Bouras G, Lazaratou E
2nd Department of Psychiatry, "Attikon" University General Hospital, of Athens, Athens.
Psychiatriki. 2012 Jun;23 Suppl 1:39-48.
Trauma comes as a result of the subject's exposure to extremely negative and stressful events, such as natural or human-provoked catastrophes, wars, serious injuries, violent deaths, tortures, terrorist attacks, rapes and other sexual crimes. A child's exposure to traumatic circumstances of this level during the crucial period of self-structuring creates rather difficult conditions for its development. Moreover, if the child does not have the opportunity to elaborate and analyze all these stressful conditions and put them into words, serious consequences, both psychological and somatic, may occur in adult life. Specific factors and child characteristics, namely, the age, the developmental stage within which the trauma occurs, its type (physical or sexual abuse, neglect or traumatic social events), frequency, duration and intensity, have been proved to seriously affect the trauma's consequences. The immediate emotional impact of trauma may include isolation, fear, feeling of weakness or loss of the sense of confidence. Moreover, mood disorders such as depression and withdrawal, negative effects on cognitive ability, language development and academic performance, difficulties in creating a secure link and post-traumatic stress disorder (PTSD) are also observed. The long-term consequences for the individual's mental health can be expressed through the following: post-traumatic stress disorder (PTSD) combined or not with depression and anxiety disorder, mood disorders, personality disorders, poor control of impulsions, dissociation disorder, psychotic disorder. Finally, apart from the dramatic impact of trauma on the person itself, there is also a high social cost to be paid as a result of the individual's poor adjustment and dysfunction in the community. Early support and intervention in the child's environment may significantly minimize the negative effects of trauma. Beyond the expression of genes, good maternal care as well as psychological support, lead to normal DNA methylation and brain development. Supporting the family and break the silence that frequently covers the traumatic events and feelings, will give the opportunity for the elaboration of all these aspects which could capture and imprison the subject in a dramatic circle of psychopathology. Moreover, the effectiveness of early interventions and child psychotherapy is now a common ground, so we have to use all our clinical instruments (dialogue, symbolic play, drawing, storytelling) in order to help the child and have the best possible result. Finally, concerning clinical practice, the emergence of early childhood trauma in adult psychiatric symptomatology is so frequent that mental health experts should take it into serious account while developing an appropriate clinical treatment for such patients.
创伤是由于个体暴露于极端负面和压力巨大的事件而产生的,比如自然或人为引发的灾难、战争、严重受伤、暴力死亡、酷刑、恐怖袭击、强奸及其他性犯罪。在自我构建的关键时期,儿童暴露于这种程度的创伤性环境会给其发展造成相当困难的条件。此外,如果儿童没有机会阐述和分析所有这些压力状况并将其诉诸言语,那么在成年生活中可能会出现严重的心理和躯体后果。已证实特定因素和儿童特征,即年龄、创伤发生时所处的发育阶段、其类型(身体或性虐待、忽视或创伤性社会事件)、频率、持续时间和强度,会严重影响创伤的后果。创伤的直接情感影响可能包括孤立、恐惧、虚弱感或自信心丧失。此外,还会观察到诸如抑郁和退缩等情绪障碍、对认知能力、语言发展和学业成绩的负面影响、建立安全联系的困难以及创伤后应激障碍(PTSD)。对个体心理健康的长期后果可表现为以下方面:创伤后应激障碍(PTSD),可伴有或不伴有抑郁和焦虑障碍、情绪障碍、人格障碍、冲动控制不佳、分离障碍、精神障碍。最后,除了创伤对个体本身的巨大影响外,由于个体在社区中适应不良和功能失调,还需付出高昂的社会代价。在儿童的环境中尽早提供支持和干预可能会显著降低创伤的负面影响。除了基因表达外,良好的母亲照料以及心理支持会导致正常的DNA甲基化和大脑发育。支持家庭并打破常常笼罩创伤事件和感受的沉默,将为阐述所有这些可能使个体陷入精神病理学戏剧性循环的方面提供机会。此外,早期干预和儿童心理治疗的有效性如今已得到普遍认可,所以我们必须运用所有临床手段(对话、象征性游戏、绘画、讲故事)来帮助儿童并取得尽可能好的效果。最后,关于临床实践,成年精神症状学中童年早期创伤的出现非常频繁,以至于心理健康专家在为这类患者制定适当的临床治疗方案时应予以高度重视。