Post-traumatic stress disorder (PTSD), like acute stress disorder, is characterized by the onset of symptoms immediately after a traumatic event. Consequently, patients with PTSD always exhibit new symptoms or changes in symptoms that reflect the specific nature of the trauma.

Although people with PTSD attribute varying levels of significance to the event, they all experience symptoms related to the trauma. The traumatic event that leads to the development of post-traumatic stress disorder usually involves experiencing the threat of one's own death (or injury) or being present at the death or injury of others. When experiencing a traumatic event, individuals who develop PTSD should experience intense fear or horror. Similar experiences can be experienced by both a witness and a victim of an accident, crime, combat, attack, child theft, or natural disaster. Post-traumatic stress disorder can also develop in a person who learns that he has a terminal illness or who experiences repeated physical or sexual abuse. There has been a direct relationship between the severity of psychological trauma, which, in turn, depends on the degree of threat to life or health, and the likelihood of developing post-traumatic stress disorder.

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ICD-10 code

F43.1 Post-traumatic stress disorder

What Causes Post-Traumatic Stress Disorder?

Post-traumatic stress disorder is sometimes thought to occur after an acute reaction to stress. However, post-traumatic stress disorder can also develop in people who did not show any mental disorders after a disaster (in these cases, post-traumatic stress disorder is considered as a delayed reaction to the event). Post-traumatic stress disorder occurs somewhat less frequently in people who have previously experienced disasters. due to repeated minor mental trauma. Some people who have experienced an acute stress reaction develop post-traumatic stress disorder after a transition period. At the same time, disaster victims often develop the idea that human life is of little value.

Scientific research into post-traumatic stress disorder is a relatively new trend and is likely to increase in importance in forensic psychiatry. There have already been references to post-traumatic stress disorder as a psychological harm in cases of stalking. Childhood trauma, physical abuse, and especially child sexual abuse are closely associated with the transformation of victim to perpetrator and rapist in adulthood. The model of borderline personality disorder suggests a direct causal relationship with long-term and repeated trauma from primary caregivers during childhood. Such prolonged and repeated trauma can greatly impact normal personal development. In adult life, acquired personality disorder may be associated with repeated episodes of maladaptive or violent behavior that “re-enact” elements of childhood trauma. Such individuals are often found in prison populations.

Several characteristics of PTSD are associated with crime. Thus, sensation-seeking (“trauma addiction”), seeking punishment to alleviate feelings of guilt, and the development of comorbid substance abuse are associated with crime. During flashbacks (intrusive re-experiencing), a person may react in an extremely violent manner to environmental stimuli that are reminiscent of the original traumatic event. This phenomenon was noted among participants in the Vietnam War and among police officers, who may react with violence to some stimulus that reflects the situation “on the battlefield.”

How does post-traumatic stress disorder develop?

Because PTSD is a behavioral disorder resulting from direct exposure to trauma, understanding its pathogenesis requires reference to numerous studies of traumatic stress in experimental animals and humans.

Hypothalamic-pituitary-adrenal axis

One of the most commonly identified changes in post-traumatic stress disorder is dysregulation of cortisol secretion. Role hypothalamic-pituitary-adrenal axis (HPA) in acute stress has been studied for many years. A large amount of information has been accumulated on the effects of acute and chronic stress on the functioning of this system. For example, it was revealed: although during acute stress there is an increase in the level corticotropin-releasing factor (CRF), adrenocorticotropic hormone (ACTH) and cortisol, there is a decrease in cortisol release over time, despite an increase in CRF levels.

In contrast to major depression, which is characterized by a violation of the regulatory function of the HPA axis, post-traumatic stress disorder reveals increased feedback in this system.

Thus, patients with post-traumatic stress disorder have lower cortisol levels during its normal daily fluctuations and higher sensitivity of corticosteroid receptors of lymphocytes than patients with depression and mentally healthy individuals. Moreover, neuro-endocrinological tests show that in post-traumatic stress disorder there is increased ACTH secretion with the administration of CRF and increased cortisol reactivity in the dexamethasone test. It is believed that such changes are explained by dysregulation of the HPA axis at the level of the hypothalamus or hippocampus. For example, Sapolsky (1997) argues that traumatic stress, through its effect on cortisol secretion, causes hippocampal pathology over time, and MRI morphometry shows that hippocampal volume reduction is observed in PTSD.

Autonomic nervous system

Since hyperactivation of the autonomic nervous system is one of the key manifestations of post-traumatic stress disorder, research has been undertaken on the noradrenergic system in this condition. When yohimbine (an alpha2-adrenergic receptor blocker) was administered, patients with post-traumatic stress disorder experienced flashbacks and panic-like reactions. Positron emission tomography suggests that these effects may be due to increased sensitivity of the noradrenergic system. These changes can be associated with data on HPA tract dysfunction, taking into account the interaction of the HPA axis and the noradrenergic system.

Serotonin

The clearest evidence for the role of serotonin in PTSD comes from pharmacological studies in humans. There is also evidence from animal models of stress that also suggests the involvement of this neurotransmitter in the development of post-traumatic stress disorder. It has been shown that environmental factors can have a significant impact on the serotonergic system of rodents and great apes. Moreover, preliminary data show that there is a connection between the external conditions of raising children and the activity of their serotonergic system. At the same time, the state of the serotonergic system in post-traumatic stress disorder remains poorly understood. Additional research is needed using neuroendocrinological tests, neuroimaging, and molecular genetic methods.

Conditioned reflex theory

It has been shown that post-traumatic stress disorder can be explained based on the conditioned reflex model of anxiety. In post-traumatic stress disorder, deep trauma can serve as an unconditioned stimulus and could theoretically influence the functional state of the amygdala and associated neural circuits that generate feelings of fear. Overactivity of this system may explain the presence of “flashbacks” and a general increase in anxiety. External manifestations associated with trauma (eg, sounds of battle) can serve as conditioned stimuli. Therefore, similar sounds through the mechanism of a conditioned reflex can cause activation of the amygdala, which will lead to a “flashback” and increased anxiety. Through connections between the amygdala and the temporal lobe, activation of the neural circuit that generates fear can “revive” memory traces of a traumatic event even in the absence of corresponding external stimuli.

Among the most promising studies were studies that examined the strengthening of the startle reflex under the influence of fear. A flash of light or sound acted as a conditioned stimulus; they were turned on after the presentation of an unconditional stimulus - an electric shock. An increase in the amplitude of the startle reflex upon presentation of a conditioned stimulus made it possible to assess the degree of influence of fear on the reflex. This response appears to involve the fear circuit described by LeDoux (1996). Although there are some inconsistencies in the findings, they indicate a possible connection between post-traumatic stress disorder and the fear-potentiated startle reflex. Neuroimaging methods also indicate the involvement of structures related to the generation of anxiety and fear in post-traumatic stress disorder, primarily the amygdala, hippocampus and other structures of the temporal lobe.

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Symptoms of Post-Traumatic Stress Disorder

Post-traumatic stress disorder is characterized by three groups of symptoms: constant experience of a traumatic event; desire to avoid stimuli reminiscent of psychological trauma; increased autonomic activation, including increased startle response (startle reflex). Sudden painful plunges into the past, when the patient relives what happened again and again as if it happened just now (so-called “flashbacks”), is a classic manifestation of post-traumatic stress disorder. Constant experiences can also be expressed in unpleasant memories, difficult dreams, increased physiological and psychological reactions to stimuli that are in one way or another associated with traumatic events. To diagnose post-traumatic stress disorder, the patient must exhibit at least one of these symptoms, reflecting the constant experience of a traumatic event. Other symptoms of PTSD include avoidance of trauma-related thoughts and actions, anhedonia, decreased memory for trauma-related events, blunted affect, feelings of alienation or derealization, and feelings of hopelessness.

PTSD is characterized by an exacerbation of the instinct of self-preservation, which is typically characterized by an increase and preservation of constantly increased internal psycho-emotional stress (excitement) in order to maintain a constantly functioning mechanism for comparing (filtering) incoming external stimuli with stimuli imprinted in consciousness as signs of an emergency.

In these cases, there is an increase in internal psycho-emotional stress - hypervigilance (excessive vigilance), concentration, increased stability (noise immunity), attention to situations that the individual regards as threatening. There is a narrowing of the volume of attention (a decrease in the ability to hold a large number of ideas in the circle of voluntary purposeful activity and difficulty in freely operating with them). An excessive increase in attention to external stimuli (the structure of the external field) occurs due to a reduction in attention to the structure of the subject’s internal field, making it difficult to switch attention.

One of the significant signs of post-traumatic stress disorder is disorders that are subjectively perceived as various memory impairments (difficulty in memorizing, retaining certain information in memory and reproducing). These disorders are not associated with true disorders of various memory functions, but are caused primarily by difficulty concentrating on facts that are not directly related to the traumatic event and the threat of its reoccurrence. However, victims cannot remember important aspects of the traumatic event, which is due to disturbances that occurred during the acute stress response stage.

Constantly increased internal psycho-emotional tension (excitement) supports a person’s readiness to respond not only to a real emergency, but also to manifestations that are to one degree or another similar to a traumatic event. Clinically, this manifests itself as an exaggerated startle response. Events symbolizing the emergency and/or reminiscent of it (visiting the grave of the deceased on the 9th and 40th days after death, etc.), a subjective deterioration of the condition and a pronounced vasovegetative reaction are observed.

Simultaneously with the above-mentioned disorders, involuntary (without a sense of accomplishment) memories of the most vivid events associated with the emergency occur. In most cases, they are unpleasant, but some people themselves (through an effort of will) “evoke memories of an emergency,” which, in their opinion, helps them survive this situation: the events associated with it become less scary (more ordinary).

Some people with PTSD may at times experience flashbacks - disorders manifested by the emergence of involuntary, very vivid ideas about a traumatic situation. Sometimes it is difficult to distinguish them from reality (these conditions are close to clouding of consciousness syndromes), and a person at the moment of experiencing a flashback can show aggression.

Sleep disturbances are almost always present in post-traumatic stress disorder. Difficulty falling asleep, as noted by victims, is associated with an influx of unpleasant memories of the emergency. There are frequent night and early awakenings with a feeling of unreasonable anxiety “something must have happened.” Dreams are noted that directly reflect the traumatic event (sometimes the dreams are so vivid and unpleasant that the victims prefer not to fall asleep at night and wait until the morning “to sleep peacefully”).

The constant internal tension in which the victim is (due to the exacerbation of the instinct of self-preservation) makes it difficult to modulate affect: sometimes victims cannot restrain outbursts of anger even for a minor reason. Although outbursts of anger may be associated with other disorders: difficulty (inability) to adequately perceive the emotional mood and emotional gestures of others. Victims also experience alexithymia (the inability to verbalize emotions experienced by themselves and others). At the same time, there is difficulty in understanding and expressing emotional undertones (polite, soft refusal, wary benevolence, etc.).

People suffering from post-traumatic stress disorder may experience emotional indifference, lethargy, apathy, lack of interest in the surrounding reality, a desire to have fun (anhedonia), a desire to learn new, unknown things, as well as a decrease in interest in previously significant activities. Victims, as a rule, are reluctant to talk about their future and most often perceive it pessimistically, not seeing any prospects. They are irritated by large companies (the only exception being people who have suffered the same stress as the patient himself), they prefer to be alone. However, after a while, loneliness begins to oppress them, and they begin to express dissatisfaction with their loved ones, reproaching them for inattention and callousness. At the same time, a feeling of alienation and distance from other people arises.

Particular attention should be paid to the increased suggestibility of the victims. They are easily persuaded to try their luck at gambling. In some cases, the game is so exciting that the victims often lose everything, including the allowance allocated by the authorities for the purchase of new housing.

As already mentioned, with post-traumatic stress disorder a person is constantly in a state of internal tension, which, in turn, reduces the threshold for fatigue. Along with other disorders (decreased mood, impaired concentration, subjective memory impairment), this leads to decreased performance. In particular, when solving certain problems, victims find it difficult to identify the main one, when receiving the next task, they cannot grasp its main meaning, they strive to delegate the making of responsible decisions to others, etc.

It should be especially emphasized that in most cases the victims realize (“feel”) their professional decline and, for one reason or another, refuse the offered work (not interesting, does not correspond to their level and previous social status, is poorly paid), preferring to receive only unemployment benefits , which is much lower than the proposed salary.

The sharpening of the instinct of self-preservation leads to a change in everyday behavior. The basis of these changes are behavioral acts, on the one hand, aimed at early recognition of emergencies, on the other, representing precautionary measures against the possible re-unfolding of a traumatic situation. The precautions taken by the individual determine the nature of the stress experienced.

Earthquake survivors tend to sit close to a door or window so they can quickly leave the room if necessary. They often look at a chandelier or aquarium to determine if an earthquake is starting. At the same time, they choose a hard chair, since soft seats soften the shock and thereby make it difficult to catch the moment the earthquake begins.

