PTSD (post-traumatic stress disorder): how to identify and treat. Post-traumatic stress disorder (PTSD): signs and phases of passing Post-traumatic stress conditions

According to historians, over the past 5 thousand years, the peoples of the Earth have experienced 14.5 thousand big and small wars and only 300 years were absolutely peaceful. In recent months, a serious armed conflict has flared up in Ukraine, which has directly affected tens of thousands of people and indirectly hundreds of thousands. The biggest medical problem will not be gunshot wounds, but mental disorders. I have tried to summarize the available information about post-traumatic stress disorder, better known to the people under the names " afghan syndrome», « vietnamese syndrome”, etc. It turned out a lot, so be patient. It is important to read only this page to know the signs and symptoms of the disorder. The rest you can find later.

What is post-traumatic stress disorder

scientific name - post-traumatic stress disorder(PTSD).

In English - posttraumatic stress disorder(PTSD). The term was introduced into scientific use by an American psychologist M. Horowitz in 1980. PTSD refers to borderline mental illness and anxiety disorders.

PTSD occurs after extremely severe psycho-emotional stress, exceeding the usual human experience in intensity.

To normal human experience that does not lead to PTSD include:

• death of a loved one from natural causes,
• threat to one's own life
• chronic severe illness
• job loss,
• family conflict.

Post-traumatic stress disorder occurs after more severe situations that accompany personal violence, feelings of helplessness and hopelessness:

• military action,
• natural disasters (earthquakes, floods, landslides),
• big fires,
• man-made disasters (accidents at work and nuclear power plants),
• extremely cruel treatment of people (torture, rape). Including presence in such situations.

A characteristic feature is the presence persistent long-term experiences of a traumatic situation(this is what difference PTSD from other anxiety, depressive and neurotic disorders).

old titles post-traumatic stress disorder:

• soldier heart,
• cardiovascular neurosis,
• combat neurosis,
• operating fatigue,
• combat fatigue,
• stress Syndrome,
• military neurosis,
• trauma neurosis,
• fright neurosis,
• psychogenic wartime reactions,
• neurasthenic psychosis,
• reactive psychosis,
• post-traumatic reactive state,
• post-reactive personality development.

PTSD is an event associated with a threat to life and at the same time accompanied by the experience intense fear, dread, or feelings of hopelessness. The trauma here is mental. Physical damage doesn't matter. In other words, PTSD is non-psychotic delayed human response to traumatic stress.

Since a person lives among other people, the need arose categorize all mental illnesses by severity for the patient himself and for society on 2 levels:

1. psychotic level(psychosis): the patient is NOT in control of himself and therefore can be subjected to psychiatric treatment forcibly in accordance with the laws of the country;
2. non-psychotic level: psychiatric care is provided to the patient only with his consent. This includes uncomplicated PTSD (more on possible complications below).

Who gets PTSD?

Post-traumatic stress disorder occurs in a person who has been exposed to severe danger himself or it happened to someone else in front of him. Regardless of the type of situation, psychogenic effects of the same severity led to the development similar symptoms.

PTSD can occur at any age. Throughout life, they get sick about 1% of the population(the same number suffers, for example, from rheumatoid arthritis). In the US, PTSD is 2.6% of the population (excluding risk groups). Women are 2 times more likely. The frequency depends on the severity of stress: for example, it is diagnosed in 75% of concentration camp prisoners. The problem of post-traumatic stress disorder is most studied in American Vietnam War Veterans(1965-1973). By 1990, according to various estimates, 15-30% of veterans were sick and another 11-23% had partial symptoms.

Recently, a variant of PTSD has been singled out separately, when loss of a loved one or a loved one. It takes a long time and manifests itself in two varieties:

1. constant reproduction in his life of a situation similar to that experienced,
2. complete avoidance of situations reminiscent of psychotrauma.

Thus, PTSD is a broader concept and is currently its causes are not limited to military operations, natural and man-made disasters. In modern psychiatry, post-traumatic stress disorder is not seen as a protracted acute reaction to stress, but as qualitatively different state arising from an acute reaction to stress, but based on many other factors (genetic and biological characteristics, previous life experience, personality characteristics, gender, age, race, social status, the possibility of social support, etc.).

Signs of PTSD

PTSD usually occurs in the first six months after psychotrauma. However, symptoms can appear both immediately after the trauma and many years later (their appearance in veterans 40 years after the Second World War is described). people constantly return thoughts to what happened and try to find an explanation for it. Some believe that it was a sign of fate. Others have anger out of a deep sense of injustice. Experiences manifest themselves in endless conversations without any need and for any reason. The indifference of others to the problem leads to isolation of the sufferer and cause further injury.

Symptoms PTSD falls into several categories:

1) repeated involuntary experience of psychotrauma in the form of:

• intrusive memories,
• recurring dreams or nightmares,
• stereotypical games in a child related to psychotrauma (the meaning of the game for other people is usually incomprehensible, the only participant is the child himself, who over and over again performs the same set of actions and manipulations; the game remains the same for a very long time). Read more about these children's games at http://www.autism.ru/read.asp?id=152&vol=5

Memories are painful, therefore, the constant avoidance of reminders of psychotrauma is characteristic: a person tries don't think about it and avoid situations to remind her. It happens sometimes psychogenic (dissociative) amnesia psychotrauma.

At psychogenic amnesia a person suddenly loses memory for a short time for recent important events. It is a defense mechanism that allows consciousness to cope with a subjectively unbearable situation. The ability to remember new information remains. Psychogenic amnesia usually does not last long and ends as abruptly as it began.

2) depression and decreased vitality:

• indifference to business,
• emotional dullness("emotional impoverishment"): the inability to love, enjoy life and hope for the best. Wives characterize patients as cold, insensitive and uncaring people. Marriage is difficult for many, and there are too many divorces among the married.
• inability to focus on a long life perspective. The thoughts “the future is unpromising”, “there is no future” are characteristic. These people do not plan to pursue a career, get married, have children, or build a normal life. They expect misfortune in the future and an early death.
• feeling isolation from others,
• in children behavior worsens with loss of previously acquired skills.

3) overstimulation of the nervous system(along with depression!):

• irritability, anxiety, impatience, aggressiveness,
• 95% cannot concentrate for a long time,
• winces, nervous trembling,
• sleep disorders(difficulty falling asleep, shallow sleep, early awakening, feeling of lack of rest after sleep),
• nightmares(their important feature in PTSD is a very accurate reproduction of really experienced events),
• sweating,
• 80% have excessive alertness, suspicion, etc. This also includes obsessive painful memories.

Excessive excitation of the nervous system manifests itself in various somatovegetative complaints about loss of appetite, fatigue, dry mouth, constipation, decreased libido(sexual desire) and impotence(mostly psychogenic) feeling of heaviness in the body, insomnia and etc.

Often there are additional symptoms:

• acute outbreaks fear (phobia), panic and rage with aggression
• feelings of guilt towards the dead and self-flagellation for having survived,
• drunkenness,
• demonstrative denial of generally accepted social norms and rules,
• antisocial behavior with a tendency to physical violence.

Characteristic:

• violation of relations in society and in the family,
• distrust of those in power(officials, militia/police),
• craving for gambling and risky entertainment (speeding by car, skydiving by paratrooper veterans, etc.).

Some scholars point to the emergence dissociative symptoms (« bifurcation"), which manifests itself:

• emotional dependence,
• narrowing of consciousness(a small group of ideas and emotions predominates with the complete suppression of other thoughts and feelings. It happens with extreme fatigue and hysteria),
• depersonalization(own actions are perceived as if from the outside and it seems that they cannot be controlled). A person is at home and at the scene of the tragedy at the same time. Develop " flashback episodes" (see below). The inability to relax is manifested by insomnia despite being exhausted. Sleep disturbances exacerbate a severe condition, causing fatigue, apathy and substance abuse (smoking, alcohol, drugs).

Flashback(English flashback - literally " backfire”) is an involuntary and unpredictable revival of psychotrauma through unusually vivid memories, during which a terrible reality from the past invades the patient's real life. The boundaries between apparent and actual reality are blurred. For example, people with PTSD hear explosions, throw themselves on the floor, trying to hide from imaginary bombs, wring the hands of loved ones, and may unmotivatedly attack an interlocutor, a bystander. There have been cases of severe bodily harm and murder, sometimes followed by suicide.

Flashback episodes occur both on their own and after the use of alcohol or drugs. Various types of addictions almost all combatants with PTSD (for example, alcohol addiction was diagnosed in 75% of veterans with PTSD). Constant excitation of the nervous system increases susceptibility to chemicals. Alcohol and drugs are a kind of pain reliever and help to cope with stress by suppressing the physiological activity of certain areas of the nervous system, but at the same time contribute to the development of "flashbacks". Therefore, drugs and alcohol relieve the symptoms of PTSD, but exacerbate the syndrome itself. Cause and effect constantly change places and circulate in a vicious circle.

For the mental health of the population terrorist act is more dangerous than natural disasters. Unfortunately, when studying PTSD, most of the efforts of scientists are directed only at the direct victims and their loved ones, and no attention is paid to the peculiarities of the perception of terrorist attacks through the media.

Features of PTSD in veterans

stress factors at war:

• fear death, injury, pain, disability,
• painting the death of comrades in arms and the need to kill another person,
• combat environment factors(lack of time, high pace, suddenness, uncertainty, novelty)
• deprivation(lack of proper sleep, features of food and liquid intake),
• unusual natural conditions(unusual terrain, heat, solar radiation, etc.).

According to some data (Pushkarev A. L., 1999), in Belarus, 62% of veterans of the war in Afghanistan defined by PTSD of varying severity.

Experience Options mental trauma in war veterans:

1. 80% - recurring nightmares. In the first 2-4 years after the war, nightmares disturb absolutely all (!) Participants in hostilities, but especially acutely after a concussion (bruise) of the brain. These dreams are characterized by a feeling of helplessness, loneliness in a potentially deadly situation, being chased by enemies with shots and attempts to kill, and the absence of weapons to protect. During nightmares, people make involuntary movements of varying intensity.
2. 70% - psychological distress(stress associated with strong negative emotions and destroying health). Various events of peaceful life cause unpleasant associations, for example:
   • helicopter flying overhead, reminiscent of military action,
   • camera flashes resemble shots, etc.
3. 50% - memories of military events(sadness over loss with acute emotional pain, repeated traumatic memories).

Fixture types for veterans:

1. active-defensive: adequate assessment of the severity of PTSD or ignoring it. Neurotic disorders are possible. Some of the combatants are ready to be examined and treated on an outpatient basis.
2. passive defensive: retreat, reconciliation with illness, depression, hopelessness. Mental discomfort is expressed in somatic complaints (that is, in complaints about the work of body systems, from the Greek. soma- body).
3. destructive: disruption of life in society. Internal tension, explosive behavior, conflicts. In search of relief, patients use alcohol, drugs, break the law, commit suicide.

Participants of the Vietnam War concerned about 6 main problems:

• guilt,
• abandonment/betrayal
• loss,
• loneliness,
• loss of meaning
• fear of death.

The use of the latest types of weapons, which not only kill, but also injure the psyche of others, becomes an additional source of psychological trauma.

At typical development post-traumatic stress disorder in war veterans 5 phase:

1. initial impact(psychotrauma);
2. resistance/denial(people cannot and do not want to realize what happened);
3. admission/suppression(the psyche accepts the fact of psychotrauma, but the person tends not to think about it and suppress such thoughts);
4. decompensation(deterioration of the state; consciousness is trying to process the psychotrauma into life experience in order to live on) - the presence of this phase is feature PTSD.
5. overcoming trauma and recovery.

In cases of chronic PTSD (longer than 6 months), people stuck between 2nd and 3rd phases. In an attempt to " come to terms with trauma» they change their ideas about themselves and the world around them. These processes lead to personality changes. Attempts to avoid unpleasant re-experiencing of psychotrauma lead to a pathological outcome of PTSD.

Delayed mental reactions Stress in veterans depends on 3 factors:

1. from pre-war personality traits and the ability to adapt to the new;
2. response to life-threatening situations;
3. on the level of restoration of the integrity of the individual.

A person's response to psychotrauma also depends on biological features body (primarily from work nervous and endocrine systems).

Features of PTSD after the accident at the Chernobyl nuclear power plant

This is a type of post-traumatic stress disorder. very poorly studied.

The liquidators of the accident at the Chernobyl nuclear power plant are characterized by a high level of anxiety, depression, restlessness for the future life. Typical symptoms - sleep disturbances, loss of appetite, decreased sex drive, irritability. Almost all examined had astheno-neurotic disorders (" irritable fatigue”), vegetative-vascular dystonia (dysregulation of blood vessels, internal organs and other parts of the body), arterial hypertension.

According to some estimates, after the accident on Chernobyl nuclear power plant about 1-8% of the population contaminated areas has symptoms of PTSD.

Risk and protective factors

Risk factors development of PTSD:

1. features and deviations of the psyche (dissocial personality disorder),
2. mental trauma in the past (physical abuse in childhood, accidents),
3. loneliness (after the loss of a family, divorce, widowed, etc.),
4. financial insolvency (poverty),
5. isolation of a person for the period of experiencing psychotrauma and social isolation (disabled people, prisoners, homeless people, etc.),
6. negative attitude of others (physicians, social workers). However, excessive guardianship also harms, alienating the victims from the outside world.

Protective factors from the development of post-traumatic stress disorder:

1. the ability to control your emotions,
2. a high self-evaluation,
3. the ability to timely process the traumatic experience of others into your own life experience (for example, read about other people's problems and draw important conclusions for yourself),
4. the presence of good social support (from the state, society, friends, acquaintances).

Behavior and complaints at the doctor

Most often people with PTSD can't find a connection on their own between his condition and the previous psychotrauma. Feelings contribute to the concealment of traumatic events. shame, guilt, the desire to forget painful memories or a misunderstanding of their importance.

If the doctor touches upon the psychotrauma, the patient may show more with your reaction than to put into words. Characteristic:

• increasing tearfulness (especially in women),
• avoiding eye contact
• excitation,
• manifestations of hostility.

Symptoms disorders include:

• sleep disorders. As stated above, PTSD should be suspected in anyone with unusually vivid or plausible nightmares.
• distancing and alienation from people, including family members. Especially if such behavior was not typical before the psychotrauma.
• irritability, propensity to physical violence, explosive outbreaks (outbursts of anger, hatred, violence; from the English explosion - explosion),
• alcohol or drug use, especially for the purpose of "removing the sharpness" of painful experiences and memories,
• illegal actions or antisocial behavior, especially absent during adolescence,
• depression, suicide attempts,
• alarming tension or psychological instability
• non-specific complaints pain in the head, muscles, joints, heart, abdomen, constant muscle tension, increased fatigue, stool disorders(diarrhea), etc.

According to Horowitz (1994), major complaints for PTSD are:

• 75% have headaches and a feeling of weakness,
• 56% - nausea, pain in the heart, in the back, dizziness, a feeling of heaviness in the limbs, numbness in various parts of the body, "lump in the throat",
• 40% have difficulty breathing.

On the restoration of personality strongly conditions affect, in which a person gets after a psychotrauma:

1. silence, denial leave a person alone with unreacted and unprocessed stress. Oddly enough, a good upbringing that puts restrictions on communication often prevents the processing of traumatic situations, driving them into the subconscious. A low level of education and a low social position can also make it difficult to properly navigate a traumatic situation. The psychologist is obliged to explain to the person that suffering and life have meaning.
2. Initial presence of personality disorders and mental abnormalities aggravates the course of PTSD.
3. Correct and timely social assistance relieves PTSD.

