Dissociation, somatization, and affect dysregulation: the complexity of adaptation of trauma.
Dissociation, somatization, and affect dysregulation: the complexity of adaptation of trauma.
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DOI：
10.1176/ajp.153.7.83
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发表时间：
1996-07
期刊：
影响因子：
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通讯作者：
B. Kolk;D. Pelcovitz;S. Roth;Francine S. Mandel;A. McFarlane;J. Herman
中科院分区：
文献类型：
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作者：
B. Kolk;D. Pelcovitz;S. Roth;Francine S. Mandel;A. McFarlane;J. Herman
一个世纪的临床研究已经注意到一系列创伤相关的心理问题，这些问题并没有在创伤后应激障碍（PTSD）的DSM-IV框架中被捕获。本研究调查了暴露于极端压力、PTSD的出现和传统上与“歇斯底里”相关的症状之间的关系，“歇斯底里”可以理解为刺激歧视、自我调节和经验认知整合方面的问题。方法采用DSM-IV PTSD实地试验，对395名创伤性寻求治疗的被试和125名有创伤性经历的非寻求治疗的被试进行研究。收集了发病年龄、创伤性质、创伤后应激障碍、分离、躯体化和情感失调的数据。结果PTSD与分离、躯体化、情绪失调高度相关。符合终身PTSD（但不是当前）标准的受试者在这些障碍上的得分明显低于当前PTSD患者，但明显高于从未患过PTSD的患者。成年后发生人际创伤后应激障碍的受试者的症状明显少于童年创伤患者，但明显多于灾难受害者。结论：创伤后应激障碍、分离、躯体化和情感失调代表了一系列的创伤适应。它们通常同时发生，但受创伤的个体可能会随着时间的推移而出现各种症状的组合。在治疗这些患者时，至关重要的是要注意刺激辨别、自我调节和经验的认知整合的丧失对整体损伤的相对贡献，并提供系统的治疗，以解决不请自来的侵入性回忆和与暴露于创伤经历而不知所措相关的这些其他症状。
OBJECTIVE A century of clinical research has noted a range of trauma-related psychological problems that are not captured in the DSM-IV framework of posttraumatic stress disorder (PTSD). This study investigated the relationships between exposure to extreme stress, the emergence of PTSD, and symptoms traditionally associated with "hysteria," which can be understood as problems with stimulus discrimination, self-regulation, and cognitive integration of experience. METHOD The DSM-IV field trial for PTSD studied 395 traumatized treatment-seeking subjects and 125 non-treatment-seeking subjects who had also been exposed to traumatic experiences. Data on age at onset, the nature of the trauma, PTSD, dissociation, somatization, and affect dysregulation were collected. RESULTS PTSD, dissociation, somatization, and affect dysregulation were highly interrelated. The subjects meeting the criteria for lifetime (but not current) PTSD scored significantly lower on these disorders than those with current PTSD, but significantly higher than those who never had PTSD. Subjects who developed PTSD after interpersonal trauma as adults had significantly fewer symptoms than those with childhood trauma, but significantly more than victims of disasters. CONCLUSIONS PTSD, dissociation, somatization, and affect dysregulation represent a spectrum of adaptations to trauma. They often occur together, but traumatized individuals may suffer from various combinations of symptoms over time. In treating these patients, it is critical to attend to the relative contributions of loss of stimulus discrimination, self-regulation, and cognitive integration of experience to overall impairment and provide systematic treatment that addresses both unbidden intrusive recollections and these other symptoms associated with having been overwhelmed by exposure to traumatic experiences.