In post-traumatic stress disorder, ptsd is a mental disorder. Causes, signs, diagnosis and treatment of post-traumatic stress disorder

Each of us dreams of living life calmly, happily, without incidents. But, unfortunately, almost everyone experiences dangerous moments, are subjected to severe stress, threats, even attacks and violence. What should a person who has suffered from post-traumatic stress disorder do? After all, the situation does not always pass without consequences; many suffer from serious mental pathologies.

To make it clear to those who do not have medical knowledge, it is necessary to explain what PTSD means and what its symptoms are. First, you need to imagine, at least for a second, the state of a person who has experienced a terrible incident: a car accident, beating, rape, robbery, death of a loved one, etc. Agree, this is difficult to imagine, and scary. At such moments, any reader will immediately ask for a petition - God forbid! And what can we say about those who actually found themselves victims of a terrible tragedy, how can they forget about everything. A person tries to switch to other activities, get carried away by a hobby, devote all his free time to communicating with loved ones and friends, but all in vain. A severe, irreversible acute reaction to stress, terrible moments, causes stress disorder, post-traumatic stress disorder. The reason for the development of pathology is the inability of the reserves of the human psyche to cope with the transferred situation; it goes beyond the scope of the accumulated experience that a person can survive. The condition often does not appear immediately, but approximately 1.5-2 weeks after the event, for this reason it is called post-traumatic.

A person who has suffered severe trauma may suffer from post-traumatic stress disorder

Situations that are traumatic to the psyche, whether isolated or repeated, can disrupt the normal functioning of the mental sphere. Provoking situations include violence, complex physiological injuries, being in the zone of a man-made or natural disaster, etc. Directly at the moment of danger, a person tries to pull himself together, save his own life, his loved ones, tries not to panic or is in a state of stupor. After a short time, obsessive memories of what happened arise, which the victim tries to get rid of. Post-traumatic stress disorder (PTSD) is a return to a difficult moment that has “affected” the psyche so much that serious consequences arise. According to the international classification, the syndrome belongs to the group of neurotic conditions caused by stress and somatoform disorders. A clear example of PTSD is military personnel who served in “hot” spots, as well as civilians who find themselves in such areas. According to statistics, after experiencing stress, PTSD occurs in approximately 50-70% of cases.

The most vulnerable categories are more susceptible to mental trauma: children and the elderly. The former have insufficiently developed protective mechanisms; the latter, due to the rigidity of processes in the mental sphere, loss of adaptive abilities.

Post-traumatic stress disorder - PTSD: causes

As already indicated, a factor in the development of PTSD are disasters of a mass nature, which pose a real threat to life:

• war;
• natural and man-made disasters;
• terrorist attacks: being held captive as a prisoner, experiencing torture;
• serious illnesses of loved ones, own life-threatening health problems;
• physical loss of relatives and friends;
• experienced violence, rape, robbery.

In most cases, the intensity of anxiety and experiences directly depends on the characteristics of the individual, his degree of susceptibility and impressionability. The person’s gender, age, physiological and mental state also matter. If mental trauma occurs regularly, then mental reserves are depleted. An acute reaction to stress, the symptoms of which are common in children, women who have experienced domestic violence, in prostitutes, can occur in police officers, firefighters, rescuers, etc.

Experts identify another factor that contributes to the development of PTSD - neuroticism, in which obsessive thoughts about bad events arise, there is a tendency to neurotic perception of any information, and a painful desire to constantly reproduce a terrible event. Such people always think about dangers, talk about serious consequences even in non-threatening situations, all thoughts are only about the negative.

Cases of post-traumatic disorder are often diagnosed in people who have survived war.

Important: those prone to PTSD also include individuals suffering from narcissism, any type of addiction - drug addiction, alcoholism, prolonged depression, excessive addiction to psychotropic, neuroleptic, sedative medications.

Post-traumatic stress disorder: symptoms

The psyche’s response to severe stress experienced is manifested by certain behavioral traits. The main ones are:

• state of emotional numbness;
• constant reproduction in thoughts of the experienced event;
• detachment, avoidance of contacts;
• desire to avoid important events, noisy companies;
• detachment from society in which the incident is repeated again;
• excessive excitability;
• anxiety;
• attacks of panic, anger;
• feeling of physical discomfort.

The PTSD condition usually develops over a period of time: from 2 weeks to 6 months. Mental pathology can persist for months or years. Depending on the severity of the manifestations, experts distinguish three types of PTSD:

1. Spicy.
2. Chronic.
3. Deferred.

The acute type lasts for 2-3 months; in the chronic type, symptoms persist for a long period of time. In the delayed form, post-traumatic stress disorder can manifest itself over a long period of time after a dangerous event - 6 months, a year.

A characteristic symptom of PTSD is detachment, alienation, a desire to avoid others, that is, there is an acute reaction to stress and adaptation disorders. There are no elementary types of reactions to events that arouse great interest among ordinary people. Regardless of the fact that the situation that traumatized the psyche is already far behind, patients with PTSD continue to worry and suffer, which causes a depletion of resources capable of perceiving and processing a fresh information flow. Patients lose interest in life, are unable to get pleasure from anything, refuse the joys of life, become unsociable, and move away from former friends and relatives.

A characteristic symptom of PTSD is detachment, aloofness, and a desire to avoid others.

Acute reaction to stress (micd 10): types

In the post-traumatic state, two types of pathologies are observed: obsessive thoughts about the past and obsessive thoughts about the future. At the first sight, a person constantly “replays” like a film an event that traumatized his psyche. Along with this, other scenes from life that brought emotional and mental discomfort can be “connected” to the memories. The result is a whole “compote” of disturbing memories that cause persistent depression and continue to traumatize the person. For this reason, patients suffer:

• eating disorders: overeating or loss of appetite:
• insomnia;
• nightmares;
• outbursts of anger;
• somatic disorders.

Obsessive thoughts about the future manifest themselves in fears, phobias, and groundless predictions of the repetition of dangerous situations. The condition is accompanied by such symptoms as:

• anxiety;
• aggression;
• irritability;
• isolation;
• depression.

Often, affected individuals try to disconnect from negative thoughts through the consumption of drugs, alcohol, and psychotropic drugs, which significantly worsens the condition.

Burnout syndrome and post-traumatic stress disorder

Two types of disorders are often confused - EMS and PTSD, however, each pathology has its own roots and is treated differently, although there is a certain similarity in symptoms. Unlike stress disorder after trauma, caused by a dangerous situation, tragedy, etc., emotional burnout can occur during a completely cloudless, joyful life. The cause of SEV may be:

• monotony, repetitive, monotonous actions;
• intense rhythm of life, work, study;
• undeserved, regular criticism from the outside;
• uncertainty in the assigned tasks;
• feeling undervalued and useless;
• lack of material and psychological encouragement for the work performed.

SEW is often called chronic fatigue, which can cause people to experience insomnia, irritability, apathy, loss of appetite, and mood swings. The syndrome is more likely to affect individuals with the following characteristic character traits:

• maximalists;
• perfectionists;
• overly responsible;
• those who are inclined to give up their interests for the sake of business;
• dreamy;
• idealists.

Often, housewives who deal with the same routine, monotonous task every day come to specialists with SEV. They are almost always alone, and there is a lack of communication.

Burnout syndrome is almost the same as chronic fatigue

The risk group for pathology includes creative individuals who abuse alcohol, drugs, and psychotropic drugs.

Diagnosis and treatment of post-traumatic stress situations

The specialist makes a diagnosis of PTSD based on the patient’s complaints and analysis of his behavior, collecting information about the psychological and physical trauma he has suffered. The criterion for establishing an accurate diagnosis is also a dangerous situation that can cause horror and numbness in almost all people:

• flashbacks that occur both in sleep and wakefulness;
• the desire to avoid moments reminiscent of the stress experienced;
• excessive excitement;
• partial erasing of a dangerous moment from memory.

Post-traumatic stress disorder, the treatment of which is prescribed by a specialized specialist - a psychiatrist, requires an integrated approach. An individual approach to the patient is required, taking into account the characteristics of his personality, type of disorder, general health condition and additional types of dysfunctions.

Cognitive behavioral therapy: the doctor conducts sessions with the patient in which the patient fully talks about his fears. The doctor helps him look at life differently, rethink his actions, and directs negative, obsessive thoughts into a positive direction.

Hypnotherapy is indicated for acute phases of PTSD. The specialist brings the patient back to the moment of the situation and makes it clear how lucky the survivor is who has experienced stress. At the same time, thoughts switch to positive aspects of life.

Drug therapy: antidepressants, tranquilizers, beta blockers, antipsychotics are prescribed only when absolutely necessary.

