Disturbo post-traumatico da stress: fattori di ... - Marco Cannavicci

Giornale di Medicina Militare - A. 154°, Fasc. 1-2, gen. - apr. 2004
Table 2 - Specification of symptoms
(in order of importance).
Nightmares
Flashbacks
Keeping away from others
Reduction of interest in own activities
Avoidance of things the remind one of event
Emotional numbness
Irritability
Anxiety
Concentration disorders
Sleep disorders
Hypervigilance
Startled reaction
3. The Cognitive Model
A big traumatic event induces an overload of stimuli
(objective and subjective) of the personal system of
information processing. The system enters a condition
that prevents “digesting” this mass of information that
is new and emotively very involving. It uses some
defence mechanisms of a psychotic type, such as depersonalisation
and derealisation.
Later, the subject is unable to transform the trauma experienced,
into a recollection normally inserted into memory,
and therefore in the sense of individual experience.
However, the overburden of information related to
the event, persists with time and leads to the blocking
of information processing.
Intrusive thoughts are nothing more than the
attempt to contnually reprocess the traumatic event.
According to some recent theories dreaming is seen
as an attempt to resolve these problems and it would
explain also the presence of recurrent nightmares.
From the moment when this processing of experience
fails, the subject tends to avoid everything that
could be connected in some way to the recollection and
therefore to the unbearable pain connected to the event.
The hyperalert of the central nervous system and the
changes borne by the neurovegetative system are the
simple correlate of this state of mind of extreme tension.
4. Cognitive Evaluation
The capacity of cognitive evaluation in the subject
regarding a traumatic event and in particular an excess
of information, both subjective and objective, of which
follows a partial and inadequate elaboration, is fundamental
in determining Post-traumatic Stress Disorder.
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The inadequate elaboration of these situations
prevails in the young, because of cognitive immaturity
and in the old because of cognitive rigidity.
The inadequate elaboration leads to the block of
the system of information processing. It is transformed
clinically with negative anticipation of events (if this
happens.. then the other will happen... and I will be
ill), with conditioned avoidance (appearance of
phobias and reactive formations which make the
subject’s cognitive model even more rigid), and with
psychotic dissociation (through the defence mechanism
of negation).
From such cognitive aspects the emotive aspects of
neurovegatative hyperarousal derive, acute anxiety
(panic) and both positive and negative psychotic
symptoms.
After a fairly long time after the trauma there is a
persistent personality modification, with interpersonal,
social and work functioning compromised. As well,
such modifications lead to maladjustment, frustration
and aggression.
5. Risk Factors
The risk factors for the development of PTSD are
present in subjects with an inadequate cognitive evaluation
of stressful or traumatic events, owing to cognitive
immaturity or rigidity in thinking.
Risk factors are present in subjects that are experiencing
or have experienced the following conditions:
• presence of infantile trauma (a later trauma
rekindles the earlier problems leading to personality
regression);
• traits of borderline, paranoid, dependent or antisocial
personality disorders (they are immature
forms of the personality that easily lend themselves
to psychotic type decompensation);
• inadequate social support system (lack of a social support
network does not help interpersonal elaboration of the
trauma through dialogue and communication);
• genetic-constitutional vulnerability to psychiatric
illnesses (known as psychiatric diathesis);
• recent stressful life changes (that have affected the
security system of the person and conditioned
emotive reactive capacity);
• perception of being controlled externally rather
than internally (for the sensation of not being able
to face and control the situations experienced);
• alexithimia (incapacity to verbalise emotional experiences);
• people on their own,divorced, widowed, economically
disadvantaged or isolated.