Victims who have suffered bombing, upon entering the room, immediately curtain the windows, inspect the room, look under the bed, trying to determine whether it is possible to hide there during the bombing. People who took part in hostilities, upon entering a room, try not to sit with their backs to the door and choose a place from where they can observe everyone present. Former hostages, if they were captured on the street, try not to go out alone and, conversely, if the seizure took place at home, do not stay alone at home.

Persons exposed to emergency situations may develop so-called acquired helplessness: the thoughts of victims are constantly occupied with the anxious anticipation of a recurrence of the emergency. experiences associated with that time and the feeling of helplessness that they experienced. This feeling of helplessness usually makes it difficult to modulate the depth of personal involvement in contact with others. Different sounds, smells, or situations can easily trigger memories of events related to the trauma. And this leads to memories of one’s helplessness.

Thus, in victims of emergencies, there is a decrease in the overall level of personality functioning. However, a person who has experienced an emergency, in most cases, does not perceive the deviations and complaints he has as a whole, believing that they do not go beyond the norm and do not require contacting a doctor. Moreover, the majority of victims consider existing deviations and complaints as a natural reaction to everyday life and are not associated with the emergency that occurred.

The victims’ assessment of the role that the emergency played in their lives is interesting. In the overwhelming majority of cases (even if no one close to them was injured during the emergency, material damage was fully compensated, and living conditions became better), they believe that the emergency had a negative impact on their fate (“the emergency ruined their prospects”). At the same time, a kind of idealization of the past (underestimated abilities and missed opportunities) occurs. Usually, during natural emergencies (earthquake, mudflows, landslides), the victims do not look for the culprits (“God’s will”), while during man-made disasters they strive to “find and punish the culprits.” Although, if the microsocial environment (including the victim) refers to “the will of the Almighty” as “everything that happens under the sun,” both natural and man-made emergencies, there is a gradual de-actualization of the desire to find the perpetrators.

At the same time, some victims (even if they were injured) indicate that the emergency played a positive role in their lives. They note that they had a reassessment of values ​​and began to “truly value human life.” They characterize their life after an emergency as more open, in which providing assistance to other injured and sick people occupies a large place. These people often emphasize that after the emergency, government officials and the microsocial environment showed concern for them and provided great assistance, which prompted them to begin “public philanthropic activities.”

In the dynamics of the development of disorders at the first stage of PSD, the individual is immersed in the world of experiences associated with emergency situations. The individual seems to live in the world, situation, dimension that took place before the emergency. It’s as if he’s trying to bring back his past life (“return everything the way it was”), trying to understand what happened, looking for the culprits and trying to determine the degree of his guilt in what happened. If an individual has come to the conclusion that an emergency is “the will of the Almighty,” then in these cases the formation of a feeling of guilt does not occur.

In addition to mental disorders, somatic abnormalities also occur during emergencies. In approximately half of the cases, an increase in both systolic and diastolic pressure is noted (by 20-40 mmHg). It should be emphasized that the observed hypertension is accompanied only by an increase in heart rate without deterioration in mental or physical condition.

After an emergency, psychosomatic diseases often worsen (or are diagnosed for the first time) (peptic ulcer of the duodenum and stomach, cholecystitis, cholangitis, colitis, constipation, bronchial asthma, etc.). It should be especially noted that women of childbearing age quite often experience premature menstruation (less often, delayed ), miscarriages in early pregnancy. Among sexual disorders, there is a decrease in libido and erection. Often victims complain of coldness and a tingling feeling in the palms, feet, fingers and toes. excessive sweating of the extremities and deterioration of nail growth (flaking and brittleness). Deterioration in hair growth is noted.

Over time, if a person manages to “digest” the impact of the emergency, memories of the stressful situation become less relevant. He tries to actively avoid even talking about his experience, so as not to “awaken difficult memories.” In these cases, sometimes irritability, conflict and even aggressiveness come to the fore.

The types of responses described above primarily occur during emergencies in which there is a physical threat to life.

Another disorder that develops after the transition period is generalized anxiety disorder.

In addition to an acute reaction to stress, which, as a rule, resolves within three days after an emergency, psychotic-level disorders can develop, which in the domestic literature are called realistic psychoses.

Course of post-traumatic stress disorder

The likelihood of developing symptoms, as well as their severity and persistence, is directly proportional to the reality of the threat, as well as the duration and intensity of the trauma (Davidson and Foa, 1991). Thus, many patients who have suffered prolonged intense trauma with a real threat to life or physical integrity develop acute stress reactions, against the background of which post-traumatic stress disorder may develop over time. However, many patients do not develop post-traumatic stress disorder following acute stress manifestations. Moreover, the full form of post-traumatic stress disorder has a variable course, which also depends on the nature of the trauma. Many patients experience complete remissions, while others retain only mild symptoms. Only 10% of people with PTSD—perhaps those who have suffered the most severe and lasting trauma—have a chronic course. Patients are often confronted with reminders of the trauma, which can trigger an exacerbation of chronic symptoms.

Diagnostic criteria for post-traumatic stress disorder

A. The person experienced psychotrauma from an event in which both conditions occurred.

1. The person was a participant in or witness to an event involving actual or threatened death, serious physical harm, or a threat to the physical integrity of himself or others.
2. The person experienced intense fear, helplessness, or horror. Note: Children may experience inappropriate behavior or agitation instead.

B. The traumatic event is the subject of ongoing experiences that may take one or more of the following forms.

1. Recurrent, intrusive, depressing memories of the trauma in the form of images, thoughts, sensations. Note: Young children may have ongoing games that are related to the trauma they have experienced.
2. Recurring, painful dreams that include scenes from the experience. Note: Children may have frightening dreams without specific content.
3. The person acts or feels as if he is reliving the traumatic event (in the form of relived experiences, illusions, hallucinations, or dissociative flashback-type episodes, including at the moment of awakening or during intoxication). Note: Children may experience repeated episodes of trauma.
4. Intense psychological discomfort when in contact with internal or external stimuli that symbolize or resemble a traumatic event.
5. Physiological reactions upon contact with internal or external stimuli that symbolize or resemble a traumatic event.

B. Persistent avoidance of stimuli associated with the trauma, as well as a number of general symptoms that were not present before the trauma (at least three of the following symptoms are required).

1. Trying to avoid thoughts, feelings, or conversations about the trauma.
2. The desire to avoid actions, places, people that can remind you of the trauma.
3. Inability to remember important details of the injury.
4. Marked limitation of interests and desire to participate in any activity.
5. Detachment, isolation.
6. Weakening of affective reactions (including the inability to experience love feelings).
7. Feelings of hopelessness (lack of any expectations related to career, marriage, children, or life expectancy).

D. Persistent signs of increased excitability (absent before the injury), which are manifested by at least two of the following symptoms.

1. Difficulty falling or staying asleep.
2. Irritability or angry outbursts.
3. Impaired concentration.
4. Increased alertness.
5. Strengthened startle reflex.

D. The duration of symptoms specified in criteria B, C, D is at least one month.

E. The disorder causes clinically significant discomfort or disrupts the patient’s functioning in social, professional, or other important areas.

The disorder is classified as acute if the duration of symptoms does not exceed three months; chronic - when symptoms persist for more than three months; delayed - if symptoms appear no earlier than six months after the traumatic event.

To be diagnosed with PTSD, at least three of the following symptoms must be present. Of the symptoms of increased activation (insomnia, irritability, increased excitability, increased startle reflex), at least two must be present. A diagnosis of post-traumatic stress disorder is made only if the noted symptoms persist for at least a month. Acute stress disorder is diagnosed before the month is reached. The DSM-IV identifies three types of post-traumatic stress disorder with different courses. Acute PTSD lasts less than three months; chronic PTSD lasts longer. Delayed PTSD is diagnosed when symptoms become apparent six months or more after the injury.

Because severe trauma can cause a range of biological and behavioral reactions, the survivor may experience other physical, neurological, or mental disorders. Neurological disorders are especially likely when the injury involved not only psychological, but also physical effects. A patient who has suffered a trauma often develops mood disorders (including dysthymia or major depression), other anxiety disorders (generalized anxiety or panic disorder), and drug addiction. Studies have noted a connection between some mental manifestations of post-traumatic syndromes and premorbid status. For example, post-traumatic symptoms are more likely to occur in individuals with premorbid anxiety or affective symptoms than in previously mentally healthy individuals. Thus, analysis of premorbid mental status is important for understanding symptoms that develop after a traumatic event.

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Differential diagnosis

Caution must be exercised when diagnosing PTSD to first rule out other syndromes that may occur after trauma. It is especially important to recognize treatable neurological or medical conditions that may contribute to the development of post-spout symptoms. For example, traumatic brain injury, drug addiction, or withdrawal symptoms may cause symptoms that appear immediately after the injury or several weeks later. Identification of neurological or somatic disorders requires a detailed history, a thorough physical examination, and sometimes neuropsychological testing. In classic uncomplicated post-traumatic stress disorder, the patient’s consciousness and orientation are not affected. If a neuropsychological examination reveals a cognitive defect that was absent before the injury, organic brain damage should be excluded.

Symptoms of PTSD can be difficult to distinguish from those of panic disorder or generalized anxiety disorder because all three conditions involve significant anxiety and increased autonomic reactivity. Establishing a temporal relationship between the development of symptoms and the traumatic event is important in diagnosing post-traumatic stress disorder. In addition, with post-traumatic stress disorder, there is a constant experience of traumatic events and a desire to avoid any reminder of them, which is not typical for panic and generalized anxiety disorder. Post-traumatic stress disorder often has to be differentiated from major depression. Although these two conditions can be easily distinguished by their phenomenology, it is important not to overlook comorbid depression in patients with PTSD, which can have an important impact on the choice of treatment. Finally, post-traumatic stress disorder should be differentiated from borderline personality disorder, dissociative disorder, or premeditation, which may have clinical manifestations similar to PTSD.

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When, after difficult experiences, people experience difficulties associated with them, we talk about post-traumatic stress disorder (PTSD). People may notice thoughts or memories of the traumatic event intruding into their thoughts, affecting their concentration during the day, and appearing as dreams at night.

Waking dreams are also possible, and they can seem so real that a person may feel as if he is reliving the same traumatic experience. Sometimes such re-experiencing is called psychopathological re-experiencing.

Psychopathological re-experiences

Psychopathological experiences differ from each other and depend on the nature of the psychological trauma. People with these types of experiences typically have the most severe symptoms of PTSD.

One of the features of these experiences is intrusive memories and thoughts about the trauma. Patients usually remember sad events that they experienced in the past, such as the death of other people.

In addition, these can be frightening memories because when a person experiences a psychological trauma, they usually experience intense fear.

Sometimes memories of the past make a person feel guilty, sad or afraid. Even if a person does not specifically remember, but simply encounters something that reminds him of the trauma, he begins to feel tension, anxiety and insecurity.

For example, we often notice that soldiers coming home from war zones are constantly anxious and uncomfortable in situations in which they feel vulnerable. They constantly watch for doors opening and closing and act cautiously in crowded places.

In addition, their arousal system is quickly activated, and they are often tense, irritable, and have anxiety attacks. They may experience this even when they are not thinking about the injury.

Typically, psychopathological experiences are short-lived and last one or two minutes. But when a person experiences psychopathological re-experiencing, they react poorly to external stimuli.

However, if you are talking to a person with a psychopathological re-experiencing and can engage them in conversation, you can make the re-experiencing shorter. There are also medications, such as Valium, that can help people relax in these situations.

Symptoms and diagnosis

Main symptoms of post-traumatic stress disorder- these are obsessive thoughts about the injury, hyperarousal, and sometimes shame and guilt. Sometimes people cannot feel emotions and act like robots in everyday life.

In other words, people do not experience any emotions or do not experience any specific emotions such as pleasure.

In addition, they constantly feel like they have to defend themselves, they are in a state of anxiety, and they experience some symptoms of depression. These are the main groups of symptoms of post-traumatic stress disorder.

It would be nice if there was some kind of biological test that would tell us whether a person has PTSD without checking for symptoms. But in general, PTSD is diagnosed by getting every detail of the patient's history of what happened to them and then examining the history of each symptom.

There are several diagnostic criteria, and if you observe enough symptoms, you may be diagnosed with PTSD. However, there are people whose disorder does not meet diagnostic criteria because they do not have all the symptoms but still have symptoms associated with PTSD.

Sometimes, even if you don't fully meet the diagnostic criteria, you still need help managing your symptoms.

History of research

Interestingly, researchers, relying on literature, turning to the Iliad and other historical sources, have proven that people at all times realized that a person will always respond to a terrible experience with a strong emotional reaction.

However, the term “post-traumatic stress disorder” did not appear as a formal diagnosis until 1980, which is quite recent in terms of the history of psychiatry.

During the American Civil War, the Crimean War, World Wars I and II, the Korean War, the Vietnam War - all of these events at the beginning of the conflict, physicists, psychologists or mental health specialists behaved as if they had forgotten all previous experience previous wars.