Complications and prognosis

As the years come complications:

• alcoholic and medicinal addiction,
• conflicts with the law,
• family breakdown(uselessness of close interpersonal relationships, family life and the birth of children),
• persistent litigious behavior(Pugnaciousness and quarrels with people, constant complaints, accusations, lawsuits),
• attempts suicide.

For example, among Vietnam War veterans with PTSD, there were:

• the unemployment rate is 5 times higher than the average,
• 70% have divorces,
• 56% have borderline (with normal) neuropsychiatric disorders,
• 50% - went to jail or were arrested,
• 47% have extreme forms of isolation from people,
• 40% have pronounced hostility,

(PTSD) - a violation of the normal functioning of the psyche as a result of a single or recurring psychotraumatic situation. Among the circumstances that provoke the development of PTSD are participation in hostilities, sexual violence, severe physical injuries, being in life-threatening situations caused by natural or man-made disasters, etc. PTSD is characterized by increased anxiety and obsessive memories of a traumatic event with persistent avoidance thoughts, feelings, conversations, and situations related to the trauma in one way or another. The diagnosis of PTSD is established on the basis of the conversation and anamnestic data. Treatment - psychotherapy, pharmacotherapy.

ICD-10

F43.1

General information

Post-traumatic stress disorder (PTSD, post-traumatic stress syndrome) is a mental disorder caused by a severe traumatic situation that goes beyond the normal human experience. In the ICD-10, it belongs to the group "Neurotic, stress-related and somatoform disorders". PTSD is more likely to occur during wartime. In peacetime, it is observed in 1.2% of women and 0.5% of men. Getting into a severe psychotraumatic situation does not necessarily entail the development of PTSD - according to statistics, 50-80% of citizens who have experienced traumatic events suffer from this disorder.

Children and the elderly are more susceptible to PTSD. Experts suggest that the low resistance of young patients is due to the insufficient development of protective mechanisms in childhood. The reason for the frequent development of PTSD in the elderly is probably the increasing rigidity of mental processes and the gradual loss of the adaptive capabilities of the psyche. PTSD is treated by specialists in psychotherapy, psychiatry, and clinical psychology.

Causes of PTSD

The cause of the development of PTSD is usually mass disasters that pose a direct threat to people's lives: military operations, man-made and natural disasters (earthquakes, hurricanes, floods, explosions, building collapses, blockages in mines and caves), terrorist acts (being held hostage, threats, torture, being present during the torture and murder of other hostages). PTSD can also develop after tragic events on an individual scale: severe injuries, long-term illnesses (of one's own or relatives), death of loved ones, attempted murder, robbery, beating or rape.

In some cases, the symptoms of PTSD appear after traumatic events that have a high individual significance for the patient. Traumatic events leading up to PTSD can be single (natural disaster) or recurring (participation in combat), short-term (criminal incident) or long-term (long illness, prolonged hostage). Of great importance is the severity of experiences during a traumatic situation. PTSD is the result of extreme terror and an acute sense of helplessness in the face of circumstances.

The intensity of experiences depends on the individual characteristics of the PTSD patient, his impressionability and emotional susceptibility, the level of psychological preparation for the situation, age, gender, physical and psychological state, and other factors. The recurrence of psychotraumatic circumstances is of certain importance - a regular traumatic effect on the psyche entails the depletion of internal reserves. PTSD is often detected in women and children who have been subjected to domestic violence, as well as in prostitutes, police officers and other categories of citizens who often become victims or witnesses of violent acts.

Among the risk factors for the development of PTSD, experts indicate the so-called "neuroticism" - a tendency to neurotic reactions and avoidant behavior in stressful situations, a tendency to "get stuck", an obsessive need to mentally reproduce traumatic circumstances, focusing on possible threats, alleged negative consequences and other negative aspects. events. In addition, psychiatrists note that individuals with narcissistic, dependent, and avoidant personality traits suffer from PTSD more than people with antisocial behavior. The risk of PTSD is also increased by a history of depression, alcoholism, drug addiction, or drug dependence.

Symptoms of PTSD

Post-traumatic stress disorder is a long-term delayed response to very severe stress. The main signs of PTSD are the constant mental reproduction and re-experiencing of the traumatic event; detachment, emotional numbness, a tendency to avoid events, people and topics of conversation that can remind you of a traumatic event; irritability, anxiety, irritability and physical discomfort.

Usually, PTSD does not develop immediately, but some time later (from several weeks to six months) after a traumatic situation. Symptoms may persist for months or years. Based on the time of onset and duration of PTSD, three types of the disorder are distinguished: acute, chronic, and delayed. Acute post-traumatic stress disorder lasts no more than 3 months; if symptoms persist for a longer time, they speak of chronic PTSD. In the delayed type of disorder, symptoms appear 6 or more months after the traumatic event.

PTSD is characterized by a constant feeling of alienation from others, lack of reaction or mild reaction to current events. Despite the fact that the traumatic situation is in the past, patients with PTSD continue to suffer from the experiences associated with this situation, and the psyche does not have the resources for normal perception and processing of new information. Patients with PTSD lose the ability to enjoy and enjoy life, become less sociable, move away from other people. Emotions are dulled, the emotional repertoire becomes more scarce.

There are two types of obsessions in PTSD: past obsessions and future obsessions. The obsessions of the past in PTSD manifest themselves in the form of repetitive traumatic experiences that emerge as memories during the day and as nightmares at night. The obsessions of the future in PTSD are characterized by not fully conscious, but often unfounded predictions of the recurrence of the traumatic situation. With the appearance of such obsessions, outwardly unmotivated aggression, anxiety and fear are possible. PTSD can be complicated by depression, panic disorder, generalized anxiety disorder, alcoholism, and drug addiction.

Taking into account the prevailing psychological reactions, four types of PTSD are distinguished: anxious, asthenic, dysphoric, and somatoform. In the asthenic type of disorder, apathy, weakness and lethargy predominate. Patients with PTSD show indifference, both to others and to themselves. The feeling of one's own failure and the impossibility of returning to normal life has a depressing effect on the psyche and emotional state of patients. Physical activity decreases, patients with PTSD sometimes have difficulty getting out of bed. Heavy drowsiness is possible during the daytime. Patients easily agree to therapy, willingly accept the help of loved ones.

Anxious type of PTSD is characterized by bouts of causeless anxiety, accompanied by tangible somatic reactions. Emotional instability, insomnia and nightmares are observed. Panic attacks are possible. Anxiety is reduced during communication, so patients willingly contact with others. The dysphoric type of PTSD is manifested by aggressiveness, vindictiveness, resentment, irritability and distrust towards others. Patients often initiate conflicts, are extremely reluctant to accept the support of loved ones, and usually categorically refuse to see a specialist.

The somatoform type of PTSD is characterized by the predominance of unpleasant somatic sensations. Headaches, pains in the abdomen and in the region of the heart are possible. Many patients develop hypochondriacal experiences. As a rule, such symptoms occur with delayed PTSD, which makes it difficult to diagnose. Patients who have not lost faith in medicine usually turn to general practitioners. With a combination of somatic and mental disorders, behavior may vary. With increased anxiety, PTSD patients undergo numerous studies, repeatedly turn to various specialists in search of "their doctor". In the presence of a dysphoric component, patients with PTSD may attempt to self-medicate, start using alcohol, drugs, or pain medication.

Diagnosis and treatment of PTSD

The diagnosis of "post-traumatic stress disorder" is made on the basis of the patient's complaints, the presence of severe psychological trauma in the recent past, and the results of special questionnaires. The diagnostic criteria for PTSD according to ICD-10 are a threatening situation that can cause fear and despair in most people; persistent and vivid flashbacks that occur both in the waking state and in sleep, and intensify if the patient consciously or involuntarily associates current events with the circumstances of psychological trauma; attempts to avoid situations reminiscent of the traumatic event; increased excitability and partial loss of memories of a traumatic situation.

Treatment tactics are determined individually, taking into account the characteristics of the patient's personality, the type of PTSD, the level of somatization and the presence of concomitant disorders (depression, generalized anxiety disorder, panic disorder, alcoholism, drug addiction, drug dependence). Cognitive behavioral therapy is considered the most effective method of psychotherapeutic influence. In the acute form of PTSD, hypnotherapy is also used, in the chronic form, work with metaphors and DPDH (desensitization and processing by eye movements) is used.

If necessary, psychotherapy for PTSD is carried out against the background. Adrenoblockers, antidepressants, tranquilizers and sedative antipsychotics are prescribed. The prognosis is determined individually depending on the characteristics of the patient's personality organization, the severity and type of PTSD. Acute disorders respond better to treatment, chronic ones more often turn into pathological personality development. The presence of pronounced dependent, narcissistic and avoidant personality traits, drug addiction and alcoholism is a prognostically unfavorable sign.

PTSD (post-traumatic stress disorder) is a condition that occurs against the background of traumatic situations. Such a reaction of the body can be called severe, because it is accompanied by painful deviations, which often persist for a long time.

An event that traumatizes the psyche is somewhat different from other phenomena that cause negative emotions. It literally knocks the ground out from under a person’s feet and makes them suffer greatly. Moreover, the consequences of the disorder can manifest themselves for several hours or even several years.

What can cause PTSD?

There are a number of situations that most often cause post-traumatic stress syndrome - these are mass disasters that lead to the death of people: wars, natural disasters, man-made disasters, a terrorist act, an attack with physical impact.

In addition, post-traumatic stress can manifest itself if violence was used against a person or a tragic personal event took place: serious injury, prolonged illness of both the person himself and his relative, including fatal.

The traumatic events triggered by the manifestations of PTSD can be either single, such as during a disaster, or repeated, such as participation in hostilities, short-term or long-term.

The intensity of the symptoms of a psychological disorder depends on how hard a person experiences a traumatic situation. PTSD occurs when circumstances cause feelings of terror or helplessness.

People react differently to stress, this is due to their emotional susceptibility, level of psychological preparation, mental state. In addition, gender and age play an important role.

Post-traumatic stress disorder often occurs in children and adolescents, as well as women who have experienced domestic violence. The risk category of post-traumatic stress includes people who, due to their professional activities, often face violent actions and stresses - rescuers, policemen, firefighters, etc.

The diagnosis of PTSD is often made to patients suffering from any kind of addiction - drug, alcohol, drug.

Symptoms of post-traumatic stress disorder

Post-traumatic stress disorder, which has a variety of symptoms, can manifest as:

1. A person replays past events in his head over and over again, and experiences all the traumatic sensations again. Psychotherapy for PTSD highlights such a frequent phenomenon as a flashback - a sudden immersion of the patient in the past, in which he feels the same as on the day of the tragedy. A person is visited by unpleasant memories, there is a frequent sleep disturbance with difficult dreams, his reactions to stimuli reminiscent of a tragic event are intensified.
2. On the contrary, it seeks to avoid everything that can remind you of the stress experienced. In this case, the memory for the events that caused PTSD is reduced, the state of affect is dulled. A person seems to be alienated from the situation that caused traumatic stress and its consequences.
3. The emergence of startle syndrome (eng. startle - to frighten, startle) - an increase in autonomic activation, including an increase in the startle reaction. There is a function of the body that causes an increase in psycho-emotional arousal, which allows you to filter incoming external stimuli, which consciousness perceives as signs of an emergency.

In this case, the following symptoms of PTSD are noted:

• increased vigilance;
• increased attention to situations similar to threatening signs;
• keeping attention on events that cause anxiety;
• attention spans shrink.

Often, post-traumatic disorders are accompanied by impaired memory functions: a person has difficulty remembering and retaining information that is not related to the experienced stress. However, such failures do not refer to true memory damage, but are a difficulty in concentrating on situations that do not remind of the trauma.

With PTSD, apathetic mood, indifference to what is happening around, and lethargy are often observed. People may strive for new sensations without thinking about the negative consequences, and do not make plans for the future. Relations with the family of a person who has undergone traumatic stress most often deteriorate. He fences himself off from loved ones, more often voluntarily remains alone, and after that he can accuse relatives of inattention.

Behavioral signs of the disorder depend on what the person encountered, for example, after an earthquake, the victim will often position himself towards the door in order to have a chance to quickly leave the premises. After the bombings suffered, people behave cautiously, entering the house, closing and curtaining the windows.

Clinical types of post-traumatic stress syndrome

Post-traumatic stress leads to a variety of symptoms, but certain conditions are more pronounced in different cases. To prescribe effective therapy, doctors use the clinical classification of the course of the disorder. There are the following types of PTSD:

1. Anxious. In this case, a person is disturbed by frequent bouts of memories that occur against the background of psycho-emotional overstrain. His sleep is disturbed: he has nightmares, he can suffocate, feel horror and chills. This condition complicates social adaptation, although character traits do not change. In ordinary life, such a patient will in every possible way avoid discussions of what he has experienced, but often agrees to a conversation with a psychologist.
2. Asthenic. With this traumatic stress, there are signs of an exhausted nervous system. The patient becomes lethargic, performance decreases, he feels constant fatigue and apathy. He is able to talk about the event and often independently seeks the help of a psychologist.
3. Dystrophic. This type of PTRS is characterized as embittered and explosive. Patients are in a depressed state, constantly expressing dissatisfaction, and often in a rather explosive form. They withdraw into themselves and try to avoid society, do not complain, so often their condition is detected only because of inadequate behavior.
4. Somatoform. Its development is associated with a delayed form of PTSD and is accompanied by multiple symptoms in the gastrointestinal tract, cardiovascular and nervous systems. The patient may complain of colic, heartburn, pain in the heart, diarrhea and other symptoms, but most often specialists do not detect any diseases. Against the background of such symptoms, obsessive-compulsive states occur in patients, but they are not associated with experienced stress, but with a deterioration in well-being.

With such an ailment, patients calmly communicate with others, but they do not seek psychological help, attending consultations with other specialists - a cardiologist, neuropathologist, therapist, etc.

Diagnosing PTSD

To establish a diagnosis of stress PT, the specialist evaluates the following criteria:

1. To what extent the patient was involved in an extreme situation: there was a threat to the life of the person himself, relatives or others, what was the reaction to the critical event that arose.
2. Do obsessive memories of tragic events haunt a person: the reaction of the visceral nervous system to stressful events similar to those experienced, the presence of a flashback state, disturbing dreams
3. The desire to forget the events that caused post-traumatic stress that occurs on a subconscious level.
4. Increased stress activity of the central nervous system, in which severe symptoms occur.

In addition, the diagnostic criteria for PTSD include assessment of the duration of pathological signs (the minimum indicator should be 1 month) and impaired adaptation in society.

PTSD in childhood and adolescence

PTSD in children and adolescents is diagnosed quite often, because they are much more sensitive to psychic trauma than adults. In addition, the list of reasons in this case is much wider, since, in addition to the main situations, post-traumatic stress in children can be caused by a serious illness or the death of one of the parents, placement in an orphanage or boarding school.

Like adults with PTSD, children tend to avoid situations that remind them of the tragedy. But when reminded, the child may experience emotional overexcitation, manifesting in the form of screaming, crying, inappropriate behavior.

According to research, children are much less likely to be disturbed by unpleasant memories of tragic events, and their nervous system tolerates them more easily. Therefore, small patients tend to experience a traumatic situation over and over again. This can be found in the drawings and games of the child, and their uniformity is often noted.

Children who have experienced physical violence on themselves can become aggressors in a team of their own kind. Very often they are disturbed by nightmares, so they are afraid to go to bed, and do not get enough sleep.

In preschoolers, traumatic stress can cause regression: the child begins not only to lag behind in development, but begins to behave like a toddler. This can manifest itself in the form of simplification of speech, loss of self-service skills, etc.