Psychological assistance in post-traumatic situations may include group psychotherapy sessions with individuals who have also experienced an acute reaction during dangerous moments. In such cases, the patient does not feel “abnormal” and understands that most people have difficulty surviving life-threatening tragic events and not everyone can cope with them.

Important: the main thing is to see a doctor on time, when the first signs of a problem appear.

Treatment for PTSD is carried out by a qualified psychotherapist

By eliminating incipient mental problems, the doctor will prevent the development of mental illnesses, make life easier and help you overcome negativity easily and quickly. The behavior of those close to the suffering person is important. If he does not want to go to the clinic, visit the doctor yourself and consult with him, outlining the problem. You should not try to distract him from difficult thoughts on your own, or talk in his presence about the event that caused the mental disorder. Warmth, care, common hobbies and support will be just the thing, by the way, and the black streak will quickly change to a bright one.

PTSD (Post-Traumatic Stress Disorder) is a special set of psychological problems or painful behavioral abnormalities dictated by a stressful situation. Synonyms for PTSD are PTSS (Post-traumatic stress syndrome), “Chechen syndrome”, “Vietnamese syndrome”, “Afghan syndrome”. This condition occurs after a single traumatic or multiple repeated situations, for example, physical trauma, participation in hostilities, sexual violence, threat of death.

Features of PTSD include the manifestation of characteristic symptoms for more than a month: involuntary recurrent memories, high levels of anxiety, avoidance or loss of memory of traumatic events. Statistics show that most people do not develop PTSD after traumatic situations.

PTSD is the most common psychological disorder in the world. Statistics say that up to 8% of all inhabitants of the planet experience this condition at least once during their lives. Women are susceptible to this disorder 2 times more often than men due to reactivity and physiological instability to a stressful situation.

Causes of PTSD

This condition is caused by the following traumatic influences: natural disasters, terrorist acts, military actions, which include violence, hostage-taking, torture, as well as severe long-term illnesses or death of loved ones.

In many cases, if the psychological trauma is severe, it is expressed in feelings of helplessness, intense, extreme horror. Traumatic events include service in law enforcement agencies, domestic violence, where he witnesses serious crimes.

People develop post-traumatic stress disorder due to post-traumatic stress. The features of PTSD are expressed in the fact that the individual, having managed to adapt to various life circumstances, has changed internally. The changes that happen to him help him survive, no matter what conditions he finds himself in.

The degree of development of the pathological syndrome depends on the level of the individual’s participation in a stressful situation. Also, the development of PTSD can be influenced by the social and living conditions in which the individual finds himself after the trauma he has experienced. The risk of developing a disorder is greatly reduced when there are people around who have experienced a similar situation. Often, individuals with poor mental health and increased reactivity to environmental stimuli are susceptible to PTSD.

In addition, there are other individual characteristics that provoke the occurrence of the disorder:

— hereditary factors (mental illness, close relatives, alcoholism, drug addiction);

- childhood psychological trauma;

- nervous, concomitant mental pathologies, diseases of the endocrine system;

— difficult economic and political situation in the country;

- loneliness.

One of the most common causes of PTSD is participation in combat. A war situation develops in people a neutral mental attitude towards difficult situations, but these circumstances, remaining in memory and emerging in peacetime, cause a strong traumatic effect. The majority of participants in hostilities are characterized by disturbances of internal balance.

What are the signs of PTSD? The criteria for PTSD are events that go beyond normal human experience. For example, war horrors have an impact due to their intensity, as well as their frequent repetition, which does not help a person to come to his senses.

The other side of PTSD affects the inner world of the individual and is associated with his reaction to experienced events. All people react differently. One person may be permanently traumatized by a tragic incident, while another may be largely unaffected.

If the injury is relatively minor, then increased anxiety and other signs will disappear within a few hours, days, weeks. If the trauma is severe or traumatic events are repeated many times, the painful reaction persists for many years. For example, for combat veterans, an explosion or the rumble of a low-flying helicopter can cause an acute stressful situation. At the same time, the individual strives to feel, think, and act in such a way as to avoid unpleasant memories. The human psyche with PTSD develops a special mechanism to protect itself from painful experiences. For example, an individual who has experienced the tragic death of loved ones will subconsciously avoid a close emotional connection with anyone in the future, or if a person believes that at a crucial moment he showed irresponsibility, then in the future he will not take responsibility for anything.

“Combat reflexes” do not seem unusual to a person until he finds himself in peacetime and makes a strange impression on people.

Help with PTSD for participants in tragic events includes creating an atmosphere so that people can rethink everything that is happening to them, analyze their feelings and internally accept and come to terms with the experience. This is necessary in order to continue to move forward in life and not get stuck on your experiences. It is very important for people who have experienced military events or violence that they are surrounded by love, harmony, and understanding at home, but often this is not the case and at home people are faced with misunderstanding, lack of a sense of security and emotional contact. Often people are forced to suppress their emotions, not allowing them to come out, at the risk of losing them. In these situations, nervous mental tension does not find a way out. When an individual for a long time does not have the opportunity to relieve internal tension, then his psyche and body themselves find a way to get along with this state.

PTSD symptoms

The course of PTSD is expressed in repeated and obsessive reproductions of traumatic events in the mind. Often the stress experienced by the patient is expressed in extremely intense feelings, causing suicidal thoughts to stop the attack. Characteristic nightmares and recurring dreams and involuntary flashbacks are also noted.

Features of PTSD are expressed in increased avoidance of feelings, thoughts, conversations associated with traumatic events, as well as actions, people and places that initiate these memories.

Signs of PTSD include psychogenic amnesia, which is the inability to recall a traumatic event in detail. People have constant vigilance, as well as a constant state of anticipation of a threat. This condition is often complicated by diseases and somatic disorders of the endocrine, cardiovascular, nervous and digestive systems.

The “trigger” of PTSD is an event that causes an attack in the patient. Often the “trigger” is only part of a traumatic experience, for example, the noise of a car, a crying child, an image, being at a height, text, a TV show, etc.

Patients with PTSD usually do their best to avoid encounters with factors that provoke this disorder. They do this subconsciously or consciously, trying to avoid a new attack.

PTSD is diagnosed when the following symptoms are present:

- exacerbation of psychopathological experiences that cause serious harm through mental trauma;

- the desire to avoid situations reminiscent of the trauma experienced;

— loss of traumatic situations from memory (amnestic phenomena);

- a significant level of generalized anxiety during the 3rd - 18th week after the traumatic incident;

- manifestation of exacerbation attacks after meeting with factors that provoke the development of this disorder - anxiety triggers. Triggers are often auditory and visual stimuli - a gunshot, squeaking brakes, the smell of some substance, crying, the hum of an engine, etc.;

- dullness of emotions (a person partially loses the ability to express emotions - friendship, love, there is a lack of creative enthusiasm, spontaneity, playfulness);

- impaired memory, as well as concentration when a stress factor appears;

- with accompanying feelings, a negative attitude towards life and nervous exhaustion;

- general anxiety (concern, worry, fear of persecution, fear, guilt complex, lack of self-confidence);

— (explosions similar to a volcanic eruption, often associated with the influence of alcohol and drugs);

— abuse of medicinal and narcotic substances;

- uninvited memories that emerge in ugly, terrible scenes associated with traumatic events. Unbidden memories surface both while you are awake and while you sleep. In reality, they appear in cases where the environment resembles what happened during a traumatic situation. They are distinguished from ordinary memories by a feeling of fear and anxiety. Uninvited memories that come in a dream are classified as nightmares. The individual wakes up “broken,” wet with sweat, with tense muscles;

- hallucinatory experiences, which are characterized by behavior as if the person is reliving the traumatic event;

- insomnia (intermittent sleep, difficulty falling asleep);

- thoughts of suicide due to despair, lack of strength to live;

- a feeling of guilt due to the fact that he survived difficult trials, while others did not.

Treatment of PTSD

Therapy for this condition is complex; at the beginning of the disease, medication is provided, and then psychotherapeutic assistance.

All groups of psychotropic drugs are used in the treatment of PTSD: hypnotics, tranquilizers, antipsychotics, antidepressants, and in some cases, psychostimulants and anticonvulsants.

The most effective in treatment are antidepressants of the SSRI group, as well as tranquilizers and drugs that act on MT receptors.

An effective treatment technique is one in which the patient, at the beginning of an attack, concentrates attention on a distracting, vivid memory, which over time contributes to the formation of the habit of automatically moving to positive or neutral emotions, bypassing the traumatic experience when a trigger appears. A psychotherapeutic method in the treatment of PTSD is the method, as well as processing using eye movements.

For patients with severe symptoms, psychedelic psychotherapy is prescribed using serotonergic psychedelics and psychostimulants of the phenylethylamine group.