And each time, at the end of one of them, a clinical examination was carried out at a level that was high for this historical period.

Soldiers during the Battle of the Somme in World War I, many of whom suffered "trench shock"

During the First World War, much work was done on what was then called trench shock, or traumatic neurosis.

In the US, psychiatrist Abram Kardiner wrote extensively on this topic, and Sigmund Freud wrote about it at the end of the First World War and during the Second. When people see so much trauma, a serious understanding of the phenomenon begins, but on the other hand, there seems to be a tendency that in society, after major traumatic periods, knowledge about trauma and its importance is gradually lost.

However, after World War II, Dr. Grinker and Spiegel's classic study of pilots appeared, which can be considered a remarkable description of post-traumatic stress disorder.

In the late 1950s and early 1960s, a group of psychiatrists studied PTSD. Robert J. Lifton was one of them, as was my father, Henry Crystal. After that there was a whole group of people, including Matt Friedman, Terry Keene, Dennis Cerny, etc., who worked with Vietnam veterans, as well as many other researchers from around the world, such as Leo Eitinger and Lars Weiseth. This is a field of research, this problem is relevant in all countries, and in each country there are people who study this phenomenon and contribute to the common work.

One important PTSD researcher was my father, Henry Crystal, who passed away last year. He was one of the survivors of Auschwitz and also went through other camps. When he was released from the camps, he decided to try medical school.

He eventually moved to the United States with his aunt, graduated from medical school, became involved in psychiatry, and began working with other survivors of Nazi death camps. Examining other survivors claiming disability benefits, he carefully studied their cases, which became one of the earliest descriptions of post-traumatic stress disorder.

He was a psychoanalyst, so he tried to develop psychotherapeutic approaches from a psychoanalytic point of view, which included elements of behavioral psychology, cognitive neuroscience and other disciplinary fields that interested him.

In this way, he developed some improvements in therapy to help people with PTSD, who often had difficulty expressing emotions and feelings.

Classification of injury

One important outcome of cultural experiences such as war and other major shocks is that we have begun to broaden our appreciation of those situations that can lead to trauma (adult trauma, childhood trauma, physical or sexual abuse), or situations where the patient witnesses terrible events and so on.

Thus, PTSD in society extends beyond social groups such as soldiers for whom PTSD is a prominent problem.

What is often misunderstood about PTSD is that it doesn't matter how bad the events were from the other person's perspective. Although there are attempts to classify or in some sense narrow the set of events that would be considered truly traumatic, for some people the cause of trauma is not so much the objective danger of the event as its subjective meaning.

For example, there are situations when people react sharply to something that seems completely harmless. This usually happens because people believe that life as they knew it is over; something deeply tragic and destructive happened to them, and they perceive it that way, even if it looks different to others.

It's easy to get confused by the labels, so it's useful to differentiate the concept of PTSD from other types of stress reactions. But you can imagine, for example, that some people experience a breakup in a romantic relationship as the end of life as they know it.

So, even if the event does not ultimately cause PTSD, doctors have learned to take seriously the impact of these types of events on people's lives, and they try to help them no matter what adjustment process they are going through.

Treatment with psychotherapy

The most common type of treatment for PTSD is, on the one hand, either psychotherapy or psychological counseling, and on the other hand, the use of special medications.

Today, no one anymore forces people who are upset and preoccupied with trauma to tell a traumatic story over and over again immediately after a traumatic experience. In the past, however, this was practiced using the technique of “traumatic debriefing,” because it was believed that if people could tell their story, they would feel better.

But it was later discovered that too much insistence and pushing to tell the story tended to intensify memories and negative reactions to the trauma.

Nowadays there are a number of techniques that are used to very gently lead people to their memories and talk about them - counseling or psychotherapeutic techniques that are very useful.

Among them, the most reliable and practiced are progressive exposure therapy, correction of cognitive distortions (cognitive processing therapy) and eye movement desensitization.

These therapies have a lot in common: they all start by teaching people to relax, because for these therapies to be effective, they need to be able to relax and be relaxed when working with trauma.

Each deals in a different way with trauma-related memories, trauma re-enactment, and analysis of those aspects of the traumatic situation that people find most difficult.

In progressive exposure therapy, one begins with a memory that is associated with the trauma and is least painful, and learns to relax and not become upset.

Then they move on to the next moment, which is more painful, and so on. In the correction of cognitive distortions there are similar procedures, but in addition, work is carried out in which the patient tries to correct incorrect ideas, assumptions or conclusions drawn from traumatic experiences.

For example, a woman who has been sexually assaulted may think that all men are dangerous. In reality, only some men are dangerous, and putting traumatic ideas into a more adaptive context is an important part of correcting cognitive distortions.

Eye movement desensitization, in turn, includes elements of the other two types of therapy, as well as a third component in which the therapist distracts the patient by having him move his finger from one side to the other and focus on moving the finger back and forth. This focusing on a finger that is not related to the trauma is a technique that helps some people relax during a traumatic memory.

There are also other techniques that are beginning to be explored. For example, there are mindfulness-based therapies. They represent various practices through which people can learn to relax and their emotional reactions can be managed, as well as many other therapies. At the same time, people find it both pleasant and useful. Another common aspect of all of these therapies is that they all contain a didactic/educational component.

In the days when post-traumatic stress disorder was not yet understood, people came for treatment but did not understand what was happening at all and thought that something was wrong with their heart, intestinal tract or head or that something bad was happening to them , but they didn't understand what it was. Lack of understanding was a source of anxiety and problems. So when doctors explained to these people what PTSD was and that the symptoms they were experiencing were common and treatable, that understanding helped people feel better.

Treatment with medications

Currently, the evidence supporting psychotherapy is stronger than that supporting drug treatment. However, there are several tested medications that have been shown to be effective.

Both drugs approved for treatment in the United States are antidepressants and have a similar mechanism of action. They belong to selective serotonin reuptake inhibitors, and one of them is called Sertraline, and the other is Paroxetine.

Sertraline formula

These are standard antidepressant medications designed to treat depression. They have some impact on PTSD patients and help many of them. There are also many other related drugs with relatively proven effectiveness.

These include serotonin and norepinephrine reuptake inhibitors, an example of which is the drug Venlafaxine. Venlafaxine has been studied for the treatment of PTSD, and there have also been several studies of earlier generations of antidepressants such as Desipramine, Imipramine, Amitriptyline, and monoamine oxidase inhibitors, which are often prescribed in Europe and other parts of the world.

Some medications used in clinical practice do not have sufficient theoretical basis for their use. These include second-generation antipsychotics, benzodiazepines such as Valium, anticonvulsants such as Lamotrigine, and the typical antidepressant Trazodone, which is often prescribed as a sleep aid.

Such medications are used to relieve anxiety, increased excitability, and usually help patients better control their emotions and normalize sleep. In general terms, medications and psychotherapy show equal effectiveness. In clinical practice, it is often possible to observe cases where both psychotherapy and medications are used to treat patients with severe symptoms of PTSD.

Brain Tissue Bank and SGK1

There have been many breakthroughs in PTSD research recently. One of the most exciting among them comes from Dr. Ronald Duman of Yale University, who worked with the first brain tissue collection in the field of PTSD.

From a medical point of view, if a patient has some kind of kidney problem, there is a high probability that the attending physician has a good understanding of it, since he has previously studied kidney biology in the context of all possible kidney diseases. The doctor will look at the kidney cells under a microscope and determine what is happening to them.

The same approach has been extremely effective in some cases of neuropsychiatry: scientists have been able to learn a lot about the biology of Alzheimer's disease, schizophrenia and depression by studying autopsy tissue. However, brain tissue samples from patients with PTSD have never been collected, as this is a fairly narrow area of ​​research.

With the support of the Department of Veterans Affairs, the first attempts to collect a collection of PTSD brain tissues began in 2016, and the first study based on it was published, which, as expected, showed that only part of our ideas about PTSD is correct, while others wrong.

PTSD brain tissue tells us many interesting things, and there is a story that illustrates it perfectly.

In post-traumatic stress disorder, executive control of emotions, or our ability to calm down after encountering something frightening in the external environment, is impaired. Some of the techniques we use to calm ourselves down are distractions.

For example, when we say, “It's okay, don't worry,” our brain's frontal cortex is responsible for this calming effect. The brain bank now contains tissue from the frontal cortex of PTSD, and Dr. Duman has been studying mRNA levels in this tissue. mRNAs are the products of genes that code for the proteins that make up our brains.

It turned out that the levels of an mRNA called SGK1 were particularly low in the frontal cortex. SGK1 has never been studied before in the field of PTSD, but it is associated to a small extent with cortisol, a stress hormone that is released in people during stressful situations.

SGK1 protein structure

To understand what low levels of SGK1 might mean, we decided to study stress, and the first thing we found was the observation that SGK1 levels were reduced in the brains of animals exposed to stress. Our second step, which was especially interesting, was to ask the question: “What happens if the level of SGK1 itself is low?

Does low SGK1 make a difference? We bred animals with low levels of SGK1 in the brain, and they were very sensitive to stress, as if they already had PTSD, even though they had never been exposed to stress before.

Thus, the observation of low SGK1 in PTSD and low SGK1 in animals under stress means that low SGK1 makes a person more anxious.

What happens if you increase the level of SGK1? Dr. Duman used a special technique to create these conditions and then maintain high levels of SGK1. It turns out that in this case the animals do not develop PTSD. In other words, they become resistant to stress.

This suggests that perhaps one strategy PTSD research should pursue is to look for drugs or other methods, such as exercise, that can increase SGK1 levels.

Alternative areas of research

This completely new strategy of moving from molecular signals in brain tissue to a new drug has never been used in PTSD before, but is now feasible. There are also many other exciting areas.

From brain scan results, we learn about possible brain circuits involved in PTSD: how these circuits are distorted, how they relate to PTSD symptoms (this is learned through functional neuroscanning). From genetic studies we learn about gene variations that influence increased sensitivity to stress.

For example, previous research suggested that the serotonin transporter gene made children more susceptible to early childhood maltreatment and increased their chances of developing symptoms of PTSD and depression.

This type of research is now being actively conducted in children and adults, and another cortisol-related gene, FKBP5, has recently been identified, changes in which may be related to PTSD.

There is one interesting example in particular of how biology translates into new treatments. Currently, in 2016, we are testing a new drug for PTSD that has been used to treat depression and pain syndromes, the anesthetic drug ketamine.

Fifteen or even twenty years of research have shown that when animals are exposed to uncontrolled, prolonged stress, over time they begin to lose synaptic connections (connections between nerve cells in the brain) in the brain circuitry responsible for regulating mood, as well as in some areas responsible for thinking and higher cognitive functions.

One of the questions facing scientists is how can we develop treatments that aim not only at relieving the symptoms of PTSD, but also at helping the brain restore synaptic connections between nerve cells so that circuits are more effective at regulating mood?

And, interestingly enough, Dr. Duman's lab found that when a single dose of ketamine was administered to animals, the circuits actually restored these synapses.

It's an incredible thing to look through a microscope and actually see these new "dendritic spines" grow within an hour or two of one dose of ketamine. Subsequently, ketamine was given to people with PTSD and they experienced clinical improvements.

This is another exciting area where drugs are being developed not only based on the visible symptoms of a disease, but also in the context of brain circuitry. This is a rational, scientific approach.

Thus, from a biological point of view, there is now a lot of interesting research being carried out, work is underway to study and disseminate psychotherapy, research on genetics continues, and attempts are being made to develop medical drugs. Much of what is happening has the potential to change the way we think about things related to PTSD.

(during a critical incident and immediately after it – up to 2 days)

Acute stress disorder

(within 1 month after a critical incident – ​​from 2 days to 4 weeks)

Post-traumatic stress disorder

(more than a month after the critical incident - more than 4 weeks)

Post-traumatic personality disorder

(during the subsequent life of the person who experienced the trauma)

Rice. 1 Stages of formation of post-stress disorders

One of the main diagnostic criteria for determining the form of the stress response is the time factor.

According to A.V. Petrovsky’s definition, acute stress disorder (ASD) is considered to be a very quickly transient disorder of varying severity and nature, which is observed in individuals who have not had any obvious mental disorder in the past, in response to an exceptional somatic or mental situation (for example, a natural disaster or combat) and which usually disappear after a few hours or days (Petrovsky A.V., 2007).

According to K.Yu. Galkin, OSD has not been sufficiently studied, despite the fact that in 1994 this disorder was included in the DSM-IV. In his studies during the terrorist attack in Volgodonsk in 1999, the presence of symptoms of OSD was established and their duration was noted from two to four weeks after a collision with an extraordinary situation (Galkin K.Yu., 2004).

B. Kolodzin believes that for most people, events associated with traumatic events pass without a trace after four to six weeks or are processed and integrated into the self-concept. In the case of fixation on trauma, chronification of the post-stress state develops (Kolodzin B. 1992).

