post-traumatic depression. Post-traumatic stress disorder: treatment and rehabilitation. Video: PTSD Documentary

post-traumatic stress disorder(synonyms: PTSD, post-traumatic stressful condition, PTSS, "Afghan syndrome", "Vietnamese syndrome", "Chechen syndrome") is a complex mental deviation caused by one or more regularly recurring mental traumas - situations that heavily affect a person's emotional experiences.

PTSD is characterized by a number of specific clinical features:

• the regularity of exacerbation of the psychopathological clinic (re-experiencing) at the time of which the patient mentally experiences the same traumatic situation before,
• the desire to avoid situations that remind him of the trauma experienced,
• amnestic phenomena - a protective reaction of the patient's psyche, characterized by falling out of the permanent memory of a traumatic situation,
• a significant level of generalized anxiety within 3-18 weeks after the traumatic event,
• the manifestation of exacerbation attacks at the time of meeting with anxiety triggers (“triggers”), which remind a person, both on a conscious level and unconsciously, of the conditions for the occurrence or manifestation of his traumatic situation in the past. Triggers are often visual and auditory stimuli, such as squealing brakes, a shot, crying, the smell of some substance, the hum of an engine, etc.

One of the most common causes of PTSD is participation in hostilities. The surrounding military situation develops the neutrality of the mental attitude of the soldiers in the most difficult situations, however, remaining in memory, these circumstances emerge and cause a traumatic effect during the period of treatment in the hospital or returning to peaceful living conditions.

The geographical localization of hostilities is reflected in the names of the post-traumatic syndrome, thus characterizing the patient's attitude to the specifics of the situations that took place in those places.

History of the study of post-traumatic stress syndrome

The first mention of the signs of post-traumatic syndrome can be found in the records of the philosophers of ancient Greece with former and current soldiers of the Roman legion. Herodotus and Lucretius described in great detail the state of regularly occurring anxiety, irritability and repetition. bad memories hard battles.

orderliness scientific research PTSD began to appear in the 19th century, when individual clinical manifestations of the pathology began to be combined into a syndrome in former military men. Thus, the following were systematized: increased excitability, fixation on a traumatic situation, the desire to avoid situations reminiscent of a trauma, as well as high level disposition to spontaneous aggression.

At the end of the 19th century, the concept of "traumatic neurosis" was introduced, which was served by the same type of manifestation of the clinic in large group survivors of a major railroad accident.

Rich in various natural and social cataclysms, the 20th century provided a huge field for the study of post-traumatic syndrome. Thus, among veterans of the First World War, German psychiatrists included in the PTSD syndrome a sign of a confident increase in the clinical symptoms of the disorder over the years.

This conclusion was also confirmed by specialists who studied the "syndrome of concentration camp prisoners", when people who survived in brutal conditions, returning to a normal way of life, committed suicide many years after the tragedy. A similar picture was observed among survivors of natural disasters: floods, tsunamis, earthquakes. Nightmares, constant anxiety and nervousness plagued the victims for many years, interfering with their quality of life.

The modern interpretation of the post-traumatic syndrome was finally formulated by the 80s of the XX century, which was served by the accumulated rich material in the field of relevant research.

It should be emphasized that the etiological component of the syndrome was initially attributed only to serious natural or political events - natural disasters, armed conflicts, terrorist acts etc., however, today the causal boundaries of the manifestation of the disorder are expanded by the influence of social traumatism: domestic violence, rape, robbery, bullying.

Risk of developing post-traumatic stress disorder

PTSD is one of the most common psychological disorders in the world. Statistical psychiatry confirms that about 8% of all inhabitants of the planet suffer pathology during their lives at least once. It was also noted that women are subject to the disorder 2 times more often than men due to physiological instability and reactivity to stressful situation.

The development of post-traumatic stress disorder can be the so-called post-traumatic stress disorder, but this happens extremely rarely. Transition to pathological syndrome depends on the level of participation of a person in a particular stressful situation. For example, witnesses of a car accident involving a passenger bus endure heavy emotional experiences about 3 times easier than its passengers.

Post-traumatic stress is a physiologically normal protective reaction of the human psyche to unpleasant events that have occurred. The phenomenon of stress is characterized by the desire to exclude traumatic events from memory, including at the subconscious level.

It is extremely rare for PTSD to transform into PTSD, but scientific research supports the transition.

With the right approach to the treatment of post-traumatic stress, the manifestation of the disorder can be ruled out after a few days. American specialists especially advanced in the treatment of post-traumatic disorders after the events of September 11th.

The risk of developing post-traumatic stress disorder in children is much higher than in adults, at a ratio of about 80% to 30%, respectively.

An important role in the development of PTSD is played by the social and living conditions in which the patient is located after the trauma. The risk of pathology is greatly reduced when there are people around who have experienced a similar situation. Individually, PTSD affects people with poor mental health and increased reactivity to environmental stimuli. In addition, other individual characteristics of a person can be distinguished.

1. hereditary factors. Aggravation of the situation due to mental illness, suicide of close relatives, alcoholism, drug addiction.
2. Psychological trauma suffered at an early age.
3. Associated mental, nervous pathologies, diseases of the endocrine system.
4. Loneliness.
5. The difficult economic and political situation in the country.

Etiology of post-traumatic stress disorder

The reason for the development of PTSD can be any environmental situation that goes beyond the standard human experience, causing a strong load on the emotional-volitional component of his psyche.

The most common cause of PTSD is military action, which is exacerbated by the difficult and lengthy adaptation of veterans to the conditions of peaceful civilian life in conditions of social loneliness.

With regard to civilian etiology, the most common cause of PTSD (more than 60% of victims) is abduction and hostage-taking. An interesting feature of the manifestation of the syndrome is the "Stockholm syndrome".

- a phenomenon characterized by protective-unconscious sympathy, both mutual and one-sided between the aggressor and the victim. The syndrome often manifests itself between the invaders and their hostages, when the victims, under the influence of the strongest psychological shock, begin to sympathize with the aggressors, adopt their ideas, and even compare themselves with them. Victims often believe that their capture is a necessary ingredient to achieve common purpose. "Stockholm Syndrome" got its name from the capture of four employees of the bank "CreditBank" on August 23, 1973 in Stockholm.

After their release, the former victims stated that they did not feel any negative emotions towards the invaders, but were afraid of the police, which, in order to resolve the conflict, are authorized to use various methods, including those that could lead to the death of people.

The likelihood of developing post-traumatic stress disorder in victims of sexual violence ranges from 30% to 60%, depending on the level of social education of the victim. When beaten - about 30%, robbery - 16%, witnesses to murders - 8%.

In the modern world, PTSD is especially relevant among victims of physical, moral or sexual domestic violence, which is aggravated by a separate category of victims. It is, as a rule, children and women who are exposed to such violence more often. Over the subsequent time, this category often has cases of transformation of PTSD into more severe disorders: inferiority complex, depression, generalized anxiety disorder and even paraphrenia.

Clinical picture of post-traumatic stress disorder

A hallmark symptom in post-traumatic stress disorder is an obsessive memory of the traumatic event in the form of separate flashbacks (returning to the past).

The moment of recollection is always accompanied by a state of anxiety, a feeling of fear, longing and detachment, which in their strength can be equal to the emotions during the most traumatic event. At the same time, physical changes occur in the body in the form of a response from the vegetative nervous system: increased pressure, tachycardia, arrhythmia, involuntary urination, diarrhea, increased sweating.

Illusions are one of the characteristic symptoms of PTSD, when a person dreams of people screaming in loud noises or specific individuals in dark corners of a room. Hallucinations, both visual and auditory, are also possible, the patient can talk with a dead person, be in a fictional space, really feel the touch.

Hallucinatory and illusory symptoms often cause inappropriate actions in a person, more often of an aggressive nature, can cause suicide attempts.

Flashback and illusory-hallucinatory complex can be provoked by triggers, long nervous tension, insomnia, use large quantities alcohol, drugs, but can also appear spontaneously.

In addition to the main symptom, there are a number of characteristic clinical manifestations PTSD:

• an attempt to avoid everything that somehow reminds of a tragic situation. A person very quickly catches the connection between triggers and exacerbation of the disease, therefore, avoids situations and objects that even remotely remind him of the trauma,
• sleep dysfunction. Nightmares with details of individual moments of a traumatic situation are a constant companion of PTSD. In addition, there is often a perversion of the rhythm of sleep, heavy falling asleep and shallow restless sleep,
• guilt complex. It often manifests itself in the commanders of military units and survivors of disasters, who blame themselves for the death of others, greatly overestimating their own role in the current tragic situation,
• overstrain of the nervous system with the subsequent result of its exhaustion. A state of constant alertness, sleep disturbances, exhausting seizures inevitably lead to: a decrease in physical and mental capacity, attention, constant irritability, inability to creative activity,
• psychopathological disorders: poorly controlled aggression, social phobia, selfishness, addictions, usually alcohol and drugs.

Post-traumatic stress disorder in children

As already mentioned, the risk of developing PTSD in children is much higher than in adults - the child's psyche is much more receptive and sensitive to traumatic situations that leave their mark on the rest of their lives.

Like adults, children try to avoid triggers, when they meet with them, they experience emotional experiences, manifested by screaming, crying, inappropriate behavior, especially at night. A characteristic feature of childhood PTSD is the desire to experience the traumatic situation again, which is reflected in games, drawings and behavior. Such children often take an aggressive leadership position with their peers.

The child becomes withdrawn, irritable, develops a serious attachment to the "mother's skirt". Perhaps the development of regression in the mental development of a small patient - the child seems to refuse back: self-service skills disappear, the vocabulary becomes impoverished.

In the case of chronic PTSD, over the years, children develop a lag in mental and physical development, an irreparable formation of character traits that determine antisocial behavior, and the development of various addictions.

When the following symptoms Post-traumatic stress disorder in children requires urgent specialist help - parents may not always be aware that their child is undergoing a traumatic event:

• frequent nightmares, enuresis,
• appetite disorders,
• games of the same type or drawings of strange, constantly repeating content,
• too bright and long-term reaction to household stimuli,
• the disappearance of previously acquired life skills, the return to behavior characteristic of a younger age,
• sudden appearance of fear of parting with the mother,
• a categorical rejection kindergarten, schools,
• a sharp decline in academic performance, teachers' complaints about the aggressive behavior of the child,
• loss of interest in activities that were previously satisfying
• lethargy, drowsiness daytime trying to avoid contact with peers and strangers,
• increased frequency of domestic accidents with a child.

