ORIRGINAL RESEARCH
Posttraumatic or pеritraumatic disorders: a diagnostic dilemma.
Author information
- S.G. Sukiasyan
- Armenian State Pedagogical University named after Kh. Abovyan, Psychosocial recovery center
- Published
- September 30, 2022
- Pages
- 3-13
Abstract
Introduction. The problem of mental trauma and post-traumatic disorders is one of the most urgent problems of psychiatry. The article presents approaches to the interpretation of this concept and to its adequate diagnosis.
Relevance. There are still no clear theoretical concepts defining approaches to the study of psycho-biological mechanisms of the development of post-traumatic disorders, the problem of specificity of both mechanisms and clinical symptoms of PTSD has not been solved.
The aim of the study was to investigate and identify the most significant factors in the development of clinical manifestations of combat trauma. A working hypothesis on the clinical dynamics and transformation of the concept of PTSD is presented.
Material and methods. The study is based on the analysis of our early studies on this issue and their comparison with the data of the 44-day war in Artsakh. All patients underwent clinical and psychopathological examination in combination with psychological and psychometric methods. The SCL-90-R questionnaire, the Mississippi Questionnaire for Combat PTSD and the Shmishek personality questionnaire were used.
Results. An algorithm for the diagnosis of post-traumatic disorders, consisting of four blocks, is presented. The main characteristics and criteria of mental trauma are considered. The features of the response to trauma and the variety of clinical manifestations of combat trauma are shown. Every third combatant showed symptoms of PTSD in the first days of post-trauma, every fourth revealed acute psychotic, affective and other disorders.
Discussion and conclusions. The criterion of «non-routine» injury loses its diagnostic significance. Chronological criteria for determining acute and post-traumatic disorders are far from clinical reality. The boundaries between the clinical manifestations of posttrauma are quite amorphous and overlap in many ways. This allows us to talk about «peritraumatic disorders», which includes all disorders that occur after an extraordinary combat mental trauma.
Keywords
- post-traumatic stress disorder
- combat trauma
- diagnostic criteria
- peritraumatic stress disorder
How to Cite
References
- Литвинцев С.В., Снедков Е.В., Резник А.М. Боевая психическая травма: руководство для врачей - М.: Из-во «Медицина», 2005. - 432 с.
- Посттравматическое стрессовое расстройство / ГБОУ ВПО РостГМУ Минздрава России; под ред. В.А. Солдаткина. – Ростов н/Д: Изд-во РостГМУ, 2015. – 624 с.
- Снедков Е.В. Боевая психическая травма (клинико-патогенетическая динамика, диагностика, лечебно-реабилитационные принципы): aвтореф. дисс. … докт. мед. наук. - СПб., 1997. – 50 с.
- Снедков Е.В. Проблема нозологической самостоятельности посттравматического стрессового расстройства // Журнал неврологии и психиатрии им. С.С. Корсакова. - 2009. - N109(12). – С. 8-11.
- Ford J.D., Courtois C.A. Complex PTSD and borderline personality disorder // Borderline Personality Disorder and Emotion Dysregulation. – 2021. – Vol. 8 (1). - 16. https://doi.org/10.1186/s40479-021-00155-9
- Schnurr P.P. PTSD: 30 Years on // Journal of Traumatic Stress. – 2010. – Vol. 23 (1). – Pp. 1–2. – DOI: https://doi.org/10.1037/0022-006X.68.5.748
- МКБ-10: классификация психических и поведенческих расстройств. Клинические описания и указания по диагностике / пер. под ред. Ю.Л. Нуллера, С.Ю. Циркина. – СПб.: Адис, 1994. – 304 с.
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington: American Psychiatric Association, 2013.
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders (3rd Edition). – Washington, DC: American Psychiatric Association, 1980
- Kessler R.C, Aguilar-Gaxiola S., Alonso J. et al. Trauma and PTSD in the WHO World Mental Health Surveys // European Journal of Psychotraumatology. – 2017. – Suppl. 5. – DOI: https://doi.org/10.1080/20008198.2017.1353383
- Wallace A.F.C. Tornado in Worcester: An exploratory study of individual and community behavior in an extreme situation // National Academy of Sciences-National Research Council Publication. – 1956. – No. 392 (Disaster Study No. 3).
