[Psychopathology and treatment of traumatic mental disorders--on the vicissitude and controversy around theory and practice].
Recently, among advanced nations, including the United States, there have been growing interest in trauma related psychopathology. Regarding Japan, since Hanshin Awaji Great Earthquake and Sarin gas terrorism by Aum Shinrikyo, interest for psychological trauma has grown high. It is only about twenty years since active research and discussion around these issues started. Therefore, there are still hot dispute around psychopathology of these disorders. Also, therapeutic method is ever progressing. Regarding psychotherapy, there remain a lot of dispute and no general agreement has been made. In this paper, I would like to summarize the literature on psychological trauma and trauma-related psychopathology historically and provide current overview about the theory and practice of this pathology. The summary of the overview is as follows: 1. Psychological trauma is defined as a state caused by traumatic event described in DSM-IV, not as a traumatic event itself. Traumatic mental disorder should be understood as a spectrum of disorders, ranging from phobias and panic reactions related to distinct traumatic events to personality disorders, where intense and chronic traumatic experience is integrated into the personality organization. 2. Historically speaking, traumatic disorders were studied from two directions; war neuroses and etiology of hysteria. Each is corresponds to physioneurosis model and memory processing disturbance model, respectively, which is thought to be two major etiological models of this disorder. 3. Regarding treatment, although corresponding therapeutic idea for each model is provided, currently, most promising treatments are pharmacotherapy using SSRI and novel cognitive-behavioral techniques such as PE (prolonged exposure treatment), SIT (stress inoculation training) and EMDR (eye movement desensitization and reprocessing). As for psychotherapy, hot arguments has been done as to how authentic recovered traumatic memories are and how to deal with them. Regardless of these disputes, it is essential to establish empathic therapeutic bond with the patients.
Wada
H
H
Department of Psychiatry, Kawasaki Saiwai General Hospital.
D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D003887:Desensitization, Psychologic; D006801:Humans; D001523:Mental Disorders / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D008996:Monoamine Oxidase Inhibitors / Q000627:therapeutic use; D011599:Psychopathology; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy; D013315:Stress, Psychological / Q000150:complications*
D000929:Antidepressive Agents, Tricyclic; D008996:Monoamine Oxidase Inhibitors