創傷後壓力症 Posttraumatic Stress Disorder

簡介 Introduction

創傷後壓力症(PTSD)，歷史上曾被稱為「砲彈休克症」或「戰爭精神官能症」，自1980年起被美國精神醫學會認可為一個正式診斷。PTSD是一個精神健康問題，出現在一些經歷過創傷（e.g., 嚴重受傷、暴力、重大意外、戰爭）的人身上。PTSD有四大症狀類別：(1) 再度體驗、(2) 逃避症狀、(3) 認知和情緒症狀，及 (4) 警醒及反應症狀(Lancaster, Teeters, Gros, & Back, 2016)。PTSD在一般人口的終生盛行率為1.9% 至 8.8%，在受創社群（e.g., 群眾衝突或性侵受害人）則更普遍 (Bisson, Cosgrove, Lewis, & Roberts, 2015)。新的診斷手冊DSM-5已承認PTSD解離亞型之效度。有些PTSD患者會同時出現其他症狀（e.g., 抑鬱、自殺傾向、幻覺、物質濫用）。以創傷為焦點的一些心理治療法，諸如延長暴露(PE)療法、認知處理療法(CPT)和眼動減敏與歷程更新治療法(EMDR)，是PTSD的一線治療方案。藥物治療也可能有幫助。有些學者長久以來認為，單一創傷和多重創傷（e.g., 家庭暴力、童年受虐）所帶來的後果，在病理和所需治療方面，可能有很大分別。他們建議，複合型PTSD應該是獨立於一般PTSD之外的一個診斷。經過長期的研究和倡導，複合型PTSD終於被近來的世界衛生組織診斷手冊(ICD-11)列為正式診斷。PTSD不僅是一個醫學和精神健康問題──這跟社會壓迫和政治力量也息息相關。
Posttraumatic stress disorder (PTSD), used to be known as "shell shock" or "combat neurosis" in history, has been recognized as an official diagnosis by the American Psychiatric Association since 1980. PTSD is a mental health problem which develops in some persons who have encountered a traumatic event (e.g. serious injury, violence, serious accident, war). There are four major PTSD symptom clusters: (1) re-experiencing symptoms, (2) avoidance symptoms, (3) cognitive and mood symptoms, and (4) arousal and reactivity symptoms (Lancaster, Teeters, Gros, & Back, 2016). The lifetime prevalence of PTSD is between 1.9% to 8.8% in the general population and PTSD is much more common in traumatized populations (e.g., mass conflict or sexual abuse victims) (Bisson, Cosgrove, Lewis, & Roberts, 2015). The validity of a dissociative subtype of PTSD has been recognized in the recent diagnostic manual DSM-5. Some patients with PTSD also suffer from other comorbid symptoms (e.g., depression, suicidality, hallucinations, substance abuse). Trauma-focused psychotherapies, such as prolonged exposure (PE) therapy, cognitive processing therapy (CPT) and eye movement desensitization and reprocessing (EMDR), are the first-line treatments for PTSD. Drug treatment may also be helpful. Some scholars have long suggested that the consequences of a single trauma and multiple traumas (e.g., family violence, child abuse) can be very different in terms of the psychopathology and treatment needed, and they proposed that complex PTSD should be a diagnosis separate from simple PTSD. After a long period of research and advocacy, complex PTSD has been eventually included as an official diagnosis in the recent World Health Organization (WHO) diagnostic manual (i.e., ICD-11). PTSD is not just a medical or mental health problem – it is also highly related to social oppression and political power.

作者/Author: Hong Wang Fung

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2018.10.08

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2020.04.22

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