Disorders that develop after experiencing psychological trauma affect the physiological, personal, interpersonal and social levels of interaction of human functioning not only in people who have experienced stress, but also in members of their families (Kitaev-Smyk L.A., 1983; Romek V.G. , Kontorovich V.A., Krukovich E.I., 2004; Kolodzin B., 1992). The transformation of personality from a psychological norm to a borderline abnormal personality and further to a pathological mental constitution in the form of psychopathy, according to Kosmolinsky F.P. (1998), is determined by personal constitutional-typological variability.

Analysis of the results of numerous studies conducted by Romek V.G., Kontorovich V.A., Krukovich E.I. (2004) showed that the condition that develops under the influence of traumatic stress does not fall into any of the classifications available in clinical practice. The consequences of trauma can appear suddenly, over a long period of time, against the background of a person’s general well-being. Over time, the condition becomes more severe and, for some people, may lead to the development of post-traumatic stress disorder in the future.

Theoretical models explaining etiology and pathogenesis

post-traumatic stress disorder

As a result of many years of research, several theoretical models have been developed to explain the etiology and mechanism of post-traumatic stress disorder. Despite this, there is still no single generally accepted theoretical concept. Apparently this can explain the fact that N.V. Tarabrina, an authoritative specialist in this field, in her dissertation research, having identified psychological and biological models within the framework of the established categorical apparatus, classified the two-factor model of PTSD as “Other concepts of PTSD.”

Psychological models of the emergence and development of post-traumatic stress disorder traditionally include psychodynamic, cognitive and psychosocial models.

According to psychodynamic approach Freud to the mechanism of development of trauma, intense experience leads in a short time “to such a strong increase in irritation that liberation from it or its normal processing fails, as a result of which long-term disturbances in the expenditure of energy may occur”, deep psychological defense “includes” alienation, which disrupts a person’s adaptation to life. Freud viewed traumatic neurosis as a narcissistic conflict. He introduces the concept of a stimulus barrier. Due to intense or prolonged exposure, the barrier is destroyed, libidinal energy is shifted to the subject himself. Fixation on trauma is an attempt to control it (Freud Z. 1989).

From the standpoint of the modern psychodynamic paradigm of D. Kalsched, “if traumatic defense once arises, all relations with the outside world become the responsibility of the self-preservation system. What was supposed to be a defense against further or re-traumatization becomes the main stumbling block, resistance to any manifestations of the “I” directed to the outside world.” The psyche transforms external trauma into internal strength, initially protective, but then self-destructive (Kalshed D., 2001).

Currently, the “energetic” understanding of trauma is increasingly being replaced by an “informational” one. The information model developed by M. Horowitz is an attempt to synthesize cognitive, psychoanalytic and psychophysiological models. The concept of “information” refers to both cognitive and emotional experiences and elements of perception that have an external and/or internal nature. Trauma response phenomena, according to M. Horowitz, are a normal reaction to shocking information. The author believes that only extremely intense reactions are abnormal, non-adaptive, and therefore capable of blocking the processing of information and integrating it into the individual’s cognitive schemes. This approach assumes that information overload plunges a person into a state of constant stress until the information undergoes appropriate processing. Following the principle of pain avoidance, a person strives to store information in an unconscious form, but during the process of information processing, traumatic information becomes conscious. Conscious information is influenced by psychological defense mechanisms and is obsessively reproduced in memory (flashbacks); emotions, which play an important role in the post-stress state, are essentially a reaction to cognitive conflict and at the same time motives for protective, controlling and coping behavior. From the standpoint of theory, neutralization of trauma is possible subject to the integration of the information processing process (Horowitz M., 1986; Lasarus R., 1966).

The concept of M. Horowitz, formed under the influence of the cognitive psychology of J. Piaget, R. Lazarus, T. French, I. Janis, reveals the mechanism of response to stressful events. It contains a number of phases:

– primary emotional reaction;

– “denial” – avoiding thoughts about the injury;

– alternation of “denial” and “invasion”;

– processing of traumatic experience.

The duration of the response process can last from several weeks to several months. According to research results, M. Horowitz identified three styles of delayed response: hysterical, obsessive, narcissistic (Horowitz M. J., 1979). .

Subsequently, B. Green, D. Wilson, D. Lindy developed the concept of M. Horowitz, building an interactionist model of the process of delayed response to the traumatic impact of stress factors in a combat situation, they identified the following elements in the process of cognitive processing of traumatic experience:

– recurring memories;

– mental stress;

– avoidance of memories;

– gradual assimilation.

Analyzing the traumatic factors of the Vietnam War, Green B. L., Grace M. C., Lindy J. D. (1983) made a major contribution to the theory of traumatic combat stress.

Cognitive Concepts mental trauma go back to the works of A. Beck and the stress theory of R. Lazarus. From the perspective of the cognitive model, traumatic events lead to an individual’s “assessment” of a stressful situation, forming a type of coping with stress. Schemes for experiencing events are updated, forcing the individual to look for information that corresponds to this scheme and ignore other information (Lazarus R.S., Folkmann S., 1984; Beck A.T., 1983).

Of theoretical interest is the theory of pathological associative networks by R. Pitman, based on the cognitive theory of P. Lang, which explains the body’s ability to form, within the framework of a traumatic experience, patterns of response to re-experiencing stimuli and flash-back effects. These models seem to most fully explain the etiology, pathogenesis and symptoms of post-traumatic stress disorder, because take into account genetic, cognitive, emotional, and behavioral factors (Pitman R.K., Altman B, 1991).

In the cognitivist concept of mental trauma, as interpreted by R. Yanoff-Bulman, basic beliefs formed in childhood provide the child with a sense of security and trust in the world, and later – a sense of his own invulnerability. Most healthy, adult people believe that there is more good in the world than bad. “If something bad happens, it happens mainly to those people who do something wrong... I’m good, so nothing should happen to me...” Mental trauma is a change in the basic beliefs of the individual, ideas about the world and about oneself, leading to pathological reactions to stress, a state of disintegration. (Janoff - Bulman R., 1995).

In the case of successful coping with trauma, basic beliefs are qualitatively different from “pre-traumatic” ones, the restoration of which does not occur completely, but only to a certain level at which the person is free from the illusion of invulnerability.

The picture of the world of an individual who has experienced mental trauma and successfully coped with it changes. A person still believes that the world is benevolent and fair to him, it gives him the right to choose. But a sense of reality already arises, an understanding comes that this does not always happen. The individual begins to perceive reality in a form as close as possible to the real one, assessing his own life and the world around him in a new way.

The Yanoff-Bulman concept, relying primarily on the cognitive structures of the psyche, attributes a decisive role in the formation of these structures to the interaction of a child with an adult in the first years and months of life. The fundamental concept of “basic beliefs”, introduced by A. Beck (1979), according to M.A. Padun (2003), largely coincides with the concept of “generalized representations of interaction” by D. Stern (Stern D., 1985), and also with the term “self-other schema” by M. Horowitz (Horowitz M., 1991) and with the concept of “internal working model” by J. Bowlby (Bowlby J., 1969, 1973, 1980). Thus, in the concept of mental trauma, Yanoff-Bulman in a certain way merges cognitivist and modern psychodynamic ideas about the key determinants of mental development.

We fully support the opinion of L.V. Trubitsina (2005) that this model seems to most fully explain the etiology, pathogenesis and symptoms of the disorder, because takes into account genetic, cognitive, emotional, and behavioral factors. From these positions, any events or circumstances that are neutral in themselves, but are somehow associated with a traumatic stimulus-event, can serve as conditioned reflex stimuli that cause an emotional reaction corresponding to the initial trauma.

A multifactorial model of response to trauma was proposed by B. Green, J. Wilson and J. Lindy, proponents of the so-called psychosocial approach to post-traumatic stress disorder. The authors and supporters of the model emphasize the need to take into account environmental factors: social support factor, stigma factor, demographic factor, cultural characteristics, additional stressors. (Green B.L., Lindy J.D., Grace M.C., 1985).

The result of a generalization of the theoretical, methodological and practical work of the laboratory “Personality and Stress” of the Department of General Psychology, Faculty of Psychology, Moscow State University in 1989–1996. became the development person-centered model, which differs, according to M.Sh. Magomed-Eminov from “stimulus-reactive” models, in which an extreme situation is understood as a separate stressor (or group of stressors) of extreme intensity, causing a pattern of mental reactions in an individual in a post-traumatic situation, denoted by the construct of PTSD. The authors emphasize that, as developed by the American Psychiatric Association, PTSD has a clinical interpretation as a set of interconnected symptoms that characterize a nosological form and are included in the broader category of affective disorders.

Psychological factors, processes and structures, and mainly reactions to stressful events, seem to the authors of the concept to be extremely superficial, despite the fact that the personal organization itself in PTSD, right down to nuclear structures and processes, undergoes profound transformations. And this means that all the various psychological phenomena (symptoms, syndromes, reactions) are manifestations of the deep mechanisms of the personality. This important idea was expressed earlier by B. S. Bratus, who interprets PTSD as a special form of abnormal personality development: “Meanwhile, since the psyche is unified, then pathology does not result from the fact that, along with normal ones,” purely “abnormal” mechanisms begin to operate , but due to the fact that general psychological mechanisms begin to pervert, functioning in special, extreme, detrimental conditions for them” (Bratus B.S., 1988).

In the case of PTSD, as emphasized by M.Sh. Magomed-Eminov, there is a psychological organization of personality that was formed in an abnormal situation and gives rise to various manifestations in the form of symptoms and syndromes of PTSD. Any interpretation of the determination of PTSD should include the primary mechanisms of personality, and, therefore, the phenomenon of PTSD can be considered a manifestation of deep nuclear factors and personality structures that have undergone transformation and reintegration in an abnormal situation. Research by Magomed-Eminova M. Sh., Filatova A. T., Kaduk G. I., Kvasova O. G. (1990) made it possible to identify the following personal sources of some mental reactions: 1) mental organization of the personality that has developed in an anomalous situation (symbolic acting out traumatic scenarios, invasion of the past); 2) a tendency to eliminate personal dissociation caused by anomalous experiences (nightmares, intrusive memories); 3) the desire for self-actualization on the basis of paradoxical new experience (development of a form of assimilation of experience); 4) personality transformation according to the type of mental “numbness” (emotional dullness, avoidance tendency).

Biological model proposes to consider injury as the result of long-term physiological changes accompanied by complex biochemical transformations.

From the point of view neuropsychological hypothesis L.C. Kolb (1984), an increase in the tone of the sympathetic nervous system, promoting the release of adrenaline and activation of the secretion of the hypothalamus, is the initial triggering mechanism of the stress reaction (Pavlov I.P., 1951). As shown by L.C. Kolb, B.A. Van der Kolk (1991, 1996). in response to the stressor, the turnover of norepinephrine increases, which, in turn, leads to an increase in the level of plasma catecholamine. At the same time, the levels of adrenaline, serotonin and dopamine in the brain decrease. The authors explain the manifested analgesic effect by the production of endogenous opioids. N.V. Tarabrina (2008) emphasizes that L.C. Kolb also found that as a result of exposure to extreme intensity and duration of stimulating effects, changes occur in the neurons of the cerebral cortex, blockade of synaptic transmission and even neuronal death. First of all, the areas of the brain associated with the control of aggressiveness and the sleep cycle are affected.

Similar biochemical changes, according to R.J. Lifton (1973, 1978), Horowitz (1972, 1986), Green B.L., Lindy J.D (1985), being a central link in the stress response syndrome, cause changes in mental states, in particular, they can cause mental numbness.

Modern views on the mechanism of development of stress and trauma assign a significant role to the hypothalamus and extrahypothalamic structures (limbic system and reticular formation) in the central regulation of the pituitary-adrenal system in extreme conditions of life (Malyshenko N.M., Eliseev A.V. (1993); Lakosina N. D., Trunova M. M. (1994).

When considering physiological mechanisms development of psychological trauma, it is necessary to highlight the mechanism of stress development, a special case of which it can be considered (Selye G., 1979). The theoretical foundations of the doctrine of stress were developed in the concept of psychological stress by R. Lazarus, who “first began to study psychological processes as intermediate variables that mediate human responses to stress stimuli.”

According to Lazarus, stress occurs when a person perceives threatening circumstances as requiring significantly more resources than those available to him. Adhering to traditional views on the development of the stress reaction, Kassil G.N. (1978), Nikolaeva E.I. (2003) emphasize the importance of cortisol in its implementation, which inhibits inflammatory reactions; beta-endorphin, which reduces the pain threshold; compounds of corticosteroids with transcortin, a blood protein, the entry of which into the blood leads to depletion of the hypothalamic-pituitary-adrenal system. Central to the stress response syndrome, according to modern data, is a condition in which the levels of serotonin, dopamine and norepinephrine in the brain decrease, the level of acetylcholine increases, and an analgesic effect mediated by endogenous opioids develops. A decrease in the level of norepinephrine and a drop in the level of dopamine in the brain correlate with a state of mental numbness (Van der Kolk B.A., 1987; Kassil G.N., 1983; Nikolaeva E.I., 2003; Green B.L., Lindy J.D., Grace M.C., 1985). A decrease in serotonin levels leads to a slowdown and even cessation of all processes in the development of behavior, so only the conditioned response to stimuli associated with the original stressor is preserved. The cause of amnesia for specific traumatic experiences may be, according to Van der Kalk, suppression of the functioning of the hippocampus.