- Hyams K.C., Wignall F.S., Roswell R. War Syndromes and Their Evaluation: From the U.S. Civil War to the Persian Gulf War // Ann Intern Med. – 1996. – Vol. 125. – Pp. 398–405.
- Александровский Ю.А. Социально-стрессовые расстройства // Обозрение психиатрии и медицинской психологии имени В.М. Бехтерева. – 1992. – № 2. – С. 5–10.
- Yehuda R., McFarlane A.C. Conflict between current knowledge about posttraumatic stress disorder and its original conceptual basis // Am J Psychiatry. – 1995. – Vol. 152. – Pp. 1705–1713.
- Сукиасян С.Г., Тадевосян М.Я. Об этиопатогенетических соотношениях при боевом ПТСР: состояние проблемы // Психология и психотехника. – 2010. – № 7. – С. 86–95.
- Сукиасян С.Г., Тадевосян М.Я. Посттравматические стрессовые расстройства: медицинская и социально-психологическая проблема в Армении // Российский психиатрический журнал. – 2010. – № 5. – С. 59–69
- Сукиасян С.Г., Тадевосян М.Я. Боевой травматический стресс: психическая или моральная травма? // Обозрение психиатрии и медицинской психологии имени В.М. Бехтерева. – 2010. – № 3. – С. 4–7.
- Сукиасян С.Г., Тадевосян М.Я. Роль черепно-мозговой травмы в динамике боевого посттравматического стрессового расстройства // Журнал неврологии и психиатрии имени С.С. Корсакова. – 2014. – Т. 114, № 4. – С. 16–24
- Сукиасян С.Г., Тадевосян М.Я. Посттравматическое стрессовое расстройство: из функционального в органическое // Психиатрия. – 2011. – № 1. – С. 59–69.
- Сукиасян С.Г. О некоторых аспектах динамики посттравматических стрессовых расстройств у участников боевых действий // Социальная и клиническая психиатрия. – 2009. – Т. 19, вып. 1. – С. 12–18.
- Sukiasyan S.G., Tadevosyan M.Ya., Babakhanyan A.A., Grigoryan A.K. Acute stress reactions and disorders in participants of the war in Artsakh // EC Psychology and Psychiatry. – 2022. – Vol. 11 (5). – Pp. 25–43.
- Ozer E.J., Best S.R., Lipsey T.L., Weiss D.S. Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis // Psychological Bulletin. – 2003. – Vol. 129 (1). – Pp. 52–73. – DOI: https://doi.org/10.1037/0033-2909.129.1.52
- Tortella-Feliu M., Fullana M.A., Pérez-Vigil A., Torres X., Chamorro J., Littarelli S.A., Solanes A., Ramella-Cravaro V., Vilar A., González-Parra J.A., Andero R. Risk factors for posttraumatic stress disorder: An umbrella review of systematic reviews and meta-analyses // Neuroscience and Biobehavioral Reviews. – 2019. – Vol. 107. – Pp. 154–165. – DOI: https://doi.org/10.1016/j.neubiorev.2019.09.013
- Insel T., Cuthbert B., Garvey M. et al. Research domain criteria (RDoC): toward a new classification framework for research on mental disorders // Am J Psychiatry. – 2010. – Vol. 167 (7). – Pp. 748–751. – DOI: https://doi.org/10.1176/appi.ajp.2010.09091379
- Sanislow C.A. Updating the research domain criteria // World Psychiatry. – 2016. – Vol. 15 (3). – P. 222.
