The importance of the concepts of disaster, catastrophe, violence, trauma and barbarism in defining posttraumatic stress disorder in clinical practice
The importance of the concepts of disaster, catastrophe, violence, trauma and barbarism in defining posttraumatic stress disorder in clinical practice
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DOI：
10.1186/1471-244x-8-68
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发表时间：
2008-08-12
期刊：
影响因子：
4.4
通讯作者：
Mello, Marcelo F.
中科院分区：
文献类型：
--
作者：
Braga, Luciana L.;Fiks, Jose P.;Mello, Marcelo F.
背景资料：科学文献中关于创伤后应激障碍的几个术语在不同作者进行的研究中具有不同的含义。创伤、暴力、灾难、灾难、野蛮等词汇经常被模糊或混淆地使用，其含义在不同的文章中也会发生变化。这些表达缺乏概念参考，使文献的组织复杂化。此外，缺乏明确的概念可能是一个障碍，临床治疗，因为使用这些词的患者并不一定指向一个诊断创伤后应激障碍。讨论：一个关键的审查科学文献表明，压力可以分为阶段，以促进特定的术语调整事件本身，主题-事件的相互作用和心理反应。此外，它表明，创伤的不同概念扩展到基本的心理治疗定义，与野蛮行为有关的暴力的含义是恢复能力的障碍。因此，本研究更新了这些词的词源和应用，将它们与创伤后应激障碍患者的临床护理中可以操作的意义扩展联系起来，并根据DSM-IV和ICD-10的标准A对其进行批判性分析。文献中关于创伤后应激障碍的术语包括过多的术语，其含义尚未完全理解，因此，限制这个术语。对这些术语的分析表明，创伤概念的转变使人们对这种现象的心理维度有了更广泛的理解，野蛮类型的暴力构成了复原力的障碍，并且DSM-IV和ICD-10的标准A显示出不精确性和概念上的脆弱性。方法：为了发展这篇辩论文章，通过从两个主要数据库（PubMed和PsycINFO）中检索和检索关键术语，完成了当前的专业文献综述。关键术语包括“灾害”、“灾难”、“野蛮”、“恐怖主义”、“创伤”、“精神创伤”和“暴力”，以及“创伤后应激障碍”、“概念”和“概念方面”等术语。这些数据是专门从综述文章中获取的。纳入的研究大多是作者通过在论文的任何部分中存在概念方法而确定为相关的研究。仅依赖于经验指标的研究，如精神病理学，神经生物学或药理学方面，被排除在外。这里的重点是在概念方面，即使有一些经验研究包括在内，因为它被指出，与这些术语的概念方面有关的医学参考文献的缺乏，更广泛的文献需要包括，包括章节，书籍和文章从人文领域进行。“在这一领域需要进行跨学科研究，以包括来自一系列不同学科的观点”，一旦“促进公共卫生（......）应与更广泛领域的研究人员合作，探讨这种相互作用的新层面及其影响”[ 1]。
Background: Several terms in the scientific literature about posttraumatic stress disorder are used with different meanings in studies conducted by different authors. Words such as trauma, violence, catastrophe, disaster and barbarism are often used vaguely or confusingly, and their meanings change in different articles. The lack of conceptual references for these expressions complicates the organization of literature. Furthermore, the absence of clear concepts may be an obstacle to clinical treatment because the use of these words by the patients does not necessarily point to a diagnosis of posttraumatic stress disorder.Discussion: A critical review of scientific literature showed that stress can be divided in stages to facilitate specific terminological adjustments to the event itself, to the subject-event interaction and to psychological responses. Moreover, it demonstrated that the varying concept of trauma expands into fundamental psychotherapeutic definitions and that the meanings of violence associated with barbarism are an obstacle to resilience. Therefore, this study updates the etymological origins and applications of these words, connects them to the expansions of meanings that can be operated in the clinical care of patients with posttraumatic stress disorder, and analyzes them critically according to the criterion A of DSM-IV and ICD-10.Summary: The terminology in the literature about posttraumatic stress disorder includes a plethora of terms whose meanings are not fully understood, and that, therefore, limit this terminology. The analysis of these terms suggested that the transformation of the concept of trauma led to a broader understanding of this phenomenon in its psychic dimensions, that a barbarian type of violence constitutes an obstacle to resilience, and that the criterion A of the DSM-IV and ICD-10 shows imprecision and conceptual fragilities.Methods: To develop this debate article, a current specialized literature review was achieved by searching and retrieving the key terms from two major databases: PubMed and PsycINFO. The key terms included "disaster", "catastrophe", "barbarism", "terrorism", "trauma", "psychic trauma" and "violence", also in combination with the terms "PTSD", "concept" and "conceptual aspects". The data were captured specially from review articles. The included studies were those mostly identified by the authors as relevant by the presence of a conceptual approach in any part of the paper. Researches that relied solely on empirical indicators, like psychopathological, neurobiological or pharmacological aspects, were excluded. The focus here was in conceptual aspects, even when some few empirical studies were included.As it was noted a paucity of medical references related to conceptual aspects of these terms, a wider literature needed to be included, including chapters, books and articles proceeded from the Humanities areas. "Interdisciplinary research is needed in this area to include perspectives from a range of different disciplines" once that "to promote public health (...) new dimensions of such interactions and the implications thereof should be pursued in collaboration with researchers from broader areas" [ 1].