The disadvantage of these models is that most studies have been conducted on animals or in vitro. And at the same time, modern knowledge about the psychophysiological mechanisms of reaction to trauma allows us to predict standard situations, give a more nuanced assessment of personal changes and physical condition for the provision of psychotherapeutic and pharmacological assistance.

An attempt to integrate the psychoanalytic and medical-biological approach to trauma under extreme influences on the body was made by N.N. Pukhovsky. In his opinion, primary affective-shock reactions during traumatization are replaced by the syndrome of primary ego-stress, which is considered as the main link in the pathogenesis of such psychopathological consequences as frustration regression, acute reactions to stress, epileptoid psychopathy, individual mental degeneration (Pukhovsky N.N., 2000).

Our research conducted over eight years to study the course of traumatic reactions of various etiologies in university students has shown that the features of an etiological and pathogenetic nature make it possible to consider the phenomena of trauma from the standpoint of various concepts of mental trauma. In our practice, there were cases of moderate social maladaptation in students who suffered during the terrorist attack in Budennovsk, who retained a constant feeling of fear, severe anxiety, impaired concentration, and changes in physiological reactivity for 7 years after the events. They stopped visiting previously actively visited recreational areas and lost interest in previously significant activities. Extreme lack of confidence in one's own abilities, conformity, which creates a feeling of dependence, lack of initiative, and lack of independence in actions and judgments were noted. The material factor was named as the only motivation for socially significant behavior.

We tend to consider such consequences of traumatic experience from the perspective of H. Horowitz, who believed that if traumatic memories remain not integrated into the cognitive sphere of the individual, the traumatic experience persists for many years. (Churilova T.M., 2009). L., Lindy J.D., Grace M.C., 1985).

At the same time, the surveys and tests we conducted showed that changes in basic life beliefs during psychological trauma are fully consistent with the main provisions of the cognitivist concept of mental trauma as interpreted by R. Yanoff-Bulman (Topchiy M.V., 2004, 2006; Churilova T.M. , 2003, 2007).

Research in Post-Traumatic Stress Disorder

disorders

Post-traumatic stress disorder is one of the possible psychological consequences of experiencing traumatic stress. The basis for determining the independent content of the term “post-traumatic stress” is the criterion of the presence in the individual’s biography of a traumatic event associated with a threat to life and accompanied by the experience of negative emotions of intense fear, horror or a feeling of hopelessness (helplessness), i.e. experienced traumatic stress (Tarabrina N.V., 2008).

We do not agree with the conclusion of I.G. Malkina-Pykh that “research in the field of post-traumatic stress has developed independently of stress research, and to date the two areas have little in common.” At the same time, the author assures that in the psychological picture of PTSD, the specifics of the traumatic stressor are certainly taken into account, although the general patterns of the occurrence and development of PTSD do not depend on specific traumatic events (Malkina-Pykh I.G., 2008).

We are closer to the point of view of E. Hobfoll (1988), who proposed an option that connects the concepts of stress and traumatic stress. In his opinion, the idea of ​​a total stressor is possible, capable of provoking a qualitatively different type of reaction, which consists in the conservation of adaptation resources. H. Krystal (1978) has a similar opinion, who suggested that mental collapse can cause “freezing of affect” with subsequent alexithymia.

Studying the relationship between the concepts of stress, traumatic and post-traumatic stress, N.V. Tarabrina (2008) highlighted the contextual dependence of the concepts “post-traumatic stress disorder”, “traumatic stress”, “post-traumatic stress”, which in foreign studies outside empirical work are often are used as synonyms. In domestic scientific publications, the category of PTSD is becoming increasingly widespread, and in popular science publications the concepts of “traumatic” and “post-traumatic” stress or simply “stress” are more often used. N.V. Tarabrina (2008), emphasizing the differences between stress and traumatic stress, highlighted, on the one hand, the ideas of homeostasis, adaptation and “normality”, and on the other – separation, discontinuity and psychopathology.

We were interested in information from I.G. Malkina-Pykh (2008) and N.V. Tarabrina (2001) that information about the features of the development of a condition that develops under the influence of super-strong influences on the human psyche has been recorded for centuries. Back in 1867, J.E. Erichsen published the work “Railway and Other Injuries of the Nervous System,” in which he described mental disorders in survivors of railroad accidents. A similar reaction to what was happening was described in 1871 by Da Costa during the American Civil War; as a result of observations of autonomic reactions in the heart, he proposed the term “soldier’s heart.” In 1888, H. Oppenheim introduced the well-known diagnosis of “traumatic neurosis” into practice, within which he described many of the symptoms of modern PTSD (Smulevich A.B., Rotshtein V.G., 1983). The works of the Swiss researcher E. Sterlin, published in 1909 and 1911, according to P. V. Kamenchenko, became the basis of all modern disaster psychiatry. Early domestic research, in particular, the study of the consequences of the Crimean earthquake in 1927 (Brusilovsky et al., 1928) also made a great contribution to the development of knowledge about psychological trauma.

The emergence of major military conflicts, causing suffering, destruction, and loss of loved ones, has always given impetus to a special kind of research (Krasnyansky, Morozov, 1995). The works of E. Kraepilin (1916), which appeared in connection with the First World War (1914–1918), remain classic to this day. In them, the researcher, for the first time characterizing traumatic neurosis, pointed out the fact of the presence after severe mental trauma of permanent disorders that intensify over time. Later, Myers, in his work “Artillery Shock in France 1914–1919,” identified the difference in the etiology and pathogenesis of disorders associated with concussion, physical trauma and “shell shock.” He considered the concussion caused by a shell explosion as a neurological condition; with “shell shock,” from Myers’s point of view, a mental state developed due to severe stress.

Following I. G. Malkina-Pykh (2004), we recognize the importance of research by domestic authors devoted to the mental consequences of the Great Patriotic War, based on the results of which several important provisions have been highlighted:

– war is a situation of permanent psychotraumatization, which contributes to emotional exhaustion (G.E. Sukhareva, E.K. Krasnushkin);

– the adverse effects of extreme (combat) conditions increase sensitivity to traumatic factors. This is facilitated by general asthenia, decreased tone, lethargy and apathy (V.A. Gilyarovsky);

– psychotraumatic factors affect not only the human psyche, but also the entire body as a whole (V.G. Arkhangelsky);

– the impact on the psyche under extreme conditions is the result of the interaction of many factors (E.M. Zalkind, E.N. Popov).

It should be noted that for the first time the conclusion about the possibility of long-term preservation of the consequences of the psycho-traumatic effects of war was made by Soviet scientists based on studies of post-war adaptation of veterans of the Great Patriotic War (Gilyarovsky V.A. (1946), Vvedensky I.N. (1948), Krasnushkin E.K. (1948), Kholodovskaya E.M. (1948, etc.). Reactions caused by participation in hostilities became the subject of widespread discussion during the Second World War. New terms appeared in psychiatry: “war fatigue”, “combat exhaustion”. , “war neurosis”, “post-traumatic neurosis”, introduced by V. E. Galenko (1946), E. M. Zalkind (1946, 1947), M. V. Solovyova (1946) and others (see Malkina-Pykh, 2008 ).

The first systematic study abroad was attempted in 1941 by the French psychiatrist and psychologist A. Kardiner (Kardiner A., ​​1941), who called the group of symptoms accompanying the phenomena of nervous disorders and associated with military operations “chronic military neurosis.” Kardiner believed that war neurosis has both a physiological and psychological nature. Based on Freud's ideas, he introduces the concept of “central physioneurosis,” which, in his opinion, causes a violation of a number of personal functions that ensure successful adaptation to the outside world. The cause of mental disorders is a decrease in the internal resources of the body and a weakening of the strength of the “EGO”. For the first time, they were given a comprehensive description of the symptoms:

– excitability and irritability;

– unrestrained type of reaction to sudden stimuli;

– fixation on the circumstances of the traumatic event;

– escape from reality;

– predisposition to uncontrollable aggressive reactions.

Detailed types of disorders have been described in concentration camp prisoners and prisoners of war (Etinger L., Strom A., 1973).

A number of monographs by American researchers outline theoretical and applied issues related to the study of the condition of Vietnam veterans, many of whom were socially maladjusted and committed suicide (Boulander et al., 1986; Egendorf et al., 1981). In the 50-60s, the US National Academy of Sciences approved a number of planned studies, with the help of which an attempt was made to evaluate the adaptation of individuals who survived major disasters, fires, gas attacks, earthquakes and other similar disasters.

The beginning of systematic research into post-stress conditions caused by experiencing natural and industrial disasters can be dated back to the 50–60s of the last century. An analysis of literary sources showed that by the end of the 70s, significant material had been accumulated on psychopathological and personality disorders among war participants. In the 1980s, victims of crime, sexual violence, and radiation hazards were added to the research subjects.

As it turned out, people who suffered in various situations, similar in severity of psychogenic impact, showed similar symptoms. Attempts were made to bring the classifications available in clinical practice and introduce special terminology. Many different symptoms of such a change in condition have been described, but for a long time there were no clear criteria for its diagnosis. In this regard, in 1980, M. Horowitz (Horowitz, 1980) proposed to distinguish it as an independent syndrome, calling it “post-traumatic stress disorder” (Post-traumatic stress disorder, PTSD). Subsequently, a group of authors led by M. Horowitz (1986) developed diagnostic criteria for PTSD, adopted first into the American National Psychiatric Standard (DSM-III and DSM III-R), and later (almost unchanged) for ICD-10 (Smulevich A.B., Rotshtein V.G., 1983). The need to introduce diagnostic criteria, according to N.V. Tarabrina, was associated with a boom in research into numerous mental problems associated with social and mental maladaptation of Vietnam War veterans (Egendorf et al., 1981; Boulander G. et al., 1986; Figley C. R. , 1985; Kulka R. A. et al, 1990). These works made it possible to clarify many issues related to the nature and diagnosis of PTSD.

Taking information from N.V. Tarabrina (2008) that the increase in the number of countries using the diagnosis of PTSD in clinical practice increased in the period from 1983-1987 to 1998-2002 from 7 to 39 due to the increase in international terrorist activity, we believe that this can be explained also an increase in the number of chronic stressors associated with economic, geopolitical, social, and information problems.

In our research, we proceed from the definition of post-traumatic stress disorder (PTSD) accepted today in psychology as a non-psychotic delayed human reaction to traumatic stress. The criteria included in the European diagnostic standard ICD-10 since 1994 define post-traumatic stress disorder (PTSD) as a condition that can occur following traumatic events that are beyond the scope of normal human experience. At the same time, “ordinary” human experience meant such events as the loss of a loved one due to natural causes, a threat to one’s own life, the death or injury of another person, a chronic serious illness, job loss, or family conflict. Trauma is defined as an experience, a shock that causes fear, horror, and helplessness in most people.

Most authors, following M.J. Horowitz (1980), within the framework of post-traumatic pathology, distinguishes three main groups of symptoms: 1) excessive arousal (including autonomic lability, sleep disturbance, anxiety, intrusive memories, phobic avoidance of situations associated with traumatic); 2) periodic attacks of depressive mood (dullness of feelings, emotional numbness, despair, consciousness of hopelessness); 3) features of hysterical reaction (paralysis, blindness, deafness, seizures, nervous tremors).

At the same time, F. Parkinson (2002) believes that to diagnose post-traumatic disorder, it is enough to take into account the following groups of symptoms:

– states and feelings;

– behavior;

– physical reactions.

It should be noted that F. Parkinson suggests taking into account when making a diagnosis the symptoms that the victim may have exhibited before the incident.

Thanks to studies of the mental states of people who have experienced extreme situations, the main signs of post-traumatic stress reactions have been established. Thus, R. Grinker and D. Spiegel included impatience, aggressiveness, irritability, apathy and fatigue, personality changes, depression, tremors, fixation on war, nightmares, suspicion, phobic reactions, addiction to alcohol as delayed reactions to combat stress. Much attention was paid to restoring self-esteem in the process of psychological rehabilitation of combatants (Grinker R.P., Spiegel J.P., 1945).

It was found that delayed mental reactions to stress in veterans depend on three factors:

– from pre-war personal characteristics and a person’s ability to adapt to new situations;

– from reacting to dangerous situations that threaten human life;

– on the level of restoration of personality integrity (Kardiner, A., Spiegel, H., 1945).

