Hirohata Sayuri, Konishi Takako, Shirakawa Miyako, Asakawa Chiaki, Morita Nobuaki, Nakatani Yoji
Doctoral Program in Medical Science, University of Tsukuba, (National Institute of Mental Health, National Center for Neurology and Psychiatry).
Seishin Shinkeigaku Zasshi. 2002;104(6):529-50.
To clarify the clinical characteristics of mental disorders in sexual assault victims, we investigated the victims focusing on PTSD, depression, physical symptoms, and their relationships.
Participants were 46 treatment-seeking female victims of sexual assault who consulted four hospitals, one clinic and one psychological services center, between February 2000 and April 2001. The mean +/- SD age of the participants was 28.0 +/- 8.9 years, the mean +/- SD period from the traumatic event was 94.5 +/- 88.0 months. PTSD was diagnosed and evaluated using a structured interview (Clinician-Administered PTSD Scale for DSM-IV: CAPS). Depressive symptoms were assessed using Self-rating Depression Scales (SDS). Physical symptoms were assessed using the Physical symptom scale developed by the authors.
Thirty-two participants (69.6%) met the criteria for PTSD in their current diagnosis, and 41 (89.1%) had the disorder at some point during their lives. SDS score and Physical symptom scale score of the PTSD group were significantly higher than those scores of the non-PTSD group. The SDS score correlated with the Avoidant-numbing score. The Physical symptoms scale score correlated with the Intrusion score and Hyperarousal score. We think that the PTSD group had the co-existing depression secondary to PTSD. Although previous studies have discussed the relationship between physical symptoms and Hyperarousal symptoms, this study suggested that physical symptoms were related to Intrusion symptoms as much as Hyperarousal symptoms. We found 2 patterns when PTSD patients reported physical symptoms related to Intrusion symptoms. The patterns were caused (1) by physiological reactivity on exposure to internal or external cues that symbolize an aspect of the traumatic event, and caused (2) by somatic reenactment symptoms.
We discuss the importance for clinicians to distinguish Intrusion symptoms from physical symptoms as well as Avoidant-numbing symptoms from depressive symptoms on PTSD diagnosis. Because sexual assault victims have difficulty in talking about the traumatic experience, clinicians should pay attention to these findings in developing therapeutic plans for the victims.
为阐明性侵犯受害者精神障碍的临床特征，我们以创伤后应激障碍（PTSD）、抑郁、躯体症状及其关系为重点对受害者进行了调查。
参与者为2000年2月至2001年4月间在四家医院、一家诊所和一家心理服务中心就诊的46名寻求治疗的性侵犯女性受害者。参与者的平均年龄±标准差为28.0±8.9岁，距创伤事件的平均时间±标准差为94.5±88.0个月。使用结构化访谈（DSM-IV临床医生管理的PTSD量表：CAPS）对PTSD进行诊断和评估。使用自评抑郁量表（SDS）评估抑郁症状。使用作者编制的躯体症状量表评估躯体症状。
32名参与者（69.6%）在当前诊断中符合PTSD标准，41名（89.1%）在一生中曾患过该疾病。PTSD组的SDS评分和躯体症状量表评分显著高于非PTSD组。SDS评分与回避-麻木评分相关。躯体症状量表评分与闯入评分和过度警觉评分相关。我们认为PTSD组存在继发于PTSD的共病性抑郁。尽管先前的研究讨论了躯体症状与过度警觉症状之间的关系，但本研究表明躯体症状与闯入症状的相关性与过度警觉症状一样大。当PTSD患者报告与闯入症状相关的躯体症状时，我们发现了两种模式。这些模式是由（1）接触象征创伤事件某个方面的内部或外部线索时的生理反应引起的，以及由（2）躯体重演症状引起的。
我们讨论了临床医生在PTSD诊断中区分闯入症状与躯体症状以及回避-麻木症状与抑郁症状的重要性。由于性侵犯受害者在谈论创伤经历时存在困难，临床医生在为受害者制定治疗计划时应注意这些发现。
