Article

Le concept de traumatisme et ses conséquences théoriques et cliniques

Theoretical and clinical implications of trauma

Équipe « Contrôle-Interoception-Attention », Institut du Cerveau (ICM), Sorbonne Université, INSERM, CNRS, APHP, DMU Neurosciences, Service de Psychiatrie Adultes, GH Pitié Salpêtrière, 47-83 Boulevard de l’Hôpital, 75013 Paris, France

^* Auteur correspondant : philippe.fossati@aphp.fr

Reçu : 1 Février 2023

Résumé

Le traumatisme, conçu comme un choc violent, imprévu et qui expose l’individu à sa propre mort, est pourvoyeur de nombreuses pathologies. Dans ce travail, nous discutons principalement le trouble de stress post-traumatique (TSPT), ses spécificités cliniques en fonction du type de traumatisme ainsi que son rapport étroit avec la notion de dissociation. Le traumatisme, par sa violence, bouleverse totalement les croyances fondamentales de l’individu sur les autres, le monde et son rapport à la mort.

Abstract

Usually, trauma is defined as exposure to an event that threatens death or induces serious injury or sexual violence. Beyond post-traumatic stress disorder (PTSD), trauma may increase the risk for severe mental disorders including mood disorders and psychotic disorder. PTSD, following exposure to a traumatic event, is strongly linked to dissociation. However, in contrast convergent findings indicated that, despite the relationship between peri-traumatic dissociation and later PTSD, many people who develop PTSD do not display dissociative responses in the acute phase after the event. Several risk factors are described for PTSD including previous history of traumatic event, previous mental disorders, genetic factors and gender. It is now proposed to distinguish PTSD with or without dissociative symptoms with some specific neural signature for each syndrome. Dissociation may also lead to change in cultural belief and worldview. According to the terror management theory (TMT), it is suggested that cultural worldviews, self-esteem, and interpersonal relationships work together to protect individuals from death anxiety. The trauma, by disrupting this anxiety buffering system, contributes to change beliefs in victims and exposes them to a feeling of social exclusion.