War areas, migration journey, intra -family, sexual or physical violence, natural disasters: all these events participate in the climate of insecurity in which billions of people live.
[Article issu de The Conversation, écrit par Camille Raysséguier, Doctorante en psychologie spécialisée en psychologie clinique et psychopathologie, Université de Bordeaux]
In the world, 70 % of the population is confronted at least once in their life with an event of this type, qualified as traumatic, and more than half of individuals live at least two traumatic events during their life. These alarming figures raise the question of psychological health in such contexts.
We now know that the repetition of traumatic events and endangering situations or their establishment in the long term can have consequences on the development of people who live them and on their daily functioning, especially emotional. These effects can be felt at any time in life, and prove to be durable.
To improve the care of the individuals concerned, the researchers in psychology are working to better understand the impact of such exhibitions. Their work has made it possible to define a particular post-traumatic stress disorder, complex post-traumatic stress disorder.
Insecurity and psychological health
Since 2018, complex post-traumatic stress disorder has entered the international classification of diseases, one of the reference collections of diseases recognized by health professionals.
It is defined by symptoms similar to post-traumatic stress disorder (flashbacks, nightmares, impression of being threatened, avoidance of places, situations or people), while resulting in a triad of more specific symptoms: people suffering from a complex disorder have difficulty regulating their emotions, formulating negative beliefs on themselves (they believe that they are worth nothing, that they do not deserve to be happy, loved, etc.) and encounter difficulties in relations with others.
If the existence of this disorder was mentioned in the 1990s by the researchers in psychopathology, its recognition was much later, since it was only active in 2018. Which was not without consequences.
A very slow gratitude
As early as 1991, Leonor Terr, a American psychiatrist recognized for his work on psychotrauma, had defended-through the exploration of infantile mistreatment-the existence of a new type of post-traumatic stress disorder. According to her, this separate disorder was directly related to the occurrence of multiple traumatic events. The latter had consequences on the psychological functioning of children, who lost adolescence and adulthood.
In 1992, another American psychiatrist recognized for her work on traumatic memory, Judith Lewis Herman, evoked a complex form of post-traumatic stress disorder in survivors of prolted, repeated traumatic events. Notable difference with the disorder highlighted by Leonor Terr, according to Judith Lewis, the events involved could occur at any age and no longer just early, in childhood.
Based on these two fundamental studies, knowledge has been expanding thanks to the work of other researchers, including Marylène Cloitre. US professor in psychiatry, she is particularly recognized for her contributions on the subject of complex post-traumatic stress disorder. In 2005, Marylène Cloitre enabled research on the subject to take new directions by emphasizing, in a study, the importance of emotional regulation in the ability to operate normally. From his work will result from new perspectives for the management of these patients.
However, it will be necessary to wait until 2018 that the complex post-traumatic stress disorder is finally officially recognized. This long delay delayed the understanding of its functioning and its repercussions on mental health, delaying the development of effective therapies.
The importance of regulating emotions
The regulation of emotions plays an important role in complex post-traumatic stress disorder. Well known in the field of psychology, this skill can be defined as the means of controlling how and when an emotion is expressed, lived and “reduced” (this last term expresses the fact that emotion decreases in intensity).
For most of us, this well -acquired process occurs continuously; We are able to notice and understand the body and behavioral changes that our emotions imply. On the other hand, for people faced with traumatic life events, things are different. Everything happens as if they found themselves in the center of an “emotional storm”.
Imagine: where you live, the situation is such that only your survival matters. In addition, you are almost impossible to influence the course of events that you have been continuously suffered for some time. Staying healthy, preserving your physical integrity, occupies you entirely. In this context, the annoyances and the emotions felt do not have the same repercussions as in a daily “healthy” situation.
People who live in a prolonged way in such a climate of insecurity, or who face it repeatedly, develop difficulties in regulating their emotions, characteristics of complex post-traumatic stress disorder. The research carried out in psychopathology indicates that people who have been faced with this type of events are more inclined to suppress their unpleasant emotions, to bury them, to “put them under the carpet”.
However, this technique does not effectively regulate emotions. Without being able to manage these properly, mental health is deteriorating more and more, a bit like a pressure cooker whose valve no longer works gradually in pressure, until the explosion.
In fact, this situation results in intense irritability or access of anger, as well as, in some cases, in strong reactions to certain situations, and by a tendency to hurt yourself.
What treatments?
Management of patients with complex post-traumatic stress disorder requires, upstream of psychotherapeutic treatment, to adopt an approach centered on emotions. The goal is to help them recognize them, understand and manage them, in order to reduce the suffering they cause. This is an essential step on the way to recovery and psychological well-being.
Patients concerned can be offered a first work on the acceptance of these emotions, as well as alternative strategies to regulate them. For example, rather than “putting the emotion under the carpet” and going up the pressure, breathing exercises can be taught, in order to play on the modulation of the emotional feeling, so as not to be overflowed. This psychotherapeutic proposal allows patients to improve their capacities to manage strong emotions and, thus, to face what is, for them, a major difficulty of everyday life.
If complex post-traumatic stress disorder is now recognized, research on this subject is far from over. They are even expanding. Among the questions that remain unanswered is in particular that of interindividual disparities. Indeed, the difficulties encountered do not express themselves in the same way from one person to another. Better taking these differences into account would improve the training of professionals in the detection of this disorder, and to adapt psychotherapeutic interventions.
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