Treatment for post-traumatic stress disorder

When clinical signs characteristic of PTSD are detected and a diagnosis is made, drug treatment is used with a mandatory combination of psychotherapy and psychocorrection under the strict supervision of a doctor.

In conditions light flow diseases with a predominance nervous strain appoint sedatives, with their insufficient action - antidepressants from the group selective inhibitors serotonin reuptake (SSRI). In rare, especially severe cases, in the first 2-3 weeks, drugs from the group of tranquilizers are used. This complex therapy reduces the entire spectrum of clinical signs of PTSD.

In the first days of use, small doses of drugs are prescribed, due to the possible strengthening of the clinic of the disease. Then the dosage is gradually increased, bringing to the optimum level. At complex therapy PTSD requires the use of beta-blockers, especially indicated for symptoms of an autonomic nervous system disorder.

With the appearance of an illusory-hallucinar syndrome, drugs from the group of neuroleptics are used up to the relief of symptoms.

Methods of psychotherapy for PTSD include: hypnosis, self-hypnosis and relaxation techniques. A special place is occupied by psycho-correction with the help of drawing - it is believed that it is easier for the patient to overcome his fears if he tries to reflect them on paper.

Any affect the human psyche. Anxiety and mental discord at this time are considered normal manifestations. If the experience was short-term and small in level, then the symptoms will go away in the near future. But with a strong emotional impact, difficult events remain on long period. In the international classifier of diseases (ICD) similar condition described as post-traumatic stress disorder.

Description in ICD-10

A painful post-traumatic reaction occurs after an event of catastrophic proportions. Similar to almost every person. The following characteristics aggravate the course of the disease and accompany its development:

• low stress resistance;
• mental illness;
• physical disability;
• personal characteristics.

At the same time, they cannot be called sufficient to explain the appearance of post-traumatic stress syndrome. The disorder can proceed in different people in different scenarios. So, not all people have symptoms immediately after a tragic event. It is not uncommon for post-traumatic stress disorder (or PTSD) to occur months later. In the ICD-10 classifier, it is noted that the interval between an alarming event and the onset of the disease can be 6 months.

ICD-10 fixes the disease as an independent unit. The main manifestation is delayed after trauma, that is, they come after a threatening event. The ICD-10 description notes that a traumatic event may be short-lived or extended in time, but as a result of it, a person felt danger, felt helpless, and, as a result, the event shocked him very much.

Basis for post-traumatic stress disorder

Any experience that goes beyond the perception of the norm of a particular person can cause a disease. There are many studies in the literature on the topic of the military, who received post-traumatic stress. Participants in hostilities are most susceptible to the occurrence of PTSD, almost every participant and eyewitness, after returning to a peaceful mode of existence, is covered with symptoms. No wonder there are such designations as "Chechen syndrome", "Afghan syndrome" and others. What else is the basis for the appearance of PTSD? Any tragic, stressful and traumatic events.

1. Kidnapping or hostage-taking. It is worth noting that in this case, post-traumatic stress disorder manifests itself already during the period of exposure to a threatening event. Prolonged stay in captivity by terrorists causes PTSD, which requires long-term rehabilitation from many specialists, including mandatory psychological assistance.
2. Sexual abuse. Post-traumatic stress exacerbates the shame, guilt, and impunity of the perpetrator.
3. Extreme catastrophes of a global nature. This group includes climate disasters, traffic accidents, fires, explosions. This should also include disasters associated with radiation and chemical contamination. A striking example is the tragedy at Chernobyl.
4. Watching the death of a loved one or random person. Post-traumatic stress syndrome is also recorded in children, psychologists note that as a result of an unexpected scene of severe violence, most children and adolescents can develop a severe disorder.

Symptoms of the disease

The symptoms of PTSD appear unexpectedly, may increase gradually and disappear for a while. Consider the main symptoms of the disease.

Intrusive recollection of details of the event

Memories are fragmentary, but always accompanied by fear, hopelessness or horror. A stress attack can last quite a long time, against the background of it, blood pressure rises, the heartbeat quickens, limbs tremble, and sweating appears.

Sensory hallucinations

A suffering person can hear the screams of dying people, crying, moaning, smell burning or feel unpleasant touches. Such hallucinations occur under the influence of alcohol, drugs, after a sleepless night. But in some patients, obsessive illusions appear without good reason.

Flashbacks

Overwhelming intrusive memories and a nervous attack after the appearance of a situation or object that are associated with a past tragedy. It could be meeting a person who looks like a rapist, riding the subway after a terrorist attack, or seeing blood.

Sleep problems

Nightmares, insomnia, shallow sleep, difficulty falling asleep are common symptoms of PTSD patients. Sometimes terrifying dreams are indistinguishable from reality, this does not allow a person to adapt, torments him.

excitability of the nervous system

Due to increased excitability, a person may startle from a phone call, clap, whistle, knock. At the same time, the concentration of attention decreases, the person reacts sharply to minor life situations, gets irritated without a significant reason.

Guilt

The victim inadequately assesses the traumatic event that happened to him. He blames himself for the death of loved ones, overestimates his role in the outcome dangerous situation. Often the situation is aggravated by the illusion that it was possible to do the “right” and not get into a difficult situation. If a person has experienced violence, then a feeling of inferiority is added to the feeling of guilt.

Symptoms of reduced social adaptation

If the patient does not receive adequate treatment, he is not supported by relatives or he is too broken, then over time he may refuse to work, not look for new meetings, conflict with others, and increasingly be alone. In severe cases, a person resorts to alcohol or drugs, but such a substitution only increases the destruction of the personality.

Emotional devastation

Post-traumatic stress is characterized by impoverishment of emotional life, aggression, selfishness, coldness appear. The ability to compassion decreases, a person cannot see the beauty of life.

Other symptoms

The symptoms described do not give a complete picture of post-traumatic stress disorder. It is also worth adding: thoughts about own death, headaches, feeling of emptiness, depression. The main signs of PTSD include living by past events, since the suffering person does not look to the future, he cannot plan his life, all his attention is “stuck” in the past moment of the tragedy.

According to ICD-10, PTSD is diagnosed when symptoms persist for more than one month. Acute course the disease occurs when the symptoms continue for less than 3 months, and the chronic stage is designated after the persistence of symptoms for more than three months. The acute phase is set after a period of 6 months.

Medical treatment

Post-traumatic stress disorder is treated with medication. But in addition to drugs, it is necessary to connect psychotherapeutic treatment. Two types of rehabilitation and treatment should be carried out in a complex.

Medical treatment includes:

1. Sedatives.
2. Antidepressants.
3. Antipsychotics.
4. Beta blockers.
5. Normotimics.

Important: drugs are used for acute and chronic disease. All appointments should be carried out only by the attending physician.

The purpose of the use of drugs: to reduce fears, anxiety, signs of depression.

Psychotherapy

Working with a psychotherapist is based on the experience of negative feelings, the specialist teaches to cope with the consequences of trauma. A psychotherapist helps a suffering person gain a sense of control over life, adapt to reality, and reduce the impact of a traumatic event.
Psychotherapeutic treatment includes the following methods:

1. Cognitive-behavioral psychotherapy. The specialist works with the patient on thoughts, feelings. With the help of a course of meetings, one can accept reality and increase adaptation.
2. Psychodynamic psychotherapy. The treatment is aimed at restoring one's own "I", self-respect, and resolving internal conflicts.
3. Family psychotherapy. Post-traumatic stress can affect all family members, so a joint course with a psychotherapist helps to understand the problems of each family member, both suffering from trauma and supporting him.
4. Client-centered therapy. The specialist and the patient work with such manifestations of PTSD as loneliness, discomfort, depression, moral fatigue.

In a situation with post-traumatic stress disorder, it is important not to delay treatment. Psychological support help get out of difficult situation, work through the trauma, teach you to cope with undesirable manifestations of the stress syndrome.

Video: Psychologist Marina Lindholm “There is no joy in life. PTSD - post-traumatic stress disorder"

First medical term post-traumatic stress disorder became public knowledge after the Vietnam War - 1965-1975, when the US military participating in it, having already returned home, could not get comfortable in a peaceful society and were constantly in a state of severe stress. In America, it was called the "Vietnamese syndrome", and in Russia - "Afghan" and "Chechen".

The concept of post-traumatic stress disorder?

This type of disorder is a cumulative response to stress and adjustment disorders. According to the existing international classification diseases of the tenth revision, according to ICD-10 - post-traumatic stress disorder is a severe form of mental condition that develops with one-time or constantly recurring psycho-traumatic situations, life threatening person or the life of other people, relatives and friends.

Getting into a situation that can cause fear or horror, experiencing defenselessness and powerlessness, during an accident, crime, attack or natural, industrial disaster, military action, a person transfers too much stress on the psyche, which causes traumatic stress. News of incurable disease, disability, as well as physical or sexual abuse, torture. Signs of PTSD are also observed in those who have experienced - betrayal, divorce, or the death of a loved one. The symptoms of the disease include: regular re-experiencing of psychopathological situations, a return to the experienced or loss of memory of the event that led to a mental disorder, a very high level of anxiety after the received psychological trauma lasting over a month.

Main Causes of PTSD

The reason for the development of the disorder can be any situations that a person finds himself in, if they go beyond his experience, and put a very large burden on his volitional and emotional components of the psyche. The most common causes of post-traumatic stress disorder are conflicts involving the military. Prolonged PTSD does not allow them to adapt normally to peaceful life and causes a feeling of social loneliness, misunderstanding, uselessness.

In the case of civil etiology, common causes diseases serve as abductions or hostage-taking. Psychological stress in such situations is expressed in the most different form the person's response to the situation. For example, the so-called "Stockholm Syndrome" is known, when the hostages began to sympathize with the terrorists, their ideas, associate themselves with them and express negative feelings towards the police, who tried to free them. "Stockholm Syndrome" became known as such, after the case of the capture of a bank in Stockholm in 1973, when 4 bank employees became hostages of the aggressors. After they were released, they reported that they did not feel hatred for the invaders and were only afraid that the police, from whom they expected help, would take measures leading to their death.
Depending on the social level of upbringing, the victim of physical or sexual violence has a probability of developing PTSD from 20 to 70%, after a beating - up to 35%, a robbery - 15%, and for witnesses of a murder - 10%. Modern world changing and post-traumatic stress disorder today is very relevant among victims of moral, domestic, physical and sexual violence, and this is especially burdened by a separate category of weaker and more vulnerable people - children and women who are most often subjected to such violence. AT recent times, in this category, more severe types of mental disorders are most often recorded - severe, prolonged depression, an inferiority complex, anxiety disorder and paraphrenia.

