An Enduring Somatic Threat Model of Posttraumatic Stress Disorder Due to Acute Life-Threatening Medical Events
An Enduring Somatic Threat Model of Posttraumatic Stress Disorder Due to Acute Life-Threatening Medical Events
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DOI：
10.1111/spc3.12089
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发表时间：
2014-03-01
影响因子：
4.6
通讯作者：
Edmondson, Donald
中科院分区：
文献类型：
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作者：
Edmondson, Donald
创伤后应激障碍（PTSD）发生在12-25%的急性危及生命的医疗事件（如心脏病发作，中风和癌症）的幸存者中，并与心脏事件的复发和心脏病发作幸存者的死亡率相关。这篇文章回顾了目前的知识状态PTSD后，这样的事件，并提出了一个持久的躯体威胁（EST）模型的PTSD由于急性危及生命的医疗事件，以解决PTSD之间的差异，由于过去的，离散的/外部的创伤性事件（如战斗）和PTSD由于慢性疾病的急性表现是持久的/内部的性质（如心脏病发作和中风）。这些差异包括威胁的外部与内部/躯体来源，威胁认知的过去与现在/未来时间焦点，回避行为的不同类型和后果，以及过度觉醒的不同性质和后果。虽然两种类型的PTSD之间存在重要差异，但EST模型提出，由于离散/外部和持续/躯体事件，潜在的死亡恐惧维持了PTSD症状。最后，本文提供了一个测试EST模型的研究议程，特别关注可能改善心脏病发作和中风幸存者心血管预后和健康行为的领域。
Posttraumatic stress disorder (PTSD) occurs in 12-25% of survivors of acute life-threatening medical events such as heart attack, stroke, and cancer, and is associated with recurrence of cardiac events and mortality in heart attack survivors. This article reviews the current state of knowledge about PTSD after such events, and proposes an Enduring Somatic Threat (EST) model of PTSD due to acute life-threatening medical events to address underappreciated differences between PTSD due to past, discrete/external traumatic events (such as combat) and PTSD due to acute manifestations of chronic disease that are enduring/internal in nature (such as heart attack and stroke). The differences include the external versus internal/somatic source of the threat, the past versus present/future temporal focus of threatening cognitions, the different types and consequences of avoidance behavior, and the different character and consequences of hyperarousal. Although important differences between the two types of PTSD exist, the EST model proposes that the underlying fear of mortality maintains PTSD symptoms due to both discrete/external and ongoing/somatic events. Finally, this article offers a research agenda for testing the EST model, with a particular focus on areas that may improve cardiovascular prognosis and health behaviors in survivors of heart attack and stroke.