Controversias respecto de la conceptualización del trastorno de estrés postraumático / Controversies in regards to the conceptualization of the post-traumatic stress disorder

Las controversias respecto al TEPT, desde su formulación como categoría diagnóstica hasta el presente, han sido múltiples. Se han planteado interrogantes respecto de su estatus como concepto científico por los factores socio históricos que influyeron tanto en su origen como categoría como en la expansión de su empleo, así como cuestionamientos específicos a su validez de constructo. El concepto de evento traumático, la relación de causalidad entre evento traumático y consecuencias psicopatológicas, la especificidad que tendría la respuesta traumática, son parte relevante de esos cuestionamientos. El artículo presenta una visión de estas controversias y señala sus implicaciones para la comprensión y tratamiento de las consecuencias psicológicas de los eventos traumáticos.

The controversies respect to the PTSD, since its formulation as a diagnostic category up to the present, have been multiple. Questions have been posed in relationship to its status as a scientific concept because due to socio-historical factors that influenced in its origin as a category as well as in the expansion of its use. Also, queries have been raised concerning the validity of this construct. The concept of traumatic event, the causal relationship between the traumatic event and its psychopathological consequences, the specificity of the traumatic response, are relevant parts of these queries. The article presents an overview of these controversies and states its implications for the understanding and treatment of the psychological consequences of traumatic events.

Análisis de los deseos en dos cartas de Frida Kahlo / Analysis of desires in two letters by Frida Kahlo

A partir de dos cartas de Frida Kahlo (27 de marzo de 1927 y 29 de julio de 1932), serán analizados los deseos manifiestos y su relación con el período vital de la artista, remitiéndonos a la obra de arte en el mismo período histórico (Autorretrato con traje de terciopelo, septiembre de 1926, y Mi nacimiento o Nacimiento, 1932). El instrumento metodológico utilizado es el Diccionario Computarizado y las grillas diseñadas para el análisis de los actos del habla, aplicadas en los textos seleccionados. El resultado esperado es detectar los deseos dominantes, con independencia de los prejuicios que pueden generarse desde la biografía de la artista, en sus manifestaciones artísticas y cartas.

Based on two of Frida Kahlo’s letters (27 March 1927-29 July 1932), the manifest wishes and their relationship to the vital period of the artist will be analyzed, by referring to the work of art in the same historical period (Self-portrait in velvet clothes, September 1926, and My birth or Birth, 1932). The methodological instrument usedis the Computerized Dictionary and the grids designed for the analysis of speechacts, applied in selected texts. The expected outcome is the detection of the dominant wishes irrespective of the prejudices that could stem from the biography of the artist in its artistic manifestations and letters.

Los eventos traumáticos tempranos y su relación con la psicopatía criminal / Early traumatic events and its relationship with criminal psychopathy

INTRODUCCION: Son diversos los factores que intervienen en el desarrollo de la psicopatía. Se ha observado una predisposición genética que al interactuar con la vivencia de eventos traumáticos en edades tempranas, potencia el desarrollo de este trastorno conductual, fuente de actos agresivos y violentos en contra de la sociedad. OBJETIVO: Conocer la incidencia de eventos traumáticos (p.ej. eventos estresantes, abuso físico, abuso emocional y abuso sexual) y su influencia en el nivel de psicopatía de adultos convictos masculinos. PARTICIPANTES Y MATERIAL: Se realizó una revisión del historial criminal y una entrevista semiestructurada para clasificar a los internos de acuerdo a su nivel de psicopatía. Se les aplicó el Inventario de Eventos Traumáticos para conocer la frecuencia y diversidad de eventos sufridos antes de los 18 años. RESULTADOS: Los internos con alta psicopatía presentaron una alta incidencia de eventos traumáticos, específicamente de eventos estresantes, de abuso emocional y de abuso sexual y un total de eventos significativamente mayor que el grupo con psicopatía baja. Los eventos traumáticos y el abuso emocional fueron variables que contribuyeron significativamente al nivel de psicopatía de los internos. CONCLUSIONES: Los eventos traumáticos vividos durante la infancia y la adolescencia favorecen la manifestación de conductas violentas a través de la afectación de los mecanismos neurobiológicos que subyacen a la psicopatía, en donde se puede observar una asociación entre la frecuencia de eventos vividos y el grado de psicopatía presentes en la vida adulta.