Excursion into history

In the records of the first philosophers and healers of ancient Greece, there are references to diseases caused by strong stressful experiences, which in all respects correspond to the post-traumatic syndrome. They were observed among Roman soldiers. Post-traumatic stress and its symptoms were described in great detail in their writings by Lucretius and Herodotus, and the soldiers noted a state of irritability, anxiety and repetition of memories of experienced difficult moments of battles.

In the 19th century, after scientific studies of PTSD, the clinical symptoms and manifestations of the pathology of which were combined into a syndrome, were systematized, and they include: the desire to avoid a situation that reminds of a traumatic event, increased excitability, a high predisposition to spontaneous manifestations of aggression, fixation on the situation which led to injury. Post-traumatic stress, which causes "traumatic neurosis", was introduced in medical terminology after the same type of manifestation of the clinic in a group of people who survived after a serious accident on the railway.

The twentieth century was rich in social and natural disasters, wars, and provided medicine with a wide field for the study of psychological pathology, including post-traumatic syndrome. German psychiatrists during the First World War noted PTSD in veterans, and noted the increase in the disorder over the years, identified it classic symptoms. Specialists conducted research on the “concentration camp prisoner syndrome”, which was observed in people who survived in the brutal conditions of concentration camps. They could not return to a normal life, and even after many years, unable to withstand the burden of what they experienced, they ended their lives by suicide. Such a picture could also be observed among those who survived natural disasters: earthquakes, tsunamis, floods, lost their loved ones. Constant anxiety, nervousness and nightmares tormented the victims for years, not allowing them to live. Post-traumatic stress caused by military conflict has been studied for decades, and combat-induced stress responses have been the subject of research during both World War I and World War II. Different authors have called the symptoms of this disorder differently - "military neurosis", "military fatigue", "post-traumatic neurosis", "combat exhaustion".

Their first systematization was made in 1941 by Kardiner, calling this condition “chronic military neurosis”. He developed the ideas of Freud, and believed that the cause of all violations of personal functions that ensure adaptation to environment, serves as a "central physioneurosis", which has both a psychological and physiological nature. The interpretation of PTSD was fully formulated in the eighties of the 20th century, thanks to the rich material collected, numerous studies carried out.

There was a renewed interest in this area of ​​research after the end of the Vietnam War. Almost 75-80% of the American military who took part in this war were able to easily adapt to a new life, and it did not entail a deterioration in their mental and physical health. But among the remaining 20-25% of the military, who received psychological trauma, there was an increase in the number of suicides and acts of violence. Unfavorable changes in personality under the influence of the received psychological trauma were observed in 15.3% of cases in men and 8.8% in women. They did not find a common language with the people around them and could not establish normal relationships in the family and at work. In subsequent years, this condition did not disappear, but only worsened, despite the apparent outward well-being of a person.

Supervised post-traumatic stress survivors needed medical help for a while. They were in a serious condition for about a month after what happened to them, and again returned to normal life. But for some people, traumatic events affected after this period, turning into a severe form of post-traumatic stress, making it difficult for them to adapt, and leading to maladaptive behaviors.

American researchers, having studied all the symptoms of the disorder, divided them into two concepts: “combat fatigue” and “combat shock”.

combat shock

Manifested in an emotional reaction within hours or weeks after heavy fighting. According to its progression, it is divided into 3 different stages:

• in the first stage, a person feels overwhelming fear, depression and anxiety;
• in the second (more acute stage) symptoms of acute neurosis may appear, and it lasts for several weeks. When providing assistance, and using medication and psychological methods treatment, prognosis for recovery is favorable;
• last ( chronic stage) - is manifested by chronic, psychological decompensation. The patient recovers very slowly and this requires medical methods treatment.

Combat exhaustion

This post-traumatic stress manifests itself in the form of a mental disorder of moderate severity. Symptoms of the disease appear after several weeks of incessant fighting. Main psychological reasons combat overwork - high responsibility in the performance of a combat mission, constant threat to life, uncertainty and lack of information, mismatch of professional and military skills that meet the requirements, lack of time to make decisions, isolation.

Too much huge pressure on the psyche, psychological and psychogenic factors of hostilities, lead to a reaction - "anxiety". Symptoms of the disorder are manifested in tremor (trembling), muscle tension, problems with the digestive, respiratory and cardiovascular system. The person becomes apathetic or vice versa very irritable. The “alarm reaction” ends with a state of resistance, with the mobilization of all compensatory forces of the body. With too long psychogenic factors and a state of resistance, the body's forces are depleted and the moment of "combat overwork" comes.

American specialists have developed methods for the prevention of such disorders that will help prevent such disorders, and they include a number of measures to provide psychological assistance to the military. In domestic science, theoretical and comprehensive research began to be held in connection with the problems of adaptation of veterans of Afghanistan and the military, who participated in the Chechen war, and needed psychological assistance.

Work on PTSD - V.V. Signs that he devoted to the study of the adaptation of Afghan veterans include studies of the disorder, as well as the reasons for the misunderstanding of "Afghans" when communicating, and the fact that many create their own stereotype or negative "psychological portrait" of an Afghan veteran, which does not correspond to reality. Such stereotypes do not allow those who fought to find a common language with partners not participating in combat operations. And this is due primarily to the inability to separate the political aspects of the war from the psychological component and the distorted idea of ​​morality, which has recently occupied the minds of the public. In fact, according to the experiments, the participants in the war have a very negative attitude towards physical pressure per person, unlike those who did not participate in the war, and are much less aggressive. Having experienced many hardships, they felt psychological difficulties in adapting, disappointment in people, discomfort, resentment, due to misunderstanding. But at the same time, they developed such qualities as a more active civic position, respect for parents, responsibility, sympathy for victims of violence, devotion to comrades and readiness to help a person in trouble.

Works by V.V. Znakova only confirmed that today there is an acute problem in the study of post-traumatic mental disorders, which requires the development of more effective methods and programs of psychotherapeutic and psychological assistance to victims of PTSD.

It is worth emphasizing that the main component of the syndrome was attributed only to serious political events or natural disasters, terrorist acts and military conflicts, but today these boundaries have been expanded by the influence of the social factor: rape, domestic violence, bullying and robbery.

Symptoms of post-traumatic stress

Included in 1998, in the ICD-10, PTSD syndrome is characterized by symptoms such as:

• recurring memories of the traumatic event, both awake and asleep;
• antisocial behavior;
• decreased interest in social life;
• poor sleep or insomnia;
• feeling of aimlessness in one's life, thoughts of suicide.

All this is complicated by somatic disorders, which are manifested by problems in the nervous, digestive, endocrine and cardiovascular systems.

PTSD is characterized by certain clinical signs, which include the following symptoms:

• frequent and regular exacerbations of clinical psychopathology, when the patient experiences the same situation that caused his trauma, early;
• the desire to avoid a situation that is at least somewhat similar to, or reminiscent of, the trauma experienced;
• amnesia - how defensive reaction the psyche of the patient, which is characterized by loss of memory of the event, the situation that caused the injury;
• a high level of anxiety that lasts more than one to three months after the traumatic situation;
• frequent attacks of exacerbation, at the moment with the so-called “triggers” or triggers of anxiety, which on a conscious and subconscious level remind a person of what he experienced in the past, and create conditions for “losing” the situation. These can be both auditory and visual stimuli - a shot, crying, smell, squeaking brakes, engine hum, thunderstorm noise, a certain melody, etc.

Many patients complaining of depression often confuse it with PTSD. But unlike depression, PTSD is always caused by a specific cause, and it has a number of features. When a person is depressed, nothing pleases him, and he does not want to live, but he does not know how it began. The countdown to the onset of a stress disorder is misfortune or trauma, which entails mental disorders. But how to distinguish one from the other?

Back to the past

People suffering from PTSD, as in a time machine, are mentally carried away all the time into experiences of past events. It is useless to tell them to “get it all out of your head”, since it is what happened in the past that has a greater reality or relevance for them than the present. It is in it that there is no ordinary idleness, and it seems that if you return to it, you can fix something. The event scrolls all the time to somehow remember something important that can change the existing state.

In forensic science, they know that both victim and perpetrator often return to the scene of a crime looking for something they can't explain themselves. It is the belief in magic, that the past can be changed, that pulls them to this place. Psychoanalysts advise their patients not to try to change what is impossible to change, but to try to change their attitude towards it and their thoughts. Constant experiences of the situation will eventually lead to frequent nightmares, antics, unexpected actions, physiological disorders.

The constant “playing out” of the past can also be more terrible, fatal, when, having survived violence, the victim again looks for someone who would subject her to violence, believing that this time she will be able to cope and avoid it, changing her past, removing from yourself a "curse". Being in such self-deception, a person thinks that he controls the whole situation, not realizing that it is his injury that controls him, poisoning him more and more - spiritually, mentally and physically. And breaking this circle can be difficult on your own, and even impossible without the help of a specialist.

Alienation

Returning from the war zone, the military constantly feel misunderstood, as if between them and ordinary civilians there are walls of alienation and cold. And no matter how hard their relatives tried to help them, they still had a bitter aftertaste of misunderstanding, and even disappointment. All phrases and words seem banal to him, while relatives do not talk about their experiences with him, so as not to remind him once again of the war. In such a situation, a person feels like a toy of fate and believes that he needs help that he does not see, and at the same time closes even more. Additional burdening here can be caused by complex postoperative period recovery from injury or disability.

Suicidal thoughts

Feeling completely powerless during an event that entails trauma, the victim does not see prospects in his life, and is even afraid to look into the future. His life seems worthless to him, and more and more thoughts about death begin to come, as about deliverance. Very often, victims of violence consider themselves to be guilty of what happened, and they cannot live with such a burden, they see no other way out of the situation.

Treatment options for PTSD

Realizing the seriousness of the problem in which the person is, if not himself, then his relatives should turn to a specialist who would help in solving it. When PTSD is detected and the final diagnosis is established, a complex is used: both psychological and drug treatment, depending on the severity of the disease, and after some time - psychotherapeutic. Such therapy reduces the entire spectrum of clinical symptoms of the disorder. It includes methods of psychotherapy and self-hypnosis techniques, hypnosis, relaxation, as well as art therapy, when the patient reflects his fears on paper, overcoming them with the help of drawing.