Psychological assistance for PTSD is aimed at teaching patients to accept the reality of their lives and create new cognitive models of life.

Correction of PTSD is expressed in gaining true mental and physical health, which does not consist of meeting someone else's standards and norms, but of coming to an agreement with oneself. To do this, on the path to true recovery, it is not so important to behave as is customary in society, but you need to be extremely honest with yourself, assessing what is currently happening in life. If life circumstances are influenced by: way of thinking, disturbing memories, behavior, it is important to honestly acknowledge their existence. Complete relief from PTSD can be obtained by seeking help from specialists (psychologist, psychotherapist).

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 evoke negative emotions. It literally knocks the ground out from under a person’s feet and makes him suffer greatly. Moreover, the consequences of the disorder can manifest themselves for several hours or even several years.

What can cause PTRS?

There are a number of situations that most often cause post-traumatic stress syndrome - these are mass disasters that lead to death: wars, natural disasters, man-made disasters, terrorist attacks, physical attacks.

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

Traumatic events that provoke manifestations of PTSD can be either single, for example, during a disaster, or multiple, for example, participation in combat, 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 a feeling of horror or a feeling of helplessness.

People react to stress differently, this is due to their emotional sensitivity, level of psychological preparation, and state of mind. In addition, a person’s gender and age play an important role.

Post-traumatic stress disorder often occurs in children and adolescents, as well as women who have been exposed to domestic violence. The risk category for post-traumatic stress includes people who, due to their professional activities, often encounter violent acts and stress - rescuers, police officers, firefighters, etc.

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

Symptoms of Post-Traumatic Stress Disorder

Post-traumatic stress disorder, which has varying symptoms, may include:

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 common phenomenon as a flashback - a sudden immersion of the patient in the past, in which he feels the same way as on the day of the tragedy. A person is visited by unpleasant memories, frequent sleep disturbances with difficult dreams occur, and his reactions to stimuli reminiscent of the tragic event intensify.
2. On the contrary, he strives to avoid anything that may remind him of the stress he has experienced. In this case, memory for the events that caused PTSD is reduced, and the state of affect is dulled. The person seems to be alienated from the situation that caused the traumatic stress and its consequences.
3. The occurrence of startle syndrome (English startle - to scare, to flinch) is an increase in autonomic activation, including an increase in the fear reaction. There is a function of the body that causes an increase in psycho-emotional arousal, which makes it possible to filter incoming external stimuli, which the consciousness perceives as signs of an emergency situation.

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

• increased vigilance;
• increased attention to situations similar to threatening signs;
• maintaining attention on events that cause anxiety;
• attention spans are narrowing.

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

With PTSD, apathetic mood, indifference to what is happening around, and lethargy are often observed. People may seek new experiences without thinking about the negative consequences and do not make plans for the future. Relationships with family for a person who has suffered traumatic stress most often deteriorate. He isolates himself from his loved ones, more often voluntarily remains alone, and then can accuse his relatives of inattention.

Behavioral signs of the disorder depend on what the person has encountered, for example, after an earthquake, the victim will be more likely to move towards the door in order to have a chance to quickly leave the room. After the bombings, people behave warily when entering the house, closing and curtaining the windows.

Clinical types of post-traumatic stress syndrome

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

1. Anxious. In this case, the person is bothered by frequent attacks of memories that arise against the background of psycho-emotional stress. His sleep is disturbed: he has nightmares, may 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 discussing his experiences, but often agrees to a conversation with a psychologist.
2. Asthenic. With this traumatic stress, signs of a depleted nervous system are observed. The patient becomes lethargic, performance decreases, he feels constant fatigue and apathy. He is able to talk about the event that happened and often independently seeks the help of a psychologist.
3. Dystrophic. This type of PTRS is characterized as angry and explosive. Patients are depressed, constantly expressing dissatisfaction, often in a rather explosive form. They withdraw into themselves and try to avoid society, do not complain, so often their condition is revealed only because of inappropriate 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, patients experience obsessive states, but they are not associated with the stress they have experienced, but with a deterioration in well-being.

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

Diagnosing PTSD

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

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

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

PTSD in childhood and adolescence

PTSD in children and adolescents is diagnosed quite often, because they react much more sensitively to mental 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 death of one of the parents, placement in an orphanage or boarding school.

Like adults with PTSD, children tend to exclude situations that remind them of the tragedy. But when reminded, the child may become emotionally overexcited, manifesting itself in the form of screaming, crying, and inappropriate behavior.

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

Children who have experienced physical violence themselves can become aggressors in a group of their own kind. Very often they are bothered 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 may manifest itself in the form of simplification of speech, loss of self-care skills, etc.

In addition, symptoms of the disorder may include:

• impaired social adaptation: children are not able to imagine themselves as adults;
• there is isolation, capriciousness, irritability;
• Children have a hard time separating from their mother.

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

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

Often children find themselves in stressful situations without their parents' knowledge, for example, when they are exposed to violence from strangers. The child’s loved ones should be concerned if he begins to sleep poorly, screams in his sleep, is tormented by nightmares, and is often irritated or capricious for no apparent reason. You should immediately consult 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, which allows you to assess the child’s traumatic experiences. It is administered to 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 discussion 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 traumatic experience the child has. If he himself cannot name such an event, then he is asked to select them from a ready-made 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.

Treatment options for PTSD

The basis of treatment for PTSD in both adult patients and children is high-quality psychological assistance from a qualified doctor, 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 completely justified, and he is a full-fledged member of society. In addition, treatment includes various activities:

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

It is important that the 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 advanced stage of the disease. In some cases, it is impossible to do without medications; the following drugs are prescribed:

• antidepressants;
• benzodiazepines;
• mood stabilizers;
• beta blockers;
• tranquilizers.

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

Post-traumatic stress condition or syndrome is an ailment 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: it is not recommended to fight it alone; only working together as a family and with a doctor will help overcome stress.

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

Acute stress disorder

(within 1 month after a critical incident – ​​from 2 days to 4 weeks)

Post-traumatic stress disorder

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

Post-traumatic personality disorder

(during the subsequent life of the person who experienced the trauma)

Rice. 1 Stages of formation of post-stress disorders

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

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

According to K.Yu. Galkin, OSD has not been sufficiently studied, despite the fact that in 1994 this disorder was included in the DSM-IV. In his studies during the terrorist attack in Volgodonsk in 1999, the presence of symptoms of OSD 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 for most people, 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 trauma, chronification of the post-stress state develops (Kolodzin B. 1992).

Disorders that develop after experiencing 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 members of their families (Kitaev-Smyk L.A., 1983; Romek V.G. , Kontorovich V.A., Krukovich E.I., 2004; Kolodzin B., 1992). The transformation of personality from a psychological norm to a borderline abnormal personality and further to a pathological mental constitution in the form of psychopathy, according to Kosmolinsky F.P. (1998), is determined by personal constitutional-typological variability.

Analysis of the results of numerous studies conducted 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 trauma can appear suddenly, over a long period of time, against the background of a person’s general well-being. Over time, the condition becomes more severe and, for some people, may lead to 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, an authoritative specialist in this field, in her dissertation research, having identified psychological and biological models within the framework of the established categorical apparatus, classified the two-factor model of PTSD as “Other concepts of PTSD.”

Psychological 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 development of trauma, intense experience leads in a short time “to such a strong increase in irritation that liberation from it or its normal processing fails, as a result of which long-term disturbances in the expenditure of energy may occur”, deep psychological defense “includes” alienation, which disrupts 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, 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 traumatic defense once arises, 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 the main stumbling block, resistance to any manifestations of the “I” directed to the outside world.” The psyche transforms external trauma into internal strength, 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, non-adaptive, and therefore capable of blocking the processing of information and integrating 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 strives to store information in an unconscious form, but during the process of information processing, traumatic information becomes conscious. Conscious information is influenced by psychological defense mechanisms and is obsessively reproduced in memory (flashbacks); emotions, which play an important role in the post-stress state, are essentially a reaction to cognitive conflict and at the same time motives for protective, controlling and coping behavior. From the standpoint of theory, neutralization of trauma is possible provided that the information processing process is integrated (Horowitz M., 1986; Lasarus R., 1966).

The concept of M. Horowitz, formed under the influence of the cognitive psychology of 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 injury;

– alternation of “denial” and “invasion”;

– processing of traumatic experience.

The duration of the response process can last from several weeks to several months. According to research results, 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, building an interactionist model of the process of delayed response to the traumatic impact of stress factors in a combat situation, they identified the following elements in the process of cognitive processing of 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 major contribution to the theory of traumatic combat stress.