In a study during the Korean War, in which the psychogenic losses of the US Army amounted to 24.2%, psychologists finally came to the conclusion that “combat stress is the basis of mental disorders” understood mental trauma as an individual’s reaction to external demands and internal stimuli, which consists in severe impairment of the mediator function of the “EGO” (Goodwin D.D., 1999).

Research into PTSD became even more widespread in the 1980s. Numerous studies have been conducted in the United States to develop and clarify various aspects of PTSD. The works of Egendorf et al. (1981) are devoted to a comparative analysis of the characteristics of the adaptation process in Vietnam veterans and their non-combatant peers. Boulander et al. (1986) studied the characteristics of the delayed reaction to stress in the same population. The results of these studies have not lost their importance to this day. The main results of international research were summarized in a collective two-volume monograph “Trauma and Its Trace” (Figley, 1985), where, along with the developmental features of PTSD of military etiology, the results of studying the consequences of stress in victims of genocide, other tragic events or violence against the individual are presented.

For anyone who has dealt with stress issues, what makes PTSD especially tricky is that symptoms can appear immediately after exposure to a traumatic situation, or they can occur many years later. Cases have been described in which veterans of the Second World War developed symptoms of PTSD forty years after the end of hostilities (Boulander, 1986). The past “does not let go” - people constantly return their thoughts to what happened, trying to find an explanation for what happened. Some begin to believe that everything that happened is a sign of fate (Parkinson F., 2002), others develop anger due to a feeling of deep injustice. The obsession about the incident manifests itself in endless conversations without any need and on any occasion. The detachment of others from the problem leads to isolation of the trauma survivor, which causes secondary traumatization.

A number of researchers point to the appearance of dissociative symptoms, manifested by a feeling of emotional dependence, narrowing of consciousness, depersonalization with the feeling that at the same time a person is at home and at the scene of the tragedy. Significant distress is manifested by physiological responses to key stimuli associated with the trauma. “Flashback episodes” develop. The inability to relax manifests itself in a state of constant tension - a person cannot sleep, despite exhaustion. Sleep disturbances that accompany such conditions aggravate the serious condition, fatigue and apathy occur (Kindras G.P., Turokhadzhaev A.M., 1992; Pushkarev A.L., 1997; Sidorov P.I., Lukmanov M.F. , 1997; Arnold A.. 1993; Boudewyns P. A., 1997;

Among the main symptoms of PTSD are Boudewyns P. A. (1996) and Chemtob C. M., Novaco R. W., Hamada R. S., Gross D. M. (1994) call the development of passive avoidance of stimuli associated with trauma, decreased interest in previously significant activities, and narrowing of the range of affective reactions. Sustained manifestations of increased arousal, absent before the injury, are manifested by irritability, wariness, outbursts of anger, increased reaction to fear, difficulty falling asleep, and the need to concentrate. K. Scull, himself a veteran, explored these issues in a series of deep-seated interviews with Vietnam veterans and identified six themes: guilt, abandonment/betrayal, loss, loneliness, loss of meaning, and fear of death. He concluded that these themes set the context and identify the causes of PTS symptoms and that “when addressing what worries Vietnam veterans most, one should rely primarily on an existential perspective” (Scull S. S., 1989).

Research by N.V. Tarabrina and her colleagues found that in the case of military trauma (veterans of the war in Afghanistan), the most changed is the emotional component of the perception of future prospects. Veterans with PTSD experience acute feelings of uncertainty, discomfort, and disappointment, but retain hope and the ability to imagine and plan for their future.

We completely agree with the opinion of the American researcher R. Pitman (1988), who called post-traumatic stress “the black hole of trauma.” The destructive effect of a war, a disaster, or a terrorist attack continues to influence a person’s entire life, depriving a person of a sense of security and self-control. A strong, sometimes unbearable tension arises, leading to a real danger for the psyche.

We consider it necessary to add that an additional source of traumatization can be the newest types of weapons tested by the United States during local wars in the countries of the Middle East, which have not only a murderous effect, but also a powerful psycho-traumatic effect on survivors (Kormos H.R., 1978; Snedkov E.V. ., 1997; Dovgopolyuk A.B., 1997; Epachintseva E.M., 2001; Vasilevsky V.G., Litvintsev S.G., 1994; ., Fastovets G.L., 2005; Kharitonov A.N., Korchemny P.A. (ed.), 2001).

Of interest are numerous research results showing that persons with PTSD participating in combat operations, compared to civilians without this disorder, are 2-3 times more likely to be dependent on psychoactive substances (PAS). Nearly 75% of combat veterans with PTSD also had symptoms consistent with alcohol abuse or dependence during their lifetime (Kulka R.A., Hough R.L., Jordan B.K., 1990). An individual’s overcoming the traumatic impact of stressors in a combat situation depends not only on the success of processing the traumatic experience, but also on the interaction of three factors: the nature of the traumatic events, the individual characteristics of veterans and the characteristics of the conditions in which the veteran finds himself after returning from war (Green B.L., 1992). Impaired processing of traumatic experience and overcoming combat trauma leads to social maladaptation with the formation of affective disorders and PTSD, which are factors provoking substance abuse (Petrosyan T. R., 2008).

An analysis of the literary sources at our disposal has shown that most of the modern research on PTSD is devoted to the epidemiology, etiology, dynamics, diagnosis and treatment of PTSD, which are carried out on a wide variety of populations: participants in combat operations, victims of violence and torture, man-made and man-made disasters, patients with life-threatening diseases, refugees, firefighters, rescue workers, etc.

Study of the circumstances of a person’s stay in the emergency zone Yu.A. Aleksandrovsky and colleagues (1991), V.P. Antonov (1987), Yu.V. Malova (1998); I.B. Ushakov, V.N. Karpov (1997), V.A. Molyako (1992) indicate that a living environment in which there is a threat of radiation damage and where a person is exposed to a real danger of losing health or life serves as the basis for including such situations in the list of traumatic ones, i.e. capable of causing PTSD. patterns of change in each individually studied area. However, the question of whether it is possible to develop PTSD in people who have suffered the stress of a radiation threat still remains controversial. In domestic works, much attention is paid to the analysis of neuropsychic and neuropsychiatric disorders (Krasnov et al., 1993). N.V. Tarabrina, emphasizing the extensiveness of research on this issue, particularly highlights studies of post-traumatic syndromes in victims of radiation exposure during the accident at the American Three Mile Island nuclear power plant (Dew M. S. & Bromet E. J., 1993); in Guyana (Collins D.L. & de Carvalho A.B., 1993; Davidson L.U., Baum A., 1986), as well as among those American veterans of World War II who witnessed nuclear weapons tests (Horowitz M. et al., 1979). According to L. Weiss (Weisaeth L.), in Norway, among the population exposed to the Chernobyl accident, from 1 to 3% suffer from PTSD. Studies of the population of contaminated areas showed the presence of PTSD in 8.2% of residents of these regions (Rumyantseva et al. 1997).

We consider N.V.’s information valuable. Tarabrina (2008) about the specificity of the psychological content of PTSD symptoms among liquidators. A high percentage of symptoms of physiological excitability correlates with the level of anxiety and depression, and the semantics of symptoms are, for the most part, associated with future life. The presence of symptoms such as sleep disturbances, loss of appetite, decreased sexual desire, and irritability indicate their severe emotional state. The author shows the presence of a high level of astheno-neurotic disorders, vegetative-vascular dystonia, hypertension in almost all subjects, which corresponds to the generally accepted register of psychosomatic disorders, and suggests the psychogenic nature of the diseases as a result of experiencing chronic stress, which was the Chernobyl disaster for many. Designating the stress of the radiation threat as an “invisible” stressor, N.V. Tarabrina includes it in the same group with the threat of chemical and biological damage. At the same time, she emphasizes the similarity of the psychological mechanisms of the development of post-stress states under such influences and the extreme degree of their lack of study.

One of the most pressing problems in modern psychological science, in our opinion, is the study of the terrorist threat and its consequences, which is due to the growing scale of terrorist activity and the nature of its manifestations.

The literature data we examined based on the results of studies of the experience of terrorist attacks provide fairly consistent data on the wide prevalence of PTSD and its individual symptoms as psychological reactions to this type of traumatic event (Grieger T.A., Fullerton C.S., and Ursano R.J., 2003; Sosnin V. A., 1995; Kekelidze D.V., 2002; Portnova A.A., 2006; ;Slovic, Schuster (1977, 1978); North C. S. (1999); Shore J. H., Tatum E. L., Volhner N. W. (2002). the act is the most serious threat to the mental health of the population compared to natural disasters (Northetal., 1999).

A rather serious problem is the fact that most studies are devoted to the psychological and psychiatric consequences of terrorist attacks among direct victims of terrorist attacks and their loved ones (Idrisov K.A., Krasnov V.N., 2004; Galkin K.Yu., 2004; Gasparyan H. V., 2005). Almost no attention is paid to the specific features of the perception of the terrorist threat by indirect victims who have witnessed terrorist attacks through the media (Tarabrina N.V., 2004; Bykhovets Yu.V., Tarabrina N.V., 2007).

In recent years, the category of PTSD has been identified as a separate taxonomic unit, the formative factor for which is situations of unexpected loss of an object of special affection or a significant other. The significance of studying this problem is that almost every person finds himself in a situation of losing loved ones during his life.

We agree with A.V. Andryushchenko (2000) that, unlike other types of life disasters, this psychotraumatic situation affects, first of all, the sphere of individual personal values. Despite the fact that the direction of the psychogenic factor is different than in events associated with a threat to physical existence, this kind of extreme situation is perceived as equivalent to it - “irreparable” destruction of the individual. The loss of a significant other after a life-threatening illness, as a result of a love drama or death, accident, disappearance under tragic circumstances, suicide and other similar situations is accompanied by a feeling of complete loss of Self, a feeling of impossibility of subsequent recovery and persistent despair associated with these post-traumatic manifestations. Clinical studies show that the formation of PTSD following the loss of an attachment figure occurs in the first 6 months after a traumatic event and lasts from 6 months to several years or more. Just like the classical forms of PTSD, these conditions are distinguished by the following features: 1) they are formed in several stages, thus acquiring a prolonged course; 2) determined by a polymorphic psychopathological structure; 3) end in persistent residual conditions in 6-20% with clear long-term maladjustment. The author emphasizes that data on long-term stages (the first 6-12 months after psychotraumatic exposure) indicate the appearance in the structure of PTSD, in addition to reactive formations, of other disorders that coexist simultaneously with the main disorder through the mechanism of comorbid connections. Qualification of mental disorders in pathological reactions of loss with signs of PTSD, carried out in accordance with ICD-10, reveals a tendency towards multi-axial diagnosis of pathology. As a rule, patients are diagnosed with dysthymic level mood disorders: subclinical or psychopathologically completed forms of dysthymia, single or recurrent depressive episodes; dissociative disorders, somatoform disorders.

Experience shows that within the framework of these disorders, there is a tendency that arose in the post-traumatic period to constantly reproduce in one’s life a situation similar to the one experienced or, on the contrary, to completely avoid situations reminiscent of these events.

As our analysis showed, risk factors for the development of PTSD can be categories that are paradoxical at first glance. Thus, the Russian psychologist F. Konkov, describing the role of environmental factors in the prolongation of post-traumatic stress after the 1988 earthquake, found that the stress reactions of Yerevan children and their parents were influenced by the following values ​​of the Armenian family, culture and political context:

– emphasis on silent heroic suffering;

– altruistic resilience in overcoming everyday hardships;

– denial of pain and weakness;

– the predominance of the values ​​of the external well-being of the family over intrafamily psychological comfort;

– excessive fixation of adults on the states of their children as a defense against their own feelings and as an unconstructive demonstration of altruism;

– reluctance to inform children about the death of loved ones for fear of causing the child’s hostility towards oneself; this leads to the fact that children are left alone with unreacted stress, despite the fact that they intuitively feel this loss, which cannot be shared with an adult in open communication about the grief they are experiencing;

– parents’ fixation on the situation of interethnic conflict, which creates difficulties for psychotherapeutic influence and increases the feeling of hostility of the environment in children.

According to F. Konkov, in such situations it is impossible to do without the psychotherapeutic intervention of psychologists, since without this the stress continues. In addition to the psychotherapeutic value of openly expressing feelings associated with the tragedy, these families need help adjusting to life in a new environment characterized by the high value of human life. The author emphasizes that, despite the situation of grief and loss of loved ones, lost health and property, people can be helped by increasing the significance of their experiences, explaining that their suffering and life have meaning (Konkov F., 1989). It should be noted that in psychological practice such paradoxical phenomena occur quite often. Thus, good upbringing, which places restrictions on communication, often prevents the processing of traumatic situations, driving them into the depths of the unconscious.

The intensity of the psychotraumatic situation, the risk of PTSD, according to A.L. Pushkareva (2000) also depend on social status and low level of education; psychiatric problems preceding the traumatic event; chronic stress.