At therapeutic treatment Post-traumatic stress disorder is treated with antidepressants, tranquilizers, antipsychotics, and in some more complex cases, psychostimulants and anticonvulsants. But only a doctor can prescribe them to a patient!

Questions covered in the chapter:

Diagnostic criteria for PTSD Forms of PTSD Cotraumatization Directions for PTSD rehabilitation Stages of professional assistance Self-help methods

Post Traumatic Stress Disorder (PTSD) -

this is a specific clinical form of a violation of the process of post-traumatic stress adaptation. Criteria for diagnosing PTSD are contained in the international diagnostic standard ICD-10 - the International Classifier of Diseases, adopted in Europe and Russia. PTSD is classified as a group of disorders associated with impaired adaptation and reaction to severe stress.

PTSD occurs as a result of a person's exposure to traumatic events associated with death, serious injury to people, a possible threat of death or injury. At the same time, a person who has experienced such a traumatic situation can be both a victim of what is happening and a witness to the suffering of others. In any case, at the moment of being in a traumatic situation, he must experience intense fear, horror or a sense of helplessness.

A feature of this disorder is the tendency not only not to disappear with time, but to become more pronounced, and also to appear suddenly against the background of general well-being.

Prevalence. The study of PTSD began with clinical observations and analysis of the effects of extreme factors on a person, mainly military stress, as well as the consequences of natural and man-made disasters. It was revealed that the consequences of wars and disasters are not limited to visible victims, there are also hidden consequences - mental trauma, which can take the form of a pathological syndrome called post-traumatic stress disorder.

The prevalence rates of PTSD in people who have experienced extreme situations, according to the literature, range from 10% (in witnesses of the event) to 95% among those who were seriously injured (including those with somatic injuries). These figures depend on many circumstances, in particular, on the specific characteristics of the stressful event, the group of those examined (witnesses, participants, victims or liquidators), the diagnostic position of the researcher and the research method.

Consider the generalized data available in the literature.

According to studies conducted in the United States, among Vietnam veterans, the prevalence of PTSD was 30%. In survivors of Nazi concentration camps, the conditions that are now considered as PTSD were observed in 85-100% of cases.

In the domestic literature, the prevalence of PTSD among those who experienced severe stress was 50 - 80%. In the population, disorders are more than twice as common in women (1.2%) than in men (0.5%).

Post-traumatic stress disorder can appear at any age, however, given the nature of the situations that cause this disorder, it is more common in young adults.

The prevalence of PTSD in a population depends on the frequency of traumatic events. Thus, one can speak of traumas that are typical of certain political regimes or geographic regions, in which natural or other disasters are especially frequent.

The results of epidemiological studies show that exposure to PTSD correlates with certain physiological and mental disorders that either arise as a result of trauma or are present initially. These disorders include: anxiety neurosis, depression, a tendency to suicidal thoughts or attempts, drug, alcohol or drug addiction, psychosomatic disorders, diseases of the cardiovascular system. 50-100% of patients with PTSD have one of these comorbidities, and most often two or more. In addition, in patients with PTSD special problem represents a high rate of suicide or attempted suicide.

The intensity of the traumatic situation is a risk factor for PTSD. Other risk factors are: low level of education, social status; psychiatric problems preceding the traumatic event; the presence of close relatives suffering from psychiatric disorders, chronic stress.

Great importance is attached to personal vulnerability, the ability of an individual to cope with an event that is regarded as a life catastrophe.

Brief historical outline. Disorders that develop as a result of an experienced catastrophe have been described and diagnosed for a long time. In 1888, X. Oppenheim introduced into practice the well-known diagnosis of "traumatic neurosis", in which he described many of the symptoms of modern PTSD. E. Kraepelin (1916), characterizing traumatic neurosis, showed for the first time that after severe mental trauma, there may remain permanent disorders that increase over time.

Many works devoted to this problem appear after significant military conflicts. (Krasnyansky, 1993). Thus, important studies appeared in connection with the First World War (1914-1918).

After the First World War, American researchers identified two main hypotheses of mental disorders. The first of these can be called "shell shock". Thus, it was assumed that the violations in the soldiers are caused by the action of increased pressure during "long artillery duels." The second hypothesis was based on ideas about the emergence of "military" and "traumatic" neurosis. There were two points of view here. Supporters of the first of them believed that psychopathological syndromes occur only in those who are predisposed to this, have personality defects. The war was considered as a factor provoking the development of mental illness in an initially "inferior" person. (Figley, 1978; goodwin, 1987). The second point of view, as the main factor in the development of post-war neuroses, did not put the organic inferiority of the brain, but direct mental trauma during the war ("Psychoanalysis and military neurosis"). The cause of the injury was seen in the moments of surprise and fear present in the war.

Based on the results of the Second World War, several generalizing concepts and views on this issue can be distinguished.

The “disease model” is based on the presence of a pre-war intrapersonal conflict, which is activated by the experiences of war and leads to “traumatic neurosis” (Kardiner A.).

According to the “endurance model”, it is believed that a person participating in hostilities has a certain limit in his ability to endure these hostilities. This is followed by psychological decompensation, that is, neurosis becomes the norm and is called "combat exhaustion" (Cameron, 1963).

"Environmental Models" identified various external factors influencing the onset of PTSD: physical exhaustion, isolation from family and loved ones, lack of sleep, harsh climate, etc. It was believed that their combination causes psychological disorders. (Wenstein, 1947; hanson, 1949; Eppel, 1966).

The "model of experimental neurosis" is similar to the theory of I.P. Pavlov to create an artificial internal conflict, leading to a "confusion" ("collision") of nervous processes. In this model, the desire to survive conflicts with the desire to do one's duty. (Wilson, 1960).

After the Second World War (1939-1945), Soviet psychiatrists actively worked on the problem - V.E. Galenko (1946), E.M. Zalkind (1946-47), M.V. Solovyov (1946) and others. Interest in the problem arose in domestic psychiatry in connection with military conflicts, natural and man-made disasters that have befallen our country in recent decades. Particularly severe in terms of consequences were the accident on Chernobyl nuclear power plant(1986) and the earthquake in Armenia (1988).

The Vietnam War provided a powerful impetus for research by American psychiatrists and psychologists. By the end of the 1970s, significant material had been accumulated on psychopathological and personality disorders among war veterans. Similar symptoms were found in persons who suffered in other situations similar in severity of psychogenic effects. Due to the fact that this symptom complex did not correspond to any of the generally accepted nosological forms, in 1980 M. Horowitz proposed to single it out as an independent unit, calling this syndrome "post-traumatic stress disorder" (post-traumatic stress disorder, PTSD). Subsequently, a group of authors headed by M. Horowitz developed diagnostic criteria for PTSD, adopted first for the American classifications of mental illness (DSM-III and DSM-III-R), and then for the ICD-10.

D diagnosticpost-traumaticstress disorder( ptsd)

Criterion a. Man has ever gone through traumatic event and in relation to this event, both of the following points must be fulfilled:

The individual was a participant, witness, or otherwise involved in an event(s) that involves death or a threat of death or a threat of serious injury and/or a threat to the physical integrity of others (or one's own).

In a traumatic situation, a person experienced intense fear, helplessness, or horror.

Criterion b. The traumatic event is constantly experienced by one (or more) of the following ways, and for the diagnosis of PTSD, it is enough to have one of these symptoms:

Involuntary obsessive memories - a repetitive and obsessive reproduction in the memory of both the event itself and the images, thoughts and sensations associated with it, causing severe emotional experiences.

Constantly recurring nightmares and dreams about the event, causing intense negative experiences upon awakening.

Signs of dissociative states, manifested in the fact that after the trauma, the person periodically performs such actions or experiences such sensations as if the traumatic event occurred again. These include the following (including those that appear in a state of alcohol or drug intoxication or in a sleepy state):

sensations of "revival" of the past in the form of illusions and hallucinations;

"flashback effects", appearing in a complete loss of connection with reality and the appearance of a complete feeling of "transfer" to a traumatic situation. "Flashback effects" manifest themselves in behavior that is inappropriate to the current situation, but corresponding to the situation of traumatization.

Dramatic intrusive memories and intense painful experiences that were provoked by any situation that recalls or symbolizes traumatic events (anniversaries, films, songs, conversations, etc.).

Involuntary increase in psychophysiological reactivity in situations that symbolize various aspects traumatic event or associated with it associatively (similar terrain, sounds, smells, type of person's face, etc.).

Criterion C. A history of non-pre-injury persistent avoidance and avoidance of any trauma-related factors (a diagnosis of PTSD requires at least three of these symptoms):

Having an effort to avoid any thoughts, feelings, or conversations related to the trauma.

Having an effort to avoid activities, places, or people that evoke memories of the trauma.

Inability to recall important aspects of the traumatic situation.

Decreased interest in life, loss of interest in activities that were significant before the injury.

Feeling detached or separate from other people.

Reduced severity of positive affect (“numbing” - blockade of positive emotional reactions, emotional numbness, “insensitivity”, for example, the inability to experience an emotionally rich feeling of love that manifests itself in relation to the closest people).

Feelings of lack of future prospects (for example, lack of expectations about career, marriage, children, long life, expectation of imminent death, doomsday, global catastrophe).

Criterion D . Persistent symptoms of increased psychophysiological excitability that were not observed before the injury (to make a diagnosis of PTSD, you must have at least two symptoms).

Difficulty falling asleep or poor sleep (early awakenings) - associated with possible nightmares (sleep avoidance, "fearful sleep") and / or with increased anxiety and emotional distress accompanying obsessive thoughts and memories of trauma.

Increased, difficult to control irritability or outbursts of anger.

Difficulty concentrating - at some points a person can concentrate, but the slightest external influence or a change in the internal state sharply unsettles him.

An increased level of alertness, a state of "hyper vigilance", that is, a constant expectation of something bad.

Hypertrophied, exaggerated startle reaction to sudden stimuli - for example, to any sharp sudden sound (exhaust, gunshot, knock, etc.) or to the sensation of sudden movement at the periphery of the visual field, or to an unexpected touch.

Criterion E. The duration of the course of the disorder (simultaneous manifestation of the number of symptoms required by criteria B, C and D) - more than 1 month.

Criterion F . The disorder causes clinically significant severe emotional state or pronounced violations in social, professional or other important areas of life.

Depending on the time of occurrence, the duration of the flow, the following are distinguished diagnostic forms of post-traumatic stress disorder:

Acute disorder: the initial manifestation of symptoms during the first 6 months after the injury (but not earlier than 1 month after the event). At the same time, the duration of the combined manifestation of all the symptoms of PTSD is less than 6 months.