In addition, the symptoms of the disorder may include:

• impaired social adaptation: children are not able to present themselves as adults;
• there is isolation, capriciousness, irritability;
• Babies are having a hard time parting with their mother.

How is PTSD diagnosed in children? There are a number of nuances here, since it is much more difficult to identify the syndrome in children than in adults. And at the same time, the consequences can be more serious, for example, mental and physical developmental delay caused by PTSD, without timely correction, will be difficult to correct.

In addition, traumatic stress can lead to irreversible character deformations; antisocial behavior often occurs in adolescence.

Often children find themselves in a stressful situation without the knowledge of their parents, for example, when they are abused by strangers. The relatives of the child should be worried if he began to sleep poorly, cries out in his sleep, he is tormented by nightmares, for no apparent reason he is often irritated or naughty. You should immediately consult with a psychotherapist or child psychologist.

Diagnosing PTSD in children

There are various methods for diagnosing PTSD, one of the most effective is conducting a semi-structured interview that allows you to assess the child's traumatic experiences. It is carried out for children from the age of 10, using a three-point scale.

The structure of the interview is as follows:

1. The specialist establishes contact with the patient.
2. An introductory talk about possible events that can cause traumatic stress in children. With the right approach, it is possible to reduce anxiety and position the patient for further communication.
3. Screening. Allows you to find out what kind of traumatic experience the child has. If he himself cannot name such an event, then he is offered to choose them from a ready list.
4. A survey through which a specialist can measure post-traumatic symptoms.
5. The final stage. Negative emotions that arise when remembering the tragedy are eliminated.

This approach makes it possible to determine the degree of development of the syndrome and prescribe the most effective treatment.

Therapeutic measures for PTSD

The basis of PTSD therapy in both adult patients and children is high-quality psychological assistance from a qualified doctor, which is provided by a psychiatrist or psychotherapist. First of all, the specialist sets himself the task of explaining to the patient that his condition and behavior are fully justified, and that he is a full-fledged member of society. In addition, treatment includes various activities:

• training in communication skills, allowing a person to return to society;
• reduced symptoms of the disorder;
• the use of various techniques - hypnosis, relaxation, auto-training, art and occupational therapy, etc.

It is important that therapy gives the patient hope for a future life, and for this, the specialist helps him create a clear picture.

The effectiveness of treatment depends on various factors, including the neglect of the disease. In some cases, it is impossible to do without medication, the following drugs are prescribed:

• antidepressants;
• benzodiazepines;
• normotimics;
• beta-blockers;
• tranquilizers.

Unfortunately, the prevention of PTSD is impossible, because most tragedies happen suddenly, and the person is not ready for it. However, it is important to identify the symptoms of this syndrome as early as possible and make sure that the victim receives timely psychological assistance.

Post-traumatic stress disorder or syndrome is an illness that can unsettle not only a child, but even a man who is strong in body and spirit. This condition is extremely difficult to experience, and experts warn that it is not recommended to deal with it alone, only joint work in the family and with a doctor will help overcome stress.

(during a critical incident and immediately after it - up to 2 days)

Post Traumatic Stress Disorder

(more than a month after the critical incident - more than 4 weeks)

Post Traumatic Personality Disorder

(over the course of the survivor's later life)

Rice. 1 Stages of formation of post-stress disorders

One of the main diagnostic criteria for determining the form of reaction to stress is the time factor.

According to the definition of A.V. Petrovsky, acute stress reaction (OSR, acute stress disorder - ASD) is considered to be very quickly transient disorders of varying severity and nature, which are observed in people who did not have any obvious mental disorder in the past, in response to an exceptional somatic or mental situation (for example, a natural disaster or hostilities) and which usually disappear after a few hours or days (Petrovsky A.V., 2007).

According to K.Yu.Galkin, OSRs have not been sufficiently studied, despite the fact that in 1994 this disorder was included in DSM-IV. In his studies during the terrorist act in Volgodonsk in 1999, the presence of symptoms of ASD was established and their duration was noted from two to four weeks after a collision with an extraordinary situation (Galkin K.Yu., 2004).

B. Kolodzin believes that in most people the events associated with traumatic events pass without a trace after four to six weeks or are processed and integrated into the self-concept. In the case of fixation on the trauma, the chronification of the post-stress state develops (Kolodzin B. 1992).

Disorders that develop after an experienced psychological trauma affect the physiological, personal, interpersonal and social levels of interaction of human functioning not only in people who have experienced stress, but also in their families (Kitaev-Smyk L.A., 1983; Romek V.G. , Kontorovich V.A., Krukovich E.I., 2004; Kolodzin B., 1992). The transformation of a personality from a psychological norm to a borderline abnormal personality and further to a pathological mental constitution in the form of psychopathy, according to F. P. Kosmolinsky (1998), is determined by personal constitutional and typological variability.

Analysis of the results of numerous studies carried out by Romek V.G., Kontorovich V.A., Krukovich E.I. (2004), showed that the condition that develops under the influence of traumatic stress does not fall into any of the classifications available in clinical practice. The consequences of an injury can appear suddenly, after a long time, against the background of the general well-being of a person. Over time, the deterioration of the condition becomes more pronounced and for some people becomes the cause of the development of post-traumatic stress disorder in the future.

Theoretical models explaining etiology and pathogenesis

post-traumatic stress disorder

As a result of many years of research, several theoretical models have been developed to explain the etiology and mechanism of post-traumatic stress disorder. Despite this, there is still no single generally accepted theoretical concept. Apparently, this can explain the fact that N.V. Tarabrina, who is an authoritative specialist in this field, in her dissertation research, having singled out psychological and biological models within the framework of the existing categorical apparatus, attributed the two-factor model of PTSD to "Other concepts of PTSD".

Psychodynamic models of the emergence and development of post-traumatic stress disorder traditionally include psychodynamic, cognitive and psychosocial models.

According to psychodynamic approach Freud to the mechanism of the development of trauma, intense experience leads in a short time "to such a strong increase in irritation that release from it or its normal processing fails, as a result of which long-term disturbances in energy expenditure may occur" deep psychological defense "turns on" alienation, which interferes with a person's adaptation to life. Freud viewed traumatic neurosis as a narcissistic conflict. He introduces the concept of a stimulus barrier. Due to intense or prolonged exposure, the barrier is destroyed, the libidinal energy is shifted to the subject himself. Fixation on trauma is an attempt to control it (Freud Z. 1989).

From the standpoint of the modern psychodynamic paradigm of D. Kalsched, “if a traumatic defense once arose, all relations with the outside world become the responsibility of the self-preservation system. What was supposed to be a defense against further or re-traumatization becomes a major stumbling block, a resistance to any manifestation of the "I" directed to the outside world. The psyche translates external trauma into an internal force, initially protective, but then self-destructive (Kalshed D. 2001).

Currently, the "energetic" understanding of trauma is increasingly being replaced by an "informational" one. The information model developed by M. Horowitz is an attempt to synthesize cognitive, psychoanalytic and psychophysiological models. The concept of "information" refers to both cognitive and emotional experiences and elements of perception that have an external and / or internal nature. Trauma response phenomena, according to M. Horowitz, are a normal reaction to shocking information. The author believes that only extremely intense reactions are abnormal, not adaptive, therefore they are able to block the processing of information and build it into the individual's cognitive schemes. This approach assumes that information overload plunges a person into a state of constant stress until the information undergoes appropriate processing. Following the principle of pain avoidance, a person tends to keep information in an unconscious form, but during the process of information processing, traumatic information becomes conscious. Conscious information is influenced by psychological defense mechanisms, is reproduced in an obsessive way in memory (flashbacks); Emotions, which play an important role in a post-stress state, are essentially a reaction to a cognitive conflict and, at the same time, motives for protective, controlling, and coping behavior. From the point of view of theory, the neutralization of trauma is possible if the information processing process is integrated (Horowitz M ., 1986; Lasarus R ., 1966).

The concept of M. Horowitz, formed under the influence of cognitive psychology by J. Piaget, R. Lazarus, T. French, I. Janis, reveals the mechanism of response to stressful events. It contains a number of phases:

– primary emotional reaction;

- "denial" - avoiding thoughts about the trauma;

- alternation of "denial" and "intrusion";

- Processing of traumatic experience.

The duration of the response process can last from several weeks to several months. According to the results of research, M. Horowitz identified three styles of delayed response: hysterical, obsessive, narcissistic (Horowitz M. J., 1979). .

Subsequently, B. Green, D. Wilson, D. Lindy developed the concept of M. Horowitz, having built an interactionist model of the process of delayed response to the psycho-traumatic effect of stress factors in a combat situation, they revealed the following elements in the process of cognitive processing of psycho-traumatic experience:

- recurring memories

- mental stress;

- avoidance of memories

- gradual assimilation.

Analyzing the traumatic factors of the Vietnam War, Green B. L., Grace M. C, Lindy J. D. (1983) made a great contribution to the theory of traumatic combat stress.

cognitive concepts mental trauma go back to the works of A. Beck and the theory of stress by R. Lazarus. From the standpoint of the cognitive model, traumatic events lead to an individual's "assessment" of a stressful situation, forming a type of coping with stress. Schemes of experiencing events are updated, forcing the individual to seek information that corresponds to this scheme, to ignore the rest of the information (Lasarus R.S., Folkmann S., 1984; Beck A.T., 1983).

Of theoretical interest is the theory of pathological associative networks by R. Pitman, based on the cognitive theory of P. Lang, which explains the body's ability to form patterns in the framework of a traumatic experience of responding to the re-experiencing of stimuli, flash back effects. These models seem to most fully explain the etiology, pathogenesis and symptoms of post-traumatic stress disorder, since take into account both genetic, and cognitive, and emotional, and behavioral factors (Pitman R.K., Altman B, 1991).

In the cognitivist concept of mental trauma interpreted by R. Yanoff-Bullman, the basic beliefs that were formed in childhood provide the child with a sense of security and trust in the world, and later on with a sense of their own invulnerability. Most healthy, adult people believe that there is more good in the world than bad. “If something bad happens, it happens mainly with those people who do something wrong… I’m good, so nothing should happen to me…”. Psychic trauma is a change in the basic beliefs of the individual, ideas about the world and about oneself, leading to pathological reactions to stress, a state of disintegration. (Janoff-Bulman R., 1995).

In the case of successful coping with trauma, basic beliefs are qualitatively different from “pre-traumatic” beliefs, the restoration of which does not occur completely, but only to a certain level at which a person is free from the illusion of invulnerability.

The picture of the world of an individual who has experienced a mental trauma and successfully coped with it changes. A person still believes that the world is benevolent and fair to him, it gives him the right to choose. But already there is a feeling of reality, there comes an understanding that this is not always the case. The individual begins to perceive reality in a form as close as possible to the real one, evaluating his own life and the world around him in a new way.

Janof-Bulman's concept, relying primarily on the cognitive structures of the psyche, ascribes a decisive role in the formation of these structures to the interaction of a child with an adult in the first years and months of life. The fundamental concept for it “basic beliefs”, introduced by A. Beck (1979), according to M.A. Padun (2003), largely coincides with the concept of “generalized representations about interaction” by D. also with the term "self-other schema" by M. Horowitz (Horowitz M., 1991) and with the concept of "internal working model" by J. Bowlby (Bowlby J., 1969, 1973, 1980). Thus, in the concept of mental trauma Yanof-Bulman in a certain way merges cognitivist and modern psychodynamic ideas about the key determinants of mental development.

We fully support the opinion of L.V. Trubitsina (2005) that this model seems to most fully explain the etiology, pathogenesis and symptoms of the disorder, since takes into account genetic, cognitive, emotional, and behavioral factors. From these positions, any events or circumstances that are neutral in themselves, but somehow related to the traumatic stimulus-event, can serve as conditioned reflex stimuli that cause an emotional reaction corresponding to the initial trauma.

A multifactorial model of response to trauma, proposed by B. Green, J. Wilson and J. Lindy, supporters of the so-called psychosocial approach to post-traumatic stress disorder. The authors and supporters of the model emphasize the need to take into account the environmental factor: the social support factor, the stigmatization factor, the demographic factor, cultural characteristics, and additional stressors. (Green B.L., Lindy J.D., Grace M.C., 1985).

The result of the generalization of the theoretical, methodological and practical work of the laboratory "Personality and Stress" of the Department of General Psychology, Faculty of Psychology, Moscow State University in 1989-1996. was the development person-centered model, which differs, according to M.Sh. Magomed-Eminova from "stimulus-reactive" models, in which an extreme situation is understood as a separate stressor (or a group of stressors) of extreme intensity, causing a pattern of mental reactions in an individual in a post-traumatic situation, denoted by the PTSD construct. The authors emphasize that in the development of the American Psychiatric Association, PTSD has a clinical interpretation as a set of related symptoms that characterize the nosological form and are included in a broader category of affective disorders.

Psychological factors, processes and structures, and mainly reactions to stressful events, seem to the authors of the concept to be extremely superficial, despite the fact that the very personality organization in PTSD, up to nuclear structures and processes, undergoes profound transformations. And that means that all the various psychological phenomena (symptoms, syndromes, reactions) are manifestations of the underlying mechanisms of the personality. This important idea was expressed earlier by B. S. Bratus, who interprets PTSD as a special form of abnormal personality development: “Meanwhile, since the psyche is one, the pathology does not result from the fact that, along with normal ones, purely “abnormal” mechanisms begin to operate , but due to the fact that general psychological mechanisms begin to pervert, functioning in special, extreme, harmful conditions for them ”(Bratus B.S., 1988).

In the case of PTSD, as emphasized by M.Sh. Magomed-Eminov, there is a psychological organization of the personality, formed in an abnormal situation and giving rise to various manifestations in the form of symptoms and syndromes of PTSD. Any interpretation of the determination of PTSD should include personality mechanisms as primary ones, and, therefore, the PTSD phenomenon can be considered a manifestation of deep nuclear factors and personality structures that have undergone transformation and reintegration in an abnormal situation. The studies of Magomed-Eminova M. Sh., Filatova A. T., Kaduk G. I., Kvasovoy O. G. (1990) made it possible to identify the following personal sources of some mental reactions: acting out traumatic scenarios, intrusion of the past); 2) the tendency to eliminate personal dissociation caused by abnormal experiences (nightmares, intrusive memories); 3) the desire for self-actualization on the basis of a paradoxical new experience (development of a form of experience assimilation); 4) transformation of the personality according to the type of mental "numbness" (emotional dullness, avoidance tendency).

biological model proposes to consider trauma as the result of long-term physiological changes accompanied by complex biochemical transformations.

From point of view neuropsychological hypothesis L.C. Kolb (1984), an increase in the tone of the sympathetic nervous system, which contributes to the release of adrenaline and activation of the secretion of the hypothalamus, is the initial, trigger mechanism of the stress reaction (Pavlov IP, 1951). As shown by L.C. Kolb, B.A. Van der Kolk (1991, 1996). in response to the action of the stressor, the turnover of norepinephrine increases, which, in turn, leads to an increase in the level of plasma catecholamine. At the same time, there is a decrease in the level of adrenaline, serotonin and dopamine in the brain. The authors explain the manifested analgesic effect by the production of endogenous opioids. N.V. Tarabrina (2008) emphasizes that L.C. Kolb also found that as a result of exposure to an extraordinary intensity and duration of stimulating effects, changes occur in the neurons of the cerebral cortex, blockade of synaptic transmission, and even death of neurons. First of all, the areas of the brain associated with the control of aggressiveness and the sleep cycle are affected.

Similar biochemical changes, according to R.J. Lifton (1973, 1978), Horowitz (1972, 1986), Green B.L., Lindy J.D (1985) , being a central link in the stress response syndrome, cause a change in mental states, in particular, they can cause mental numbness.