The results of our work coincide with the data of G.I. Kaplan. (1994), who finds that traumatic events are more difficult for the very young and very old to cope with compared to those for whom the trauma occurs in midlife. For example, approximately 80% of children who suffer burns develop post-traumatic stress disorder 1–2 years after their burn injuries. On the other hand, only about 30% of adults develop this disorder after burns. It is likely that young children have not yet developed the mechanisms to cope with the physical and emotional damage caused by trauma. Likewise, older people, as well as young children, have more rigid mechanisms for dealing with trauma and are unable to adopt a flexible enough approach to counteract its effects. Moreover, the impact of trauma may be exacerbated by the physical disabilities that characterize life in the elderly, especially those affecting the nervous and cardiovascular systems, such as decreased cerebral blood flow, decreased vision, palpitations, and arrhythmias. The presence of pre-injury mental disorders, personality disorders, or more serious disorders increases the severity of the stressor. Social support provision may also influence the development, severity, and duration of PTSD. In general, patients who receive good social support are less likely to develop this disorder or, if it does develop, it is less severe. More often, this disorder develops in single, divorced, widowed, economically poor or socially isolated individuals (Churilova T.M., 2003, 2007).

According to our observations and literature data, secondary traumatization can result from the negative reaction of medical staff, social workers, and other people encountered by individuals with PTSD. In other cases, a similar diagnosis may occur in victims who are overprotected, creating a “traumatic membrane” that separates them from the outside world.

Following N.V. Tarabrina, we agree that assessment of conditions at distant stages of PTSD allows us to identify, in most cases, signs of post-traumatic personality development. PTSD leads to a decrease or loss of the need for close interpersonal relationships, an inability to return to family life, a devaluation of marriage and the birth of children, etc. Unlike personal deviations that arose after severe wartime stress, in these cases the consequences of the disaster are not so large-scale, Accordingly, the quality of life is affected to a lesser extent. PTSD of this type has a significantly less impact on professional ambitions, although in this area “breakdowns” are identified with a decrease in motivation and interest in activities, indifference to success and career (Tarabrina N.V., 2001, 2008)

The opinion of A.G. can be considered unequivocal. Maklakova, S.V. Chermyanina, E.B. Shustova (1998), M.V. Davletshina that post-traumatic stress disorder is one of the most pressing problems of the 21st century. The authors point out that the percentage of PTSD prevalence among the population varies, according to various sources, from 1% to 67% with variability associated with examination methods, characteristics of the population, and also, according to some authors, due to the lack of a single clear approach to defining diagnostic criteria. criteria for this disorder. At the same time, according to M.V. Davletshina (2003), there is a clear increase in the incidence of PTSD in the 90s. If, according to Dmitrieva T.B., about 1% of the study population develops PTSD throughout life (Dmitrieva T.B., Vasilievsky V.G., Rastovtsev G.A., 2003), then other researchers point to a wider distribution of this type of disorder . Thus, I.G. Malkina-Pykh, citing the opinion of researchers, indicates that PTSD occurs in approximately 20% of people who have experienced situations of traumatic stress (I.G. Malkina-Pykh., 2008). D. Kilpatrick shows that among the 391 women surveyed, 75% had ever been victims of crime. Of these, 53% were victims of sexual violence, 9.7% were victims of assault, 5.6% were victims of robbery, and 45.3% were victims of burglary. According to reports from epidemiologists, all of them had psychosomatic symptoms of PTSD (Kilpatrick D.G., Veronen L.J., 1985).

Special studies by A.N. Krasnyansky (1993), A.L., Pushkarev, V.A., Domoratsky, E.G. Gordeeva (2000) showed that symptoms of PTSD in a certain part of people with the consequences of military trauma become more distinct with age. In some individuals, the course of PTSD is chronic, often combined with mental illness, including affective disorders, drug addiction and alcoholism. Shore's research, based on a general sample of American citizens (without taking into account risk groups), reports that the number of people suffering from PTSD in America is on average 2.6% of the total population (see Romek V.G., Kontorovich V.A., Krukovich E.I., 2004).

We share the opinion of N.V. Tarabrina (2008) regarding the mixed assessment of PTSD by individual clinicians in different countries. The noticeable progress of research in this area does not reduce the debatability of the problems associated with it. This is especially true for the semantic field of traumatic stress, the problems of the dose-response model, the inclusion of guilt in the register of post-traumatic symptoms, the possible influence of brain disorders, the effect of stress hormones, memory distortions when diagnosing PTSD resulting from sexual abuse in early childhood, the influence of the socio-political situation in society on the diagnosis of PTSD, etc. (Krystal H., 1978; Orr S.P. 1993; Breslau N., Davis G.C. 1992; Everly G.S., 1989; Pitman R.K., 1988; Horowitz M.J., 1989).

We believe that in Russian psychology and psychiatry, interest in research in this area has increased due to the introduction of the category of post-traumatic stress disorder (PTSD) into scientific discourse. In the domestic literature, in our opinion, the works of N.V. stand out. Tarabrina, F.E. Vasilyuk, I.G. Malkina-Pykh, L.A. Kitaeva-Smyk, A.V. Gnezdilova, M.S. Kurchakova, M.A. Padun, V.A. Agarkova, P.V. Solovyova, E.O. Lazebnaya, L.V. Trubitsina, M.E. Sandomirsky, A.L. Pushkarev, V.A. Domoratsky, E.G. Gordeeva.

Most of the research on PTSD is devoted to the epidemiology, etiology, dynamics, diagnosis and treatment of PTSD, which is carried out on a wide variety of populations: combatants, victims of violence and torture, man-made and man-made disasters, patients with life-threatening diseases, refugees, firefighters, rescuers and etc. The main concepts used by researchers working in this area are “trauma”, “traumatic stress”, “traumatic stressors”, “traumatic situations” and, in fact, “post-traumatic stress disorder”. Despite the fact that the number of mostly empirical studies devoted to the study of the psychological consequences of a person’s stay in a traumatic situation has been rapidly increasing over the past decades, many theoretical and methodological aspects of this problem remain either unresolved or debatable (N.V. Tarabrina, 2008) .

We agree with B. Kolodzin in the opinion that an analysis of the literature indicates that following the identification of the clinical form of PTSD in ICD-10, there is a tendency to narrowly interpret these conditions without taking into account the specifics of the traumatic factor. The question remains unclear regarding the study of PTSD developing in people who have suffered a hostage situation as a result of a mass terrorist attack. Phenomenological ideas about psychological and psychopathological reactions in people with signs of post-traumatic stress disorder who found themselves hostages as a result of a mass terrorist attack are isolated, incomplete and scattered. There are practically no detailed scientific data reflecting the influence of personal characteristics on the psychological and psychopathological picture of the development of PTSD. There have been virtually no studies concerning the psychological differential diagnosis of post-traumatic stress disorders (Kolodzin B., 1992).

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Post-traumatic syndrome is a condition when the shocks experienced in life continue to bother you over time. A random reminder of events causes pain, and a fleeting image can bring you back to the past, which is difficult to remember.

What is Post Traumatic Stress Disorder?

This is a set of symptoms indicating mental disorders. It is formed after a single or multiple traumatic effects of great force, for example:

• violence, humiliation and other conditions that make you feel horror and helplessness;
• prolonged stress, associated, among other things, with psychological involvement in the suffering and experiences of other people.

People with post-traumatic stress disorder (PTSD) have a high degree of anxiety, in which they are periodically troubled by unusually realistic memories of terrible situations in the past. More often this happens when in contact with stimuli that lead to episodes of memories (psychologists call them triggers or keys):

• objects and sounds;
• images and smells;
• other circumstances.

Sometimes, after PTSD, fragmentary amnesia develops, which does not allow one to reproduce the traumatic situation in detail.

Causes

Any stressful situation that causes extreme mental stress can provoke PTSD:

• participation in wars and residence in the territory of military conflicts;
• being in captivity;
• the role of the victim in hostage-taking, sexual violence;
• involvement in illegal activities,
• participation in accidents and disasters;
• death and/or injury of loved ones;
• other events.

It has been proven that stress, as a reaction to extreme trauma, does not always cause mental disorders. It depends:

The environment in which a person finds himself after experiencing a shock is important. The risk of developing PTRS is significantly lower if the victim is in the company of people who have experienced a similar misfortune.

Causes of PTSD

The risk of developing PTSD increases when:

Formation mechanism

There are different approaches to assessing the mechanism of PTSD formation:

Differences in manifestation in people of different genders and ages

Experts who studied the characteristics of the manifestation of PTSD in adult men and women came to the conclusion that in the latter the pathology manifests itself more intensely. As for the features of the manifestation and course of PTSD in children, they exist, but more on that later.

The totality of the results of psychotrauma is manifested by the following blocks of signs:

1. Periodic reliving of events, namely:
   • The inability to control negative memories leads to their attacks becoming more frequent, displacing reality. Even a musical composition or a strong gust of wind can provoke another attack. Nightmares are tormented at night, which causes fear of falling asleep;
   • a stream of anxious thoughts, unusually clear and precise, arises frequently and uncontrollably. This is called hallucinogenic experiences, which can be caused, for example, by drinking alcohol;
   • persistent rejection of the surrounding reality and persistent feelings of guilt lead to thoughts of suicide.
2. Rejection of reality, which is expressed by:
   • depression and indifference to everything;
   • anhedonia - loss of the ability to experience joy, love and empathy;
   • refusal to communicate with relatives and people from the past, avoidance of new contacts. Conscious withdrawal from society is a typical symptom of stress disorder.
3. Aggression, caution and mistrust, which are manifested by:
   • the feeling of insecurity in front of terrible events of the past that could happen again is frightening. This requires constant vigilance and a willingness to fight back;
   • a person reacts inadequately to everything that reminds of psychological trauma: loud and sharp sounds, flashes, screams and other phenomena;
   • aggression flares up in response to a threat, regardless of the degree of its reality and danger, which manifests itself with lightning speed, often with the use of physical force.

The listed symptoms give a detailed picture of the symptoms, but in reality they are rarely present together. Individual variants and combinations of them are more common. Because reactions to stress vary from person to person, it is important to understand that the range of post-traumatic symptoms may also vary.

The psyche of children is extremely susceptible and vulnerable, so they suffer from the consequences of stress to a greater extent than adults.

The attachment of children and parents to each other, the state of mind of the latter, their educational measures towards the child are key factors in the process of recovery of the child after injury

The reasons for the development of PTSD in children can be:

• separation from parents, even when it is temporary;
• conflicts in the family;
• the death of a beloved animal, especially if it happened in front of the baby;
• poor relationships with classmates and/or teachers;
• poor academic performance as a reason for punishment and reprimand;
• other traumatic events.

The experienced negativity causes in the child’s psyche:

• periodic return to episodes of a terrible event, which can be expressed in conversations and games.
• sleep disorders due to fears from the past disturbing you at night;
• indifference and absent-mindedness.

In contrast to apathy, aggressiveness and irritability may occur when ordinary requests from family members cause a violent negative reaction.

Types of Post Traumatic Syndrome

The course of PTSD is characterized by features that distinguish it from other conditions:

1. The syndrome may not form immediately, but after a while. Sometimes he makes himself known after years.
2. PTSD develops in stages, which is reflected in the severity of symptoms. The brightness of the manifestations also depends on the duration of the remission period.

This served as the basis for the classification of the disorder:

• acute - lasts up to 3 months and has a wide range of symptoms;
• chronic - the severity of the main symptoms decreases, but the degree of nervous exhaustion increases. This, among other things, is expressed by a deterioration of character: a person becomes rude, selfish, and the sphere of his interests is significantly narrowed. Character is deformed, symptoms of central nervous system failure appear in the absence of obvious signs of PTSD, which can be expressed by subconscious attempts to get rid of difficult memories, outbreaks of anxiety and fear. This stage is formed when the chronic period of PTSD continues for a long time, but at the same time the person experiences the absence or insufficiency of adequate psychological help.
• delayed - symptoms occur six months or more after the trauma. Usually this form is the result of the influence of a provoking factor. It can occur both acutely and chronically.

To facilitate the process of choosing the optimal treatment option, a clinical classification of PTSD types based on the characteristics of the pathology has been developed:

1. The anxious type is characterized by frequent attacks of intrusive memories against the background of nervous overstrain, the number of which varies from several episodes per week to multiple repetitions during the day. Nightmares cause sleep disorders, and when you manage to fall asleep, you wake up in a cold sweat, fever or chills. Those suffering from an anxious type of pathology experience difficulties in social adaptation, which is caused by a severe emotional state and irritability. Meanwhile, they freely communicate with a psychologist, discussing the nuances of their condition, and in everyday life they try to avoid reminders of the psychological trauma they received.
2. The asthenic type is characterized by an abundance of symptoms indicating nervous exhaustion, including apathy and weakness, a noticeable decrease in performance and other signs. Those suffering from the asthenic type of PTSD lose interest in life and worry about feelings of inferiority. Episodes of flashbacks are moderately disturbing and therefore do not cause horror or vegetative disorders. Patients complain that they can hardly get out of bed in the morning, and feel drowsy during the day, although they do not suffer from nighttime insomnia. They do not like to talk about events that caused mental trauma.
3. The dysphoric type is defined as a state of anger in which the mood always has a depressive component. Such people are unsociable, avoid others and never complain about anything.
4. The somatophoric type is formed against the background of delayed PTSD and is distinguished by dysfunctions of the central nervous system, cardiovascular organs and digestive tract. Patients are concerned about:
   • migraines;
   • heart rhythm disturbances,
   • pain in the left side of the chest and epigastric region;
   • abdominal colic;
   • digestive disorders;
   • other somatic abnormalities.