Chronic disorder: duration of manifestation of symptoms - over 6 months.

Delayed Disorder: the complex of symptoms first appears no earlier than 6 months after the stressful situation.

Let us now consider the primary symptoms of post-traumatic stress disorder in more detail.

Primary symptoms of post-traumatic stress disorder. In the classification of mental and behavioral disorders compiled by the World Health Organization, three groups of symptoms are distinguished in the symptomatic complex of post-traumatic stress disorder:

1. A group of re-experiencing symptoms (or “intrusion” symptoms).

2. A group of symptoms of avoidance.

3. A group of symptoms of physiological hyperactivation (increased excitability).

A group of symptoms of re-experiencing.Flashbacks. The past "does not let go" of a person: obsessively and relentlessly reminds of "what was."

Horrible, unpleasant scenes associated with the experience suddenly pop up in the memory. Every hint, everything that can remind of that event: some kind of sight, smell, sound - as if drawing pictures and images of traumatic events from the depths of memory. Consciousness, as it were, splits into two: a person is simultaneously in a peaceful environment, and where events took place. There is a feeling of emotional dependence, a narrowing of consciousness, a feeling of “here and there”. These unexpected, "unsolicited" memories can last from a few seconds or minutes to several hours. And, as a result, a person again experiences severe stress. Survivors of hostilities say that it is enough to hear, for example, the sound of a flying helicopter, to hear a rattle similar to the rattle of a tank, to feel a certain smell, to see a similar silhouette, so that the traumatized images and ideas again capture consciousness, so that a person again “returns” and relives "as in reality" the situation that most traumatized him. There is a reaction of increased fright to an unexpected or loud sound. At the slightest surprise, a person makes rapid movements, he can throw himself to the ground if he hears the sound of a low-flying helicopter, he turns around sharply and assumes a combat position if he feels someone approaching from his back. Such phenomena are called "flashbacks", they cause pronounced distress, physiological reactions to any stimuli associated with trauma.

“Unsolicited” memories also come in the form of nightmares, which sometimes, like a videotape, reproduce a traumatic situation, and with the same frightening accuracy, a person in a dream experiences his own reactions to this situation. He wakes up in a cold sweat, out of breath, with a pounding heart, tensed muscles, feeling completely overwhelmed. A person has problems with sleep, it can be difficult for him to fall asleep due to unconscious fear, sometimes sleep disturbances look like a constant early awakening, resulting in fatigue and apathy.

Repetitive and forcibly erupting, invading consciousness memories of the event, including images, thoughts, ideas. Impressions received during an extraordinary event can be so strong that their experience will last for a very long time: there are often flashbacks when the feelings that a person experienced during or after the event are repeated. The person may suddenly begin to feel as if the event is happening to him again. Recurring experiences can be very difficult and frightening, but they are completely normal in this situation.

It is difficult for a person to order himself not to think about something, even if it is in no way significant to him. And if relatives and relatives are involved in the situation, and, moreover, the situation is traumatic, a person is not able to stop thinking about what happened.

We can remember the days when the earthquake occurred in Armenia. How long the experience did not “let go” of the survivors! In their games, children again and again played out the tragedy that happened to them and their families: they sorted through the rubble, dug up each other, buried and said goodbye.

Recurring nightmares about the event. Dreams develop in two scenarios.

1. The victim has nightmares in which he relives what happened again and again, but in a dream he can see some kind of magical way out of the situation.

For example, a girl who survived the earthquake in Bulgaria, but at the same time lost all her loved ones, had the same dream every night: the earth was shaking, the floor was rising, and from there the Virgin Mary came out, who then brought their entire large family to the roof of their home, thereby saving them from death.

2. A person who has experienced a traumatic event every day sees more and more “horror films” in which he is pursued by maniacs, he gets into traffic accidents, falls from high-rise buildings, cannot get out of the dungeon, etc.

Actions or feelings that correspond to experiences during the trauma (illusions, hallucinations, "flashbacks").

On one of their visits to Moscow, the foreign delegation dined at a restaurant. A thunderstorm passed over the city. The huge windows of the restaurant were open. They rattled slightly from the lightning strike. Some of the people having dinner had an experience corresponding to the one that was at the moment of the real earthquake, and they, jumping up from their seats, rushed to the windows, jumping through the window sills into the street, fortunately, the restaurant was located on the first floor of the building. The other members of the delegation, looking at the actions of the former and succumbing to the mechanism of emotional infection, repeated their actions: they also jumped through the windows, passed the children from hand to hand - they “saved” themselves and their children. Later, they explained that they experienced emotions vividly and deeply, corresponding to those that they had during the earthquake.

Cramps in the stomach, headaches. Headaches, stomach cramps are frequent companions of people who have experienced a traumatic event. When working with victims and relatives of victims of emergency situations, psychologists often hear complaints about these symptoms. Cramps in the stomach often occur when fears appear in the victims.

A group of symptoms of avoidance. Another group of symptoms manifests itself in the fact that the traumatic experience is repressed. A person tries to avoid thoughts and memories of the experience, seeks not to get into situations that could remind, evoke these memories, tries to do everything so as not to evoke them again. He stubbornly avoids everything that may be associated with the trauma: thoughts or conversations, actions, places or people that remind of the trauma, becomes unable to remember important episodes of the trauma, what happened to him.

A decrease in interest in what used to occupy is expressed, a person becomes indifferent to everything, nothing fascinates him. There is a feeling of detachment and alienation from others, a feeling of loneliness.

It becomes difficult to establish close and friendly relationships with other people. Many survivors of severe stress complain that after the experience it has become much more difficult for them to experience feelings of love and joy (emotional dullness). Less often, periods of creative upsurge arise or disappear altogether. Depression occurs, a person begins to feel worthless and rejected, he develops self-doubt, there is a real alienation from loved ones - "they do not understand me." In a state of post-traumatic stress, depression reaches the most hopeless depths of despair, a person loses the meaning of existence. There is a strong apathy, there is a feeling of guilt.

Man ceases to plan his future. Very often there is a feeling of guilt: “I am to blame for not doing something: I didn’t save, I didn’t help, I didn’t predict ...”, self-deprecating thoughts and behavior arise, up to suicidal ones. Aggression often increases. There is a desire to solve all life conflicts with the help of force pressure. This does not necessarily apply rough physical strength, it can be both verbal and emotional aggressiveness. Outbursts of anger that occur under the influence of alcohol intoxication are unmotivated and most often turn into fits of violent anger.

Avoidance of thoughts, memories of the experience, the desire not to get into those situations that could remind, evoke these memories. A person is afraid of repeating extremely strong, destructive emotions. Aggression often occurs if someone tries in any way to penetrate the memories of the victim.

In ordinary life, the victim may seem to be a completely prosperous person, but any stimulus (an appropriate sound, a smell, a similar situation, a shadow that flickers behind his shoulder - it can be anything) that returns a person to a critical situation causes an instant revival of the victim's experiences. More and more efforts are needed to protect the victim from these experiences. All the mental energy of a person is spent on this.

memory impairment, concentration. Inability to remember important episodes of the trauma, places, people.

A woman who survived the death of her husband many years ago could not remember that a few days ago she was at a meeting of school graduates and was happy to see her classmates, she was undoubtedly happy in those moments, but after only three days she forgot about it. It already seemed to her again that she was surrounded only by loneliness and gray everyday life, in which there was neither joy, nor happy moments, nor friends, nor a loved one.

From psychotherapeutic practice, there are cases when a person “cannot” remember, as it later turns out, the most traumatic moments of the situation, which emerge in the mind only after a directed psychotherapeutic intervention.

Detachment, remoteness from the outside world, alienation from other people, a feeling of loneliness (“they don’t understand me”, “they didn’t survive this”). Loss of ability to establish close relationships with others.

Pavel took part in the fighting in Chechnya. Returning home, he could not decide on a job in any way - he graduated from school weakly, and immediately after school he left to serve. By the time he returned home, everything had changed: there was not enough money, his father drank, his mother had passed strongly. Pavel said: “It seems to me that I was in no hurry to return home. I understand that no one needs. But I'm not interested in anyone close to me either. I have nothing to talk about with him. I'm not attracted to friends. Their interests are no longer mine. Everything seems unreal to me. I am less and less drawn to leave the house, the emptiness around me takes on a living shape, filled with sounds, voices. I do not want to tell anyone about my service, even at home. Nobody understands me anyway!”

It is more difficult to experience feelings of love, joy (emotional dullness), feelings of creative upsurge disappear.

From servicemen who have passed through hot spots, you can hear the phrase: “I have become different, I feel it. But I can't help myself. I don't know how to tell my wife that I love her. Sometimes it seems to me that I have forgotten how to love. I have learned to regret. It is difficult for me to both express myself and accept any manifestations of tenderness, even if it is related to my children.

The stresses and tensions that arise in ordinary life can become unbearable for those who have gone through a traumatic incident. They try to avoid close contact with family, friends and colleagues, which often leads to personal problems. Difficulties in relationships increase over time, along with a growing feeling that "no one can understand what I went through."

This misconception is a major barrier to asking for help and support. Meanwhile, it is often those around you that can become the main source of restoring a comfortable state during a crisis.

Changing ideas about the world, a sense of the shortening of the future.

The results obtained on the material of the study (Tarabrina, 2001) of veterans of the war in Afghanistan and liquidators of the Chernobyl accident showed that veterans with PTSD experience an acute sense of uncertainty, discomfort, disappointment, but retain hope and the ability to imagine and plan their future.

In the study of PTSD liquidators of the Chernobyl accident, some features were noted: regardless of the degree of traumatization, the traumatic situation is prolonged into the future, as it is associated with a threat to health or life, which causes a strong emotional reaction: feelings of hopelessness, loneliness, and a persistent feeling of unhappiness.

A traumatic event changes the way you look at important moments in a person's life. Hopes for a better future can be lost or changed by deep disappointment.

Under the influence of a traumatic situation, a person experiences horror generated by the surrounding world and his own helplessness in it - previously existing beliefs are destroyed, bringing the person into a state of disintegration.

The American psychologist J. Yalom proposed to consider all the psychological problems of traumatic stress from the point of view of death, freedom, isolation, meaninglessness. In a traumatic situation, these themes appear not in the abstract, not as metaphors, but are absolutely real objects of experience. So, becoming a witness to the death of other people, a person is faced with his own possible death. We will discuss this phenomenon in more detail in Chapter 10.