Modern views on the mechanism of development of stress and injury assign a significant role to the hypothalamus and extrahypothalamic structures (limbic system and reticular formation) in the central regulation of the pituitary-adrenal system in extreme conditions of life (Malyshenko N.M., Eliseev A.V. (1993); Lakosina N. D., Trunova M. M. (1994).

By revising physiological mechanisms development of psychological trauma, it is necessary to single out the mechanism of development of stress, a special case of which it can be considered (Selye G., 1979). The theoretical foundations of the doctrine of stress were developed in the concept of psychological stress by R. Lazarus, who "for the first time began to explore psychological processes as intermediate variables that mediate human responses as stressful stimuli."

According to Lazarus, stress occurs when a person perceives threatening circumstances as requiring significantly more resources than those that he has. Adhering to traditional views on the development of a stress reaction, Kassil G.N. (1978), Nikolaeva E.I. (2003) emphasize the importance of cortisol in its implementation, which inhibits inflammatory reactions; beta-endorphin, which lowers the pain threshold; compounds of corticosteroids with transcortin, a blood protein, the entry of which into the blood leads to the depletion of the hypothalamic-pituitary-adrenal system. Central to the stress response syndrome, according to modern data, is a condition in which the level of serotonin, dopamine and norepinephrine in the brain decreases, the level of acetylcholine increases, and an endogenous opioid-mediated analgesic effect develops. A decrease in the level of norepinephrine and a drop in the level of dopamine in the brain correlate with a state of mental numbness (Van der Kolk B.A., 1987; Kassil G.N., 1983; Nikolaeva E.I., 2003; Green B.L., Lindy J.D., Grace M.C., 1985). A decrease in the level of serotonin leads to a slowdown and even cessation of all processes in the development of behavior, so only a conditioned response to stimuli associated with the initial stressor is preserved. The cause of amnesia for a specific traumatic experience may be, according to Van der Kalk, the suppression of the functioning of the hippocampus.

The disadvantage of these models is that most of the studies have been done in animals or in the laboratory. And at the same time, modern knowledge about the psychophysiological mechanisms of reaction to trauma makes it possible to predict standard situations, to give a more subtle assessment of personal changes, physical condition for the provision of psychotherapeutic and pharmacological assistance.

An attempt to integrate the psychoanalytic and biomedical approach to trauma under extreme effects on the body was made by N.N. Pukhovsky. In his opinion, primary affective-shock reactions during traumatization are replaced by the syndrome of primary Ego-stress, which is considered as the main link in the pathogenesis of such psychopathological consequences as frustration regression, acute reactions to stress, epileptoid psychopathy, individual mental degeneration (Pukhovsky N.N., 2000).

Our eight-year studies on the course of traumatic reactions of various etiologies among university students have shown that the features of the etiological and pathogenetic nature allow us to consider the phenomena of trauma from the standpoint of various concepts of mental trauma. In our practice, there were cases of fixing social maladjustment of an average degree in students who suffered during the terrorist act in Budyonnovsk, who retained a constant feeling of fear, severe anxiety, impaired concentration, changes in physiological reactivity for 7 years after the events. They stopped going to previously actively visited vacation spots and lost interest in previously significant activities. Extreme self-doubt, conformity, forming a sense of dependence, lack of initiative, lack of independence in actions and judgments were noted. The material factor was named as the only motivation for socially significant behavior.

We tend to consider such consequences of traumatic experience from the standpoint of H. Horowitz, who believed that if traumatic memories remain not integrated into the cognitive sphere of the individual, traumatic experience persists for many years. (Churilova T.M., 2009). L., Lindy J.D., Grace M.C., 1985).

At the same time, our surveys and testing showed that the change in basic life beliefs in psychological traumatism fully corresponds to the main provisions of the cognitivist concept of mental trauma in the interpretation of R. Yanoff-Bulman (Topchiy M.V., 2004, 2006; Churilova T.M. , 2003, 2007).

Research in post-traumatic stress disorder

disorders

Post-traumatic stress disorder is one of the possible psychological consequences of experiencing traumatic stress. The basis for determining the independent content of the term "post-traumatic stress" is the criterion for the presence in the individual's biography of a traumatic event associated with a threat to life and accompanied by the experience of negative emotions of intense fear, horror or a sense of hopelessness (helplessness), i.e. experienced traumatic stress (Tarabrina N.V., 2008).

We do not agree with the conclusion of I.G. Malkina-Pykh that "research in the field of post-traumatic stress has developed independently of stress research, and to date, these two areas have little in common." At the same time, the author assures that in the psychological picture of PTSD, the specificity of the traumatic stressor is certainly taken into account, although the general patterns of the occurrence and development of PTSD do not depend on specific traumatic events (Malkina-Pykh I.G., 2008).

We are closer to the point of view of E. Hobfoll (1988), who proposed a variant that links the concepts of stress and traumatic stress. In his opinion, the idea of ​​a total stressor capable of provoking a qualitatively different type of reaction is possible, which consists in the conservation of adaptive resources. A similar opinion has H. Krystal (1978), who suggested that mental collapse can cause "freeze of affect" with subsequent alexithymia.

Studying the relationship between the concepts of stress, traumatic and post-traumatic stress, N.V. Tarabrina (2008) identified the contextual dependence of the concepts of "post-traumatic stress disorder", "traumatic stress", "post-traumatic stress", which in foreign studies outside of empirical work often are used as synonyms. In domestic scientific publications, the category of PTSD is becoming more widespread, and in popular science publications, the concepts of “traumatic” and “post-traumatic” stress or simply “stress” are more often used. N.V. Tarabrina (2008), emphasizing the differences between stress and traumatic stress, singled out, on the one hand, the ideas of homeostasis, adaptation and “normality”, and on the other hand, separation, discontinuity and psychopathology.

We were interested in the information of I.G. Malkina-Pykh (2008) and N.V. Tarabrina (2001) that information about the developmental features of a state that develops under the influence of superstrong influences on the human psyche has been recorded for centuries. Back in 1867, J.E. Erichsen published the work "Railway and other injuries of the nervous system", in which he described mental disorders in people who survived railway accidents. A similar reaction to what is happening was described in 1871 by Da Costa during the American Civil War, as a result of observing autonomic reactions from the heart, he proposed the term "soldier's heart". In 1888, H.Oppenheim introduced into practice the well-known diagnosis of "traumatic neurosis", in which he described many of the symptoms of modern PTSD (Smulevich A.B., Rotshtein V.G., 1983). The works of the Swiss researcher E. Sterlin, published in 1909, 1911, according to P. V. Kamenchenko, became the basis of all modern psychiatry of catastrophes. Early domestic research, in particular, the study of the consequences of the Crimean earthquake in 1927 (Brusilovsky et al., 1928) also made a great contribution to the development of knowledge about psychological trauma.

The emergence of major military conflicts that give rise to suffering, destruction, loss of loved ones have always given impetus to a special kind of research (Krasnyansky, Morozov, 1995). Until now, the works of E. Kraepilin (1916), which appeared in connection with the First World War (1914–1918), remain classic. In them, the researcher, for the first time characterizing traumatic neurosis, pointed out the fact that after severe mental trauma there were permanent disorders that worsened over time. Later Myers in his work "Artillery shock in France 1914-1919" identified the difference in the etiology and pathogenesis of disorders associated with concussion, physical trauma and "shell shock". The contusion caused by the rupture of the shell was considered by him as a neurological condition, with the "shell shock", from the point of view of Myers, a mental state developed, caused by severe stress.

Following I. G. Malkina-Pykh (2004), we recognize the importance of research by domestic authors on the mental consequences of the Great Patriotic War, the results of which highlight several important provisions:

- war is a situation of permanent psychotraumatization, which contributes to emotional exhaustion (G.E. Sukhareva, E.K. Krasnushkin);

- the adverse impact of extreme (combat) conditions increases sensitivity to psycho-traumatic factors. This is facilitated by general asthenization, a decrease in tone, lethargy and apathy (V.A. Gilyarovsky);

- psycho-traumatic factors affect not only the human psyche, but also the whole organism as a whole (V.G. Arkhangelsky);

- the impact on the psyche in extreme conditions is the result of the interaction of many factors (E.M. Zalkind, E.N. Popov).

It should be noted that for the first time the conclusion about the possibility of long-term preservation of the consequences of the psycho-traumatic effects of the war was made by Soviet scientists on the basis of studies of the post-war adaptation of veterans of the Great Patriotic War (Gilyarovsky V.A. (1946), Vvedensky I.N. (1948), Krasnushkin E.K. (1948), Kholodovskaya E.M. (1948 and others).Reactions due to participation in hostilities became the subject of extensive discussions during World War II.New terms appeared in psychiatry: "war fatigue", "combat exhaustion" , "military neurosis", "post-traumatic neurosis", introduced by V. E. Galenko (1946), E. M. Zalkind (1946, 1947), M. V. Solovieva (1946) and others (see Malkina-Pykh, 2008 ).

Abroad, the first systematic study was attempted in 1941 by the French psychiatrist and psychologist A. Kardiner (Kardiner A., ​​1941), who called a group of symptoms that accompanied the phenomena of nervous disorders and associated with military operations “chronic military neurosis”. Kardiner believed that military neurosis was both physiological and psychological in nature. Based on Freud's ideas, he introduces the concept of "central physioneurosis", which, in his opinion, causes a violation of a number of personal functions that ensure successful adaptation to the outside world. The cause of mental disorders is a decrease in the body's internal resources and a weakening of the "EGO" strength. They were the first to give a comprehensive description of the symptoms:

- excitability and irritability;

- unrestrained type of response to sudden stimuli;

fixation on the circumstances of the traumatic event;

- escape from reality;

- predisposition to uncontrollable aggressive reactions.

Detailed types of disorders have been described in concentration camp prisoners and prisoners of war (Etinger L., Strom A., 1973).

A number of monographs by American researchers set out theoretical and applied issues related to the study of the condition of Vietnam veterans, many of whom turned out to be socially maladjusted and committed suicide (Boulander et al., 1986; Egendorf et al., 1981). In the 1950s and 1960s, the US National Academy of Sciences approved a number of planned studies, with the help of which an attempt was made to evaluate the adaptation of individuals who survived major disasters, fires, gas attacks, earthquakes, and other similar disasters.

The beginning of systematic studies of post-stress states caused by the experience of natural and industrial disasters can be dated back to the 1950s and 1960s. An analysis of literary sources showed that by the end of the 70s, significant material had been accumulated on psychopathological and personality disorders among war veterans. In the 1980s, victims of crimes, sexual violence, and radiation hazards were added to the objects of research.

As it turned out, people who suffered in a variety of situations similar in severity to psychogenic effects showed similar symptoms. Attempts were made to bring to the classifications available in clinical practice, the introduction of special terminology. Many different symptoms of such a change in condition have been described, but for a long time there were no clear criteria for its diagnosis. In this regard, in 1980, M. Horowitz (Horowitz, 1980) proposed to distinguish it as an independent syndrome, calling it "post-traumatic stress disorder" (Post.-traumatic stress disorder, PTSD). Subsequently, a group of authors headed by M. Horowitz (1986) developed diagnostic criteria for PTSD, first adopted in the American national psychiatric standard (DSM-III and DSM III-R), and later (virtually unchanged) for the ICD-10 (Smulevich A.B., Rotstein V.G., 1983). The need to introduce diagnostic criteria, according to N.V. Tarabrina, was associated with a boom in research on numerous mental problems associated with the social and mental maladjustment of Vietnam War veterans (Egendorf et al., 1981; Boulander G. et al., 1986; Figley C. R. , 1985; Kulka R. A. et al, 1990). These works made it possible to clarify many issues related to the nature and diagnosis of PTSD.

Taking information N.V. Tarabrina (2008) that the increase in the number of countries using the diagnosis of PTSD in clinical practice increased from 7 to 39 in the period from 1983-1987 to 1998-2002 due to the growth of international terrorist activity, we believe that this can be explained as well as an increase in the number of chronic stressors associated with economic, geopolitical, social, informational problems.

In our research, we proceed from the definition of post-traumatic stress disorder (PTSD) accepted today in psychology as a non-psychotic delayed human reaction to traumatic stress. Criteria included since 1994 in the European diagnostic standard ICD.-10 define post-traumatic stress disorder (PTSD) as a condition that can follow traumatic events that are outside the normal human experience. At the same time, “ordinary” human experience meant such events as the loss of a loved one due to natural causes, a threat to one’s own life, the death or injury of another person, a chronic serious illness, loss of a job, or family conflict. Trauma is defined as an experience, a shock that causes fear, horror, helplessness in most people.

Most of the authors, following M.J. Horowitz (1980) distinguishes three main groups of symptoms within the framework of post-traumatic pathology: 1) excessive arousal (including autonomic lability, sleep disturbance, anxiety, obsessive memories, phobic avoidance of situations associated with trauma); 2) periodic bouts of depressive mood (dullness of feelings, emotional numbness, despair, consciousness of hopelessness); 3) features of hysterical response (paralysis, blindness, deafness, seizures, nervous trembling).

At the same time, F. Parkinson (2002) believes that for the diagnosis of post-traumatic disorder, it is sufficient to take into account the following groups of symptoms:

- states and feelings;

- behavior;

- physical reactions.

It should be noted that F.Parkinson proposes to take into account in the diagnosis also the symptoms that the victim could have had before the incident.

Thanks to studies of the mental states of people who have experienced extreme situations, the main signs of post-traumatic stress reactions have been established. So R. Grinker and D. Spiegel attributed impatience, aggressiveness, irritability, apathy and fatigue, personality changes, depression, tremor, fixation in the war, nightmares, suspicion, phobic reactions, addiction to alcohol to delayed reactions to combat stress. Much attention was paid to the restoration of self-esteem in the process of psychological rehabilitation of combatants (Grinker R.P., Spiegel J.P., 1945).

Delayed mental responses to stress in veterans have been found to depend on three factors:

- from pre-war personality traits and a person's ability to adapt to new situations;

- from reaction to dangerous situations that threaten a person's life;

- on the level of restoration of the integrity of the personality (Kardiner, A., Spiegel, H., 1945).

In a study during the Korean War, in which the psychogenic losses of the US Army amounted to 24.2%, psychologists finally came to the conclusion that "combat stress is the basis of mental disorders" understood mental trauma as an individual's reaction to external demands and internal stimuli, which consists in a strong violation of the mediator function of the "EGO" (Goodwin D.D., 1999).

Research on PTSD became even more extensive in the 1980s. Numerous studies have been performed in the United States to develop and clarify various aspects of PTSD. The works of Egendorf et al. (1981) are devoted to a comparative analysis of the characteristics of the adaptation process in Vietnamese veterans and their peers who did not fight. Bowlander et al. (Boulander et al., 1986) studied the features of a delayed reaction to stress in the same population. The results of these studies have not lost their importance so far. The main results of international research were summarized in the collective two-volume monograph "Trauma and its trace" (Figley, 1985), which, along with the developmental features of PTSD of military etiology, also presents the results of studying the consequences of stress in victims of genocide, other tragic events or violence against a person.

For anyone who has dealt with stress, what's especially tricky about PTSD is that symptoms can appear immediately after being in a traumatic situation, or they can appear many years later. Cases have been described in which PTSD symptoms appeared in veterans of the Second World War forty years after the end of hostilities (Boulander, 1986). The past "does not let go" - people constantly return with their thoughts to what happened, trying to find an explanation for what happened. Some begin to believe that everything that happened is a sign of fate (Parkinson F., 2002), others develop anger due to a sense of deep injustice. The obsession about the incident manifests itself in endless conversations without any need and at every opportunity. The detachment of others from the problem leads to isolation of the survivor of the trauma, which causes secondary traumatization.

