The purpose of investigation to research dissociative disorders and psychological protections of chronic posttraumatic stress disorder of different severity stages. MATERIALS AND METHODS: 545 humans (from 18 to 50 years old) were examined. Male ? 367 (67,34±)2,01 %), female ? 178 (32,66±2,01 %). The clinical research was done also we made psychometric investigation: Mississippi Scale (MS), Scale of influence of traumatic disorders, Symptom Check List – 90-Revised (SCL-90-R), Scale of dissociative disorders and also Blume test for revelation of latent incest. RESULTS: it was revealed, that decrease of severity stage of PTSD correlates with number of severe psychic traumatic events in anamnesis. Also it was determined, that as the stage of severity increases, intensity of dossociative disorders (in severe stage of PTSD were determine in female in 81,4 %, in male ? 90%) also increase. At that, men had higher indices of dissociative disorders in comparison with women. Clinical manifestations of dissociative disorders in different stages of severity in chronic PTSD were described. The mechanism of symptom forming and the dynamics of clinical manifestations of chronic PTSD were given like demonstration of psychological protection. The protective variant ? hypercompensation is typical for light form of chronic PTSD. Middle stage ? protection of second level (release from environment) and third level (“escape from themselves”). Severe PTSD ? fourth and fifth protective level ? “escape from I am” (dissociation of I am from environment) and esternalization from negative part of I am. CONCLUSION: in chronic PTSD synchronous increase of severity with number of severe psychic traumas and intensity of dissociative disorders were revealed.
1. Waddington, A. Post-traumatic stress disorder (PTSD): the syndrome with multiple faces / A. Waddington, J. F. Ampelas, F. Mauriac et al. // Encephale. – 2003. – V. 29, №1. – P. 20-27.
2. Unrecognized trauma and PTSD among public mental health consumers with chronic and severe mental illness / K. J. Cusack, A. L. Grubaugh, R. G. Knapp et al. // Community Ment. Health J. – 2006. – V. 42, №5. – P. 487-500.
3. Murray, J. Dissociation and post-traumatic stress disorder: two prospective studies of road traffic accident survivors / J. Murray, A. Ehlers, R. A. Mayou // Br. J. Psychiatry. – 2002. – V. 180. – P. 363–368.
4. McNally, R. J. Progress and controversy in the study of posttraumatic stress disorder / R. J. McNally // Annu. Rev. Psychol. - 2003. – V. 54. – P. 229-252.
5. Prediction of psychiatric morbidity in severely injured accident victims at one-year follow-up / U. Schnyder, H. Moergeli, O. Trentz et al. // Am. J. Respir. Crit. Care Med. – 2001. - V. 164, №4. – P. 653-656.
6. Korolenko, C. P. Sociodinamicheskaya psihiatriya / C. P. Korolenko, N. V. Dmitrieva. - Novosibirsk, 1999. – 418 s.
7. Responsivity to stress in chronic posttraumatic stress disorder due to childhood sexual abuse / U. M. Klumpers, J. H. Tulen, L. Timmerman et al. // Psychol. Rep. – 2004. – V. 94, №2. – P. 408-410.
8. Foa, E. B. Trauma and women: course, predictors, and treatment / E. B. Foa // J. Clin. Psychiatry. – 1997. – V. 58, Suppl. 9. – P. 25-28.
9. Foa, F. B. Psychological processes related to recovery from a trauma and an effective treatment for PTSD / E. B. Foa // Ann N.Y. Acad. Sci. – 1997. – V. 821. – P. 410-424.
10. Korolenko, C. P. Posttravmaticheskoe stressovoe rasstroistvo y lic s psihicheskoi travmoi v detstve / C. P. Korolenko, E. N. Zagoryiko // Sezd psihiatrov Rossii, 13-i: Materiali. – M., 2000. – S. 103-104.
11. Korolenko, C. P. Lichnostnie i dissociativnie rasstroistva: rasshirenie granic diagnostiki i terapii / C. P. Korolenko, N. V. Dmitrieva. – Novosibirsk, 2006. – 448 s.
12. Ispolzovanie naloksona dlya lecheniya depersonalizacii i issledovaniya ee patogeneza / U. L. Nyler, M. G. Morozova, E. E. Dybinina i dr. // Obozrenie psihiatrii i med. psihol. im. Behtereva. – 1999. - № 2. – S. 56-59.
13. Cognitive Function and Dissociative Disorder Status Among Veteran Subjects With Chronic Posttraumatic Stress Disorder: A Preliminary Study / V. Roca, J. Hart, T. Kimbrell et al. // J. Neuropsychiatry Clin. Neurosci. – 2006. V. 18. – P. 226-230.
14. Roca, V. Psychosensory Symptoms in Combat Veterans With Posttraumatic Stress Disorder / V. Roca, T. W. Freeman // J. Neuropsychiatry Clin. Neurosci. - 2002. – V. 14. – P. 185-189.
15. Koopman, G. Predictors of posttraumatic stress symptoms among survivors of the Oakland/Berkeley, Calif., firestorm / C. Koopman, C. Classen, D. Spiegel // Am. J. Psychiatry. – 1994. – V. 151. – P. 888-894.
16. Ehlers, A. A cognitivi model of posttraumatic stress disorder / A. Ehlers, D. M. Clark // Bechav. Res. Ther. – 2000. – V. 38, №4. – P. 319-345.
17. Briere, J. Peritraumatic and persistent dissociation in the presumed etiology of PTSD / J. Briere, C. Scott, F. Weathers // Am. J. Psychiatry. – 2005. – V. 162. – P. 2295–2301.
18. Ehlers, A. More evidence for the role of persistent dissociation in PTSD / A. Ehlers // Am. J. Psychiatry. – 2006. – V. 163. – P. 1112.
19. Brauchle, G. Persistent dissociation as predictor of posttraumatic stress disorder in psychosocial disaster workers / G. Brauchle // Psychother. Psychosom. Med. Psychol. – 2006. – V. 56, №8. – P. 342-346.
20. Posttraumatic stress disorder following assault: the role of cognitive processing, trauma memory, and appraisals / S. L. Halligan, T. Michael, D. M. Clark et al. // J. Consult. Clin. Psychol. – 2003. – V. 71, №1. – P. 419-431.
21. Bromberg, P. Speak That I May See You: Some Reflection on Dissociation, Reality and Psychoanalytic Listening / P. Bromberg // Psychoanal. Dial. - 2004. – V. 4, №4. – P. 517-548.
22. Tarabrina, N. V. Praktikym po psihologii posttravmaticheskogo stressa / N. V. Tarabrina.– SPb.: Piter, 2001. - 272 s.
23. Byndalo N. L.Zayavka 2007101454/14 Rossiiskaya Federaciya, MPK A 61 I 5/16 ot 15.01.2007 Sposob diagnostiki posttravmaticheskogo stressovogo rasstroistva / N. L. Byndalo // Bull. Izobreteniya. Poleznie modeli. – 2007. – № 13. – S. 32-33.
24. Kaplan, G. I. Klinicheskaya psihiatriya / G. I. Kaplan, B. Dj. Sedok. V 2t. / Per. s angl. – M.: Medicina, 1994. – T.1. - 672 s.
25. Horni K. Nashi vnytrennie konflikti. Konstryktivnaya teoriya nevroza / K. Horni. Per. s angl. V. Svetlova. – M.: Akademicheskii Prospekt, 2007. – 224 s.