In ordinary life, we have psychological defenses that allow us to exist side by side with the idea that one fine moment everything will be over for us, which, according to J. Yalom, can act as basic illusions.

The illusion of one's own immortality is as follows: “I know that all people must die sooner or later, but when it comes to me, I will somehow get out. By then, perhaps, the elixir of immortality will have been invented.” In other words: "Everything, but not me."

The very first encounter with a traumatic situation brings a person face to face with reality. For the first time, a person is forced to admit that he can die. For the majority, such a revelation can radically change the image of the world, which turns from a cozy and protected world into a world of fatal accidents, blown by all winds.

The illusion of justice says: "everyone gets what he deserves." One of her options: "If I do good to people, it will come back to me." Getting into a traumatic situation immediately shows with all obviousness the incorrectness, the unreality of the illusion about the justice of the world structure. The hero of the novel by Leo Tolstoy during the battle thought: “How can they kill me, because everyone loves me so much ?!”

The illusion of the simplicity of the structure of the world says: the world is very simple, it has only white and black, good and evil, ours and not ours, victims and aggressors. Halftones and dialectics of perception are absent here. The whole world seems to be divided into two opposite parts. The more mature a person becomes, the more she begins to agree with the phrase that can often be heard from people who have seen a lot: “Everything in life is very complicated, the more I live, the less I understand.”

The destruction of basic illusions is a painful moment for any person. And it is very important what follows. If a person can get out of the world, although comfortable, but still illusions, into a dangerous, but still real world, then he has matured as a person. If he could not overcome this barrier, then, as a rule, he either concludes that the world is terrible (and it is not good and not bad, but such as it is), or builds other illusions.

Overcoming the basic illusion could take the following form: “Everything we do, we do, first of all, for ourselves. And even though it may seem pointless, we have to do it just to be human.”

A person becomes older, different, not like "before ...". There may be a sense of emptiness of the future: what is the meaning of later life? A life in which everything has already been, and today there is only emptiness and disappointment. Representations of the past are often idealized. Thoughts appear: "Somehow before everything was different - and people are different, and my whole life was much more meaningful, brighter, but now everything is bad and everything is not like that."

Guilt. A person who has experienced a traumatic event, instead of feeling relieved that he was saved, often has a feeling of guilt. He may have doubts whether he could have done more to help his loved ones. He may constantly ask himself how he deserved to survive, why other people were not so lucky.

At the next meeting of officers who fought in Afghanistan, one of them told about a colleague who committed suicide. He left a farewell letter in which he wrote that all these years he blamed himself for the death of a friend whom he could not save during one of the ongoing operations. It was he who had to accompany the coffin to his mother's home, and subsequently live on the same street with her. He offered his help to the family of the deceased, but it was not accepted. He could not live with this burden. The officers who discussed this sad news said that Andrei was not guilty of the death of a friend, he simply honestly carried out the task set by the command.

A group of symptoms of physiological hyperactivation. It manifests itself in difficulty falling asleep (insomnia), increased irritability, difficulty concentrating, outbursts of anger and explosive reactions, unmotivated hypervigilance and increased readiness for the "flight reaction".

Hypervigilance is expressed in the fact that a person stares around, as if he is in danger. However, the danger here is not so much external as internal, it does not allow you to relax, to rest.

A young man who took part in the fighting in Chechnya described his dream as follows: “I have nightmares, I rush about in my sleep, grind my teeth, scream - I’m still fighting. My mother tells me that my sleeping position is also martial: I sleep on my stomach, my right hand is under the pillow, my left is on top of it (during the fighting, I put the gun under the pillow at night). My legs are tense, often the right leg touches the floor. I wake up not rested for the night.

Exaggerated response: at the slightest irritation, knocking, noise, a person screams loudly, rushes to run, etc. There were cases when, during the residual, weaker tremors of the earthquake, people threw themselves out of windows, smashed to death, although these tremors were not dangerous.

Increased irritability, intolerance in ordinary everyday matters, often there is violent hostility directed against specific people, accompanied by threats, sometimes not only in words. A very small event can cause intense feelings of anger. There is a feeling that a person is not like himself. Relatives, friends and colleagues may notice some changes in a person's character. A person may experience more permanent anger at the injustice and senselessness of what happened or against those who, as he thinks, were the cause of what happened.

Aggression is on the rise. There is a growing desire to solve all life's problems with the help of force pressure. Both brute physical force and verbal aggressiveness are used. There are outbursts of anger.

One of the combatants in Afghanistan told the psychologist the following: “I am afraid for myself and for my family. Outbursts of aggression that happen to me already frighten me myself ... I have become more irreconcilable, categorical in my judgments, it is difficult for me to explain something to someone. Everyone in the family should understand me from the first word. Although, of course, I'm not a gift. In the daytime, everything is fine with me, but at night I ask my wife and children to close in a separate room - I stop controlling myself.

Alcohol consumption is on the rise. The more there is a devaluation of the ideas for which the participants in the hostilities fought, the belittling of the significance of the events of those battles, the accusation of sins that they did not commit, the imposition of responsibility for the actions of the government, the more often they have problems with alcohol and drugs.

Family relationships. Obviously, the condition of a person with symptoms of PTSD cannot but affect the people around him. The presence of PTSD symptoms in one of the family members affects interpersonal interaction, the functioning of the family as a whole. We discussed above that the PTSD sufferer has an avoidance of situations or actions that are similar to or symbolize the underlying trauma. Such a strategy of behavior, according to E.O. Lazebnaya (2003), distorts the informational and emotional picture of the world, leads to limited access to new information that can provoke intense emotions, including positive ones.

A reduced level of positive emotions, their "burnout", "blockade" becomes an integral part of everyday life for those who suffer from PTSD (ibid., 2003). As a result, the level of activity sharply decreases and the desire to do any business at all disappears, even those that previously, before the injury, gave great pleasure. As a result of these processes, the circle of communication as a whole narrows, there is a feeling of one's own separation, detachment from surrounding close people, which affects relationships and often leads to marital conflicts, divorces.

Family members need to adapt to the situation in which they find themselves and do not know what to do. Adaptation of family members can be expressed in the phenomenon of co-traumatization.

Co-traumatization is the transfer to oneself of the symptoms of a psychotrauma received by the victim, with experiences similar to this psychotrauma and destabilization as a result of this, the psychological and somatic health of a traumatized family member (Kucher, 2004).

Overstrain of the nervous system as a result of the constant proximity of the injured person in family members manifests itself through feelings of internal fatigue, moral fatigue, and when neuropsychic instability appears, nervousness increases, mood becomes changeable, and psychosomatic reactions may occur.

Symptoms of cotraumatization can repeat the symptoms of PTSD to a lesser extent, they can be divided into three groups:

re-experiencing symptoms, including negative dreams, repetitive play (in children), severe distress, memories of hearing episodes and intrusive thoughts about them;

avoidance symptoms, including a sense of alienation, impoverishment of emotions;

symptoms of increased excitability, manifested in sleep disturbances, irritability, difficulty concentrating, anxiety, outbursts of anger.

Of course, psychic trauma can leave an indelible imprint on a person's soul and lead to a pathological transformation of his entire personality. However, there are methods of professional help and self-help in such situations.

O mainareas of rehabilitation ptsd

There are many directions and methods that have been effectively used and are being used to correct PTSD. a.l. Pushkarev, va. Domoratsky, E.R. Gordeeva (2000) distinguish four areas of methods:

1. Educational direction. This direction includes information support, discussion of books and articles, acquaintance with the basic concepts of physiology and psychology. For example, only a simple acquaintance with the diagnostic symptoms of PTSD helps patients realize that their experiences and difficulties are not unique, “normal” in the current situation, and this gives them the opportunity to control their condition, choose the means and methods by which they can achieve recovery.

Holistic direction. The second group of methods is located in the field of a holistic attitude to health. Experts in the formation of a healthy lifestyle rightly point out that physical activity, proper nutrition, spirituality and developed sense humor make a great contribution to the recovery of a person as a whole. The doctor who draws the attention of his patients to these aspects of the integral existence of man often discovers and activates such abilities for the restoration of man that were hidden even from himself. Healthy lifestyle - with sufficient physical activity, proper nutrition, absence of alcohol abuse, avoidance of drugs, avoidance of the use of stimulants nutrients(for example, caffeine), with the ability to relate with humor to many events in our lives - creates the basis for recovery from severe traumatic events, and also helps to prolong an active and happy life (Pushkarev, Domoratsky, Gordeeva, 2000).

Social direction. Methods aimed at the formation and increase social support and social integration. This can also include the development of a self-help network, as well as the formation of public organizations that provide support to people with PTSD. It is very important to accurately assess social skills, train these skills, reduce irrational fears, help in the ability to overcome the risk of forming new relationships. This category also includes forms of organizing social work that help the healing process flow.

Therapeutic direction(pharmacotherapy, psychotherapy) includes psychotherapy itself, aimed at working through traumatic experience, working with grief, the reasonable use of pharmacotherapy to eliminate individual symptoms.

Of the methods of self-help, we will describe several general methods that lead to the weakening of unwanted reactions.

Stress affects the entire body as a whole, so you can significantly reduce its negative effects if you devote more time to health than before.

It is necessary to observe the regime of work and rest, eat right, play sports.

It is necessary to take care of emotional comfort and devote more time to those things that are especially pleasant. Adversity can exacerbate PTSD symptoms.

Communication should not be avoided. You need to be among people more often, to be useful to others. An active social life will help to feel peace of mind.

Don't expect memories to go away on their own. Feelings will remain and will disturb for a long time. That is why it is extremely important to be able to have a heart-to-heart talk.

If you see manifestations of post-traumatic stress disorder in a loved one, colleague, friend, then in this situation you can help him by observing the following rules:

Try to create conditions for a "heartfelt" conversation. This is necessary in order to let negative feelings and experiences come out. Sometimes we are afraid to talk with a person about traumatic events that have happened in his life, it seems to us that this will affect his feelings, open up spiritual wounds, while the person himself often has a desire to speak out, “pour out his soul.” However, in no case should you put pressure on a person if he does not want to talk.

Be prepared for strong emotional reactions from a person if you manage to start a “heart-to-heart conversation”. Remember that the heartache" or the aggression that a person can "pour out" in your presence has nothing to do with you. You are simply helping the person to get rid of it.

Don't "push" the person, even if they "push" you. Continue to give him support and express your love. Accept the person as he is.