A number of researchers point to the appearance of dissociative symptoms, manifested by a feeling of emotional dependence, narrowing of consciousness, depersonalization with the feeling that a person is at home and at the scene of a tragedy at the same time. Severe distress is manifested by physiological responses to key stimuli associated with trauma. "Flashback episodes" develop. The inability to relax manifests itself in a state of constant tension - a person cannot fall asleep, despite being exhausted. Sleep disorders that accompany such conditions exacerbate a serious condition, fatigue and apathy occur (Kindras G.P., Turokhadzhaev A.M., 1992; Pushkarev A.L., 1997; Sidorov P.I., Lukmanov M.F. , 1997; Arnold A.. 1993; Bleich A. et.al., 1991; Boudewyns P. A., 1996; Carlson J. G. et. al., 1997).

Among the main symptoms of PTSD are Boudewyns P. A. (1996) and Chemtob C. M., Novaco R. W., HamadaR. S., Gross D. M. (1994) call the development of passive avoidance of stimuli associated with trauma, a decrease in interest in previously significant activities, and a narrowing of the range of affective reactions. Persistent manifestations of increased arousal, absent before the injury, are manifested by irritability, alertness, outbursts of anger, an increased reaction to fear, difficulty falling asleep, and the need to concentrate. C. Skull, himself a veteran, explored these questions in a series of deep emotion interviews with Vietnam War veterans and identified six themes: guilt, abandonment/betrayal, loss, loneliness, loss of meaning, and fear of death. He concluded that these themes set the context and reveal the causes of PTS symptoms and that "addressing what worries Vietnam veterans the most should be based primarily on an existential perspective" (Scull C. S., 1989).

Research N.V. Tarabrina and colleagues found that in the case of a military injury (veterans of the war in Afghanistan), the most changed is the emotional component of the perception of the future perspective. Veterans with PTSD experience acute feelings of uncertainty, discomfort, disappointment, but retain hope and the ability to imagine and plan for their future.

We fully agree with the opinion of the American researcher R. Pitman (1988), who called post-traumatic stress the “black hole of trauma”. The destructive effect of a war, a catastrophe experienced, a terrorist act continues to affect the whole life, depriving a person of a sense of security and self-control. There is a strong, sometimes unbearable tension, leading to a real danger to the psyche.

We consider it necessary to add that an additional source of trauma can be the latest types of weapons tested by the United States during local wars in the countries of the Middle East, which have not only a deadly effect, but also a powerful psycho-traumatic effect on the survivors (Kormos H.R., 1978; Snedkov E.V. ., 1997; Dovgopolyuk A.B., 1997; Epachintseva E.M., 2001; Dmitrieva T.B., Vasilievsky V.G., Rastovtsev G.A., 2003; Litvintsev SV., 1994; Vasilevsky V.G. ., Fastovets G.L., 2005; Kharitonov A.N., Korchemny P.A. (ed.), 2001).

Of interest are numerous studies showing that combatants with PTSD are 2 to 3 times more likely to be addicted to psychoactive substances than civilians without the disorder. Nearly 75% of combat veterans with PTSD also had symptoms during their lifetime that would allow a diagnosis of alcohol abuse or alcohol dependence (Kulka R.A., Hough R.L., Jordan B.K., 1990). Overcoming the stressors of a combat situation by an individual depends not only on the success of processing traumatic experience, but also on the interaction of three factors: the nature of traumatic events, the individual characteristics of veterans, and the characteristics of the conditions in which the veteran finds himself after returning from the war (Green B.L., 1992). Violations of the processing of traumatic experience and overcoming combat trauma leads to social maladjustment with the formation of affective disorders and PTSD, which are factors that provoke the abuse of psychoactive substances (Petrosyan T. R., 2008).

An analysis of the literature sources at our disposal showed that most of the current research on PTSD is devoted to the epidemiology, etiology, dynamics, diagnosis and treatment of PTSD, which are carried out on a variety of contingents: combatants, victims of violence and torture, anthropogenic and man-made disasters, patients with life-threatening diseases, refugees, firefighters, rescuers, etc.

Study of the circumstances of a person's stay in the emergency zone Yu.A. Aleksandrovsky with colleagues (1991), V.P. Antonov (1987), Yu.V. Malova (1998); I.B. Ushakov, V.N. Karpov (1997), V.A. Molyako (1992) indicate that the environment in which there is a threat of radiation damage and where a person is in real danger of losing health or life serves as a basis for including such situations in the list of traumatic, i.e. capable of causing PTSD. regularities of changes in each separately studied area. However, the question of whether the development of PTSD in people who have undergone the stress of a radiation threat is still debatable. In domestic works, much attention is paid to the analysis of neuropsychiatric and neuropsychiatric disorders (Krasnov et al., 1993). N.V. Tarabrina, emphasizing the vastness of the study on this issue, highlights the study of post-traumatic syndromes in victims of radiation exposure during the accident at the American nuclear power plant "Three Mile Island" (Dew M. S. & Bromet E. J., 1993); in Guyana (Collins D.L. & de Carvalho A.B., 1993; Davidson L. U., Baum A., 1986), as well as those American veterans of the Second World War who witnessed nuclear weapons tests (Horowitz M. et al., 1979). According to L. Weiss (Weisaeth L.) in Norway, among the population exposed to the Chernobyl accident, from 1 to 3% suffer from PTSD. Studies of the population of contaminated territories showed the presence of PTSD in 8.2% of the inhabitants of these regions (Rumyantseva et al. 1997).

We consider the information of N.V. Tarabrina (2008) on the specificity of the psychological content of PTSD symptoms in liquidators. A high percentage of symptoms of physiological excitability correlates with levels of anxiety and depression, and the semantics of the symptoms are, for the most part, related to the future life. The presence of symptoms such as sleep disturbances, loss of appetite, decreased sexual desire, irritability indicate their severe emotional state. The author shows the presence of a high level of astheno-neurotic disorders, vegetative-vascular dystonia, hypertension in almost all subjects, which corresponds to the generally accepted register of psychosomatic disorders, and suggests the psychogenic nature of the diseases as a result of experiencing chronic stress, which for many was the Chernobyl disaster. Denoting the radiation threat stress as an "invisible" stressor, N.V. Tarabrin includes it in one group with the threat of chemical and biological damage. At the same time, she emphasizes the similarity of the psychological mechanisms of the development of post-stress states under such influences and the extreme degree of their lack of study.

One of the most urgent problems in modern psychological science, in our opinion, is the study of the terrorist threat and its consequences, which is due to the growing scale of terrorist activity and the nature of its manifestations.

The literature data studied by us on the results of studies of the experience of terrorist attacks provide fairly consistent data on the widespread prevalence of PTSD and its individual symptoms as psychological reactions to this type of traumatic event (Grieger T.A., Fullerton C.S., and UrsanoR.J., 2003; Sosnin V. A., 1995; Kekelidze Z.I., 2002; Olshansky D.V., 2002; Tarabrina, 2004, 2005; Portnova A.A., 2005; Koltsova V.A., 2006; Krasnov A.N., 2006 Slovic, Schuster (1977, 1978); North C. S. (1999); Shore J. H., Tatum E. L., Volhner N. W. (2002) According to North C. S. et al. the act is the most serious threat to the mental health of the population in comparison with natural disasters (Northetal., 1999).

A rather serious problem is the fact that most of the studies are devoted to the psychological and psychiatric consequences of terrorist acts in direct victims of terrorist attacks and their loved ones (Idrisov K.A., Krasnov V.N., 2004; Galkin K.Yu., 2004; Gasparyan Kh. V., 2005). Practically no attention is paid to the specific features of the perception of the terrorist threat by indirect victims who witnessed terrorist attacks through the media (Tarabrina N.V., 2004; Bykhovets Yu.V., Tarabrina N.V., 2007).

In recent years, the category of PTSD has been singled out as a separate taxonomic unit, the shaping factor for which is situations of unforeseen loss of an object of special affection or a significant other. The significance of studying this problem is that almost every person finds himself in a situation of loss of loved ones during his life.

We agree with A.V. Andryushchenko (2000) that, unlike other variants of life catastrophes, this psychotraumatic situation affects, first of all, the sphere of individual personal values. Despite the fact that the direction of the psychogenic factor is different than in events associated with a threat to physical existence, this kind of limiting situation is perceived as equivalent to it - the "irreparable" destruction of the personality. The loss of a significant other after a life-threatening illness, as a result of a love drama or death, an accident, disappearance under tragic circumstances, suicide, and other related situations are accompanied by a feeling of complete loss of the Self, a feeling of the impossibility of subsequent recovery, and persistent despair associated with these post-traumatic manifestations. Clinical studies show that the formation of PTSD with the loss of an object of affection occurs in the first 6 months after a traumatic event and lasts from 6 months to several years or more. Just like the classical forms of PTSD, these conditions differ in the following features: 1) they form in several stages, thus acquiring a prolonged course; 2) are determined by a polymorphic psychopathological structure; 3) end with persistent residual states in 6-20% with a distinct long-term maladaptation. The author emphasizes that the data on remote stages (the first 6-12 months after the psychotraumatic effect) indicate the appearance in the structure of PTSD, in addition to reactive formations, of other disorders coexisting simultaneously with the main disorder by the mechanism of comorbid relationships. The qualification of mental disorders in pathological bereavement reactions with signs of PTSD, carried out in accordance with ICD-10, reveals a trend towards multi-axial diagnosis of pathology. As a rule, patients have mood disorders of the dysthymic level: subclinical or psychopathologically completed forms of dysthymia, single or recurrent depressive episodes; dissociative disorders, somatoform disorders.

Experience shows that within the framework of these disorders, there is a tendency that has arisen in the post-traumatic period to constantly reproduce in one's life a situation similar to that experienced or, on the contrary, to completely avoid situations reminiscent of these events.

As our analysis has shown, paradoxical, at first glance, categories can serve as risk factors for the development of PTSD. So the Russian psychologist F. Konkov, describing the role of environmental factors in the prolongation of post-traumatic stress after the 1988 earthquake, found that the following values ​​of the Armenian family, culture and political context influenced the stress reactions of Yerevan children and their parents:

- emphasis on silent heroic suffering;

– altruistic fortitude in overcoming everyday hardships;

- denial of pain and weakness;

- the predominance of the values ​​of the external well-being of the family over the intra-family psychological comfort;

- excessive fixation of adults on the states of their children as a defense against their own feelings and as an unconstructive demonstration of altruism;

- unwillingness to inform children about the death of loved ones for fear of causing a hostile attitude of the child towards himself; this leads to the fact that children are left alone with unreacted stress, despite the fact that they intuitively feel this loss, which cannot be shared with an adult in open communication about the grief experienced;

- fixation of parents on situations of interethnic conflict, which creates difficulties for psychotherapeutic influence and increases the feeling of hostility of the environment in children.

According to F. Konkov, in such situations it is impossible to do without the psychotherapeutic intervention of psychologists, since without this the stress continues. In addition to the psychotherapeutic value of openly expressing the feelings associated with the tragedy, these families need help to adjust to life in a new environment characterized by a high value of human life. The author emphasizes that, despite the situation of grief and loss of loved ones, lost health and property, people can be helped by increasing the significance of their experiences, explaining that their suffering and life have meaning (Konkov F., 1989). It should be noted that in psychological practice, such paradoxical phenomena are encountered quite often. So, a good upbringing, which puts restrictions on communication, often prevents the processing of traumatic situations, driving them into the depths of the unconscious.

The intensity of the psychotraumatic situation, the risk of PTSD, according to A.L. Pushkareva (2000) also depend on the social status, low level of education; psychiatric problems preceding the traumatic event; chronic stress.

The results of our work coincide with the data of G.I. Kaplan. (1994), who believes that traumatic events are more difficult to deal with in very young and very old people than in those who experience trauma in mid-life. For example, approximately 80% of burnt children develop post-traumatic stress disorder 1–2 years after the burn injury. On the other hand, only about 30% of adults after burns develop a similar disorder. Most likely, young children have not yet developed the mechanisms to cope with the physical and emotional damage caused by trauma. Similarly, the elderly, as well as young children, have more rigid mechanisms for coping with trauma and may not be flexible enough to deal with it. Moreover, the impact of trauma may be exacerbated by the physical disabilities that characterize the life of the elderly, especially those with disorders of the nervous and cardiovascular systems, such as reduced cerebral blood flow, impaired vision, palpitations and arrhythmias. The presence of mental abnormalities in the period preceding the trauma, personality disorders or more serious violations increase the strength of the stressor. The provision of social assistance may also influence the development, severity, and duration of post-traumatic stress disorder. In general, patients who receive good social care are less likely to develop this disorder, or if it does develop, it is less severe. More often, this disorder develops in single, divorced, widowed, economically distressed or socially isolated persons (Churilova t.M., 2003, 2007).

According to our observations and literature data, a negative reaction of medical staff, social workers, and other people faced by individuals with PTSD can lead to secondary traumatization. In other cases, a similar diagnosis may occur in victims who are overprotected, create a "traumatic membrane" that separates them from the outside world.

Following N.V. Tarabrina, we agree that the assessment of conditions at the remote stages of PTSD makes it possible in most cases to identify signs of post-traumatic personality development. PTSD leads to a decrease or loss of the need for close interpersonal relationships, to the inability to return to family life, to the depreciation of marriage and the birth of children, etc. Unlike personal deviations that arose after severe wartime stress, in these cases the consequences of the disaster are not so large accordingly, the quality of life is affected to a lesser extent. PTSD of this type has a much lesser effect on professional ambitions, although in this area “failures” are revealed with a decrease in motivation and interest in activities, indifference to success and career (Tarabrina N.V., 2001, 2008)

The opinion of A.G. Maklakova, S.V. Chermyanina, E.B. Shustova (1998), M.V. Davletshina that post-traumatic stress disorder is one of the most pressing problems of the 21st century. The authors point out that the percentage of prevalence of PTSD among the population varies, according to various sources, from 1% to 67% with variability associated with examination methods, characteristics of the population, and also, according to some authors, due to the lack of a single clear approach to determining diagnostic criteria for this disorder. At the same time, according to M.V. Davletshina (2003), there is a clear increase in the incidence of PTSD in the 1990s. If, according to Dmitrieva T.B., about 1% of the population of studies falls ill with PTSD throughout the life (Dmitrieva T.B., Vasilevsky V.G., Rastovtsev G.A., 2003), then other researchers point to a wider distribution of this type of disorder . So, I.G. Malkina-Pykh, referring to the opinion of researchers, indicates that PTSD occurs in approximately 20% of people who have experienced situations of traumatic stress (I.G. Malkina-Pykh., 2008). D. Kilpatrick shows that among the 391 women examined, 75% were ever victims of crime. Of these, 53% were victims of sexual violence, 9.7% of violent assault, 5.6% of robberies, and 45.3% were burglaries. According to the reports of epidemiologists, all of them had psychosomatic symptoms of PTSD (Kilpatrick D.G., Veronen L.J., 1985).

Special studies of A.N. Krasnyansky (1993), A.L., Pushkarev, V.A., Domoratsky, E.G. Gordeeva (2000) showed that the symptoms of PTSD in a certain proportion of people with the consequences of military trauma become more distinct with age. In some individuals, the course of PTSD is chronic, often associated with mental illness, including affective disorders, drug addiction and alcoholism. In Shor's studies, based on a general sample of American citizens (excluding risk groups), it is reported that the number of people suffering from PTSD in America is on average 2.6% of the total population (see Romek V.G., Kontorovich V.A., Krukovich E.I., 2004).