- Wilson J.P. The historical evolution of PTSD diagnostic criteria // Everly G.S., Lating J.M. (eds). Psychotraumatology. – The Springer Series on Stress and Coping. Springer, Boston, MA., 1995. – Pp. 9–26. – DOI: https://doi.org/10.1007/978-1-4899-1034-9_2
- Van der Hart O., Brown P. Concept of psychological trauma // Am J Psychiatry. – 1947. – Vol. 12. – Art. no. 1691. – DOI: https://doi.org/10.1176/ajp.147.12.1691
- Katrinli S., Stevens J., Wani A.H. et al. Evaluating the impact of trauma and PTSD on epigenetic prediction of lifespan and neural integrity // Neuropsychopharmacol. – 2020. – Vol. 45. – Pp. 1609–1616. – DOI: https://doi.org/10.1038/s41386-020-0700-5
- Зеленова М.Е., Лазебная Е.О., Тарабрина Н.В. Психологические особенности посттравматических стрессовых состояний у участников войны в Афганистане // Психологический журнал. – 1997. – T. 2. – С. 34–49.
- Morgan III C.A., Grillon C., Southwick S.M. et al. Exaggerated acoustic startle reflex in Gulf War veterans with posttraumatic stress disorder // Am J Psychiatry. – 1996. – Vol. 153 (1). – Pp. 64–68. – DOI: https://doi.org/10.1176/ajp.153.1.64
- O’Brien L.S., Hughes S.J. Symptoms of post-traumatic stress disorder in Falklands veterans five years after the conflict // British J. Psychiatry. – 1991. – Vol. 159. – Pp. 135–141. – DOI: https://doi.org/10.1192/bjp.159.1.135
- Тадевосян М.Я., Сукиасян С.Г. Психическая травма, ее последствия и предрасполагающие факторы // Журнал неврологии и психиатрии имени С.С. Корсакова. – 2011. – T. 111, № 11. – С. 95–100
- Guina J., Baker M., Stinson K. et al. Should posttraumatic stress be a disorder or a specifier? Towards improved nosology within the DSM categorical classification system // Current psychiatry reports. – 2017. – Vol. 19 (10). – Pp. 1–11. – DOI: https://doi.org/10.1007/s11920-017-0821-7
- Сукиасян С.Г., Тадевосян А.С., Чшмаритян С.С., Манасян Н.Г. Стресс и постстрессовые расстройства: личность и общество. – Ереван: Асогик, 2003. – 343 с
- Сукиасян С.Г., Манасян Н.Г., Чшмаритян С.С. и др. Соматоформная динамика посттравматических стрессовых расстройств у участников боевых действий // Российский психиатрический журнал. – 2006. – № 3. – С. 78–85.
- Резник А.М., Сюняков Т.С., Щербаков Д.В., Мартынюк Ю.Л. Психотические расстройства у ветеранов локальных войн // Журнал неврологии и психиатрии имени С.С. Корсакова. Спецвыпуски. – 2020. – Т. 120, № 6–2. – С. 31–36. – DOI: https://doi.org/10.17116/jnevro202012006231
- Keane T.M., Caddell J.M., Taylor K.L. Mississippi scale for combat-related posttraumatic stress disorder: Three studies in reliability and validity // Journal of Consulting and Clinical Psychology. – 1988. – Vol. 56 (1). – Pp. 85–90. – DOI: https://doi.org/10.1037/0022-006X.56.1.85
- Okkels N., Trabjerg B., Arendt M., Pedersen C.B. Traumatic stress disorders and risk of subsequent schizophrenia spectrum disorder or bipolar disorder: A nationwide cohort study // Schizophrenia Bulletin. – 2017. – Vol. 43 (1). – Pp. 180–186. – DOI: https://doi.org/10.1093/schbul/sbw082
- Compean E., Hamner M. Posttraumatic stress disorder with secondary psychotic features (PTSD-SP): Diagnostic and treatment challenges, Progress in Neuro-Psychopharmacology and Biological Psychiatry. – 2019. – Vol. 88. – Pp. 265–275. – DOI: https://doi.org/10.1016/j.pnpbp.2018.08.001
