Eşik Altı Travma Sonrası Stres Bozukluğu

Travma sonrası stres bozukluğu ruhsal hastalıklar içinde geniş bir kategoridir. DSM-III’e dahil olduğundan beri travma sonrası stres bozukluğu, tanı ölçütlerii açısından değişikliğe uğramıştır. Tanı ölçütlerini tam karşılamayan bazı travma sonrası stres bozukluğu belirtileri olan kişilerde tanının var olup olmadığı hala tartışmalıdır. Eşik altı travma sonrası stres bozukluğu ilk tanımlandığından beri tartışmalı olmasına rağmen eşik altı travma sonrası stres bozukluğu belirtilerinin varlığı ile intihar düşüncesinin önemli ölçüde arttığı bulunmuştur. Bu gözden geçirmede psikiyatri tarihinde, travma ile ilişkili hastalıkların tanımlanması ve intihar düşüncesi, komorbidite ve işlevsellikteki bozulma ile ilişkisi belirtilen eşik altı travma sonrası stres bozukluğu belirtilerinin tanımlanmasına olan ihtiyaç vurgulanmış ve eşik altı travma sonrası stres bozukluğu ile tam travma sonrası stres bozukluğu arasındaki klinik farklılıklar ele alınmıştır.

Anahtar Kelimeler:

Tanı, travma sonrası stres bozukluğu, eşik altı

Subthreshold Post-Traumatic Stress Disorder

Post-traumatic stress disorder is a very broad category among mental disorders. Since its inclusion in DSM-III, the diagnostic criteria of post-traumatic stress disorder has undergone a number of changes. The diagnosis and treatment of people who have some symptoms of post-traumatic stress disorder without meeting full criteria still remains controversial. Although subthreshold post-traumatic stress disorder has been debated since it was first defined, the presence of subthreshold post-traumatic stress disorder symptoms has found to raise the risk for suicidal ideation significantly. This article overviews the definitions of trauma related disorders in history of psychiatry and highlights the need to define subthreshold post-traumatic stress disorder symptoms that were reported to be associated with impairment, comorbidity, and suicidal ideation. Clinical differences between subthreshold and full post-traumatic stress disorder will also be discussed.

Keywords:

Diagnosis, post-traumatic stress disorder, subthreshold,

PDF

___

Adams RE, Boscarino JA, Galea S (2006) Alcohol use, mental health status and psychological well-being 2 years after the World Trade Center attacks in New York City. Am J Drug Alcohol Abuse, 32:203-224.
APA (1952) Diagnostic and Statistical Manual of Mental Disorders, 1 st ed (DSM-I). Washington, DC, American Psychiatric Association.
APA (1968) Diagnostic and Statistical Manual of Mental Disorders, 2nd ed. (DSM-II). Washington, DC, American Psychiatric Association.
APA (1980) Diagnostic and statistical manual of mental disorders, 3rd ed. (DSM-III) Washington, DC, American Psychiatric Association.
APA (1987) Diagnostic and statistical manual of mental disorders, 3rd ed. Revised (DSM-III-R). Washington, DC, American Psychiatric Association.
APA (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV). Washington, DC, American Psychiatric Association.
APA (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th ed text revision (DSM-IV-TR). Washington, DC, American Psychiatric Association.
APA (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5). Washington, DC, American Psychiatric Association.
Blanchard EB, Hickling EJ, Taylor AE, Loos WR (1995) Psychiatric morbidity associated with motor vehicle accidents. J Nerv Ment Dis, 183:495-504.
Breslau N, Lucia V, Davis G (2004) Partial PTSD versus full PTSD: an empirical examination of associated impairment. Psychol Med, 34:1205-1214.
Carlier IVE, Gersons BPR (1995) Partial posttraumatic stress disorder (PTSD): the issue of psychological scars and the occurrence of PTSD symptoms. J Nerv Ment Dis, 183:107-109.
Carty J, O’Donnell ML, Creamer M (2006) Delayed-onset PTSD: a prospective study of injury survivors. J Affect Disord, 90:257-261.
Freud S (1955) The War Neurosis. London, England, Hogarth Press.
Freud S (1987) Beyond the Pleasure Principle. New York, Norton.
Gersons BPR, Carlier IVE (1992) Post-traumatic stress disorders: the history of recent concepts. Br J Psychiatry, 161:742-748.
Grubaugh AL, Magruder KM, Waldrop AE, Elhai JD, Knapp RG, Frueh BC (2005). Subthreshold PTSD in primary care: prevalence, psychiatric disorders, healthcare use, and functional status. J Nerv Ment Dis, 193:658-664.
Jakupcak M, Conybeare D, Phelps L, Hunt S, Holmes HA, Felker B et al. (2007) Anger, hostility and aggression among Iraq and Afghanistan War veterans reporting PTSD and subtreshold PTSD. J Trauma Stress, 20;945-954.
Kaya B. (2004) Travma sonrası stres bozukluğu ve subsendrom kavramı. Anadolu Psikiyatri Dergisi, 5:231-238.
Lai TJ, Chang CM, Connor KM, Lee LC, Davidson JR (2004) Full and partial PTSD among earthquake survivors in rural Taiwan. J Psychiatr Res, 38:313-322.
Malt U (1988) The long-term psychiatric consequences of accidental injury: a longitudinal study of 107 adults. Br J Psychiatry, 153:810–818.
Marshall RD, Olfson M, Hellman F, Blanco C, Guardino M, Struening EL (2001) Comorbidity, impairment, and suicidality in subthreshold PTSD. Am J Psychiatry, 158:1467-1473.
McLeer SV, Deblinger E, Henry D, Orvaschel H (1992) Sexually abused children at high risk for post-traumatic stress disorder. J Am Acad Child Adol Psychiatry, 31:875-879.
Mc Nally RJ (2003) Progress and controversy in the study of posttraumatic stres disorder. Annu Rev Psychol, 54;229-252.
Mylle J, Maes M (2004) Partial postraumatic stres disorder revisited. J Affect Disord, 78;37-48.
Naylor JC, Dolber TR, Strauss JL, Kilts JD, Strauman TJ, Bradford DW et al. (2013) A pilot randomized controlled trial with paroxetine for subthreshold PTSD in Operation Enduring Freedom/Operation Iraqi Freedom era veterans. Psychiatry Res, 206:318-320.
Pfefferbaum B, Newman E, Nelson SD, Nitiéma P, Pfefferbaum RL, Rahman A (2014) Disaster media coverage and psychological outcomes: descriptive findings in the extant research. Curr Psychiatry Rep, 16:464.
Saigh PA, Bremner DJ (1999) The history of posttraumatic stress disorder. In Posttraumatic Stress Disorder: A Comprehensive Text (Eds PA Saigh, DJ Bremmer):1-17. Boston, Allyn and Bacon.
Smid GE, van der Velden PG, Gersons BPR, Kleber RJ (2012) Late-onset posttraumatic stress disorder following a disaster: a longitudinal study. Psychol Trauma, 4:312-322.
Solomon Z, Miculince M, Waysman M (1991) Delayed and immediate onset posttraumatic stress disorder: I differential clinical characteristics. Soc Psychiatry Psychiatr Epidemiol, 26:1-7.
Sungur M, Kaya B (2001) The onset and longitudinal course of a man-made post-traumatic morbidity: survivors of Sivas disaster. Int J Psychiatry Clin Pract, 5:195-202.
Taylor S, Koch WJ, Kuch K (1998) The structure of posttraumatic stress symptoms. J Abnorm Psychol, 107:154-160.
Van der Kolk BA, McFarlane AC (1996) Traumatic stress: The effects of overwhelming experience on mind, body, and society. In Background Issues and History: The Black Hole of Trauma, 2nd ed. (Eds BA Van der Kolk, AC McFarlane, L Weisaeth):3-23. New York, Guilford Press.
Yarvis JC (2004) Subthreshold PTSD: A comparıson of depressıon and alcohol problems in Canadian peacekeepers with different levels of traumatic stress (Doctoral thesis).Georgia, University of Georgia.
Zimering RT, Caddell JM, Fairbank JA, Keane TM (1993) Post-traumatic stress disorder in Vietnam veterans: an experimental validation of the DSM-III diagnostic criteria. J Trauma Stress, 6:327-342.
Zlotnick C, Franklin CL, Zimmerman M (2002) Does "subthreshold" posttraumatic stress disorder have any clinical relevance? Compr Psychiatry, 43:413-419.
Van Zelst WH, de Beurs E, Beekman ATF, Van Dyck R, Dee DDH (2006) Well-being, physical functioning, and use of health services in the elderly with PTSD and subthreshold PTSD. Int J Geriatr Psychiatry, 21:180-188.
Weiss DS, Marmar CR, Schlenger WE, Fairbank JA, Jordan BK, Hough RL et al. (1992) The prevalence of lifetime and partial post- traumatic stress disorder in Vietnam theater veterans. J Trauma Stress, 5:365-376.