2024-02-22 15:42:21
Francis Eustache, neuropsychologist, directs research within the Inserm “Neuropsychology and imaging of human memory” unit at the University of Caen-Normandy. He is Director of Studies at the École Pratique des Hautes Études (EPHE) in Paris. On the anniversary of the invasion of Ukraine by the Russian army on February 24, 2022, he explains how a form of so-called “complex” post-traumatic stress disorder (PTSD) occurs in a significant number of people facing armed conflict.
The Conversation: What is the definition of post-traumatic stress disorder (PTSD)?
Francis Eustache : According to the American classification of the DSM (for English “Diagnostic and Statistical Manual of Mental Disorders”, in French “Manual diagnostic and statistical of mental disorders, and psychiatric disorders”) which has consensus, post-traumatic stress disorder (PTSD, in English PTSD for post-traumatic stress disorder) occurs in a person whose personal integrity is threatened because they have been exposed to a traumatic event.
This trauma is an encounter between a major stressful event (disasters, wars, violence once morest women, attacks, etc.), a subjective feeling and a particular moment. It will usually first trigger intense acute stress. If this state persists for more than a month, we will speak of post-traumatic stress disorder (PTSD).
The Conversation: What are the main symptoms of PTSD?
Francis Eustache : PTSD is composed of a certain number of symptoms whose cardinal element is reliving dominated by intrusions. The person will have the subjective impression of reliving, as if they were present once more, very emotional sensory elements which belong to the traumatic event such as disparate images, noises, smells, etc.
The person becomes aware of these untimely elements, which are very difficult to live with. To protect themselves in some way, the person tries to avoid social situations which can favor, according to their analysis, this re-emergence. This avoidance mechanism will in turn become its symptom because it will cut the person off from their environment and from those close to them who might help them.
At the heart of PTSD, we therefore find this double symptom of intrusions into the present of elements of the trauma experienced in the past, sometimes years before, and of avoidance of these elements. Intrusions can occur when the person is confronted with situations reminiscent of the trauma (closed places, particular places dominated by certain noises, etc.).
There are also what we call neurovegetative symptoms. In other words, the person will have a tendency to startle, be on edge… We also note alterations in mood, cognition, sleep disorders with nightmares…
Furthermore, the memory of the trauma can invade the entire autobiography of the person who will have a tendency to only define themselves by this trauma that they experienced.
The brain mechanisms of PTSD are now better understood. From the cohort of the November 13 research program, in a study published in the scientific journal Scienceour team has shown that these intrusions of traumatic elements are linked to a lack of control of regions of the prefrontal cortex, over brain regions which regulate perceptions, emotions, memory, etc.
The Conversation: We distinguish a specific PTSD linked to repeated traumatic events such as armed conflicts, like what is happening in Ukraine. What is it regarding ?
Francis Eustache : We are actually talking regarding complex PTSD (or type 2), when the disorder develops as a result of multiple events repeated over time, the characteristics of which are closer to what is happening in Ukraine (while simple PTSD or type 1 is following a single traumatic event, such as an attack). In complex PTSD, on the other hand, the traumatic situation is repeated over a long period of time.
In adults, people affected by complex PTSD will experience the same symptoms as in simple PTSD, associated with other symptoms dominated by what are called dissociative symptoms. People feel disconnected from their thoughts, from their body, from reality. We sometimes talk regarding depersonalization. The person feels like they are outside their usual personality, they are less receptive to what is happening around them.
This can be seen as a defense once morest reality that is difficult to bear. This can also lead to forms of so-called dissociative amnesia, because the person does not record what they experience when they are in such a state of consciousness.
[Plus de 85 000 lecteurs font confiance aux newsletters de The Conversation pour mieux comprendre les grands enjeux du monde. Abonnez-vous aujourd’hui]
In complex PTSD, people will have difficulty regulating their emotions, sometimes their anger. Self-destructive attitudes are also observed, which can go as far as suicide. Physical symptoms can also occur, manifesting themselves, for example, in chronic pain, cardiorespiratory damage, etc.
The clinical manifestations of complex PTSD can be extremely diverse due to the situation of permanent insecurity which modifies the person’s relationship with themselves and others, more than in simple PTSD.
Note that the American DSM classification does not recognize complex PTSD but refers to PTSD with or without dissociative symptoms. In contrast, the World Health Organization’s International Classification of Diseases (ICD) recognizes complex PTSD.
The Conversation: Historically, the recognition of PTSD has been associated with wars. In what way?
Francis Eustache : Fairly precise descriptions were made on the battlefields, before the concept of PTSD was proposed. The First World War led to many descriptions of soldiers who suffered from psychological disorders. Their pathology was not recognized. We did not care for these soldiers who were sent back to the front. When they were unable to return because they suffered from various disorders, they were sometimes considered malingerers or deserters.
During the Second World War, we began to better recognize these disorders on a semiological level, that is to say to define the different associated symptoms.
In the 1960s, the Vietnam War was a turning point when the veterans of this war had their suffering recognized: it was post-Vietnam syndrome. These veterans will organize themselves and demand from the American authorities that they be recognized as mentally injured.
Other movements, not linked to armed conflicts, come together to reinforce this concept, like the post-hippie feminist movements which will bring to the forefront violence once morest women as well as child protection movements. , victims of mistreatment and abuse.
In 1980, post-traumatic stress disorder entered the American classification of the DSM. It becomes a psychopathological entity, with international recognition.
The Conversation: Are Ukrainians doomed to suffer from PTSD because they live in armed conflict?
Francis Eustache : A significant number of people facing intense war zones will be affected by PTSD, whether they are increasingly exhausted soldiers or civilian populations exposed to repeated bombings. But this pathology is fluid and evolves over time, it is not necessarily definitive.
In addition, PTSD has individual and collective aspects, and also depends on the evolution of the general situation in the country. Distinctions should also be made between people at the front and those far away, even though bombings may take place inside cities.
In addition, developments can be favorable if people affected by PTSD benefit from good health and social care: they will get better if they find a safe environment.
The war in Ukraine is difficult to understand because it is happening now. We lack perspective and, overall, the psychological health of people will depend a lot on the evolution of the conflict and its resolution.
1708658255
#Ukraine #psychological #health #people #depend #lot #evolution #conflict
