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

More documents

Recommendations

Info

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. 32 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.
Giornale di Medicina Militare - A. 154°, Fasc. 1-2, gen. - apr. 2004 6. Protective Mechanisms of the Personality The protective mechanisms of the personality when faced with traumatic and stressful events are present in subjects with mature and flexible cognitive capacities. They are able to adapt to emotionally difficult situations and know how to work out new behavioural solutions compared to their usual ones. The protective mechanisms of the personality are represented by events correlated to common concepts of psychological health: • a person who likes and accepts himself • a person who does not depend eccessively on others’ approval • a person who is not deeply hurt by others’ criticism • a person who sets realistic objectives learning from failures and defeats • people who do not aim to dominate others and do not need to humiliate others • people capable of putting up with and tolerating anxiety • people capable of loving imperfect people • people capable of controlling impulses (emotional intelligence) 33 • people capable of putting regrets and resentment to one side • people capable of asking for help. 7. Conclusions The clinical appearance of Post-traumatic Stress Disorder is determined not by the seriousness of the stressful or taumatic event, but by the subjective wayof elaborating experience, represented by the cognitive system of reference of the personality. Some people with adequate and flexible cognitive psychological mechanisms can face acute stressful situations or long term ones, without decompensation with psychopathological reactive disorders. Other people with inadequate and rigid cognitive psychological mechanisms decompensate psychopathologically even for minimally stressful events. The capacity of the subject to adapt to tension, frustration, death, to a reality that he does not like or agree with, determines the one type or the other. A capacity that can be inferred in a statement such as: “There’s something not right in me, in you, or in the situation, but it’s alright anyway”.
Page 1 and 2: Giornale di Medicina Militare - A.
Page 3 and 4: Giornale di Medicina Militare - A.
Page 5: Giornale di Medicina Militare - A.

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

Create successful ePaper yourself

Delete template?

Save as template?