We share the opinion of N.V. Tarabrina (2008) about the ambiguous assessment of PTSD by individual clinicians in different countries. Significant progress in research in this area does not reduce the debatability of the problems associated with them. This is especially true of the semantic field of traumatic stress, the problems of the dose-response model, the inclusion of guilt in the register of post-traumatic symptoms, the possible influence of brain disorders, the effect of stress hormones, memory distortions in diagnosing PTSD resulting from sexual abuse in early childhood, the influence of the socio-political situation in society on the diagnosis of PTSD, etc. (Krystal H., 1978; Orr S.P. 1993; Breslau N., Davis G.C. 1992; Everly G.S., 1989; Pitman R.K., 1988; Horowitz M.J., 1989).

We believe that in domestic psychology and psychiatry, interest in research in this area has increased due to the introduction of the category of post-traumatic stress disorder (PTSD) into the scientific discourse. In the domestic literature, in our opinion, the works of N.V. Tarabrina, F.E. Vasilyuk, I.G. Malkina-Pykh, L.A. Kitaeva-Smyk, A.V. Gnezdilova, M.S. Kurchakova, M.A. Padun, V.A. Agarkova, P.V. Solovieva, E.O. Lazebnaya, L.V. Trubitsina, M.E. Sandomirsky, A.L. Pushkarev, V.A. Domoratsky, E.G. Gordeeva.

Most of the research on PTSD is devoted to the epidemiology, etiology, dynamics, diagnosis and treatment of PTSD, which are carried out on a wide variety of contingents: combatants, victims of violence and torture, man-made and man-made disasters, patients with life-threatening diseases, refugees, firefighters, rescuers and etc. The main concepts used by researchers working in this field are “trauma”, “traumatic stress”, “traumatic stressors”, “traumatic situations” and, in fact, “post-traumatic stress disorder”. Despite the fact that the number of mostly empirical studies devoted to the study of the psychological consequences of a person being in a traumatic situation has been rapidly increasing over the past decades, many theoretical and methodological aspects of this problem remain either unresolved or debatable (N.V. Tarabrina. 2008) .

We agree with B. Kolodzin in the opinion that the analysis of the literature indicates that after the identification of the clinical form of PTSD in the ICD-10, there is a tendency for a narrow interpretation of these conditions without taking into account the specifics of the psychotraumatic factor. The question remains unclear regarding the study of PTSD that develops in people who have experienced a situation of hostage as a result of a mass terrorist attack. Phenomenological ideas about psychological and psychopathological reactions in individuals with signs of post-traumatic stress disorder, who became hostages as a result of a mass terrorist attack, are single, incomplete and fragmented. There are practically no detailed scientific data reflecting the influence of personality characteristics on the psychological and psychopathological picture of the formation of PTSD. Studies on the psychological differential diagnosis of post-traumatic stress disorders have not actually been conducted (Kolodzin B., 1992).

Literature for the introduction and the first chapter

Ababkov V.A., Pere M. Adaptation to stress: Fundamentals of the theory of therapy diagnostics. - St. Petersburg: Speech, 2004.

Alexandrovsky Yu. A. Borderline psychiatric disorders: Proc. allowance / Yu. A. Aleksandrovsky. - 3rd ed., revised. and add. - M .: Medicine, 2000.

Aleksandrovsky Yu.A., Lobastov O.S., Spivak L.I., Shchukin B.P. Psychogeny in extreme situations. - M., 1991.

Alexandrovsky Yu.A. On a systematic approach to understanding the pathogenesis of non-psychotic mental disorders and substantiating the rational therapy of patients with borderline conditions // Journal "Therapy of Mental Disorders" / Archive / TPR No. 1, 2006.

Andryushchenko A.V. Post-traumatic stress disorder in situations of loss of an object of extraordinary significance // Psychiatry and psychopharmacotherapy. - V.2, No. 4, 2000.

Antonov V. P. Radiation situation and its socio-psychological aspects. - Kyiv: Knowledge, 1987.

Bassin F.V. On the development of the problem of meaning and meaning // Questions of Psychology. - M., 1973.

Bassin F.V. The problem of the unconscious (On unconscious forms of higher nervous activity) (idem). - M., 1968.

Belan A.S. Emotional stress in flight personnel // Results of science and technology. Air Transport. Medical and psychological aspects of flight safety / Ed. N. M. Rudny. M.: VINITI AN SSSR, 1987.

Beregovoy G. T., Zavalov N. D., Lomov B. F., Ponomarenko V. A. Experimental psychological research in aviation and astronautics. Moscow: Nauka, 1978.

Bodrov V. A. Information stress: Textbook for universities. – M.: PER SE, 2000.

Bodrov V. A. Methods for assessing and predicting mental tension among submarine operators // Methods for diagnosing mental states and analyzing human activity. M.: Publishing House "Institute of Psychology of the Russian Academy of Sciences", 1994.

Bodrov V. A. Psychological stress: the development of teaching and the current state of the problem. M.: Publishing House "Institute of Psychology of the Russian Academy of Sciences", 1995.

Bodrov V. A. Psychophysiological problems of professional reliability of a human operator // Psychological problems of professional activity. M.: Nauka, 1991.

Bodrov V. A. Experimental study of emotional stress among operators // Military Medical Journal, 1973.

Bodrov V. A. Experimental-psychological study of combined operator activity // Methodology of engineering psychology, psychology of work and management. Moscow: Nauka, 1981.

Bodrov V.A., Oboznov A.A. The system of mental regulation of the stress resistance of a human operator / Psychological journal. – 2000.

Bozhovich L. I. Problems of personality formation. - M .: "Institute of Practical Psychology", Voronezh: NPO "MODEK", 1995.

Bokanova O. M. Some indicators of the cardiovascular system in students of the evening department during the examination session. Questions of hygiene and the state of health of university students. M., 1974.

Bratus B.S. C. Personality anomalies. M., 1988.

Broadhurst P.L. Biometric approach to the analysis of the study of behavior // Actual problems of behavior. – M.: Nauka, 1975.

Vasilevsky VG, Fastovets GL, Background and clinical and psychopathological features of post-traumatic stress disorder in combatants / / Post-traumatic stress disorder. Moscow: GNTSSSP im. Serbian, 2005.

Vasilyeva V. Personal characteristics and the state of tension in labor activity // Psychological tension in labor activity. Moscow: Institute of Psychology of the Academy of Sciences of the USSR, 1989.

Vasilyuk F.E. Psychology of experience. - M., 1984.

Velichkovsky B. B. Multivariate assessment of individual resistance to stress.– M. Abstract of ... cand. psychol. Sciences. 2007.

Veltishchev Yu.E. Emergency conditions in pediatrics. - M, 2005.

Volozhin A.I., Subbotin Yu.K. adaptation and compensation. – Universal adaptation mechanism. – M.: Medicine, 1987.

Galkin K. Yu. Mental disorders in persons who survived the terrorist act in the city of Volgodonsk on September 16, 1999: Clinical manifestations, dynamics, systematics: abstract of the thesis. ... cand. honey. Sciences. - M, 2009.

Ganzen V.A. System descriptions in psychology. - L.: Publishing house of Leningrad State University, 1984.

Gasparyan Kh. V. Age-psychological features of experiencing difficult life situations: abstract of dis. ... cand. psychol. Sciences. - M., 2005.

Gissen L.D. Time of stress. - M., 1990.

Grimak L.P. Ponomarenko V.A. Aviation stress // Reference book of an aviation doctor. Moscow: Air transport, 1993.

Grimak L.P. Reserves of the human psyche. - M., 1989.

Grinberg J. Stress management. - St. Petersburg: Peter, 2002

Dmitrieva T.B., Vasilevsky V.G., Rastovtsev G.A. Transient psychotic states in combatants suffering from post-traumatic stress disorder (forensic psychiatric aspect) // Russian Psychiatric Journal, No. 3, 2003.

Dmitrieva N.V., Glazachev O.S. Individual health and polyparametric diagnostics of the functional states of the body (system-information approach). - M., 2000.

Dovgopolyuk A.B. Psychogenic reactions with behavioral disorders in military personnel in peacetime and in a combat situation. Abstract diss.... cand. honey. Sciences. SPb., 1997.

Doskin V. A. Prevention of examination stress // School and mental health of students / Ed. S. M. Grombakh. M., 1988.

Epachintseva E.M. Post-traumatic stress disorder in combatants. Abstract diss. ... cand. honey. Sciences. Tomsk. 2001.

Zelenova M.E., Lazebnaya E.O., Tarabrina N.V. Psychological features of post-traumatic stress states among participants in the war in Afghanistan // Psychological journal. - T. 18, No. 2, 1997.

Zingerman A.M. Influence of the statistical characteristics of the signal system and their significance on the formation of motor and vegetative reactions of a human operator in normal conditions and under extreme influences // Essays on Applied Neurocybernetics. – L.: Nauka, 1973.

Idrisov K.A., Krasnov V.N. The state of mental health of the population of the Chechen Republic in a long-term emergency / "Social and Clinical Psychiatry" - No. 2, 2004.

Ilyin E.P. Psychophysiology of human states. - St. Petersburg: Peter, 2005.

Kalshed D. The Inner World of Trauma: Archetypal Defenses of the Personal Spirit. Per from English. M.: Academic project, 2001.

Kanen V.V., Slutsker D.S., Shafran L.M. Human adaptation in extreme environmental conditions. - Riga: Zvaygens, 1980.

Kaplan G.I. Saddock B.J. Clinical psychiatry (in 2 volumes). - Moscow: Medicine, 1994.

Kassil G.N. The internal environment of the body / Kassil G.N. .M.: Nauka, 1983

Kekelidze ZI Post-traumatic stress disorder in victims of emergency situations // Post-traumatic stress disorder. – M.: GNTSSSP im. V. P. Serbsky, 2005.

Kempinski L. Psychopathology of neuroses. –Warsaw, 1975.

Kindras G.P., Turokhadzhaev A.M. The influence of post-traumatic stress disorders on the adaptation of soldiers-internationalists - veterans of the war in Afghanistan // Sots. and clinical psychiatry. - No. 1, 1992.

Kitaev-Smyk L.A. Probabilistic forecasting and individual characteristics of human response in extreme conditions // Probabilistic forecasting in human activity. – M.: Nauka, 1977.

Kitaev-Smyk L.A. Psychology of stress. - M.: Nauka, 1983.

Kitaev-Smyk L.A. Psychology of stress. Psychological anthropology of stress. - M.: Academic Project, 2009.

Clinical psychology. Dictionary under the general editorship. Petrovsky A. V., editor-compiler Karpenko L. A., ed. Curd N. D. © PER SE 2007.

Kovrova M.V. Psychology and psychoprophylaxis of destructive stress in the youth environment: Method. allowance / Scientific ed. N.P. Fetiskin; Rep. for the issue of V.V. Chekmarev. - Kostroma: KSU im. N.A. Nekrasova, 2000.

Kolodzin B. How to live after a mental trauma. – M.: Chance, 1992.

Kolodzin B. Post-traumatic stress. – M.: Chance, 1992.

Koltsova V.A., Oleinik Yu.N. Soviet psychological science during the Great Patriotic War (1941-1945). M.: Moscow University for the Humanities, Institute of Psychology of the Russian Academy of Sciences, 2006.

Korolenko Ts.P. Human psychology in extreme conditions. - M: Nauka, 1978. Berezin F.B., 1988.

Korystov Yu.N. Emotions, stress, smoking, alcohol consumption and cancer - correlation and causality. Pavlova, 1997.

Kosmolinsky F.P. Emotional stress during work in extreme conditions. – M.: Medicine, 1998.

Kotelnikova A.V. Personal correlates of post-traumatic stress (on the basis of a sample of forced migrants. Author. CD ..... Candidate of Psychology - M., 2009.

Krasnov A.N. General psychology: Textbook. - M., 2006.

Krasnov V. N., Yurkin M. M., Voytsekh V. F. et al. Mental disorders among participants in the liquidation of the consequences of the accident at the Chernobyl nuclear power plant. Social and Clinical Psychiatry. - No. 1, 1993.

Krasnyansky A., Morozov P.V. Post-traumatic stress disorder in Afghan war veterans: Psychiatric convention. M., 1995.

Krasnyansky A.N. Post-traumatic stress disorder in participants in military conflicts // Synapse. - No. 3, 1993.

Lakosina N. D., Trunova M. M. Neuroses, neurotic personality development. - M .: Medicine, 1994.

Langmeyer I., Mateychek Z. Mental deprivation. - Prague, 1982.

Levin P., Frederic E., Waking the tiger - healing trauma. - M .: AST, 2007

Litvintsev S. V. Clinical and organizational problems of providing psychiatric care to military personnel in Afghanistan: Abstract of the thesis. diss... Dr. med. Sciences. - St. Petersburg, 1994.

Lukas K, Seiden G. Silent Grief: Living in the Shadow of Suicide. Translation from English. – M.: Meaning, 2000.

Magomed-Eminov M. Sh., Filatov A. T., Kaduk G. I., Kvasova O. G. New aspects of post-traumatic stress psychotherapy. Kharkov, 1990.

Makarchuk A.V. Psychological consequences of violence in children aged 10–13 years Abstract of the dissertation for the degree of candidate of psychological sciences, Moscow, 2004.

Maklakov A.G., Chermyanin S.V., Shustov E.B. Problems of predicting the consequences of local military conflicts // Psychological journal. - T. 19. No. 2, 1998.

Malkina-Pykh I.G. Psychological assistance in crisis situations. - M .: EKSMO, 2008.

Malkina-Pykh I.G. Psychological assistance in crisis situations.– M.: Eksmo, 2008.

Malova Yu. V. Psychological diagnostics and psychological correction in the complex of measures for the rehabilitation of participants in the LPA at the Chernobyl nuclear power plant // Results and tasks of medical monitoring of the health status of participants in the liquidation of the consequences of the disaster at the Chernobyl nuclear power plant in the long-term period. Materials of scientifically practical conference. - M., 1998.

Malyshenko N.M., Eliseev A.V. Features of stress disorders, which are the consequences of injuries. M.: Progress, 1993.

Marishchuk V. L. Redistribution of functional reserves in the body of an athlete as an indicator of stress // Stress and anxiety in sports. - M, 1984.

Marishchuk V.L. Emotions in sports stress. - St. Petersburg, 1995.

Melnik B. E., Kakhana M. S. Medico-biological forms of stress. - Chisinau, "Shtiintsa", 1981.

Milton E. The evolution of psychotherapy. – M.: Klass, 1998.

Molyako V. A. Psychological consequences of the Chernobyl catastrophe. magazine - T. 13. - No. 1, 1992.

Myager VK Theoretical premises of family psychotherapy//Family psychotherapy in nervous and mental diseases / Ed. V. K. Myager and R. A. Zachepitsky. - L., 1978.

Myager V.K., Mishina T.M., Kozlov V.P. and others. Family psychotherapy in the aspect of psychoprophylaxis / Sixth All-Union Congress of neuropathologists and psychiatrists, T. 1 - M., 1975.

Naenko N.I. Psychic tension.– M.: Ed. Moscow State University, 1976.

Nikolaeva E.I. Psychophysiology. Psychophysiological physiology with the basics of physiological psychology. Textbook. M.: PER SE, 2003.

Aldwin K. Stress, coping and development.–M., 1994.

Olshansky D.V. Psychology of terror. - M .: Academic project, Yekaterinburg: Business book, 2002.

Orel V. E. The phenomenon of "burnout" in foreign psychology: empirical research and perspectives // Psychological journal. 2001.T. 22, no. 1, p. 90–101.

Pavlov I.P. Twenty years of experience in the study of higher nervous activity (behavior) of animals. PSS.– M.–L.: Ed. in the Academy of Sciences of the USSR, 1951.