INTRODUCTION: The factors that interact to drive the development of psychopathy are diverse. A genetic predisposition has been observed that, when coupled with the experience of traumatic events at a young age, potentiates the development of this behavioral and affective disorder that leads to aggressive and violent acts against society. OBJECTIVES: To understand the incidence of traumatic events (e.g., stressful events, physical abuse, emotional abuse, and sexual abuse) and their influence in the psychopathy of adult male convicts. PARTICIPANTS AND MATERIALS: Background criminal career reviews and semi-structured interviews were conducted to classify the inmates according to their psychopathy level utilizing the Revised Hare Psychopathic Scale. In addition, the Early Trauma Inventory was applied to assess the frequency and diversity of events experienced before the participants were 18 years of age. RESULTS: Inmates with high psychopathy also presented with a high incidence of traumatic events, as well as stressful events, emotional and sexual abuse in a higher frequency than the group with low psychopathy. The incidence of traumatic events and emotional abuse were found to predict the degree of psychopathy among the inmates. CONCLUSIONS: Traumatic events experienced during infancy and adolescence seem to favor the manifestation of violent conduct by interacting with neurobiological factors that underlie psychopathy, such that an association may be observed between the frequency of childhood traumatic events and the level of psychopathy present in adult life.

Estudio de casos y controles en un grupo de mujeres embarazadas con experiencias adversas en la infancia y/o adolescencia e infecciones de transmisión sexual / Case studies and controls in a group of pregnant with adverse experience in childhood and/or adolescence and sexually transmitted infections

Introduction Psychic traumas, also called adverse experiences, are events from the subject's life characterized by its intensity, the subject's inability to respond to them properly and the pathogenic lasting effects they cause in the psychic organization. The violence effects against women and girls are usually devastating for their reproductive health and other aspects of their physical and mental well-being. Besides injuries, violence causes an increase in the long-term risk of women developing other health problems. Women with a history of psychic mistreat or sexual abuse face also a bigger risk of non-expected or involuntary pregnancies, sexual transmitted infections and adverse results from pregnancy. High rates of childhood abuse were found: 42.2% had suffered physical mistreat, 21.4% had been insulted, 16.5% was victim of humiliation and 7.6% had been a victim of sexual abuse before fifteen years of age. The main aggressors were male relatives, the stepfather or the father. A study done in the United States found that women exposed to this form of violence suffered STI in adult age in a bigger proportion (10.7%) than the ones that were never exposed (5.7%). An investigation was made in the National Perinatolgy Institute called «STD/HIV-AIDS and Personality Disorders (PD) in pregnant women and their couples. Detection and prevention from high risk practices¼ with the objective -among others- to resolve the existing association between adverse experiences in childhood and the presence of sexually transmitted infections in gestation. Material and method The investigation design was of cases and controls; the characteristics of the study in relation to temporality was prospective with respect to the presence or absence of the pathogenic agent in gestation and retrospective (investigating adverse experiences in childhood), analytical referring to the analysis type and transverse with respect to the capture of the sample. The evaluation of the STIs was made through the Laboratory of the Sexually Transmitted Infections Clinic of the INPer and from the pertinent clinic exams. The diagnostic evaluation was made on the basis of the structured clinic interviews for the diagnostic psychiatric evaluation of I and II axes of DSM-IV. To investigate adverse childhood experiences, a psychodynamic interview was made and answers were transcribed then to the questionnaire made by Whitfields, Dube, Felitti and Anda, who developed the instrument Adverse Experiences in Childhood and/or Adolescence (ACE) with the aim to measure the amplitude of the exposition to emotional, physical and sexual abuse, as well as family dysfunction in these stages of life. It includes seven categories of adverse experiences, three relative to active abuse and five to passive abuse: 1. psychological abuse; 2. physical abuse; 3. sexual abuse; 4. conjugal violence against the mother; 5. living with parent or adults with alcohol problems and/or substance abusers; 6. living with parents or adults with mental disorders or suicidal; 7. living with parents that had been in jail. Results One hundred seventy-eight pregnant women were divided in two groups, the first one with 89 participants, in which a virus that caused the STI was identified, and the second group was the control group with also 89 pregnant women without STI. Significant differences were obtained in the socioeconomic level. There was also a significant association between fathers of the women with STI that had some legal problem and had being sent to jail for a period of time (RM 3.311); they also show small alcoholic problems (RM 2.073). There was a significant association with the different types of passive abuse (carelessness, negligence and indifference) physical, emotional and sexual, emphasizing that the relation between these categories and having an STI by a virus is highly significant; this is, being exposed in childhood to adverse events, more probability to get a viral STI in adulthood. The cases group accumulated three or more in bigger proportion (20.2%) than the control group (9%). The STI pregnant group presented a bigger number of traumatic events (69.9%) in comparison to the group with no STI that was 48.3%. It is appraised the bigger prevalence of mental disorders in the STI pregnant group, having a disorder increased the potential risk of infection by 2.45 times (C:I to 95% that oscillates between 1.303 and 4.61). Conclusions The STI viral group and the control group are different concerning socioeconomic level and schooling, finding in the STI group a bigger proportion of women whose monthly family income is lower, the poverty as a risk factor and/or social vulnerability for the HIV infection, the interaction between living in poverty conditions and the difficulty to access and to stay in the national educative system are closely related. In addition, this case group was integrated in a bigger proportion with pregnant who were not united in the study period. It is important to mention that half of the pregnant that formed the HIV/ AIDS group suffered the pain of seeing their couple die. From the adverse experiences in childhood and/or adolescence that could have been in the start or been a beginning factor for getting afterwards a viral STI in adulthood, the significant ones were having lived with a alcohol abuser adult, thus being victim of carelessness, negligence or indifference, same as being hit, pushed, pushed or hit so hard to leave marks, humiliations, coarses, insults, feelings of being less and victim of being touched or having a sexual experience. These traumatic events happened simultaneously, mainly in the cases group where 40 pregnant declared being exposed to two or more categories in contrast with 22 of the control group. Alcohol abuse is a generalized health problem and common in all societies; pregnant women with STI were in bigger proportion more exposed to familiar alcohol than the control group and approximately half of them were at the same time victims of some forms of abuse or violence by their fathers or stepfathers. Studies made in 21 countries show that between 7% and the 36% of the women had accepted being victims of sexual aggressions during their childhood and, according to most of these studies, the rate of abuses suffered by girls is 1.5 to 3 times bigger than men. The same report makes evident the fact that between 133 and 275 millions of children from all over the world are witnesses of domestic violence each year; this is, witness violent scenes at their home, generally through fights between their parents or between their mother and couple, which can also seriously affect their well-being, development and their social interaction in childhood and adult age. It has also been found that suffering an active abuse in childhood is a risk factor for structuring a borderline personality disorder.

