Sonnenberg S M
Department of Psychiatry, Uniformed Services University of the Health Sciences, Washington, DC.
Psychiatr Clin North Am. 1988 Dec;11(4):581-90.
PTSD can occur in victims of violence. It is not known whether PTSD is caused by the psychological reaction of helplessness, shame, and guilt in the face of a traumatic stressor, whether there is some sort of fundamental psychobiologic change in the CNS in response to a stressor, or whether psychological reactions lead to biologic changes and both then coexist. PTSD after experiencing violence is characterized by re-experiencing phenomena, numbing or the avoidance of stimuli associated with the violent event, and symptoms of increased arousal. The disorder may begin immediately after the trauma or onset may be delayed for months or even years. Even after PTSD is resolved, it can return years later in response to an event that reminds the trauma victim of his earlier experience. Treatment consists of individual psychotherapy, family therapy, group therapy, and a range of pharmacotherapeutic interventions. Experimental therapies are being developed such as those that combine narcosynthesis and talking therapy, and descriptions of these appear in the literature. It is important for the psychiatrist attempting individual psychotherapy of a sufferer of PTSD for the first time to consider supervision with a colleague who possesses expertise in treating the disorder, for many treatment efforts fail because of countertransference reactions. Similarly, those who employ other forms of talking therapy will benefit from supervision.
创伤后应激障碍（PTSD）可发生于暴力受害者。目前尚不清楚PTSD是由面对创伤性应激源时的无助、羞耻和内疚等心理反应引起的，还是中枢神经系统（CNS）因应激源而发生了某种根本性的心理生物学变化，亦或是心理反应导致了生物学变化，二者随后并存。经历暴力后的PTSD表现为反复体验相关现象、情感麻木或回避与暴力事件相关的刺激，以及觉醒增加的症状。该障碍可能在创伤后立即开始，也可能延迟数月甚至数年才出现。即使PTSD得到解决，多年后它也可能因某一事件而复发，该事件会让创伤受害者想起其早期经历。治疗方法包括个体心理治疗、家庭治疗、团体治疗以及一系列药物治疗干预措施。正在开发一些实验性疗法，比如将麻醉合成疗法与谈话疗法相结合的疗法，相关文献中已有对这些疗法的描述。对于首次尝试对PTSD患者进行个体心理治疗的精神科医生而言，与在治疗该障碍方面拥有专业知识的同事进行督导是很重要的，因为许多治疗努力因反移情反应而失败。同样，那些采用其他形式谈话疗法的人也将从督导中受益。