Cognitive Concepts mental trauma go back to the works of A. Beck and the stress theory of R. Lazarus. From the perspective of the cognitive model, traumatic events lead to an individual’s “assessment” of a stressful situation, forming a type of coping with stress. Schemes for experiencing events are updated, forcing the individual to look for information that corresponds to this scheme and ignore other information (Lazarus 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, within the framework of a traumatic experience, patterns of response to re-experiencing stimuli and flash-back effects. These models seem to most fully explain the etiology, pathogenesis and symptoms of post-traumatic stress disorder, because take into account genetic, cognitive, emotional, and behavioral factors (Pitman R.K., Altman B, 1991).

In the cognitivist concept of mental trauma, as interpreted by R. Yanoff-Bulman, basic beliefs formed in childhood provide the child with a sense of security and trust in the world, and later – a sense of his own invulnerability. Most healthy, adult people believe that there is more good in the world than bad. “If something bad happens, it happens mainly to those people who do something wrong... I’m good, so nothing should happen to me...” Mental 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, the basic beliefs are qualitatively different from the “pre-traumatic” ones, the restoration of which does not occur completely, but only to a certain level at which the person is free from the illusion of invulnerability.

The picture of the world of an individual who has experienced 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 a sense of reality already arises, an understanding comes that this does not always happen. The individual begins to perceive reality in a form as close as possible to the real one, assessing his own life and the world around him in a new way.

The Yanoff-Bulman concept, relying primarily on the cognitive structures of the psyche, attributes 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 of “basic beliefs”, introduced by A. Beck (1979), according to M.A. Padun (2003), largely coincides with the concept of “generalized representations of interaction” by D. Stern (Stern D., 1985), and 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, Yanoff-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, because takes into account genetic, cognitive, emotional, and behavioral factors. From these positions, any events or circumstances that are neutral in themselves, but are somehow associated with a traumatic stimulus-event, can serve as conditioned reflex stimuli that cause an emotional reaction corresponding to the original trauma.

A multifactorial model of response to trauma was proposed by B. Green, J. Wilson and J. Lindy, proponents 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 environmental factors: social support factor, stigma factor, demographic factor, cultural characteristics, additional stressors. (Green B.L., Lindy J.D., Grace M.C., 1985).

The result of a 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. became the development person-centered model, which differs, according to M.Sh. Magomed-Eminov from “stimulus-reactive” models, in which an extreme situation is understood as a separate stressor (or group of stressors) of extreme intensity, causing a pattern of mental reactions in an individual in a post-traumatic situation, denoted by the construct of PTSD. The authors emphasize that, as developed by the American Psychiatric Association, PTSD has a clinical interpretation as a set of interconnected symptoms that characterize a nosological form and are included in the 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 personal organization itself in PTSD, right down to nuclear structures and processes, undergoes profound transformations. And this means that all the various psychological phenomena (symptoms, syndromes, reactions) are manifestations of the deep 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 unified, then 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, detrimental 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 personality that was formed in an abnormal situation and gives rise to various manifestations in the form of symptoms and syndromes of PTSD. Any interpretation of the determination of PTSD should include the primary mechanisms of personality, and, therefore, the phenomenon of PTSD can be considered a manifestation of deep nuclear factors and personality structures that have undergone transformation and reintegration in an abnormal situation. Research by Magomed-Eminova M. Sh., Filatova A. T., Kaduk G. I., Kvasova O. G. (1990) made it possible to identify the following personal sources of some mental reactions: 1) mental organization of the personality that has developed in an anomalous situation (symbolic acting out traumatic scenarios, invasion of the past); 2) a tendency to eliminate personal dissociation caused by anomalous experiences (nightmares, intrusive memories); 3) the desire for self-actualization on the basis of paradoxical new experience (development of a form of assimilation of experience); 4) personality transformation according to the type of mental “numbness” (emotional dullness, avoidance tendency).

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

From the point of view neuropsychological hypothesis L.C. Kolb (1984), an increase in the tone of the sympathetic nervous system, promoting the release of adrenaline and activation of the secretion of the hypothalamus, is the initial triggering mechanism of the stress reaction (Pavlov I.P., 1951). As shown by L.C. Kolb, B.A. Van der Kolk (1991, 1996). in response to the stressor, the turnover of norepinephrine increases, which, in turn, leads to an increase in the level of plasma catecholamine. At the same time, the levels of adrenaline, serotonin and dopamine in the brain decrease. 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 extreme intensity and duration of stimulating effects, changes occur in the neurons of the cerebral cortex, blockade of synaptic transmission and even neuronal death. 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 changes in mental states, in particular, they can cause mental numbness.

Modern views on the mechanism of development of stress and trauma 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).

When considering physiological mechanisms development of psychological trauma, it is necessary to highlight the mechanism of stress development, 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 “first began to study psychological processes as intermediate variables that mediate human responses to stress stimuli.”

According to Lazarus, stress occurs when a person perceives threatening circumstances as requiring significantly more resources than those available to him. Adhering to traditional views on the development of the 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 reduces the pain threshold; compounds of corticosteroids with transcortin, a blood protein, the entry of which into the blood leads to depletion of the hypothalamic-pituitary-adrenal system. Central to the stress response syndrome, according to modern data, is a condition in which the levels of serotonin, dopamine and norepinephrine in the brain decrease, the level of acetylcholine increases, and an analgesic effect mediated by endogenous opioids 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 serotonin levels leads to a slowdown and even cessation of all processes in the development of behavior, so only the conditioned response to stimuli associated with the original stressor is preserved. The cause of amnesia for specific traumatic experiences may be, according to Van der Kalk, suppression of the functioning of the hippocampus.

The disadvantage of these models is that most studies have been conducted on animals or in vitro. And at the same time, modern knowledge about the psychophysiological mechanisms of response to trauma allows us to predict standard situations, give a more nuanced assessment of personal changes and physical condition for the provision of psychotherapeutic and pharmacological assistance.

An attempt to integrate the psychoanalytic and medical-biological approach to trauma under extreme influences 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 research conducted over eight years to study the course of traumatic reactions of various etiologies in university students has shown that the features of an etiological and pathogenetic nature make it possible to consider the phenomena of trauma from the standpoint of various concepts of mental trauma. In our practice, there were cases of moderate social maladaptation in students who suffered during the terrorist attack in Budennovsk, who retained a constant feeling of fear, severe anxiety, impaired concentration, and changes in physiological reactivity for 7 years after the events. They stopped visiting previously actively visited recreational areas and lost interest in previously significant activities. Extreme lack of confidence in one's own abilities, conformity, which creates a feeling of dependence, lack of initiative, and 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 perspective of H. Horowitz, who believed that if traumatic memories remain not integrated into the cognitive sphere of the individual, the traumatic experience persists for many years. (Churilova T.M., 2009). L., Lindy J.D., Grace M.C., 1985).

At the same time, the surveys and tests we conducted showed that changes in basic life beliefs during psychological trauma are fully consistent with the main provisions of the cognitivist concept of mental trauma as interpreted by 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 of 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 feeling 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 the two areas have little in common.” At the same time, the author assures that in the psychological picture of PTSD, the specifics of the traumatic stressor are 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 an option that connects the concepts of stress and traumatic stress. In his opinion, the idea of ​​a total stressor is possible, capable of provoking a qualitatively different type of reaction, which consists in the conservation of adaptation resources. H. Krystal (1978) has a similar opinion, who suggested that mental collapse can cause “freezing of affect” with subsequent alexithymia.

Studying the relationship between the concepts of stress, traumatic and post-traumatic stress, N.V. Tarabrina (2008) highlighted the contextual dependence of the concepts “post-traumatic stress disorder”, “traumatic stress”, “post-traumatic stress”, which in foreign studies outside empirical work are often are used as synonyms. In domestic scientific publications, the category of PTSD is becoming increasingly 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, highlighted, on the one hand, the ideas of homeostasis, adaptation and “normality”, and on the other – separation, discontinuity and psychopathology.

We were interested in information from I.G. Malkina-Pykh (2008) and N.V. Tarabrina (2001) that information about the features of the development of a condition that develops under the influence of super-strong 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 survivors of railroad accidents. A similar reaction to what was happening was described in 1871 by Da Costa during the American Civil War; as a result of observations of autonomic reactions in the heart, he proposed the term “soldier’s heart.” In 1888, H. Oppenheim introduced the well-known diagnosis of “traumatic neurosis” into practice, within 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 and 1911, according to P. V. Kamenchenko, became the basis of all modern disaster psychiatry. 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, causing suffering, destruction, and loss of loved ones, has always given impetus to a special kind of research (Krasnyansky, Morozov, 1995). The works of E. Kraepilin (1916), which appeared in connection with the First World War (1914–1918), remain classic to this day. In them, the researcher, for the first time characterizing traumatic neurosis, pointed out the fact of the presence after severe mental trauma of permanent disorders that intensify 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.” He considered the concussion caused by a shell explosion as a neurological condition; with “shell shock,” from Myers’s point of view, a mental state developed due to severe stress.