It is noteworthy that despite the abundance of complaints about well-being, diagnostics do not reveal serious health problems. With the somatoform type of PTSD, patients suffer from obsessive states that manifest themselves in attacks and occur against the background of a pronounced reaction from the autonomic part of the central nervous system. However, patients are more worried not about the emotional component, but about their own health. They are reluctant to talk about a traumatic event because they believe that reliving it could cause a heart attack or stroke.

Signs, symptoms, main stages

The formation of a psychological response to large-scale stress occurs in several stages:

1. Shock, causing denial and a stunned reaction.
2. Avoidance, when rejection and stupor give way to tears and a feeling of severe failure.
3. Oscillations. This is the period when the psyche agrees that the events taking place are real.
4. Transition. Time to analyze and assimilate what is happening.
5. Integration is the stage when information processing is completed.

The main symptom of post-traumatic stress disorder is haunting memories of terrible events, which are vivid but fragmentary in nature and are accompanied by:

• horror and melancholy;
• anxiety and feelings of helplessness.
• These experiences are equal in strength to those experienced during the events themselves. They are joined by autonomic dysfunctions, causing:
• increased blood pressure;
• heart rhythm disturbances:
• hyperhidrosis with cold sweat;
• increased urination.

People who have experienced psychotrauma and suffer from PTSD:

In some cases, isolation from real life and destructive changes in character lead to the fact that those suffering from PTSD stop communicating altogether and become completely alone. A feature of social adaptation disorder in post-traumatic syndrome is the lack of life plans, because such people live in the past.

The emerging tendency to suicide is often realized under the influence of psychotropic factors or during hallucinogenic attacks. However, more often than not, taking one’s own life is a planned and conscious decision of a person who has lost the meaning of existence.

Treatment options

Treatment for PTSD is comprehensive. Drug therapy is prescribed if:

• chronic nervous overstrain;
• states of increased anxiety;
• a sharp drop in emotional background;
• more frequent attacks of intrusive memories, causing horror and vegetative disorders;
• invasions of hallucinations.

For mild PTSD with many symptoms of central nervous system overstrain, sedative medications are indicated, the effect of which is still not enough to completely suppress mental symptoms.

In recent years, antidepressants from the category of selective serotonin reuptake inhibitors have become popular.

In recent years, antidepressants from the category of selective serotonin reuptake inhibitors, which have a wide spectrum of action, have become popular, namely:

• improve emotional background;
• restore interest in life;
• remove anxiety and tension;
• normalize the activity of the autonomic nervous system;
• reduce the number of attacks of intrusive memories;
• reduce aggression and irritability;
• suppress the craving for alcohol.

Treatment with such drugs has its own specifics: at the initial stage of treatment, the opposite effect is likely in the form of an increase in anxiety. It is for this reason that therapy begins with small doses, which are subsequently increased.

The main medications for the treatment of PTSD also include beta blockers, which are recommended in cases of obvious autonomic disorders.

For the asthenic form of post-traumatic syndrome, nootropics that stimulate the central nervous system are indicated. They are safe and have no serious contraindications for use.

It is important that the use of medications, unlike psychotherapy sessions, is never prescribed as the only method of treatment.

Psychotherapy for post-traumatic stress disorder is necessarily included in the complex of measures against PTSD and is carried out in stages:

1. First, there is a conversation in which the doctor talks about the essence of the disease and methods of therapy. To achieve a positive result, it is important that the patient trusts the medical specialist and receives all the information so as not to doubt the successful outcome of the treatment.
2. Next comes the therapy itself, during which the doctor helps the patient:
   • accept and process a psychotraumatic event:
   • make peace with the past;
   • get rid of feelings of guilt and aggression towards yourself and others;
   • do not respond to triggers.
3. During psychotherapy, different forms and methods of work are used:
   • individual communication with the patient;
   • psychocorrection sessions involving a group of people with the problem of PTSD;
   • interaction with family members, which is extremely important when working with pediatric patients;
   • neurolinguistic programming;
   • hypnosis;
   • training in auto-training techniques;
   • other methods.

A set of therapeutic measures is always selected individually and in the vast majority of cases allows achieving successful results.

How to live with PTSD

When the traumatic impact was small, its consequences in the form of anxiety, worries and other signs can go away on their own. In different cases, this requires from several hours to several weeks. If the impact was powerful or the episodes were repeated repeatedly, the pathological condition may persist for a long time.

It is very important that loved ones understand the peculiarities of life of a person with a mental disorder, when a special approach and careful attitude are required, excluding stressful situations. A calm and benevolent microclimate in the family, at work and in the circle of like-minded people, combined with medical measures, makes it possible to completely get rid of the consequences of psychological trauma.

Many of those who have experienced PTSD say that the path to recovery is difficult and long. For a successful result, the attitude of the victim himself and his willingness to fight are of great importance. Under the supervision of a medical specialist and with the support of loved ones, overcoming a severe syndrome is much easier.

Video: How to overcome PTSD

Post-traumatic stress disorder is a psycho-emotional reaction to a negative event experienced that develops over the course of a month. The disorder is often called “Vietnamese” or “Afghan” syndrome, since it can be characteristic of people who have suffered combat, terrorist attacks, physical or psychological violence. People suffering from post-traumatic stress disorder are emotionally unstable and can panic at the slightest reminder of the stressful event they experienced (object, sound, image, person associated with the psychological trauma they suffered). In some individuals, post-traumatic stress disorder manifests itself in the form of so-called “flashbacks” - flashes of vivid memories of an experienced event that seem real to the person and are happening at a given moment and in a given place.

In what cases does the disease occur?

A person can suffer psychological trauma as a result of natural disasters, man-made disasters, warfare, sexual or physical violence, terrorist attacks, being taken hostage, as well as long-term illnesses or an existing fatal disease. Mental disorder occurs not only among those who have directly become victims of violence or are in a stressful situation, but also among witnesses to the troubles that have occurred. For example, a child watched his father physically abuse his mother for a long time, as a result of which he developed a panic reaction to any type of physical contact with another person. Or a person witnessed a terrorist attack in a public place, after which he began to avoid large crowds of people or feel attacks of panic attack, finding himself again in crowded places.

Post-traumatic stress disorder is an occupational disease in people who, as part of their service or work activities, are exposed to involuntary violence, crime or life-threatening situations. These types of professions include service in law enforcement agencies, contract army service, rescuers of the Ministry of Emergency Situations, firefighters and many other specialties. Mental disorder is actively developing in children and women exposed to domestic violence, as well as physical and psycho-emotional influence from the environment. A child can become an object of ridicule and cruel mockery from peers, as a result of which he begins to perceive school as a place where he will certainly be humiliated and made to feel useless. He begins to avoid going to school and communicating with other children, because he believes that all his peers will bully him.

In women, post-traumatic stress disorder can develop not only due to prolonged physical, sexual or mental violence, but also from the realization that at the moment she does not have the opportunity to change her own life and say goodbye to the source of stress forever. A woman, for example, may not have her own home where she could go, or her own funds that she could spend and move for permanent residence to another city or even another country. In this regard, a feeling of hopelessness arises, which subsequently develops into deep depression and entails post-traumatic stress disorder.

Factors in the occurrence of the disorder can also be individual personality traits,
previously arising disorders of the psycho-emotional state, constantly haunting the individual with nightmares and imaginary pictures of what happened. In this regard, the patient's sleep patterns, functioning of the central nervous system and general mental state are disrupted. The disorders are characterized by dulling of positive and negative emotions, alienation from the environment, indifference towards situations or events that previously brought joy to a person, the occurrence of hyperarousal, accompanied by fear and insomnia.

The following factors can also cause the disorder:

• daily exposure to stress;
• taking psychotropic substances;
• events that caused psychological trauma in childhood;
• the occurrence of anxiety, depression, psycho-emotional disorders before suffering psychological trauma;
• lack of support;
• the inability of an individual to independently overcome stress factors and cope with their psychological state.

Signs of the disorder in adults

Symptoms of PTSD fall into three main categories, each of which contains more detailed individual experiences of trauma. The main categories include people who:

• avoid places, objects, sounds, images, people, in general, everything that is associated with the stressful event experienced;
• mentally re-experience the psychological trauma;
• have increased excitability, anxiety, and restlessness.

A person who has experienced the most terrible moments in his life intuitively strives to never again encounter the source of emotional shock. His instinct of self-preservation is triggered and internal psychological defense is activated, which blocks all memories associated with the event that occurred, and also limits the person in further communication with the outside world. The victim believes that he has no place in this life, he will not build a happy, normal future and will never be able to forget about the nightmare moments he experienced. He completely loses interest in life, feeling apathy, alienation, and indifference. A person avoids everything connected with psychological trauma, unable to overcome himself and force him to let go of the past.

People who constantly replay the details of a stressful event in their heads cannot get rid of the feeling of tension, hyperexcitation, and psychophysiological reactions that arise at any mention of the event. Their thoughts take on an obsessive form and turn into “real” situations drawn by the imagination. Victims may feel like they are experiencing a repeat of a stressful moment in their lives right now, when in fact nothing is happening. Round-the-clock nervous tension results in nightmares, in which either all the details of psychological trauma are repeated, or a new situation is created, similar to the previous one in terms of the location, surrounding people, etc. After a re-experienced emotional event, a person cannot sleep at night and prefers to wait until the morning.

People who have high emotional arousal and increased nervous sensitivity are at risk for developing post-traumatic stress disorder in the first place. The psychological trauma inflicted causes them to experience aggression, excessive irritability, a constant feeling of nervousness, difficulty concentrating and concentrating, rapid excitability, as well as a desire to control everything. Such people have disturbed sleep patterns, they sleep only periodically, often wake up at night, and cannot fall asleep peacefully. Just one mention of an event is enough for them, and they begin to overwhelm themselves and react emotionally to any attempts to interact with others, even if support and understanding are provided from the outside.

All three categories come together through other symptoms that make PTSD manifest. Among them are self-flagellation, a feeling of guilt for committed (imperfect) actions, abuse of alcohol or psychoactive substances, thoughts of suicide, emotional isolation from the world and constant psychophysiological stress.

Manifestations of the disorder in children

Symptoms in children have several distinctive features. In particular, children may experience:

• incontinence;
• fear of being abandoned/torn away from parents;
• games of a pessimistic nature, in which the child reflects the psycho-emotional shock he has experienced;
• display of psychological trauma in creativity: drawings, stories, music;
• causeless nervous tension;
• nightmares and general sleep disturbances;
• irritability and aggression for any reason.

The psychological shock experienced has a negative impact on all aspects of life. However, timely contact with a specialist and a detailed study of stress factors will allow you to quickly get rid of the tormenting nervous condition. Parents should pay special attention to their children, since post-traumatic stress disorder in children is often inherent in nature and does not manifest itself as intensely as in adults. A child can remain silent for years about what worries him, while constantly being at the stage of a nervous breakdown.

Diagnosis and treatment of the disease

To avoid negative consequences, you should know about the basic methods of self-diagnosis of this disease. If for several weeks or months after receiving a psychological injury you observe at least some of the above symptoms, we recommend that you immediately consult a doctor who will prescribe you appropriate treatment and a course of psychotherapy.

To accurately assess your internal psychological state, you need to take a PTSD self-assessment test. The test items indicate the most common symptoms and signs of the disease. After taking the test, you will be able to determine with a high degree of probability that you have post-traumatic stress disorder based on the points you receive for your answers.

The basis of treatment for the disorder is, first of all, psychotherapy aimed at getting rid of negative memories of the past. To treat this disease, cognitive behavioral therapy is used, as well as supportive and family psychotherapy, designed to improve the mental state of not only the affected patient, but also all family members. Family psychotherapy teaches loved ones to provide support and necessary assistance to those who have suffered due to stressful events.

The consequences of post-traumatic stress disorder are eliminated with the help of special antidepressants and sedatives prescribed by a specialist. Treatment with medications is also aimed at eliminating concomitant mental disorders, such as depression, panic attacks, and manic-depressive psychosis.

Timely diagnosis and comprehensive treatment, along with self-improvement, will soon eliminate all signs of the disease. (Votes: 2, 5.00 out of 5)