Padun M. A. Peculiarities of basic beliefs in persons who have experienced traumatic stress. Dissertation for the degree of candidate of psychological sciences. Moscow, 2003.

Parkinson F. Post-traumatic stress: rescue teams and volunteers // Anthology of difficult experiences: social assistance: Collection of articles / Edited by O.V. Krasnova. - MSPU. Obninsk, 2002.

Perret M., Baumann M. Clinical psychology (ed.). - M., 2002.

Petrovsky A. V., Yaroshevsky M. G. Volitional actions // Psychology. Textbook for universities on ped. specialties. - M .: Academy, 1998. .

Petrosyan T. R. Alcohol dependence in patients with post-traumatic stress disorder. Author's abstract…..cand. honey. Sciences. - M., 2008.

Plotnikov V.V. Evaluation of psycho-vegetative indicators in students under conditions of examination stress // Labor Hygiene.– No. 5.– M., 1983.

Portnova, A.A. Acute reactions to stress in children and adolescents affected by the terrorist attack in Beslan: message 1 / Critical Care Medicine. - No. 1, 2005.

Parishioners A.M. Psychological nature and age dynamics of anxiety. - M., 1996.

Psychological stress: development and overcoming. - M .: PER SE, 2006.

Health Psychology / Ed.G. S. Nikiforov. SPb. : Izd.SPGU, 2000.

Psychological assistance to migrants: trauma, culture change, identity crisis / Ed. G. U. Soldatova. - M .: Meaning, 2002

Psychophysiology: Textbook for universities / Ed. Aleksandrova Yu.I. - St. Petersburg, 2006.

Pukhovsky N.N. Psychopathological consequences of emergency situations. - M .: Academic project, 2000.

Pushkarev A.L. Psychodiagnostic examination of patients and disabled people at the stage of medical and professional rehabilitation // Methodical recommendations. - Minsk, 1997.

Pushkarev A.L., Domoratsky V.A., Gordeeva E.G. Post-traumatic stress disorder: diagnostics, psychopharmacotherapy, psychotherapy.– M.: Ed. Institute of Psychotherapy, 2000.

Rean A.A. Psychology and psychodiagnostics of personality. Theory, research methods, workshop. - St. Petersburg: prime-EURO-SIGN, 2006.

Reznik A.M., Savostyanov V.V. Subjective assessment of the significance of combat stress factors in military personnel serving under a contract // Combat stress: mechanisms of stress in extreme conditions: Sat. Proceedings of the symposium dedicated to the 75th anniversary of the GNIII VM M.: Origins, 2005.

Rozhnov V.E. Hypnosis in medicine. Moscow: Medgiz, 1954.

Romke V.G., Kontorovich V.A., Krukovich E.I., 2004. Psychological assistance in crisis situations. - St. Petersburg: Rech, 2004.

Samoukina NV Psychology and pedagogy of professional activity. M., 1999, p. 186–213.

Samoshkina N.V. Psychology of professional activity. SPb 2003.

Sandomiersky M.E. Stress protection. Body technologies. 2nd ed. - St. Petersburg: Peter, 2008.

Svyadgoshch A.M. neuroses. SPb.: Piter, 1998.

Svyadgoshch A.M. Psychotherapy. Manual for doctors. - M., 2000.

Selye G. At the level of the whole organism. - M.: Nauka, 1966.

Selye G. Essays on the adaptation syndrome. – M.: Medgiz, 1961.

Selye G. Stress without distress.–M.: Progress, 1979.

Selye G. Stress of my life. - M.: Nauka, 1970.

Sidorov P.I., Lukmanov M.F. Features of borderline mental disorders in veterans of the war in Afghanistan // Journal of Neurology and Psychiatry. S.S. Korsakova, No. 3, 1997.

Sinitsky V.N., Depressive states (Pathophysiological characteristics, clinic, treatment and prevention). - Kyiv: Naukova Duma, 1986.

Smirnov B.A., Dolgopolov E.V. Psychology of activity in extreme situations. H.: Humanitarian Center, 2007.

Smulevich A.B., Rotshtein V.G. Psychogenic diseases // Guide to psychiatry. Ed. Snezhnevsky A.V., V.2. - M.: Medicine, 1983.

Snekov E.V. Combat and mental trauma. Abstract dis.... Dr. med. Sciences. SPb. 1997.

Sosnin V. A., Krasnikova E. A. Social psychology: textbook. allowance.– M.: FORUM; INFRA-M, 2005.

Stenko Yu.M. Mental hygiene of a sailor. – L.: Medicine, 1981.

Stenko Yu.M. New regimes of work and rest of fishermen in the North-West Atlantic. - Riga: Zvaizgne, 1978.

Suvorova V.V. Psychophysiology of stress. - M., 1975.

Suvorova V.V. Psychophysiology of stress. - M .: Pedagogy, 1975.

Sudakov K.V. Psycho-emotional stress: prevention and rehabilitation. Therapeutic archive. - No. 1, 1997.

Tarabrina NV Psychology of post-traumatic stress: an integrative approach. Author's abstract of diss ... uch. degree of Doctor of Psychology. Sciences. - M, 2008.

Tarabrina N.V. Workshop on the psychology of post-traumatic stress. - M .: Ed. Cogito Center, 2006.

Tarabrina N.V., Bykhovets Yu.V. The experience of the terrorist threat by residents of Moscow: an empirical study // Materials of the conference "Psychological problems of the family and personality in the metropolis" - M., 2007.

Tarabrina N.V., Lazebnaya E.O. Syndrome of post-traumatic stress disorders: current state and problems // Psychological journal. - T. 13. N 2, 1992.

Tarabrina N.V., Petrukhin E.V. Psychological features of perception and evaluation of radiation hazard // Psychological journal. - T.15, 1994.

Tigranyan R. Stress and its importance for the body. From molecule to organism. – M.: Nauka, 1988.

Topchiy M.V. Features of the mental state of students when using a computer as a learning tool. Modern humanitarian knowledge about the problems of social development // Materials of the XIV annual scientific meeting. - Stavropol: Izd. SKSI, 2007.

Topchiy M.V. Adaptation of students to the conditions of educational activity at different age stages. Modern humanitarian knowledge about the problems of social development // Proceedings of the XIII annual scientific meeting of the NCSI. - Stavropol: Ed. SKSI, 2006.

Topchiy M.V. Study of the activity of the hemispheres, the psycho-emotional state of students in the conditions of educational activity. Topical issues of social theory and practice // Collection of scientific articles, issue V. - Stavropol: Izd. SKSI, 2003.

Topchiy M.V. On the tasks of optimizing the structural-functional and socio-psychological adaptation of students' organisms. Modern humanitarian knowledge about the problems of social development // Proceedings of the XI annual scientific meeting of the NCSI. - Stavropol: Izd. SKSI, 2003.

Topchiy M.V. Features of the mental state of students when using a computer as a learning tool. Modern humanitarian knowledge about the problems of social development // Materials of the XIV annual scientific meeting of the NCSI. - Stavropol: Izd. SKSI, 2007.

Topchiy M.V. The development of the phenomenon of test anxiety among students / Modern humanitarian knowledge about the problems of social development // Materials of the XII annual scientific meeting of the SKSI. - Stavropol: Izd. SKSI, 2004.

Topchiy M.V. Emotional and personal characteristics of first-year students as a factor of inclusion in the study group. Topical issues of social theory and practice / Collection of scientific articles, issue IV. - Stavropol.: Izd. SKSI, 2004.

Trubitsina L.V. The process of trauma. - M .: Meaning; CheRo, 2005.

Ushakov G.K. Children's psychiatry. - M .: Medicine, 1973.

Ushakov I. B., Karpov V. N. The brain and radiation. - M .: Publishing House of the GNII AiK, 1997.

Frank V. Man in search of meaning. - M .: Progress, 1990.

Freud Z. Introduction to psychoanalysis: Lectures. Moscow: Nauka, 1989.

Fress P., Piaget J. Experimental psychology. - Issue 4. - Moscow: Progress, 1973.

Kharitonov A.N., Korchemny P.A. (ed.), Psychology and psychotherapy in the conditions of military activity. - M .: VU., 2001.

Cold M.A. Psychology of intelligence. Research paradoxes. - 2nd ed., revised. and additional - St. Petersburg: Peter, 2002.

Chapek A.V. Ground training experience//Issues of aviation medicine.– M.: Foreign Literature, 1954.

Churilova T.M. The influence of mental health and socio-psychological adaptation on the psychological characteristics of schoolchildren. Modern humanitarian knowledge about the problems of social development // Materials of the XIII annual scientific meeting. - Stavropol: SKSI, 2006.

Churilova T.M. Information and psychological terrorism as a cause of post-traumatic stress disorder / Information and analytical materials based on the results of interdepartmental interaction on a pilot project “social assistance to minors affected during armed conflicts. - Stavropol: Ed. SKSI, 2007.

Churilova T.M. Unforeseen loss of an object of special affection as a cause of post-traumatic stress disorder in students / Physiological problems of adaptation: Interregional conference. - Stavropol, April 21-22, 2003 / Materials of the conference. - Stavropol: Ed. SKSI, 2003.

Churilova T.M. Evaluation of students' adaptation to academic loads during workshops in biomedical disciplines / Modern humanitarian knowledge about the problems of social development // Materials of the XI annual scientific meeting of the NCSI. - Stavropol: Izd. SKSI, 2004.

Churilova T.M. Manifestations of signs of anxiety among students under stress. Society and personality: integration, partnership, social protection // Proceedings of the First International Conference. - Stavropol, 2004.

Churilova T.M. Changes in the functional indicators of the students' organism depending on the modes of work at the computer. Materials of the interregional scientific-practical conference "Priorities of culture and ecology in education" - Stavropol: Ed. SKSI, 2003.

Churilova T.M. Ecological psychophysiology: applied aspects / IV Winter scientific and practical psychological session "Ecology of educational space". - Pyatigorsk, 2003.

Churilova T.M. The influence of traumatic experience on the socio-psychological adaptation of students' personality / Psychological science: theoretical and applied aspects of research. - Karachaevsk, 2007.

Shcherbatykh Yu. V. Examination and students' health // Higher education in Russia, no. 3. M., 2000.

Emotional stress / Ed. L. Levy. L .: Medicine, 1970.

Ader R. Psycho-neuro-immunology, New York, Academic Press, reed, revue etccompl., 1981.

Appley & Trumbull. Dynamics of Stress: Physiological, Psychological and Social Perspectives. N.Y.: Plenum, 1986.

Arnold A. L. Outpatient treatment of posttraumatic stress disorder // Military Medicine. 1993 Vol. 158. No. 6. P.4–5.

Arnold M. Stress and emotion. In "Psychological stress" 1967.N 4, Appkton-Century-Crotts, p. 123-140.

Averill J. R. Anger and aggression: an essay on emotion. New-York, Springer-Verlag, 1982.

Averill J. R. Personal control over aversive stimuli and its relationship to stress // Psychological Bulletin. 1973.

Barley S. & Knight D. Toward a cultural theory of stress complaints. In Research in Organizational Behavior, 14, p.1, JAI Press, 1992.

Bauman U., Cobb S. Social support as a moderation of life stress//Psychosomatic Medicine. 1976. V. 38. N 5

Beck A.T. Cognitive therapy of depression: New perspectives. In P.J. Clayton & J.A. Barnett (Eds.). Treatment of depression: Old Controversies, New York Raven Press. 1983.

Beck A.T. Wahrnehmung der Wirklichkeit und Neurose.–München, 1979.

Bleach A., Kron S., Margalit C., Inbar C., Kaplan Z., Cooper S., Solomon Z. Israeli psychological casualties of the Persian Gulf war: characteristics, therapy, and selected issues // Isr-J-Med -Sci. 1991.

Boudewyns P. A. Posttraumatic stress disorder: conceptualization and treatment // Prog-Behav-Modif. 1996. N.P. 165-189.

Boulander G, Kadushin C. The Vietnam Veteran redefined: Fact and Function..–N.-Y. Hillscale, 1986.

Boulander G., Kadushin C. The Vietnam Veteran Redefined: Fact and Fiction.–N.-Y. Hillscale, 1986.

Bowlby J. Attachment and loss: Vol. 3. Loss: Sadness and depression. N.Y., Basic Books, 1980.

Breslau N., Davis G.C. Migraine, major depression and panic disorder: a prospective epidemiologic study of young adults. Cephalalgia 12(2):85–90. American Journal of Psychiatry, 153(3), 1992).

Breslau N., Davis G.C. Posttraumatic Stress Disorder in an Urban Population of Young Adults: Risk Factors for Chronicity., 1992.

Breslau, N. & Davis, G.C. Archives of General Psychiatry, 144 (5), 578 - 583. (1992).

Briner R., The State of the Psychological Contract in Employment, Institute of Personnel and Development, Issues in People Management, No. 16.1996.

British Journal of Medical Psychology, 64, 317–329. 1987.

Byrne B. M. Burnout: testing for the validity, replication and invariance of causal structure across elementary, intermediate and secondary teachers // American Educational Research J. 1994.

Carlson J. G. Chemtob C. M., Hedlund N. L. et. al. // Hawaii Medical Journal. Characteristics of veterans in Hawaii with and without diagnoses of post-traumatic stress disorder, 1997.

Carver, C.S. Models of sentences verification and linguistic comprehension // Psychological Review, 2003.

Chemtob C. M., Novaco R. W., Hamada R. S., Gross D. M. Cognitive-behavioral Characteristics of veterans. - N.-Y.: Humanities Press, 1994.

Collins D.L., de Carvalho A.B. Chronic stress from the Goiania 137 Cs radiation accident. Behavioral Medicine 18(4):149–157, 1993.

Cooper C. Payne R. (Eds.). Stress at work, N.-Y.: Wiley, 1978.

Coter C. N. and Appley, M. N. Motivation: theory and research, 1964, N.-Y., Wiley.

Davidson L. U. & Baum A. Chronic stress and post-traumatic stress disorders. Journal of Consulting and Clinical Psychology 54, 303–307, 1986.

Delong is Anita et al. Relationship of Daily Hassles, Uplifts, and Major Life Events to Health Status/Health Psychology, 1982.

Dew M.S., Bromet E.J. Predictors of temporal patters of psychiatric distress during 10 years following the nuclear accident at Three Mile Island // Social Psychiatry and Psychiatric Epidemiology, 1993.

Egendoif A., Kadushin C, Laufer R., Sloan L. Legacies ol Viol nain: comparative adjustment of veterans and their peers. Washington, D.C.: U.S. Government Printing Office, 1981.

Etinger L. Strom A. Mortality and Morbidity after Excessive Stress. Oslo. Universitetsvorlaget; New York: Humanities Press, 1973.

Everly G.S. Jr. A clinical guide to the treatment of human stress resse. N.Y.: Plenum Press, 1989.

Eysenck M.W. cognitive psychology. Hove: Lowrence Erlboaum, 1995.

Figley C. R. Trauma and its Wake: The Study and Treatment of Post-Traumatic Stress Disorder. New York: Brunner/Mazel, 1985.

Philipp S.H. Kritische Lebensereignisse (2 Aufl.) Weinheim: Beltz Psychologie Verlags Union, 1990.

Fisher S. Stress and the perception of control. – London: Elbaum, 1984.

Folkman S., Lazarus R. S. Coping as a mediator of emotion // Journal of Personality and Social Psychology. 1988.

Frijda N. H. The emotions. Cambridge and New York: Cambridge University Press, 1986.

Gardiner A., ​​Spiegel H. War stress and neurotic illness. New York: Ocher, 1941.

Giddens A. The Constitution of Society. Outline of the Theory of Structuration. Cambridge: Polity (publisher), 1984.