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

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

– the adverse effects of extreme (combat) conditions increase sensitivity to traumatic factors. This is facilitated by general asthenia, decreased tone, lethargy and apathy (V.A. Gilyarovsky);

– psychotraumatic factors affect not only the human psyche, but also the entire body as a whole (V.G. Arkhangelsky);

– the impact on the psyche under 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 war was made by Soviet scientists based on studies of 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, etc.). Reactions caused by participation in hostilities became the subject of widespread discussion during the Second World War. New terms appeared in psychiatry: “war fatigue”, “combat exhaustion”. , “war neurosis”, “post-traumatic neurosis”, introduced by V. E. Galenko (1946), E. M. Zalkind (1946, 1947), M. V. Solovyova (1946) and others (see Malkina-Pykh, 2008 ).

The first systematic study abroad was attempted in 1941 by the French psychiatrist and psychologist A. Kardiner (Kardiner A., ​​1941), who called the group of symptoms accompanying the phenomena of nervous disorders and associated with military operations “chronic military neurosis.” Kardiner believed that war neurosis has both a physiological and psychological 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 internal resources of the body and a weakening of the strength of the “EGO”. For the first time, they were given a comprehensive description of the symptoms:

– excitability and irritability;

– unrestrained type of reaction 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 outline theoretical and applied issues related to the study of the condition of Vietnam veterans, many of whom were socially maladjusted and committed suicide (Boulander et al., 1986; Egendorf et al., 1981). In the 50-60s, 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 research into post-stress conditions caused by experiencing natural and industrial disasters can be dated back to the 50–60s of the last century. 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 participants. In the 1980s, victims of crime, sexual violence, and radiation hazards were added to the research subjects.

As it turned out, people who suffered in various situations, similar in severity of psychogenic impact, showed similar symptoms. Attempts were made to bring the classifications available in clinical practice and introduce 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 led by M. Horowitz (1986) developed diagnostic criteria for PTSD, adopted first into the American National Psychiatric Standard (DSM-III and DSM III-R), and later (almost unchanged) for ICD-10 (Smulevich A.B., Rotshtein V.G., 1983). The need to introduce diagnostic criteria, according to N.V. Tarabrina, was associated with a boom in research into numerous mental problems associated with 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 from N.V. Tarabrina (2008) that the increase in the number of countries using the diagnosis of PTSD in clinical practice increased in the period from 1983-1987 to 1998-2002 from 7 to 39 due to the increase in international terrorist activity, we believe that this can be explained also an increase in the number of chronic stressors associated with economic, geopolitical, social, and information 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. The criteria included in the European diagnostic standard ICD-10 since 1994 define post-traumatic stress disorder (PTSD) as a condition that can occur following traumatic events that are beyond the scope of 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, job loss, or family conflict. Trauma is defined as an experience, a shock that causes fear, horror, and helplessness in most people.

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

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

– states and feelings;

– behavior;

– physical reactions.

It should be noted that F. Parkinson suggests taking into account when making a diagnosis the symptoms that the victim may have exhibited 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. Thus, R. Grinker and D. Spiegel included impatience, aggressiveness, irritability, apathy and fatigue, personality changes, depression, tremors, fixation on war, nightmares, suspicion, phobic reactions, addiction to alcohol as delayed reactions to combat stress. Much attention was paid to restoring self-esteem in the process of psychological rehabilitation of combatants (Grinker R.P., Spiegel J.P., 1945).

It was found that delayed mental reactions to stress in veterans depend on three factors:

– from pre-war personal characteristics and a person’s ability to adapt to new situations;

– from reacting to dangerous situations that threaten human life;

– on the level of restoration of personality integrity (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 severe impairment of the mediator function of the “EGO” (Goodwin D.D., 1999).

Research into PTSD became even more widespread in the 1980s. Numerous studies have been conducted 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 Vietnam veterans and their non-combatant peers. Boulander et al. (1986) studied the characteristics of the delayed reaction to stress in the same population. The results of these studies have not lost their importance to this day. The main results of international research were summarized in a collective two-volume monograph “Trauma and Its Trace” (Figley, 1985), where, along with the developmental features of PTSD of military etiology, the results of studying the consequences of stress in victims of genocide, other tragic events or violence against the individual are presented.

For anyone who has dealt with stress issues, what makes PTSD especially tricky is that symptoms can appear immediately after exposure to a traumatic situation, or they can occur many years later. Cases have been described in which veterans of the Second World War developed symptoms of PTSD forty years after the end of hostilities (Boulander, 1986). The past “does not let go” - people constantly return 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 feeling of deep injustice. The obsession about the incident manifests itself in endless conversations without any need and on any occasion. The detachment of others from the problem leads to isolation of the trauma survivor, 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 at the same time a person is at home and at the scene of the tragedy. Significant distress is manifested by physiological responses to key stimuli associated with the trauma. “Flashback episodes” develop. The inability to relax manifests itself in a state of constant tension - a person cannot sleep, despite exhaustion. Sleep disturbances that accompany such conditions aggravate the 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; Boudewyns P. A., 1997;

Among the main symptoms of PTSD are Boudewyns P. A. (1996) and Chemtob C. M., Novaco R. W., Hamada R. S., Gross D. M. (1994) call the development of passive avoidance of stimuli associated with trauma, decreased interest in previously significant activities, and a narrowing of the range of affective reactions. Sustained manifestations of increased arousal, absent before the injury, are manifested by irritability, wariness, outbursts of anger, increased reaction to fear, difficulty falling asleep, and the need to concentrate. K. Scull, himself a veteran, explored these issues in a series of deep-seated interviews with Vietnam 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 identify the causes of PTS symptoms and that “when addressing what worries Vietnam veterans most, one should rely primarily on an existential perspective” (Scull S. S., 1989).

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

We completely 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 disaster, or a terrorist attack continues to influence a person’s entire life, depriving a person of a sense of security and self-control. A strong, sometimes unbearable tension arises, leading to a real danger for the psyche.

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

Of interest are numerous research results showing that persons with PTSD participating in combat operations, compared to civilians without this disorder, are 2-3 times more likely to be dependent on psychoactive substances (PS). Nearly 75% of combat veterans with PTSD also had symptoms consistent with alcohol abuse or dependence during their lifetime (Kulka R.A., Hough R.L., Jordan B.K., 1990). An individual’s overcoming the traumatic impact of stressors in a combat situation depends not only on the success of processing the traumatic experience, but also on the interaction of three factors: the nature of the traumatic events, the individual characteristics of veterans and the characteristics of the conditions in which the veteran finds himself after returning from war (Green B.L., 1992). Impaired processing of traumatic experience and overcoming combat trauma leads to social maladaptation with the formation of affective disorders and PTSD, which are factors provoking the abuse of psychoactive substances (Petrosyan T. R., 2008).

An analysis of the literary sources at our disposal has shown that most of the modern research on PTSD is devoted to the epidemiology, etiology, dynamics, diagnosis and treatment of PTSD, which are carried out on a wide variety of populations: participants in combat operations, victims of violence and torture, man-made and man-made disasters, patients with life-threatening diseases, refugees, firefighters, rescue workers, etc.

Study of the circumstances of a person’s stay in the emergency zone Yu.A. Aleksandrovsky and colleagues (1991), V.P. Antonov (1987), Yu.V. Malova (1998); I.B. Ushakov, V.N. Karpov (1997), V.A. Molyako (1992) indicate that a living environment in which there is a threat of radiation damage and where a person is exposed to a real danger of losing health or life serves as the basis for including such situations in the list of traumatic ones, i.e. capable of causing PTSD. patterns of change in each individually studied area. However, the question of whether the development of PTSD in people who have suffered the stress of a radiation threat is still debatable. In domestic works, much attention is paid to the analysis of neuropsychic and neuropsychiatric disorders (Krasnov et al., 1993). N.V. Tarabrina, emphasizing the extensiveness of research on this issue, particularly highlights studies of post-traumatic syndromes in victims of radiation exposure during the accident at the American Three Mile Island nuclear power plant (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 among those American veterans of World War II 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 areas showed the presence of PTSD in 8.2% of residents of these regions (Rumyantseva et al. 1997).

