TRAVMA VE DİSSOSİYATİF BOZUKLUKLAR: GENEL BİR BAKIŞ

Travma, doğal afetler, trafik kazaları, savaş, işkence ve çocukluk çağında yaşanan ihmal ve istismar gibi akutveya kronik travmatik olaylar sonucunda kişinin yetersizliği ile yüz yüze gelmesi ve öznel baş etme gücünü aştığıdurumlarda oluşmaktadır. Travma sonrası kişilerde en sık görülen psikiyatrik tablolardan biri dissosiyatifbozukluklardır. Normalde uyuma hizmet eden bir mekanizma olarak her bireyde bulunan disosiyasyon, özellikleçocukluk çağı travmaları sonucunda travmatik yaşantının üstesinden gelme çabası olarak kullanılarak patolojikbir sürece dönüşmektedir. Bu patolojik sürecin ileri bir formu olan dissosiyatif bozukluklar, kişilik altında yeralan kontekste stresli yaşam olaylarına karşın verilen akut tepkilerdir. Bir başka ifadeyle dissosiyatifbozukluklar kişinin yaşadığı travmaya yönelik bir çeşit savunma mekanizmasıdır. Dissosiyatif bozukluklarnormalde bütünleştirici olan bilinç, bellek, kimlik, emosyon, algı, beden temsili, motor kontrol ve davranışlardabozulma ve kesinti meydana gelmesi ile karakterizedir (APA, 2013). Bu bozukluk, ani başlangıçlı veya aşamalıolabileceği gibi kısa süreli veya kalıcı da olabilmektedir. Dissosiyatif bozuklukların uzun bir tarihsel arka planıbulunmaktadır. Günümüzde dissosiyatif bozukluklara psikiyatri, klinik psikoloji ve adli bilimler alanında verilenilgi ve önem giderek artmaktadır. Son yıllarda adli psikoloji ve adli psikiyatride bilirkişilik kapsamındadissosiyatif bozukluklar psikoz‐nevroz ayrımı, ceza sorumluluğu, malulen emeklilik ve malpraktis gibikonularda yapılan değerlendirmeler büyük önem taşımaktadır. Ruhsal bozukluklar içerisinde çocukluk çağıtravmaları ile en yakın ilişkiyi gösteren dissosiyatif bozuklukların genelde erken yaşta başlaması, intihargirişimleri ve kendine zarar verme gibi davranışların sık görülmesi, yol açtığı çeşitli yaşamsal sorunlar,psikiyatrik eş tanısının yüksek olması, klinik ve travma odaklı uygun psikoterapi yöntemleriyle tam olaraktedavi edilebilmesiyle koruyucu sağlık hizmetleri açısından önem taşımaktadır.

Anahtar Kelimeler:

Travma, Dissosiyasyon, Dissosiyatif Bozukluklar, Tedavi, Psikoterapi

TRAUMA AND DISSOCIATIVE: AN OVERVIEW

Trauma occurs in the situations that the person faces with his/her inadequacy and goes beyond his/hersubjective coping efforts in consequence of acute and chronic traumatic events like natural disasters, trafficaccident, war, torture and childhood abuse and neglect. Dissociative disorders are one of the most frequentpsychiatric symptoms are seen among people after trauma. Dissociation which is present in every person as amechanism to serve adaptation normally, converts to a pathological process by using as an effort to handleparticularly traumatic experience as a result of childhood trauma. Dissociative disorders which is an advancedform of this pathologic process, rather as acute reactions to stressful life events in the context of a certainunderlying personality. In other words, disassociative disorders are a kind of defence mechanism oriented totraumatic experiences. Dissociative disorders are characterized by a disruption of and/or discontinuity in thenormal integration of consciousness, memory, identity, emotion, perception, body representation, motor controland behavior (APA, 2013). This disorders, can start suddenly or permanently and also can be short‐term orpermanent. Dissociative disorders have a long historical background. Today, dissociative disorders attract greatattention and the importance of this cluster of the disorder has been increased in the field of psychiatry, clinicalpsychology and forensic sciences. In recent years, in the scope of expertise in forensic psychology and forensicpsychiatry, the assessment on topics like difference of psychosis‐neurosis, disability retirement, criminal responsibility and malpractice in respect to disassociative disorders has a great importance. Dissociativedisorders which indicate the close relationship with childhood traumatization among all kinds of mentaldisorders usually appear in the early ages, suicide attempts and self harming behaviors appeared frequentlycause several vital complications, have high comorbidity and are treated completely by applying clinical andtrauma‐centered psychotherapy methods, thus it has substantial importance in terms of preventativehealthcare.

Keywords:

Trauma, Dissociation, Dissociative Disorders, Treatment, Psychotherapy,

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