Travma Sonrası Stres Bozukluğu ve Karmaşık Travma Sonrası Stres Bozukluğunu Tanımak
Özet
Ruhsal travma, bireyin temel düşünce, duygu ve kabullerini sarsarak uyum sürecini bozan olumsuz yaşam olaylarıdır ve toplumun %70-80'inin hayatının bir döneminde karşılaştığı yaygın bir durumdur. Travmatik deneyimler, irritable bağırsak sendromu, fibromiyalji ve kronik ağrılar gibi çok sayıda somatik ve psikosomatik semptomla doğrudan ilişkilidir. Bu süreçte Akut Stres Bozukluğu (ASB), Travma Sonrası Stres Bozukluğu (TSSB) ve Karmaşık Travma Sonrası Stres Bozukluğu (KTSSB) olmak üzere üç ana psikiyatrik tablo öne çıkmaktadır. Travmanın ardından ilk 2-30 gün içinde disosiyatif belirtilerle ortaya çıkan ve kendiliğinden gerileyen durumlar ASB olarak tanımlanırken, belirtilerin bir aydan uzun sürmesi TSSB tanısına işaret eder. TSSB; aşırı uyarılmışlık, yeniden yaşantılama ve hatırlatıcılardan kaçınma gibi spesifik semptomlarla karakterizedir. DSÖ tarafından ICD-11'de resmi olarak tanımlanan KTSSB ise bu klasik TSSB kriterlerine ek olarak duygudurum düzenlemede güçlük, olumsuz kendilik algısı ve ilişkileri sürdürmede kalıcı zorluklar barındırır. Kadın cinsiyetinin hem TSSB hem de KTSSB için belirgin bir risk faktörü olduğu bilinmektedir. Hastalar için hastane ortamı hem bir tedavi yeri hem de travmayı tetikleyen bir nesne işlevi görerek kaygı düzeylerini artırabilir. Bu bozuklukların en etkili tedavi yöntemi medikal ilaçlar ile bilişsel davranışçı terapiler (BDT) ve EMDR gibi psikoterapilerin birlikte kombinasyonudur; dirençli vakalarda ise EKT ve rTMS gibi somatik tedaviler uygulanmaktadır.
Psychological trauma refers to negative life events that disrupt an individual's adaptation process by shaking their core thoughts, emotions, and beliefs, representing a common phenomenon that 70-80% of the population experiences at some point. Traumatic experiences are directly associated with numerous somatic and psychosomatic symptoms, such as irritable bowel syndrome, fibromyalgia, and chronic pain. In this process, three main psychiatric conditions stand out: Acute Stress Disorder (ASD), Post-Traumatic Stress Disorder (PTSD), and Complex Post-Traumatic Stress Disorder (CPTSD). While conditions appearing with dissociative symptoms within the first 2-30 days post-trauma and resolving spontaneously are diagnosed as ASD, the persistence of symptoms for more than a month indicates PTSD. PTSD is characterized by specific symptoms such as hyperarousal, re-experiencing, and avoidance of reminders. Formally defined by the WHO in ICD-11, CPTSD includes these classic PTSD criteria alongside persistent difficulties in affect regulation, negative self-concept, and relational impairments. Female gender is known to be a prominent risk factor for both PTSD and CPTSD. For patients, the hospital environment can function as both a treatment center and a traumatic reminder, thereby increasing their anxiety levels. The most effective treatment for these disorders is a combination of medication and psychotherapies like cognitive behavioral therapy (CBT) and EMDR; in treatment-resistant cases, somatic therapies such as ECT and rTMS are utilized.
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