Post-traumatic stress disorder (PTSD) manifests itself with a multitude of symptoms resulting from a traumatic event. The latter can be an episode of violence suffered or witnessed, a situation in which one felt in danger of death or even the fact of being confronted with a death. “In the hours and days following a trauma, the affected person may show hypervigilance, outbursts of anger, fear, etc. This is called an “acute stress disorder”. When these symptoms last more than a month and combine with others, such as avoidance behaviors, agitation, moments of self-blame, flashbacks, among others, we are dealing with PTSD. », explains Dr Lamyae Benzakour, head of the Liaison Psychiatry Unit and the psychotraumatology consultation at the University Hospitals of Geneva (HUG).
Not all equal in the face of this disorder?
After a traumatic event, some people develop post-traumatic stress disorder and others do not. Why such a disparity? It is possible that it is linked to hormones, more precisely to glucocorticoids (cortisol in humans). These molecules are involved in stress management. A low rate is frequently observed in people suffering from PTSD. Is it the consequence of exposure to trauma or is there a pre-existing risk factor? This question remains unanswered. A team of researchers from the École Polytechnique Fédérale de Lausanne (EPFL) has demonstrated that low blood levels of these hormones are directly involved in the development of PTSD symptoms. “By analyzing rats genetically modified so that their glucocorticoid levels were low, we found that in males this led to impaired fear extinction, a reduction in hippocampal volume (part of the brain that plays a role in information processing and memory, editor’s note) and paradoxical sleep disorders. The latter is essential to consolidate the memory of the extinction of fear. Furthermore, insomnia reinforces PTSD,” explains Dr. Silvia Monari, doctor in the General Psychiatry Department of HUG and main author of the research.[1] published in 2023. By providing a better understanding of the population at risk, this study could open the way to new treatments.
Twice the risk for women
Although at one time or another, 90% of the general population is confronted with a traumatic episode, only 8% of the individuals in question develop this chronic disorder. Women are twice as likely to suffer from PTSD as men. By cumulative effect, people already exposed to such a shock are also more likely to develop symptoms, as are those with a history of depression or anxiety disorders.
Note that there are protective factors. “Support from those around you or from professionals is one. Being aware of what post-traumatic stress disorder is is also very useful, as is taking advantage of intervention immediately after the event. Those affected should not hesitate to ask for help if they feel the need. If telling what happened is not always necessary, benefiting from human warmth and support from those around you helps you reintegrate into the world “before”. When PTSD is not treated, it can develop into depression, addiction, social phobia or even OCD,” continues Dr. Benzakour.
Several therapeutic approaches exist, whether in the form of different types of psychotherapy, notably EMDR (Eye Movement Desensitization and Reprocessing), or pharmacological aid.
Specific consultations
The HUG, for their part, set up Traumacare[2]a psychotraumatology consultation provided by psychiatrists and psychologists specially trained in PTSD.
The canton of Vaud is not left out. “The Les Boréales consultation[3] is aimed at people who have suffered or committed violence within their family (read box, editor’s note). Both perpetrators and victims are likely to suffer from PTSD, among other things. Furthermore, in all departments of the Vaudois University Hospital (CHUV), people are trained in the management of trauma,” explains Professor Daniel Schechter, assistant doctor in the Child and Adolescent Psychiatry Department. (SUPEA) of the CHUV.
Children and adolescents are particularly vulnerable
It’s not easy to help toddlers, especially when they are not old enough to talk. For children aged 0 to 5 exposed to violence or other abuse, the CHUV SUPEA offers a parent-child outpatient program called “Papillon”, in collaboration with the “Les Boréales” consultation. “The therapist uses verbal and non-verbal narration in particular, sometimes with the help of videos of past interviews to make traumatic memories less frightening, while remaining attentive to the child’s bodily sensations and state of mind. », explains Professor Daniel Schechter, assistant doctor at SUPEA. Other approaches are also possible. The parents, or an attachment figure of the child, are always present. “Younger people are particularly vulnerable and they can develop PTSD without having a clear memory of the traumatic event. Therapy then becomes all the more difficult. Evoking the trauma and placing it in a less dangerous context helps to overcome it,” adds the specialist.
What attitudes should alert adults? Unusual aggressiveness, withdrawal, increased vigilance, overly sexual or overly aggressive behavior, among others. “Unfortunately, some traumatized children show none of these signs. As for adolescents, they sometimes react to such an event with self-harm or acts of delinquency. Any change in behavior should alert parents. Note that a secure attachment relationship with a parent or another adult is a protective element for the child,” concludes Professor Schechter.
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Published in Le Matin Dimanche on 12/15/2024
[1] Blunted glucocorticoid responsiveness to stress causes behavioral and biological alterations that lead to posttraumatic stress disorder vulnerability, Silvia Monari, Carmen Sandi (entre autres). Biological Psychiatry, 22 September 2023.
[2] https://www.hug.ch/psychiatrie-liaison-dintervention-crise/consultation-psychotraumatologie-traumacare
[3] https://www.chuv.ch/fr/fiches-psy/centre-de-consultation-les-boreales
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