Glass D.C., Singer J. Urban sress. N.-Y.:Acad.press, 1972.

Goodwin D.D. Spouses "s time allocation to household work: A review and critique // Lifestyles: Family and Economic Issues, Vol. 12, 1999.

Green A. H. Children Traumatized by Physical Abuse. - American Psychiatric Association, 1995.

Green B. L., Grace M. C, Lindy J. D. et al. Levels of functional impairment following a civilian disaster: The Beverly Hills Supper Club Fire // J. Consult, and Clin. Psychol. 1983.

Green B.L., Lindy J.D., Grace M.C. Posttraumatic stress disorder // Journal of Nervous and Mental Disease, 1985.

Greenberg E. R. and Canzone C., Organizational Staffing and Disability Claims–(New York: American Management Association Report, 1996.

Grieger T.A., Fullerton C.S., and Ursano R.J., Posttraumatic stress disorder, alcohol use, and perceived safety after the terrorist attack on the Pentagon, Psychiatric Services, 54: 1380–1383, 2003.

Grinker R.P., Spiegel J.P. Men under stress. Philadelphia: Blakiston, 1945.

Harrison R. V. Person-environment fit and job stress / Stress at work, C. Cooper and R. Payne (Eds.), N. Y.: Wiley, 1978.

Hobfolls. E. The ecology of stress. - N.Y.: Hemisphere, 1988.

Holmes T.H., Rahe R.H. The social readjustment rating scale // Journal of Psychosomatic Research, N 11, 1967.

Holt P., Fine M.J., Tollefson N. Mediating stress: Survival of the hardy // Psychology in the Schools. 1987.

Horowitz M. J., Wilner N. Y., Kaltreider N., Alvarez W. Signs and symptoms of posttraumatic stress disorder // Archives of General Psychiatry. 1980.

Horowitz M.J. person schemas. In: Horowitz M.J. (ed) Person schemas and maladaptive interpersonal patterns. Univ. of Chicago Press, Chicago, 1991. Bowlby J. Attachment and loss. 1.Attachment. Basic Books, N.Y., 1969.

Horowitz M.J. Stress-response syndromes //Hospital and Community Psychiatry. V.7, 1986.

Horowitz M.J., WilnerN.J., Alvarez W. Impact of event scale: A measure of subjective stress // Psychosom. Med. - 1979.

Horowitz M.J. Clinical phenomenology of narcissistic pathology. Psychiatric Clinics of North America 12:531–539. 1989.

Ivancevich J. M., Matteson M. T. Stress and work: A managerial perspective. Glenview, IL: Scott, Foresnian, 1980.

James W. Mason "A Historical View of the stress Field" International Journal of stress Management 3, 1996.

Janoff-Bulman R. Victims of violence // Psychotraumatology / Eds. G.S.Kr.Everly, J.M. Lating.–N-Y.:Plenium Press, 1995.

Jefferson A. Singer M. S. Neale, and Schwartz G. E., "The Nuts and Bolts of Assessing Occupational Stress: A Collaborative Effort with Labor", in Stress Management in Work Settings, ed. Lawrence R. Murphy and Theodore F. Schoenborn (Washington, D.C.: National Institute for Occupational Safety and Health, 1987.

Jones / Knapp T.P., Garrett W.E. Stress fractures, general concepts. Clin. Vol. 30, 1997.

Jones J. Stress in psychiatric nursing. In Stress in Health Professionals (eds R.

Kannek A.D. et al. Comarison of Two Modeso of Stress Management: Laily Hassles and Uplits Versus Major Lafe Events/Jornal of Behavioral Medicine 4, 1981.

Kardiner A. The Traumatic Neuroses of WAR .– N.Y., 1941.

Kilpatrick D.G., Vernon L.J., Best C.L. Factors predicting psychological distress avong rape victims // Trauma and wake / Ed. Figley C.R.–N.Y. V.1.– 1985.

Kimball C. P. Liaison psychiatry as a systems approach to behavior // Psy-chother. Psych., 1979. V. 32. – No. 1-4. - P. 134-147.

Kohn P. M., Lafreniere K., Gurevich M. Hassles, health and personality and Social Psychology. Vol. 61, 1991.

Kolb L. C, Multipass! L. R. The conditioned emotional response: A subclass of chronic and delayed post-traumatic stress disorder// Psychiatric Annals, 1984, vol. 12

Konkov F. Peculiarities of primary psychological interventions of families of the earthquake survivors in Armenia. Unpublished paper, Traumatic Stress Recovery Section of the Association of Practical Psychologists. Moscow, 1989.

Konkov F. Traumatic stress as the consequence of progressive, social trauma. Unpublished paper, Traumatic Stress Recovery Section of the Association of Practical Psychologists. Moscow, 1989.

Kormos H.R. The nature of combat stress / / Stress disorders among Vietnam veterans. N.Y.: Brunner and Mazel, p. 3–22, 1978.

Krohne H.W., Fuchs J., Stangen K. Operativever Stress und seine Bewaltigung // Zeitschrift fur Gesundeheitspsychologie, 1994.

Krystal H. Trauma and affects. Psychoanal Study Child. –N.-Y., 1978.

Kulak R. A., Schwinger W. E., Fairbank J. A., Hough R. L, Jordan B. K., Marmar C R. Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel, 1990.

Laireiter A. R., Baumann U. Klinich-psychologische Soziodiagnostik: Protektive Variablen und soziale Anprassung. Diagnostica, 1988.

Lasarus R.S., Folkmann S. Stress, appraisal and coping.–New York, NY: Springer Publishing Co., 1984.

Lazarus R. S. From psychological stress to the emotions: A history of changing gutlooks // Annual Review of Psychology // Vol. 44, 1993.

Lazarus R. S., & Alfert E. The short-circuiting of threat by experimentally altering cognitive appraisal. Journal of Abnormal and Social Psychology, // The Psychiatric Clinics of North America / Ed. D. A. Tomb. 1994, vol. 8. 1964.

Lazarus R. S., Launier R. Stressbezogene Transaktioncn zwischen Person und Umwelt. In: R. Nitsch (Hrsg.). Stress: Theorien, Untersuchungen, Massnahmen. Bern: Huber, 1981.

Lazarus R. S., Launier R. Stress-related transactions between person and environment. In: L A. Pervin, M. Lewis. (Eds.). Perspectives in interactional psychology. New York: Plenum Press, 1978.

Lazarus R., Psychilogical Stress and the Coping Process. New York: McGraw-Hill Book Co., 1966.

Lee E., Lu F. Assessment and treatment of Asian-American survivors of mass violence // Journal of Traumatic Stress. - 1989. - V. 2. - P. 93-120.

Lettner K. Negative Aspektc sozialer Beziehungcn und sozialer Unterstutzung. Unvcroff. Diss., Salzburg: Paris; London: Universitat, 1994.

Leventhal H., SchererK. R. The relationship of emotion to cognition: A functional approach to a semantic controversy// Cognition and Emotion. 1987.

Lifton R.J. Home from the war. New-York; Basik books, 1973.

Lifton R.J. Understanding the traumatized self // Wilson J.P., Harel Z., Kahana B. (Eds.) Human adaptation to extreme stress. N.Y. & L., Plenium Press, 1988.

Maslach C. Burnout: A multidimensional perspective // ​​Professional burnout: Recent developments in the theory and research. Washington D.C.; Taylor & Trancis, 1993.

May R. Man "s search for himself. N.- Y .: Norton, 1953.

North K. et al. Types of drinks consumed by infants at 4 and 8 months of age: sociodemographic variations. Journal of human nutrition and dietetics, 13: 71–82 (1999).

Orr D. B. Psychophysiologic testing for post-traumatic stress disorder Forensic psychiatric application. N.-Y., 1993.

Orr S.P., Claiborn J.M., Altman B., Forgue D.F., de Jong J.B., Pitman R.K. & Herz L.R. Psychometric Profile of PTSD, Anxious, and Healthy Vietnam Veterans: Correlations with Psychophysiologic Responses // Journal of Consulting and Clinical Psychology. 1990. No. 58.

Paykel E.S. Recent life events in the development of depressive disorders: implications for the effects of stress. N.-Y.: Acad. press, 1984.

Paykel, E. S. Stress and life events. In L. Davidson & M. Linnoila (Eds.), Risk factors for youth suicide. New York: Hemisphere. 1991.

Pearlin L. I. The social context of stress. Handbook of sress. Theoretical and clinical aspects. New York: The Free Press, 1982.

Pitman R.K. Post-traumatic stress Disorder, Conditioning, and Network Theory // Psychiatric Annals. 1988.

Pitman R.K., Altman B, Greenwald et al. Psychiatric applications during flooding therapy for posttraumatic stress disorder //J. of Clinical Psychiatry, 1991.

Pollock J.C. Cambridge, London: Cambridge University Press. Lave, J. Cognition in practice: Mind, mathematics and culture in everyday life, 1988.

Pollock J.C., & Sullivan, H.J. Practice mode and learner control in computer based instruction // Contemporary Educational Psychology, 1990.

Sandler J., Dreher A.U., Drews S. An approach to conceptual research in psychoanalysis, illustrated by a consideration of psychic trauma. International Review of Psycho-Analysis, 1991, 18:1991.

Schabracq M. Winnubst & Cooper (Eds.) Everyday Well-Being and Stress in Work and Organizations / In The Handbook of Work and Health Psychology. –N.-Y. John Wiley and Sond, 2003.

Scull C. S. Existential themes in interviews with Vietnam veterans: Doctoral dissertation. Institute of Transpersonal Psychology, 1989.

Shore J.H., Tatum E.L., Volhner N.W., et al. Community patterns of posttraumatic stress disorders. Aust N Z J Psychiat. 2002; 36:515-520. 37.

Simon and Schuster. The emotional brain. NY: Leeuwenberg, E.L.J. 1978.

Solomon Z., Mikulincer M., Blech A., 1988. Characteristic Expressions of Combat-recanted PTSD among Israeli soldiers in the Lebanon War// Behavioral Med., V.14, No. 4, P.171-178, 1982

Spielberger C.D., O "Neil H.F., Hansen J., Hansen D.N. Anxiety Drive Theory and Computer Assisted Learning // Progress in Exp. Pers. Res. - N.-Y .; L, 1972.

Tarabrina Nadya V. The empirical study of the terrorist threat / In proceeding NATO Advanced Research Workshop. Social and Psychological Factors in the Genesis of Terrorism. Castelvecchio Pascoli, Italy. 2005.

Taylor S.E. Adjustment to threatening events. A theory of cognitive adaptation. American psychologist, November 1983.

The mismeasure of woman. New York: Simon Schuster. Travis C. & Offir C. 1977.

Ulrich C. Stress and sport. In "Science and medicine of exercise and sports" Ed. W. R. Johnson. N.-Y, Harper and Bros., 1960.

Van der Veer G. Psychotherapy with Refugees. Amsterdam: SCS, 1991.

Van der Kolk B.A. psychological trauma. Washington: American Psychiatric Press, 1987.

Van der Kolk B.A., McFarlaneA. C, Weisaeth L. Traumatic stress: the effects of overwhelming experience on mind, body, and society. - N. Y: Guilford Press, 1996.

Van Maanen J., Barley S. R. Occupational communities: Culture and control in organizations. In B. M. Staw and L. L. Cummings (Eds.) Research in Organizational Behavior, 1984.

Veiel H.O.F., Ihle M. Das Copingkonzept Undterstutzungskonzept: Ein Strukturvergleich. In A.-R. laireiter. Socialez Network und Social Unterstutzung: Konzepte, Methoden und Befunde. Bern: Huber, 1993

PTSD (post-traumatic stress disorder)- this is a mental illness that occurs a few weeks or months after a severe life-threatening event - military operations (both among soldiers and civilians), captivity, man-made disasters, attacks, rape, natural disasters, terrorist acts.

The diagnosis and treatment of post-traumatic stress disorder is carried out by a psychotherapist.

The disorder may begin weeks or years after the traumatic experience. Traumatic neurosis is a person's "stuck" in an extreme situation, he constantly mentally returns to it and cannot forget.

The criteria for PTSD are as follows:

1. The person was in a life or health threatening situation, was a participant or even just a witness.
2. During the event, he experienced helplessness, horror, fear.
3. The situation has remained in the past, but the patient with PTSD constantly experiences it - mentally, in nightmares, returns to it again and again. He does not share his experiences with those around him, he keeps everything in himself.

A person is not able to objectively assess their well-being and cope with emotions. He begins to react inadequately to real events, does not perceive new information, tries to isolate himself from communication, reacts sharply to criticism and jokes.

A person becomes a shadow of his former self, because he does not exist in the present. Seeing a psychotherapist is the only effective way to deal with a traumatic disorder.

Features of development and diagnosis of PTSD

The breakdown is often preceded by a latent period of relative calm. After an injury, a person can lead a normal life for six months or even longer. In PTSD, the signs that signal the disease are as follows:

• experiences, anxiety and tension associated with the traumatic situation. They are repeated at any time of the day: at night - in nightmares, during the day - in thoughts, memories;
• there are flashbacks- a person is “transferred” to a past situation, re-experiencing it very vividly and ceases to orient himself in reality, the state is similar to clouding of consciousness. Last from a few seconds to several hours;
• a person closes in on himself loses interest in work and communication. At the same time, he can react to innocent remarks and jokes with impulsive, severe beatings.

Post-traumatic stress disorder is characterized by agitation, aggression, increased caution, and suspicion. A person avoids any mention of what happened (actions, places, conversations), becomes anxious and emotionally inhibited.

Internal tension leads to fatigue, apathy, emptiness. Memory and attention deteriorate. The person becomes distracted, which leads to constant mistakes at work. Often this condition is accompanied by depressed mood (depression), thoughts of suicide.

In post-traumatic stress disorder, symptoms may include complaints of:

• insomnia or superficial sleep;
• increased sweating;
• palpitations, interruptions in the work of the heart;
• fatigue, hypersensitivity.

The psychotherapist diagnoses disease at an individual consultation - collects an anamnesis (life history), evaluates complaints, tries to find out the causes of the disorder. Psychic trauma can trigger the development of other mental illnesses - severe depression, endogenous diseases. For differential diagnosis, a pathopsychological study is also used (performed by a clinical psychologist).

Treatment for post-traumatic stress disorder (PTSD)

Psychotherapeutic sessions are the basis of recovery. They help the patient accept and process the traumatic experience in order to move on. Treatment for PTSD includes:

1. Individual psychotherapy.
2. Medical correction of symptoms (anxiety, depression, irritability, sleep problems).
3. BOS-therapy.
4. Group therapy.

PTSD can be treated with cognitive behavioral psychotherapy. The psychotherapist teaches the patient not to run away from the traumatic situation, helps to increase self-control and cope with painful memories.

Biofeedback Therapy (Biofeedback Therapy)- these are relaxation techniques that relieve internal tension and reduce muscle stiffness. The patient learns to control breathing, pulse, pressure. These techniques he can use at an inauspicious moment to regain control of his condition.

Biofeedback therapy is a modern non-drug method of treating mental disorders that helps patients gain control over their bodies.

Group therapy is based on the support and interaction of people who have also experienced various traumatic situations. At the sessions, they learn to express their thoughts, show emotions and look with hope into the future. Thanks to joint work, an increase in the adaptive capabilities of a person occurs.

For post-traumatic stress disorder, treatment also includes medications. If you have symptoms of depression, your doctor will prescribe antidepressants. Sleeping pills, anxiolytics or antipsychotics are prescribed for a short course to restore sleep and reduce anxiety levels. Medicines are prescribed only if necessary and after a preliminary discussion with the patient.