We consider N.V.’s information valuable. Tarabrina (2008) about the specificity of the psychological content of PTSD symptoms among liquidators. A high percentage of symptoms of physiological excitability correlates with the level of anxiety and depression, and the semantics of symptoms are, for the most part, associated with future life. The presence of symptoms such as sleep disturbances, loss of appetite, decreased sexual desire, and 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 was the Chernobyl disaster for many. Designating the stress of the radiation threat as an “invisible” stressor, N.V. Tarabrina includes it in the same 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 pressing 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 we examined based on the results of studies of the experience of terrorist attacks provide fairly consistent data on the wide prevalence of PTSD and its individual symptoms as psychological reactions to this type of traumatic event (Grieger T.A., Fullerton C.S., and Ursano R.J., 2003; Sosnin V. A., 1995; Kekelidze D.V., 2002; Portnova A.A., 2006; ;Slovic, Schuster (1977, 1978); North C. S. (1999); Shore J. H., Tatum E. L., Volhner N. W. (2002). the act is the most serious threat to the mental health of the population compared to natural disasters (Northetal., 1999).

A rather serious problem is the fact that most studies are devoted to the psychological and psychiatric consequences of terrorist attacks among direct victims of terrorist attacks and their loved ones (Idrisov K.A., Krasnov V.N., 2004; Galkin K.Yu., 2004; Gasparyan H. V., 2005). Almost no attention is paid to the specific features of the perception of the terrorist threat by indirect victims who have 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 identified as a separate taxonomic unit, the formative factor for which is situations of unexpected 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 losing loved ones during his life.

We agree with A.V. Andryushchenko (2000) that, unlike other types of life disasters, 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 extreme situation is perceived as equivalent to it - “irreparable” destruction of the individual. The loss of a significant other after a life-threatening illness, as a result of a love drama or death, accident, disappearance under tragic circumstances, suicide and other similar situations is accompanied by a feeling of complete loss of Self, a feeling of impossibility of subsequent recovery and persistent despair associated with these post-traumatic manifestations. Clinical studies show that the formation of PTSD following the loss of an attachment figure 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 are distinguished by the following features: 1) they are formed in several stages, thus acquiring a prolonged course; 2) determined by a polymorphic psychopathological structure; 3) end in persistent residual conditions in 6-20% with clear long-term maladjustment. The author emphasizes that data on long-term stages (the first 6-12 months after psychotraumatic exposure) indicate the appearance in the structure of PTSD, in addition to reactive formations, of other disorders that coexist simultaneously with the main disorder through the mechanism of comorbid connections. Qualification of mental disorders in pathological reactions of loss with signs of PTSD, carried out in accordance with ICD-10, reveals a tendency towards multi-axial diagnosis of pathology. As a rule, patients are diagnosed with dysthymic level mood disorders: 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 arose in the post-traumatic period to constantly reproduce in one’s life a situation similar to the one experienced or, on the contrary, to completely avoid situations reminiscent of these events.

As our analysis showed, risk factors for the development of PTSD can be categories that are paradoxical at first glance. Thus, 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 stress reactions of Yerevan children and their parents were influenced by the following values ​​of the Armenian family, culture and political context:

– emphasis on silent heroic suffering;

– altruistic resilience in overcoming everyday hardships;

– denial of pain and weakness;

– the predominance of the values ​​of the external well-being of the family over intrafamily 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;

– reluctance to inform children about the death of loved ones for fear of causing the child’s hostility towards oneself; 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 they are experiencing;

– parents’ fixation on the situation 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 feelings associated with the tragedy, these families need help adjusting to life in a new environment characterized by the 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 occur quite often. Thus, good upbringing, which places restrictions on communication, often prevents the processing of traumatic situations, driving them into the depths of the unconscious.

The intensity of the traumatic situation, the risk of PTSD, according to A.L. Pushkareva (2000) also depend on 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 finds that traumatic events are more difficult for the very young and very old to cope with compared to those for whom the trauma occurs in midlife. For example, approximately 80% of children who suffer burns develop post-traumatic stress disorder 1–2 years after their burn injuries. On the other hand, only about 30% of adults develop this disorder after burns. It is likely that young children have not yet developed the mechanisms to cope with the physical and emotional damage caused by trauma. Likewise, older people, as well as young children, have more rigid mechanisms for dealing with trauma and are unable to adopt a flexible enough approach to counteract its effects. Moreover, the impact of trauma may be exacerbated by the physical disabilities that characterize life in the elderly, especially those affecting the nervous and cardiovascular systems, such as decreased cerebral blood flow, decreased vision, palpitations, and arrhythmias. The presence of pre-injury mental disorders, personality disorders, or more serious disorders increases the severity of the stressor. Social support provision may also influence the development, severity, and duration of PTSD. In general, patients who receive good social support 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 poor or socially isolated individuals (Churilova T.M., 2003, 2007).

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

Following N.V. Tarabrina, we agree that assessment of conditions at distant stages of PTSD allows us to identify, in most cases, signs of post-traumatic personality development. PTSD leads to a decrease or loss of the need for close interpersonal relationships, an inability to return to family life, a devaluation 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-scale, Accordingly, the quality of life is affected to a lesser extent. PTSD of this type has a significantly less impact on professional ambitions, although in this area “breakdowns” are identified with a decrease in motivation and interest in activities, indifference to success and career (Tarabrina N.V., 2001, 2008)

The opinion of A.G. can be considered unequivocal. 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 PTSD prevalence 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 defining diagnostic criteria. 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 90s. If, according to Dmitrieva T.B., about 1% of the study population develops PTSD throughout life (Dmitrieva T.B., Vasilievsky V.G., Rastovtsev G.A., 2003), then other researchers point to a wider distribution of this type of disorder . Thus, I.G. Malkina-Pykh, citing 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 studied, 75% had ever been victims of crime. Of these, 53% were victims of sexual violence, 9.7% were victims of assault, 5.6% were victims of robbery, and 45.3% were victims of burglary. According to reports from epidemiologists, all of them had psychosomatic symptoms of PTSD (Kilpatrick D.G., Veronen L.J., 1985).

Special studies by A.N. Krasnyansky (1993), A.L., Pushkarev, V.A., Domoratsky, E.G. Gordeeva (2000) showed that symptoms of PTSD in a certain part of people with the consequences of military trauma become more distinct with age. In some individuals, the course of PTSD is chronic, often combined with mental illness, including affective disorders, drug addiction and alcoholism. Shore's research, based on a general sample of American citizens (without taking into account risk groups), reports 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) regarding the mixed assessment of PTSD by individual clinicians in different countries. The noticeable progress of research in this area does not reduce the debatability of the problems associated with it. This is especially true for 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 when 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 Russian 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 scientific discourse. In the domestic literature, in our opinion, the works of N.V. stand out. 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. Solovyova, 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 is carried out on a wide variety of populations: 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 area 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’s stay 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 an analysis of the literature indicates that following the identification of the clinical form of PTSD in ICD-10, there is a tendency to narrowly interpret these conditions without taking into account the specifics of the traumatic factor. The question remains unclear regarding the study of PTSD developing in people who have suffered a hostage situation as a result of a mass terrorist attack. Phenomenological ideas about psychological and psychopathological reactions in people with signs of post-traumatic stress disorder who found themselves hostages as a result of a mass terrorist attack are isolated, incomplete and scattered. There are practically no detailed scientific data reflecting the influence of personal characteristics on the psychological and psychopathological picture of the development of PTSD. There have been virtually no studies concerning the psychological differential diagnosis of post-traumatic stress disorders (Kolodzin B., 1992).

References for the introduction and the first chapter

Ababkov V.A., Pere M. Adaptation to stress: Fundamentals of the theory of diagnostic therapy. – St. Petersburg: Rech, 2004.

Aleksandrovsky Yu. A. Borderline psychiatric disorders: Textbook. manual / Yu. A. Aleksandrovsky. – 3rd ed., revised. and additional – M.: Medicine, 2000.

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

Aleksandrovsky Yu.A.. On a systematic approach to understanding the pathogenesis of non-psychotic mental disorders and the substantiation of rational therapy for patients with borderline states // 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. – T.2, No. 4, 2000.

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

Bassin F.V. Towards 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 among 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.

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

Bodrov V. A. Information stress: A 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 RAS", 1994.

Bodrov V. A. Psychological stress: development of teaching and current state of the problem. M.: Publishing house "Institute of Psychology RAS", 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 in operators // Military Medical Journal, 1973.

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

Bodrov V.A., Oboznov A.A. System of mental regulation of stress and 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 among evening students during the examination session // Questions of hygiene and health status of university students. M., 1974.

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

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

Vasilevsky V.G., Fastovets G.L., History of the issue and clinical and psychopathological features of post-traumatic stress disorder in combatants // Post-traumatic stress disorder. M.: GNTsSSP im. Serbsky, 2005.