- Shalev A.Y., Freedman S., Peri T. et al. Prospective study of posttraumatic stress disorder and depression following trauma // Am J Psychiatry. – 1998. – Vol. 155. – Pp. 630–637. – DOI: https://doi.org/10.1176/ajp.155.5.630
- Mayou R., Farmer A. ABC of psychological medicine: Trauma // British Medical Journal. – 2002. – Vol. 325. – Pp. 426–429. – DOI: https://doi.org/10.1136/bmj.325.7361.426
- Ford J.D. Disorders of extreme stress following war-zone military trauma: associated features of posttraumatic stress disorder or comorbid but distinct syndromes? // J Consult Clin Psychol. – 1999. – Vol. 67 (1). – Pp. 3–12. – DOI: https://doi.org/10.1037/0022-006X.67.1.3
- Cero I., Kilpatrick D.G. Network Analysis of Posttraumatic stress disorder symptoms in a National sample of U.S. Adults: Implications for the phenotype and the ICD-11 model of PTSD // J Trauma Stress. – 2020. – Vol. 33 (1). – Pp. 52–63. – DOI: https://doi.org/10.1002/jts.22481
- Bryant R.A., Creamer M., O’Donnell M., Forbes D., McFarlane A.C., Silove D., Hadzi-Pavlovic D. Acute and chronic posttraumatic stress symptoms in the emergence of posttraumatic stress disorder: A network analysis // JAMA Psychiatry. – 2017. – Vol. 4 (2). – Pp. 135–142. – DOI: https://doi.org/10.1001/jamapsychiatry.2016.3470
- Азарных Т.Д., Азарных Н.А. Акцентуации характера как предикторы острой стрессовой реакции. – URL: https://core.ac.uk/download/pdf/222815751.pdf (дата обращения 15.09.2022).
- Bryant R., Stein M.B., Hermann R. Acute stress disorder in adults: epidemiology, pathogenesis, clinical manifestations, course and diagnosis. Available at: https://www.uptodate.com/contents/acute-stress-disorder-in-adults-epidemiology-pathogenesis-clinicalmanifestations-course-and-diagnosis (accessed August 12, 2022).
- McNally R.J., Robinaugh D.J., Wu G.W.Y. et al. Mental disorders as causal systems: a network approach to posttraumatic stress disorder // Clin Psychol Sci. – 2015. – Vol. 3 (6). – Pp. 836–849. – DOI: https://doi.org/10.1177/2167702614553230
- Лебедева Н.А., Борисова Е.Н. Изменение функций внимания у людей, страдающих посттравматическим стрессовым расстройством // Психология стресса и совладающего поведения: вызовы, ресурсы, благополучие: матер. V Междунар. науч. конф.: в 2 т. / отв. ред. М.В. Сапоровская, Т.Л. Крюкова, С.А. Хазова. – Кострома: Костромской государственный университет, 2019. – С. 276–280.
- Bomyea J., Johnson A., Lang A.J. Information processing in PTSD: Evidence for biased attentional, interpretation, and memory processes // Psychopathology Review. – 2017. – Vol. 4 (3). – Pp. 218–43. – DOI: https://doi.org/doi:10.5127/pr.037214
- Brown A.D., Root J.C., Romano T.A. et al. Overgeneralized autobiographical memory and future thinking in combat veterans with posttraumatic stress disorder // J Behav Ther Exp Psychiatry. – 2013. – Vol. 44 (1). – Pp. 129–134. – DOI: https://doi.org/10.1016/j.jbtep.2011.11.004
- Сукиасян С.Г., Татевосян М.Я. Личностный фактор в генезе и развитии боевого посттравматического стрессового расстройства // Психология и психотехника. – 2010. – Т. 12. – С. 82–98.
- Сукиасян С.Г., Тадевосян М.Я. Соотношение посттравматических стрессовых и экзогенно-органических психических расстройств // Журнал неврологии и психиатрии имени С.С. Корсакова. – 2010. – Т. 110, № 11. – С. 63–70
- Сукиасян С.Г., Манасян Н.Г., Чшмаритян С.С. Соматизированные психические нарушения // Журнал неврологии и психиатрии им С.С. Корсакова. – 2001. – Т. 101, № 2. – С. 57–61.