It is important to create a calm, accepting atmosphere around a person, without creating special conditions due to the fact that he has suffered a trauma, since this makes many people feel inferior, offends them, otherwise the person will not learn to live in new conditions, but will remain forever " a victim of circumstance."

These measures may reduce the symptoms of the problem, but are unlikely to help overcome post-traumatic stress disorder, so the visit of a specialist is necessary to overcome it completely.

Stages of professional help. Let us give a brief description of the stages of professional assistance when working with the symptoms of post-traumatic stress disorder, that is, we will talk about the actions that the specialist, together with the person who turned to him, take in the psychological correction of this problem.

The first stage of any psychological consultation is psychological diagnosis. It can take the form of tests, but more often it is just a conversation, during which the specialist clarifies the details of the problem situation of the person who turned to him.

The second stage is the conclusion of the so-called "psychotherapeutic contract". As a rule, this agreement does not take the form of an official legal document, it is simply some kind of agreement between a specialist and a client on the procedure for their joint work (what problem is the work on, how long it can last, what stages it will consist of, what result is expected).

The third stage is the beginning of work on the problem. At this stage, the most important joint achievement of the specialist and the client is the creation, expansion and strengthening of those psychological resources that will help to cope with the traumatic experience. In order to cope with psychological trauma, psychological, mental strength is needed; preparation, "cultivation" of these forces determines the success of further corrective measures.

The fourth stage is the study of traumatic experience. This stage of work begins when the forces are accumulated and the person is ready to meet with the memories, experiences of the event that caused the psychological problem. A person at this stage experiences and accepts a traumatic situation. When we use the word "experience", we assume that this event becomes part of personal experience a person, while post-traumatic stress disorder suggests that psychologically for a person this situation is real. Therefore, experiencing a traumatic experience is an integral part of recovery.

The psychological trauma received by a person becomes part of the personal past. People realize what this situation has given them, what it has taught - “thanks to this situation, I became strong”, “this situation showed that I have real friends”, etc.

The last step in the psychological correction of post-traumatic disorder is the stage that experts call "environmental verification." At this stage, the person tries to live with the new experience. This stage is necessary so that traumatic experiences do not return again. After all, often a person gets used to living in his problem, and the people around him get used to it.

A case from professional practice can be cited as an example. The woman turned to a specialist with the fact that she could not recover from the accident she had. She was afraid to drive again, she was afraid when she knew that one of her loved ones was on the road now, she constantly dreamed of this accident. The family of this woman was so used to her condition that her family members themselves constantly told her that she should not drive, reminded her of what had happened to her. This greatly undermined her faith in the ability to cope with the situation. Only after the woman, together with a psychologist, talked with family members, talked about her experiences and explained that she really needed their support, she was able to cope with her problem.

During this period, the person discusses with the specialist the changes that occur in his life in connection with the work on the trauma. Thus, there is a test of how a person coped with post-traumatic stress disorder, a test that life itself arranges.

Questions and tasks for the chapter 9:

Define traumatic stress. Psychological trauma can occur when:

a) the person experienced or became an eyewitness to an event related to the death or injury of another person;

b) the event was accompanied by intense feelings of fear, horror and helplessness;

c) the event was not accompanied by strong feelings of horror and fear.

3. Risk factors for PTSD include:

a) the strength and duration of the traumatic factor;

b) insufficient support of relatives;

c) alcohol abuse;

d) the presence in the biography of situations associated with a threat to health and life, both one's own and close people;

e) All answers are correct.

4. Post-traumatic stress disorder can manifest itself:

a) within 1 hour after the event;

b) after 7 days - the first manifestations;

c) in a few months;

d) in a few years.

5. Which group of symptoms of post-traumatic stress disorder include the following characteristics: repeated, obsessive, negative memories of the event; dreams associated with the event; experiencing new stress in events that resemble or symbolize the trauma experienced; sudden actions and feelings, as if the experienced event was happening now:

6. Which group of symptoms of post-traumatic stress disorder include the following characteristics: inability to remember the details of the event; feeling of detachment, alienation from other people; avoidance of thoughts, feelings and activities associated with the event; loss of access to the resources of the past; impoverishment of feelings; Lack of future orientation

a) to the group of symptoms of avoidance;

b) to the group of symptoms of re-experiencing;

c) to the group of symptoms of hyperexcitability.

7. Which group of symptoms of post-traumatic stress disorder include the following characteristics: increased irritability, the presence of explosive reactions; any sleep disturbances; difficulty concentrating; depressive states; hypervigilance associated with a lack of a sense of security:

a) to the group of symptoms of avoidance;

b) to the group of symptoms of re-experiencing;

c) to the group of symptoms of hyperexcitability.

List the stages of experiencing a traumatic situation. Give examples that would talk about each of the phases of the experience.

What do you understand by the term "cotraumatization"? What are the causes of co-traumatization? How does it express itself in the family members of the traumatized?

Prevention of PTSD. Providing psychological assistance to victims of emergency situations.

According to historians, over the past 5 thousand years, the peoples of the Earth have experienced 14.5 thousand big and small wars and only 300 years were absolutely peaceful. AT recent months A serious armed conflict broke out in Ukraine, which directly affected tens of thousands of people and indirectly hundreds of thousands. The biggest medical problem will not be gunshot wounds, but mental disorders. I have tried to summarize the available information about post-traumatic stress disorder, better known to the people under the names " afghan syndrome», « vietnamese syndrome”, etc. It turned out a lot, so be patient. It is important to read only this page to know the signs and symptoms of the disorder. The rest you can find later.

What is post-traumatic stress disorder

scientific name - post-traumatic stress disorder(PTSD).

In English - posttraumatic stress disorder(PTSD). The term was introduced into scientific use by an American psychologist M. Horowitz in 1980. PTSD refers to borderline mental illness and anxiety disorders.

PTSD occurs after extremely severe psycho-emotional stress, the intensity of which exceeds the usual human experience.

To normal human experience that does not lead to PTSD include:

• death of a loved one from natural causes,
• threat to one's own life
• chronic severe illness
• job loss,
• family conflict.

Post-traumatic stress disorder occurs after more severe situations that accompany personal violence, feelings of helplessness and hopelessness:

• military action,
• natural disasters (earthquakes, floods, landslides),
• big fires,
• man-made disasters (accidents at work and nuclear power plants),
• extremely cruel treatment of people (torture, rape). Including presence in such situations.

A characteristic feature is the presence persistent long-term experiences of a traumatic situation(this is what difference PTSD from other anxiety, depressive and neurotic disorders).

old titles post-traumatic stress disorder:

• soldier heart,
• cardiovascular neurosis,
• combat neurosis,
• operating fatigue,
• combat fatigue,
• stress Syndrome,
• military neurosis,
• trauma neurosis,
• fright neurosis,
• psychogenic wartime reactions,
• neurasthenic psychosis,
• reactive psychosis,
• post-traumatic reactive state,
• post-reactive personality development.

PTSD is an event associated with a threat to life and at the same time accompanied by the experience intense fear, dread, or feelings of hopelessness. The trauma here is mental. Physical damage doesn't matter. In other words, PTSD is non-psychotic delayed human response to traumatic stress.

Since a person lives among other people, the need arose share everything mental illness by severity for the patient himself and for society on 2 levels:

1. psychotic level(psychosis): the patient does NOT control himself and therefore can be subjected to psychiatric treatment forcibly in accordance with the laws of the country;
2. non-psychotic level: psychiatric care is provided to the patient only with his consent. This includes uncomplicated PTSD (more on possible complications below).

Who gets PTSD?

Post-traumatic stress disorder occurs in a person who has been exposed to severe danger himself or it happened to someone else in front of him. Regardless of the type of situation, psychogenic effects of the same severity led to the development similar symptoms.

PTSD can occur at any age. Throughout life, they get sick about 1% of the population(the same number of people get sick, for example, rheumatoid arthritis). In the US, PTSD is 2.6% of the population (excluding risk groups). Women are 2 times more likely. The frequency depends on the severity of stress: for example, it is diagnosed in 75% of concentration camp prisoners. The problem of post-traumatic stress disorder is most studied in American Vietnam War Veterans(1965-1973). By 1990, according to various estimates, 15-30% of veterans were sick and another 11-23% had partial symptoms.

Recently, a variant of PTSD has been singled out separately, when loss of a loved one or a loved one. It takes a long time and manifests itself in two varieties:

1. constant reproduction in his life of a situation similar to that experienced,
2. complete avoidance of situations reminiscent of psychotrauma.

Thus, PTSD is a broader concept and is currently its causes are not limited to military operations, natural and man-made disasters. In modern psychiatry, post-traumatic stress disorder is seen not as a protracted acute reaction to stress, but as qualitatively different state arising from acute reaction to stress, but based on many other factors (genetic and biological characteristics, previous life experience, personality traits, gender, age, race, social status, ability social support and etc.).

Signs of PTSD

PTSD usually occurs in the first six months after psychotrauma. However, symptoms can appear both immediately after the trauma and many years later (their appearance in veterans 40 years after the Second World War is described). people constantly return thoughts to what happened and try to find an explanation for it. Some believe that it was a sign of fate. Others have anger out of a deep sense of injustice. Experiences manifest themselves in endless conversations without any need and for any reason. The indifference of others to the problem leads to isolation of the sufferer and cause further injury.

Symptoms PTSD falls into several categories:

1) repeated involuntary experience of psychotrauma in the form of:

• intrusive memories,
• recurring dreams or nightmares,
• stereotypical games in a child related to psychotrauma (the meaning of the game for other people is usually incomprehensible, the only participant is the child himself, who over and over again performs the same set of actions and manipulations; the game remains the same for a very long time). Read more about these children's games at http://www.autism.ru/read.asp?id=152&vol=5

Memories are painful, therefore, the constant avoidance of reminders of psychotrauma is characteristic: a person tries don't think about it and avoid situations to remind her. It happens sometimes psychogenic (dissociative) amnesia psychotrauma.

At psychogenic amnesia man suddenly on little time loses memory for recent important events. It is a defense mechanism that allows consciousness to cope with a subjectively unbearable situation. The ability to remember new information remains. Psychogenic amnesia usually does not last long and ends as abruptly as it began.

2) depression and decreased vitality:

• indifference to business,
• emotional dullness("emotional impoverishment"): the inability to love, enjoy life and hope for the best. Wives characterize patients as cold, insensitive and uncaring people. Marriage is difficult for many, and there are too many divorces among the married.
• inability to focus on a long life perspective. The thoughts “the future is unpromising”, “there is no future” are characteristic. These people do not plan to pursue a career, get married, have children, or build a normal life. They expect misfortune in the future and an early death.
• feeling isolation from others,
• in children behavior worsens with loss of previously acquired skills.