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

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

Velichkovsky B.B. Multidimensional assessment of individual resistance to stress. – M. Abstract….candidate. psychol. Sci. 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 suffered a terrorist attack in the city of Volgodonsk on September 16, 1999: Clinic, dynamics, systematics: abstract of thesis. ...cand. honey. Sciences. – M, 2009.

Ganzen V.A. System descriptions in psychology. – L.: Leningrad State University Publishing House, 1984.

Gasparyan Kh. V. Age-related and psychological characteristics of experiencing difficult life situations: abstract of thesis. ...cand. psychol. Sciences. – M., 2005.

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

Grimak L.P. Ponomarenko V.A. Aviation stress // Directory of an aviation doctor. M.: Air transport, 1993.

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

Greenberg J. Stress management. – St. Petersburg: Peter, 2002

Dmitrieva T.B., Vasilievsky 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 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 combat situations. Author's abstract. diss....cand. honey. Sci. St. Petersburg, 1997.

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

Epachintseva E.M. Post-traumatic stress disorder of combatants. Author's abstract. diss. ...cand. honey. Sci. Tomsk 2001.

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

Zingerman A.M. The influence of the statistical characteristics of the signal system and their significance on the formation of motor and autonomic reactions of a human operator under normal conditions and under extreme influences // Essays on applied neurocybernetics. – L.: Science, 1973.

Idrisov K.A., Krasnov V.N. The state of mental health of the population of the Chechen Republic in conditions of 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. Translation from English M.: Academic project, 2001.

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

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

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

Kekelidze Z. I. 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 internationalist soldiers - veterans of the war in Afghanistan // Soc. 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 ed. Petrovsky A.V., editor-compiler L.A. Karpenko, ed. Tvorogova N.D.© PER SE 2007.

Kovrova M.V. Psychology and psychoprophylaxis of destructive stress among young people: Method. manual / Scientific ed. N.P. Fetiskin; Rep. for the release of V.V. Chekmarev. – Kostroma: KSU named after. N.A. Nekrasova, 2000.

Kolodzin B. How to live after 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 causation // Journal of VND im. Pavlova, 1997.

Kosmolinsky F.P. Emotional stress when working in extreme conditions. – M.: Medicine, 1998.

Kotelnikova A.V. Personality correlates of post-traumatic stress (based on a sample of forced migrants. Author. disk.....candidate of psychological sciences - M., 2009.

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

Krasnov V.N., Yurkin M.M., Voitsekh V.F. et al. Mental disorders among participants in the liquidation of the consequences of the Chernobyl nuclear power plant accident // Social and clinical psychiatry. – No. 1, 1993.

Krasnyansky A., Morozov P.V. Post-traumatic stress disorder in veterans of the war in Afghanistan: Congress of Psychiatrists. 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., Matejcek Z. Mental deprivation. – Prague, 1982.

Levin P., Frederick E., Awakening 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 thesis. diss... Dr. med. Sci. – St. Petersburg, 1994.

Lucas K., Seiden G. Silent grief: living in the shadow of suicide. Translation from English – M.: Smysl, 2000.

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

Makarchuk A.V. Psychological consequences of violence in children 10–13 years old Abstract of a 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 rehabilitation measures for participants in the emergency response 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 scientific and practical conference. – M., 1998.

Malyshenko N.M., Eliseev A.V. Features of stress disorders that are consequences of trauma. M.: Progress, 1993.

Marishchuk V.L. Redistribution of functional reserves in the athlete’s body 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., Kahana M. S. Medical and biological forms of stress. – Chisinau, “Shtiintsa”, 1981.

Milton E. Evolution of psychotherapy. – M.: Klass, 1998.

Molyako V. A. Psychological consequences of the Chernobyl disaster // Psychol. magazine – T. 13. – No. 1, 1992.

Myager V.K. Theoretical premises of family psychotherapy//Family psychotherapy for nervous and mental illnesses/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. Mental tension. – M.: Publishing house. 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, Ekaterinburg: Business book, 2002.

Orel V. E. The phenomenon of “burnout” in foreign psychology: empirical research and prospects // Psychological Journal. 2001.T. 22, no. 1, p. 90–101.

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

Padun M. A. Features 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. – Moscow State Pedagogical University. Obninsk, 2002.

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

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

Petrosyan T. R. Alcohol dependence in patients with post-traumatic stress disorder. Abstract…..cand. honey. Sciences. – M., 2008.

Plotnikov V.V. Assessment of psycho-vegetative indicators in students under exam stress // Occupational Hygiene. – No. 5. – M., 1983.

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

Prikhozhan 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. St. Petersburg : Publishing House SPGU, 2000.

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

Psychophysiology: Textbook for universities / Ed. Alexandrova Yu.I. – St. Petersburg, 2006.

Pukhovsky N.N. Psychopathological consequences of emergency situations. – M.: Academic Project, 2000.

Pushkarev A.L. Psychodiagnostic examination of sick and disabled people at the stage of medical and professional rehabilitation // Methodological recommendations. – Minsk, 1997.

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

Rean A.A. Psychology and psychodiagnostics of personality. Theory, research methods, workshop. – St. Petersburg: Prime-EURO-ZNAK, 2006.

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

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

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

Samukina N.V. Psychology and pedagogy of professional activity. M., 1999, p. 186–213.

Samoshkina N.V. Psychology of professional activity. St. Petersburg 2003.

Sandomirsky M.E. Protection from stress. Body technologies. 2nd ed. – St. Petersburg: Peter, 2008.

Svyadgoshch A.M. Neuroses. St. Petersburg: Peter, 1998.

Svyadgoshch A.M. Psychotherapy. A 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. The 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 named after. S.S. Korsakova, No. 3, 1997.

Sinitsky V.N., Depressive states (Patophysiological characteristics, clinical picture, treatment and prevention). – Kyiv: Naukova Duma, 1986.

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

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

Snekov E.V. Combat and mental trauma. Author's abstract. dis.... dr. med. Sci. St. Petersburg 1997.

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

Stenko Yu.M. Psychohygiene of a seafarer. – L.: Medicine, 1981.

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

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

Suvorova V.V. Psychophysiology of stress. – M.: Pedagogika, 1975.

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

Tarabrina N. V. Psychology of post-traumatic stress: an integrative approach. Abstract of diss... study. degree of Doctor of Psychology. Sci. – M, 2008.

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

Tarabrina N.V., Bykhovets Yu.V. Experience of the terrorist threat by Moscow residents: an empirical study//Proceedings of the conference “Psychological problems of family and personality in a metropolis”. – M., 2007.

Tarabrina N.V., Lazebnaya E.O. Post-traumatic stress disorder syndrome: current state and problems // Psychological Journal. – T. 13. N 2, 1992.

Tarabrina N.V., Petrukhin E.V. Psychological features of perception and assessment of radiation hazard // Psychological Journal. – T.15, 1994.

Tigranyan R. Stress and its significance 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: Publishing house. SCSI, 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 // Materials of the XIII annual scientific meeting of the SCSI. – Stavropol: Publishing house. SCSI, 2006.

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

Topchiy M.V. On the tasks of optimizing the structural-functional and socio-psychological adaptation of the students’ body. Modern humanitarian knowledge about the problems of social development // Materials of the XI annual scientific meeting of the SCSI. – Stavropol: Publishing house. 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 SCSI. – Stavropol: Publishing house. SCSI, 2007.

Topchiy M.V. 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 SCSI. – Stavropol: Publishing house. SCSI, 2004.

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

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

Ushakov G.K. Child psychiatry. – M.: Medicine, 1973.

Ushakov I. B., Karpov V. N. Brain and radiation. – M.: Publishing house GNII AiK, 1997.

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

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

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

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

Kholodnaya M.A. Psychology of intelligence. Paradoxes of research. – 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 the pilot project “social assistance to minors affected by armed conflicts. – Stavropol: Publishing house. SCSI, 2007.

Churilova T.M. Unexpected 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 / Conference materials. – Stavropol: Publishing house. SKSI, 2003.

Churilova T.M. Assessment 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 SCSI. – Stavropol: Publishing house. SCSI, 2004.

Churilova T.M. Manifestations of anxiety symptoms in students under stress. Society and personality: integration, partnership, social protection // Materials of the First International Conference. – Stavropol, 2004.

Churilova T.M. Changes in the functional indicators of students’ bodies depending on the modes of working at the computer. Materials of the interregional scientific and practical conference “Priorities of culture and ecology in education.” – Stavropol: Publishing house. SKSI, 2003.

Churilova T.M. Ecological psychophysiology: applied aspects / IV Winter scientific and practical psychological session “Ecology of the 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 health of students // Higher education in Russia, No. 3. M., 2000.

