicated. The object is based on a double dissociation explained by the work of Richard Bandler.
- Transcendental meditation : research has shown that the practice of Transcendental Meditation (TM) generates a significant reduction in symptoms within a short period of time. Meditation makes one feel more responsible for one's well-being than other treatments: “I wanted to remedy this, but felt that I had to do it myself” .It demonstrates its effectiveness during anxiety states as well as in the treatment of post-traumatic stress disorder with a more marked effectiveness in higher levels of anxiety, allowing the reduction and sometimes the cessation of psychotropic drugs.
- Drug treatments: indicated in cases of chronic disorder lasting more than one year, and for which comorbidity is associated (often depression)
- Antidepressants: SSRI-type antidepressants are offered as the first line. Tetracyclic antidepressants show relative effectiveness.
- Beta-blockers and alpha-blockers beta-blockers, such as propranolol as well as alpha-blockers such as prazosin, are particularly effective. Regarding propranolol, it has proven its effectiveness (prevents the effects of adrenaline) by reducing the spontaneous and initial anxiety load of the event and thus, would limit or even prevent the constitution of anxiety-inducing and recurring memories linked to this event. The prescription of beta-blocker on demand, at the end of each relapse of post-traumatic stress, could avoid the memory recycling of the emotional load of the stressful original event.
- Other drugs: alpha 2 agonists, antihistamines, neuroleptics
7. Psychotherapy assisted by MDMA:
The MAPS, Multidisciplinary Association for Psychedelic Studies, which studies the therapeutic potential of psychedelic substances (LSD, Psilocybin,,, Ibogaine, Ayahuasca ...), conducted the first two phases of trials with convincing results. Indeed, after a single dose (participants receiving either a placebo or MDMA) 83% of the participants were no longer considered to be suffering from PTSD, and this for the two months following the dose. The experiment was preceded and followed by a psychotherapy session this time without substance, and it was noted that over time the results remained stable: more than 3 and a half years after the session, people confirmed the effect. beneficial experience in their lives.
However, it is important to note that in this study MDMA is not Ecstasy but a pure product : the use, and synthesis have been controlled and the 3rd phase of the study has been approved by the FDA.
MDMA could be the first psychedelic substance (although it is more precisely an empathogen) reintroduced in 2021 in the medical environment, administered by psychiatrists and doctors trained in psychedelic therapy, a first since the wave of prohibition of psychedelics in the 1960s.
June is Post traumatic Stress Disorder (PTSD) Awareness Month.