3) overstimulation of the nervous system(along with depression!):

• irritability, anxiety, impatience, aggressiveness,
• 95% cannot concentrate for a long time,
• winces, nervous trembling,
• sleep disorders(difficulty falling asleep, shallow sleep, early awakening, feeling of lack of rest after sleep),
• nightmares(their important feature in PTSD is a very accurate reproduction of really experienced events),
• sweating,
• 80% have excessive alertness, suspicion, etc. This also includes obsessive painful memories.

Excessive excitation of the nervous system manifests itself in various somatovegetative complaints about loss of appetite, fatigue, dry mouth, constipation, decreased libido(sexual desire) and impotence(mostly psychogenic) feeling of heaviness in the body, insomnia and etc.

Often there are additional symptoms:

• acute outbreaks fear (phobia), panic and rage with aggression
• feelings of guilt towards the dead and self-flagellation for having survived,
• drunkenness,
• demonstrative denial of generally accepted social norms and rules,
• antisocial behavior with a tendency to physical violence.

Characteristic:

• violation of relations in society and in the family,
• distrust of those in power(officials, militia/police),
• craving for gambling and risky entertainment (speeding by car, skydiving by paratrooper veterans, etc.).

Some scholars point to the emergence dissociative symptoms (« bifurcation"), which manifests itself:

• emotional dependence,
• narrowing of consciousness(a small group of ideas and emotions predominates with the complete suppression of other thoughts and feelings. It happens with extreme fatigue and hysteria),
• depersonalization(own actions are perceived as if from the outside and it seems that they cannot be controlled). A person is at home and at the scene of the tragedy at the same time. Develop " flashback episodes" (see below). The inability to relax is manifested by insomnia despite being exhausted. Sleep disturbances exacerbate serious condition, causing fatigue, apathy and substance abuse (smoking, alcohol, drugs).

Flashback(English flashback - literally " backfire”) is an involuntary and unpredictable revival of psychotrauma through unusually vivid memories, during which a terrible reality from the past invades the patient's real life. The boundaries between apparent and actual reality are blurred. For example, people with PTSD hear explosions, throw themselves on the floor, trying to hide from imaginary bombs, wring the hands of loved ones, and may unmotivatedly attack an interlocutor, a bystander. There have been cases of severe bodily harm and murder, sometimes followed by suicide.

Flashback episodes occur both on their own and after the use of alcohol or drugs. Various types of addictions almost all combatants with PTSD (for example, alcohol addiction diagnosed in 75% of veterans with PTSD). Constant excitation of the nervous system increases the susceptibility to chemicals. Alcohol and drugs are a kind of pain reliever and help to cope with stress by suppressing the physiological activity of certain areas of the nervous system, but at the same time contribute to the development of "flashbacks". Therefore, drugs and alcohol relieve the symptoms of PTSD, but exacerbate the syndrome itself. Cause and effect constantly change places and circulate in a vicious circle.

For mental health population terrorist act is more dangerous than natural disasters. Unfortunately, when studying PTSD, most of the efforts of scientists are directed only at the direct victims and their loved ones, and no attention is paid to the peculiarities of the perception of terrorist attacks through the media.

Features of PTSD in veterans

stress factors at war:

• fear death, injury, pain, disability,
• painting the death of comrades in arms and the need to kill another person,
• combat environment factors(lack of time, high pace, suddenness, uncertainty, novelty)
• deprivation(lack of proper sleep, features of food and liquid intake),
• unusual natural conditions(unusual terrain, heat, solar radiation, etc.).

According to some data (Pushkarev A. L., 1999), in Belarus, 62% of veterans of the war in Afghanistan defined by PTSD of varying severity.

Experience Options mental trauma for war veterans:

1. 80% - recurring nightmares. In the first 2-4 years after the war, nightmares disturb absolutely all (!) Participants in hostilities, but especially acutely after a concussion (bruise) of the brain. These dreams are characterized by feelings of helplessness, being alone in a potentially deadly situation, being chased by enemies with shots and attempts to kill, and having no weapons to defend. During nightmares people make involuntary movements of varying intensity.
2. 70% - psychological distress(stress associated with strong negative emotions and destroying health). Various events of peaceful life cause unpleasant associations, for example:
   • helicopter flying overhead, reminiscent of military action,
   • camera flashes resemble shots, etc.
3. 50% - memories of military events(sorrow at the loss with an acute emotional pain, repeated memories of psychotrauma).

Fixture types for veterans:

1. active-defensive: adequate assessment of the severity of PTSD or ignoring it. Neurotic disorders are possible. Some of the combatants are ready to be examined and treated on an outpatient basis.
2. passive defensive: retreat, reconciliation with illness, depression, hopelessness. Mental discomfort is expressed in somatic complaints (that is, in complaints about the work of body systems, from the Greek. soma- body).
3. destructive: disruption of life in society. Internal tension, explosive behavior, conflicts. In search of relief, patients use alcohol, drugs, break the law, commit suicide.

Participants of the Vietnam War concerned about 6 main problems:

• guilt,
• abandonment/betrayal
• loss,
• loneliness,
• loss of meaning
• fear of death.

The use of the latest types of weapons, which not only kill, but also injure the psyche of others, is becoming additional source psychotrauma.

At typical development post-traumatic stress disorder in war veterans 5 phase:

1. initial impact(psychotrauma);
2. resistance/denial(people cannot and do not want to realize what happened);
3. admission/suppression(the psyche accepts the fact of psychotrauma, but the person tends not to think about it and suppress such thoughts);
4. decompensation(deterioration of the state; consciousness is trying to process the psychotrauma into life experience in order to live on) - the presence of this phase is feature PTSD.
5. overcoming trauma and recovery.

In cases of chronic PTSD (longer than 6 months), people stuck between 2nd and 3rd phases. In an attempt to " come to terms with trauma» they change their ideas about themselves and the world around them. These processes lead to personality changes. Attempts to avoid unpleasant re-experiencing of psychotrauma lead to a pathological outcome of PTSD.

Delayed mental reactions Stress in veterans depends on 3 factors:

1. from pre-war personality traits and the ability to adapt to the new;
2. response to life-threatening situations;
3. on the level of restoration of the integrity of the individual.

A person's response to psychotrauma also depends on biological features body (primarily from work nervous and endocrine systems).

Features of PTSD after the accident at the Chernobyl nuclear power plant

This is a type of post-traumatic stress disorder. very poorly studied.

The liquidators of the accident at the Chernobyl nuclear power plant are characterized by a high level of anxiety, depression, restlessness for the future life. Characteristic symptoms - sleep disturbances, loss of appetite, decreased sexual attraction, irritability. Almost all examined had astheno-neurotic disorders (" irritable fatigue"), vegetative-vascular dystonia (dysregulation of blood vessels, internal organs and other parts of the body), arterial hypertension.

According to some estimates, after the accident on Chernobyl nuclear power plant about 1-8% of the population contaminated areas has symptoms of PTSD.

Risk and protective factors

Risk factors development of PTSD:

1. features and deviations of the psyche (dissocial personality disorder),
2. mental trauma in the past (physical abuse in childhood, accidents),
3. loneliness (after the loss of a family, divorce, widowed, etc.),
4. financial insolvency (poverty),
5. isolation of a person for the period of experiencing psychotrauma and social isolation (disabled people, prisoners, homeless people, etc.),
6. negative attitude of others (physicians, social workers). However, excessive guardianship also harms, alienating the victims from the outside world.

Protective factors from the development of post-traumatic stress disorder:

1. the ability to control your emotions,
2. a high self-evaluation,
3. the ability to timely process the traumatic experience of others into one's own life experience (for example, read about other people's problems and made important findings for myself),
4. the presence of good social support (from the state, society, friends, acquaintances).

Behavior and complaints at the doctor

Most often people with PTSD can't find a connection on their own between his condition and the previous psychotrauma. Feelings contribute to the concealment of traumatic events. shame, guilt, the desire to forget painful memories or a misunderstanding of their importance.

If the doctor touches upon the psychotrauma, the patient may show more with your reaction than to put into words. Characteristic:

• increasing tearfulness (especially in women),
• avoiding eye contact
• excitation,
• manifestations of hostility.

Symptoms disorders include:

• sleep disorders. As stated above, PTSD should be suspected in anyone with unusually vivid or plausible nightmares.
• distancing and alienation from people, including family members. Especially if such behavior was not typical before the psychotrauma.
• irritability, propensity to physical violence, explosive outbreaks (outbursts of anger, hatred, violence; from English explosion - explosion),
• alcohol or drug use, especially for the purpose of "removing the sharpness" of painful experiences and memories,
• illegal actions or antisocial behavior, especially absent during adolescence,
• depression, suicide attempts,
• alarming tension or psychological instability
• non-specific complaints pain in the head, muscles, joints, heart, abdomen, permanent muscle tension, increased fatigue, stool disorders(diarrhea), etc.

According to Horowitz (1994), major complaints for PTSD are:

• 75% have headaches and a feeling of weakness,
• 56% - nausea, pain in the heart, back, dizziness, feeling of heaviness in the limbs, numbness in various parts body, "lump in the throat",
• 40% have difficulty breathing.

On the restoration of personality strongly conditions affect, in which a person gets after a psychotrauma:

1. silence, denial leave a person alone with unreacted and unprocessed stress. Surprisingly, good upbringing, which puts restrictions in communication, often prevents the processing of traumatic situations, driving them into the subconscious. A low level of education and a low social position can also make it difficult to properly navigate a traumatic situation. The psychologist is obliged to explain to the person that suffering and life have meaning.
2. Initial presence of personality disorders and mental disorders exacerbate PTSD.
3. Correct and timely social help relieves PTSD.

Complications and prognosis

As the years come complications:

• alcoholic and medicinal addiction,
• conflicts with the law,
• family breakdown(uselessness of close interpersonal relationships, family life and the birth of children),
• persistent litigious behavior(Pugnaciousness and quarrels with people, constant complaints, accusations, lawsuits),
• attempts suicide.

For example, among Vietnam War veterans with PTSD, there were:

• the unemployment rate is 5 times higher than the average,
• 70% have divorces,
• 56% have borderline (with normal) neuropsychiatric disorders,
• 50% - went to jail or were arrested,
• 47% have extreme forms of isolation from people,
• 40% have pronounced hostility,