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

Ader R. Psycho-neuro-immunology, New York, Academic Press, reed, revue et compl., 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. N 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 patterns 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 disorder. N.Y.: Plenum Press, 1989.

Eysenck M.W. Cognitive psychology. Hove: Lawrence 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 Structure. 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., Wilner N.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 Modes 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 prolonged, 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 V. K., Marmar S. 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., Psychological 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; Basic 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, Anxiety, and Healthy Vietnam Veterans: Correlations with Psychophysiologic Responses // Journal of Consulting and Clinical Psychology. 1990. N 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 stress. 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 S. 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 S. 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., McFarlane A. C, Weisaeth L. Traumatic stress: the effects of overwhelming experience on the 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

Post-traumatic stress disorder (PTSD) is a mental disorder that arises against the background of a single or repeated traumatic situation. The reasons for the appearance of such a syndrome can be completely different situations, for example, the period after returning from war, news of an incurable illness, disaster or injury, as well as fear for the lives of loved ones or friends.

The main symptoms of this disorder are sleep disturbances, even lack of sleep, constant irritability and a depressed state of the patient. This disorder is most often observed in children and the elderly. For the former, this is due to the fact that the child’s defense mechanisms have not yet fully formed, and for the latter, this is due to slowing processes in the body and thoughts of imminent death. Moreover, PTSD can develop not only in a direct participant in the events, but also in witnesses to an accident.

The duration of this disorder depends on the severity of the incident that led to it. Thus, it can range from several weeks to decades. According to statistics, females are most often susceptible to the syndrome. Only experienced specialists in the field of psychotherapy and psychiatry can diagnose PTSD, based on conversations with the victim and additional methods for confirming the diagnosis. Treatment is carried out with medications and psychocorrective methods.

Etiology

The main cause of PTSD is considered to be a stress disorder that occurs after a tragic event. Based on this, the etiological factors for the manifestation of this syndrome in an adult may be the following:

• various natural disasters;
• a wide range of disasters;
• terrorist attacks;
• extensive and severe personal injuries;
• childhood sexual abuse;
• child theft;
• consequences of surgery;
• military actions often cause PTSD in males;
• Miscarriages very often lead to the manifestation of this disorder in women. Some of them then refuse to plan to have a child again;
• a crime committed in front of a person;
• thoughts about an incurable disease, both one’s own and those of loved ones.

Factors influencing the manifestation of post-traumatic stress disorder in children:

• domestic violence or child abuse. It is most acutely manifested due to the fact that parents themselves often cause pain to their child not only physically, but also morally;
• previous operations in early childhood;
• parents' divorce. It is common for children to blame themselves for the fact that their parents separate. In addition, stress is caused by the fact that the child will see less of one of them;
• neglect from relatives;
• conflicts at school. It is quite common for children to gather in groups and bully someone in class. This process is aggravated by the fact that the child is intimidated so that he does not tell his parents anything;
• violent acts in which the child either takes part or witnesses;
• the death of a close relative can cause PTSD in children;
• moving to another city or country;
• adoption;
• natural disasters or transport accidents.

In addition, there is a risk group whose representatives are most susceptible to the development of PTSD syndrome. These include:

• medical workers who are forced to attend various catastrophic situations;
• rescuers who are in close proximity to the loss of life, rescuing people caught in the middle of catastrophic events;
• journalists and other representatives of the information sphere, who, due to their duty, have to be in the thick of the incident;
• directly the participants of extreme events and members of their families.

Reasons why PTSD may worsen in children:

• the severity of the injury, both physical and emotional;
• parents' reaction. A child may not always understand that this or that situation threatens his health, but because the parents demonstrate this to him, the child develops a panicky feeling of fear;
• the degree of distance of the child from the center of the traumatic event;
• presence of such PTSD syndrome in the past;
• age category of the child. Doctors assume that some situations can be traumatic at a certain age, but at an older age they will not cause psychological harm;
• Being without parents for a long time can cause post-traumatic stress disorder in a newborn baby.

The degree to which this syndrome is experienced depends on the individual characteristics of the victim’s character, his sensitivity and emotional perception. The repetition of circumstances that cause mental trauma is important. Their regularity, for example, in domestic violence against women or children, can lead to emotional exhaustion.

Varieties

Depending on the length of time it occurs, post-traumatic stress disorder can be expressed in the following forms:

• chronic - only when symptoms persist for three or more months;
• delayed - in which signs of the disorder do not appear until six months after a particular incident;
• Acute – symptoms appear immediately after the event and last up to three months.

Types of PTSD syndrome, according to the international classification of diseases and symptoms:

• anxious – the victim suffers from frequent attacks of anxiety and sleep disturbances. But such people strive to be in society, which reduces the manifestation of all symptoms;
• asthenic - in this case, a person is characterized by indifference to surrounding people and current events. In addition, constant drowsiness appears. Patients with this type of syndrome agree to treatment;
• dysphoric – people are characterized by frequent mood swings from calm to aggressive. Therapy is forced;
• somatoform - the victim suffers not only from a mental disorder, but also feels painful symptoms, often manifested in the gastrointestinal tract, heart and head. As a rule, patients independently seek treatment from doctors.

Symptoms

Symptoms of PTSD in adults may include:

• sleep disorders, depending on the type of disorder it can be insomnia or constant drowsiness;
• unclear emotional background - the victim’s mood changes from little things or for no reason at all;
• prolonged or state of apathy;
• lack of interest in current events and life in general;
• decreased appetite or complete loss of it;
• unmotivated aggression;
• addiction to alcoholic beverages or drugs;
• thoughts about taking your own life.

Symptoms that bring a person painful and unpleasant sensations:

• frequent headaches, up to;
• disruption of the functioning of the gastrointestinal tract;
• discomfort in the heart area;
• increase in heart rate;
• trembling of the upper extremities;
• , alternating with diarrhea, and vice versa;
• bloating;
• dryness of the skin, or, conversely, increased fat content.

Post-traumatic stress disorder affects a person’s social life in the following ways:

• constant change of place of work;
• frequent conflicts in family and with friends;
• isolation;
• tendency to wander;
• aggressive behavior towards strangers.

Symptoms of this syndrome in children under six years of age:

• sleep disturbances - the child often has nightmares about a previously experienced event;
• absent-mindedness and inattention;
• pale skin;
• increased heart rate and breathing;
• refusal to communicate with other children or strangers.

Signs of PTSD in children aged six to twelve years:

• aggression towards other children;
• suspiciousness that the sad event occurred through their fault;
• manifestation of a recent event in everyday life, for example, through drawings or stories one can trace some aspects of a previously occurring event.

In adolescents over twelve and up to eighteen years of age, post-traumatic stress disorder manifests itself with the following symptoms:

• fear of death;
• reduced self-esteem;
• feeling of being looked at sideways;
• abuse of alcoholic beverages or urge to smoke;
• isolation.

In addition, such symptoms are aggravated by the fact that parents, in most cases, try not to notice changes in their child’s behavior and attribute everything to the fact that he will outgrow it. But in fact, it is necessary to begin treatment immediately, because if treatment is not timely in childhood, in adulthood the likelihood of achieving success and starting a full-fledged family is reduced.

Diagnostics

Diagnostic measures for post-traumatic stress disorder must be applied after one month after the event that provoked psychological trauma. During diagnosis, several criteria are taken into account:

• what event happened;
• what is the patient’s role in a particular incident - a direct participant or a witness;
• how often the phenomenon is repeated in the victim’s thoughts;
• what pain symptoms appear;
• disturbances from social life;
• the degree of fear felt at the time of the incident;
• at what time, day or night, episodes of the event emerge in memory.

In addition, it is very important for a specialist to determine the form and type of psychological disorder. A final diagnosis is made when the patient has at least three symptoms. In diagnosis, it is also important to distinguish this syndrome from other diseases that have similar symptoms, especially pain, for example, prolonged depression or traumatic brain injuries. The main thing is to establish a connection between the event that occurred and the patient’s condition.

Treatment

Methods of treating the syndrome for each patient are established individually, depending on the symptoms, type and form of the disorder. The main method of getting rid of PTSD is psychotherapy. This method consists of conducting cognitive-behavioral treatment, during which the specialist needs to help the patient get rid of obsessive thoughts and correct his feelings and behavior.

Often, in the acute form of the disorder, a method of therapy such as hypnosis is prescribed. The session lasts one hour, during which the doctor needs to find out the full picture of the event that occurred and select the basic methods of therapy. The number of sessions is set for each patient in a personal form.

In addition, additional treatment with medications may be necessary, including:

• antidepressants;
• tranquilizers;
• drugs that block adrenaline receptors;
• antipsychotic medications.

In the acute course of this syndrome, patients respond much better to treatment than in the chronic form.