Hasanoğlu Alper
Basel U Tip Fak., Psikiyatri AD, Basel.
Turk Psikiyatri Derg. 2008 Spring;19(1):94-100.
Psychological reactions to negative life events have been among the most interesting subjects to researchers for a long time. In recent years post traumatic stress disorder (PTSD), in particular, has been the focus of numerous studies. This disorder is defined as a reaction to an event that is accepted as traumatic by almost everyone, to an extraordinary life-threatening event, or to a disaster. Psychological reaction to events, which are not directly life threatening, is classified as adjustment disorder and is rarely diagnosed in clinical practice. As a result of experiencing such non-life threatening events, PTSD is claimed to be an adjustment disorder as well. Immigrants frequently report a depressive state in which physical symptoms are in the foreground accompanied by social withdrawal and diminished energy. Negative life events, which are not life threatening and are not experienced everyday, can impair mental health so that the above state may worsen and an immigrant may have a reduction in his performance at work. This state, which is accompanied by such symptoms as embitterment, feelings of injustice, repeated intrusive memories of critical events (injustice at work place, loss of a job, discrimination in a public office, etc.), phobic symptoms, and avoidance behavior towards the place or persons related to the event, might best be described by the term, posttraumatic embitterment disorder (PTED). This disorder, which was initially described in immigrants from East Germany following the fall of the Berlin Wall, and which does not exactly match the diagnostic criteria of adjustment disorder or PTSD, is presented in a case vignette and its differential diagnosis is discussed.
长期以来，负面生活事件的心理反应一直是研究人员最感兴趣的课题之一。近年来，创伤后应激障碍（PTSD）尤其成为众多研究的焦点。这种障碍被定义为对几乎所有人都认为具有创伤性的事件、对危及生命的异常事件或对灾难的反应。对并非直接危及生命的事件的心理反应被归类为适应障碍，在临床实践中很少被诊断出来。由于经历了这类非危及生命的事件，PTSD也被认为是一种适应障碍。移民经常报告一种抑郁状态，其中身体症状最为突出，同时伴有社交退缩和精力减退。并非危及生命且并非每天都会经历的负面生活事件会损害心理健康，从而使上述状态恶化，移民的工作表现可能会下降。这种状态伴有诸如痛苦、不公正感、对关键事件（工作场所的不公正、失业、在公职部门受到歧视等）的反复侵入性记忆、恐惧症状以及对与事件相关的地点或人的回避行为，用创伤后痛苦障碍（PTED）这个术语来描述可能最为恰当。这种障碍最初是在柏林墙倒塌后从东德移民中描述的，它并不完全符合适应障碍或PTSD的诊断标准，本文通过一个病例 vignette 进行呈现并讨论其鉴别诊断。