- Blake D.D., Weathers F., Nagy L.M. et al. A clinician rating scale for assessing current and lifetime PTSD: The CAPS-1 // The Behaviour Therapist. – 1990. – Vol. 13. – Pp. 187–188.
- Southwick S.M., Yehuda R., Giller Jr. E.L. Personality disorders in treatment – seeking combat veterans with posttraumatic stress disorder // Am J Psychiatry. – 1993. – Vol. 150. – Pp. 1020–1023. – DOI: https://doi.org/10.1176/ajp.150.7.1020
- Cloninger C.R., Svrakic D.M., Przybeck T.R. A Psychobiological Model of Temperament and Character // Arch Gen Psychiatry. – 1993. – Vol. 50 (12). – Pp. 975–990. – DOI: https://doi.org/10.1001/archpsyc.1993.01820240059008
- Cloninger C.R. Temperament and Personality // Current Opinion in Neurobiology. – 1994. – Vol. 4. – Pp. 266–273. – DOI: https://doi.org/10.1016/0959-4388(94)90083-3
- Разумникова О.М. Опросник Р. Клонингер для определения темперамента и характера // Сибирский психологический журнал. – 2005. – Т. 22. – С. 150–152.
- Miller M.W. Personality and the etiology and expression of PTSD: A three-factor model perspective // Clinical Psychology: Science and Practice. – 2003. – Vol. 10 (4). – Pp. 373–393. – DOI: https://doi.org/10.1093/clipsy.bpg040
- Xin Y., Wu J, Yao Z., Guan Q., Aleman A., Luo Y. The relationship between personality and the response to acute psychological stress // Scientific Reports. – 2017. – Vol. 7 (1). – Pp. 1–8. – DOI: https://doi.org/10.1038/s41598-017-17053-2
- Франкл В. Человек в поисках смысла. - М.: Прогресс, 1990. - 368 с.
- Леонтьев Д.А. Психология смысла: природа, строение и динамика смысловой реальности. – М.: Смысл, 2019. – 583 с.
- Снедков Е.В., Литвинцев С.В., Нечипоренко В.В., Лыткин В.М. Медико-психологические последствия боевой психической травмы: клинико-динамические и лечебно-реабилитационные аспекты // Современная психиатрия. – 1998. – Т. 1, № 1. – С. 21–25.
- Фромм Э. Анатомия человеческой деструктивности: перевод с англ. – М.: Республика, 1994. – 447 с
- Bryant R.A. The Current Evidence for Acute Stress Disorder // Current Psychiatry Reports. – 2018. – Vol. 20 (12). – Pp. 1–8. – DOI: https://doi.org/10.1007/s11920-018-0976-x
- Haag C., Robinaugh D.J., Ehlers A., Kleim B. Understanding the Emergence of Chronic Posttraumatic Stress Disorder Through Acute Stress Symptom Networks // JAMA Psychiatry. – 2017. – Vol. 74 (6). – Pp. 649–650. –DOI: https://doi.org/10.1001/jamapsychiatry.2017.0788
- McFarlane A.C. Posttraumatic Stress Disorder: A Model of the Longitudinal Course and the Role of Risk Factors // J Clin Psychiatry. – 2000. – Vol. 61, suppl. 5. – Pp. 15–20..
- Shalev A.Y., Peri T., Canetti L., Schreiber S. Predictors of PTSD in injured trauma survivors: a prospective study // Am J Psychiatry. – 1996. – Vol. 153 (2). – Pp. 219–225. – DOI: https://doi.org/10.1176/ajp.153.2.219
- Visser E., Gosens T., Den Oudsten B.L., De Vries J. The course, prediction, and treatment of acute and posttraumatic stress in trauma patients: A systematic review // J Trauma Acute Care Surg. – 2017. – Vol. 82 (6). – Pp. 1158–1183. – DOI: https://doi.org/10.1097/TA.0000000000001447
- Андрющенко А.В. Посттравматическое стрессовое расстройство при ситуациях утраты объекта экстраординарной значимости // Психиатрия и психофармакотерапия. – 2000. – T. 2, № 4. – С. 104–109
- Бондарев Н.И. Условия возникновения и развития реактивных состояний // Труды Военно-морской медицинской академии. – Л.: ВММедА, 1944. – С. 46–52
- Добротворский Н.М. Душевные заболевания в связи с войной (по литературным данным за 1915–1918 гг.) // Научная медицина. – 1919. – № 1. – С. 378–386.
