Post Traumatic Stress

Stress: to bear and endure.

From the Latin stringere (tighten, embrace) via the Old French estrece (tightness, oppression), the word stress appears in English as early as the 15th century. Later, engineers used the word to describe the stress to which certain metal parts were subjected. It was in 1956 that Hans Selye first described the "stress adaptation syndrome" as a "non-specific response of the body to any demand made upon it. Under stress, the body goes through a phase of alarm (adrenaline), resistance (cortisol), and exhaustion.

Acute stress response

In an acute stress situation (accident, aggression), we also find a hormonal response that allows the threatened person to

1. Survive (adrenaline and noradrenaline or epinephrine and norepinephrine).

2. Adapt (cortisone releases energy sources, activates metabolism and blocks inflammatory responses)

3. Calm irritability, excitability, and impulsivity (serotonin)

4. “Numb" emotions and reduce pain sensitivity (endorphins).

A normal response

Responses to stress are not pathological symptoms. They are normal. However, if the state of stress is prolonged, these reactions can cause problems: chronic heart palpitations, constant sweating, diarrhea, chronic fatigue, etc. The person is torn between excitement and apathy by alternately stimulating the sympathetic (flight and aggression) and parasympathetic (digestion, rest) systems. High levels of cortisol can weaken the immune system. Endorphins can induce the kind of apathy or numbness we know so well from opiates.

Under stress, our nervous system does amazing things: we gain strength, run faster, and can outperform ourselves. Sensitivity to pain and fatigue diminishes remarkably. Who would want to give up the stress of adventure, the state of love, the excitement of departure? However, this survival system does not distinguish between real danger (e.g., war) and imaginary danger. When exposed to the many small aggressions of modern life (environmental stress), the organism reacts as if it were a matter of life and death. In other cases, when the danger has long since passed, we continue to be alarmed: this is post-traumatic stress.

Normal post-traumatic reactions

After a significant traumatic event (disaster, rape, torture), over 90% of people will develop the following specific reactions:

• Recurrent, intrusive memories are very characteristic: flashbacks, repeated nightmares, panic in response to triggers. When the memories return, it's "as if I were there again".

• External avoidance (avoidance of situations, places, conversations) or internal avoidance (avoidance of thoughts, partial amnesia, loss of interests).

• Persistent hyperarousal: sleep disturbances, aggressive outbursts, irritability, constant need for exercise, difficulty concentrating.

Victims of aggression or severe shock need to understand that these various reactions are normal. They must be reassured, learn stress management techniques (e.g., breath techniques), and avoid becoming avoidant. Debriefing can be a useful preventative measure at this stage.

These reactions are often accompanied by feelings of paralysis and dissociation (staring into space, feelings of unreality, "not being there," seeing oneself from the outside). While dissociation protects the survivor during the danger, it can significantly hinder their return to everyday life.

Pathological posttraumatic reactions

Under normal circumstances, these reactions resolve spontaneously within 4 to 8 weeks. If they persist beyond this period, or if significant dissociation is observed immediately, we are probably dealing with a pathological development that requires appropriate action. Depending on the case, we will describe

a) Acute stress syndrome (DSM IV-1994), which can be diagnosed as early as the first month if, in addition to intrusion, avoidance, and hyperactivity reactions, at least three of the following criteria are met

1. Lack of sensation or detachment.

2. Decreased awareness of the environment.

3. Derealization: "everything is unreal", "like a dream".

4. Depersonalization: "Who am I? Feeling of being taken out of one's body.

5. Dissociative amnesia (forgetting an essential aspect of the event).

b) Post-traumatic stress syndrome: in 10-15% of cases, reactions become chronic. Avoidance, panic, nightmares, and flashbacks persist for 4-8 weeks. In Vietnam veterans, 25% of the disorders persist for more than a year. Without appropriate therapy, these extremely distressing reactions can last a lifetime.

If the various preventive measures (defusing, debriefing, etc.) have failed, the traumatized person should be referred to a therapist (psychiatrist/psychologist) trained in psychotraumatology. This is usually a brief, trauma-focused therapy. It is structured, directive, and draws on the person's resources. Sessions (from 1 to 12 for a simple trauma) can be spread over a year. Several models are available (EMDR, NLP, Brief Eclectic Psychotherapy).