- Осипов В.П. Введение // Психозы и психоневрозы войны: сб. – Л.; М.: ОГИЗ: Государственное издательство биологической и медицинской литературы, 1934. – С. 6–13.
- Rubonis A.V., Bickman L. Psychological impairment in the wake of disaster: The disasterpsychopathology relationship // Psychological Bulletin. – 1991. – Vol. 109 (3). – Pp. 384– 399. – DOI: https://doi.org/10.1037/0033-2909.109.3.384
- Wen-peng Cai, Yu Pan, Shui-miao Zhang, Cun Weia, Wei Dong, Guang-hui Deng. Relationship between cognitive emotion regulation, social support, resilience and acute stress responses in Chinese soldiers: Exploring multiple mediation model // Psychiatry Research. – 2017. – Vol. 256. – Pp. 71–78. – DOI: https://doi.org/10.1016/j.psychres.2017.06.018
- Guthrie R.M., Bryant R.A. Auditory startle response in firefighters before and after trauma exposure // Am J Psychiatry. – 2005. – Vol. 162. – Pp. 283–290. –DOI: https://doi.org/10.1176/appi.ajp.162.2.283
- Marmar C.R., Weiss D.S., Schlenger W.E. et al Peritraumatic dissociation and posttraumatic stress in male Vietnam theater veterans // Am J Psychiatry. – 1994. – Vol. 151. – Pp. 902–907.
- Garfin D.R., Thompson R.R., Holman E.A. Acute stress and subsequent health outcomes: A systematic review // J Psychosomatic Research. – 2018. – Vol. 112. – Pp. 107–113. – DOI: https://doi.org/10.1016/j.jpsychores.2018.05.017
- Dunmore E., Clark D.M., Ehlers A. A prospective investigation of the role of cognitive factors in persistent posttraumatic stress disorder (PTSD) after physical or sexual assault // Behaviour research and therapy. – 2001. – Vol. 39 (9). – Pp. 1063–1084. – DOI: https://doi.org/10.1016/S0005-7967(00)00088-7
- Ehlers A., Clark D.M. A cognitive model of posttraumatic stress disorder // Behav Res Ther. – 2000. – Vol. 38 (4). – Pp. 319–345. – DOI: https://doi.org/10.1016/S0005-7967(99)00123-0
- Porter K.E., Stein M.B., Martis B., Avallone K.M., McSweeney L.B., Smith E.R., Simon N.M., Gargan S., Liberzon I., Hoge C.W., Rauch S.A. Postconcussive symptoms (PCS) following combat-related traumatic brain injury (TBI) in Veterans with posttraumatic stress disorder (PTSD): Influence of TBI, PTSD, and depression on symptoms measured by the Neurobehavioral Symptom Inventory (NSI) // Journal of Psychiatric Research. – 2018. – Vol. 102. – Pp. 8–13. – DOI: https://doi.org/10.1016/j.jpsychires.2018.03.004
- Vasterling J.J., Aslan M., Lee L.O., Proctor S.P., Ko J., Jacob S., Concato J. Longitudinal associations among posttraumatic stress disorder symptoms, traumatic brain injury, and neurocognitive functioning in army soldiers deployed to the Iraq war // Journal of the International Neuropsychological Society. – 2018. – Vol. 24 (4). – Pp. 311–323. – DOI: https://doi.org/10.1017/S1355617717001059
- Carlson E.B., Josef R. Effects of traumatic experiences: A National center for PTSD fact sheet. National center for post-traumatic stress disorder. – 2013. – Available at: URL: https://www.mirecc.va.gov/cih-visn2/Documents/Patient_Education_Handouts/Effects_of_Traumatic_Experiences_Version_3.pdf (accessed August 21, 2022).