Resumen Introducción Los traumas psíquicos, también denominados experiencias adversas, son acontecimientos de la vida del sujeto caracterizados por su intensidad, la incapacidad del sujeto para responder a ellos adecuadamente y los efectos patógenos duraderos que provocan en la organización psíquica. Los efectos de la violencia contra las mujeres y las niñas suelen ser devastadores para la salud reproductiva de la mujer y otros aspectos de su bienestar físico y mental. Además de causar lesiones, la violencia lleva a que aumente el riesgo a largo plazo de que las mujeres desarrollen otros problemas de salud. Las mujeres con una historia de maltrato físico o abuso sexual también enfrentan un riesgo mayor de embarazos no previstos o involuntarios, infecciones de transmisión sexual (ITS) y resultados adversos del embarazo. En el Instituto Nacional de Perinatología se realizó una investigación titulada «ETS/VIH-SIDA y trastornos de la personalidad en mujeres embarazadas y sus parejas. Detección y prevención de prácticas de alto riesgo¼ con el objetivo -entre otros- de determinar la asociación existente entre experiencias adversas en la infancia y la presencia de infecciones de transmisión sexual en la gestación. Material y método El diseño de la investigación fue de casos y controles; el estudio fue prospectivo respecto de la presencia o ausencia del agente patógeno en la gestación y retrospectivo (indagación de experiencias adversas en la infancia). La evaluación de las ITS se efectuó por medio del laboratorio; la evaluación diagnóstica se efectuó con base en las Entrevistas Clínicas Estructuradas para la evaluación diagnóstica psiquiátrica de los Ejes I y II del DSM-IV. Se aplicó el instrumento Experiencias Adversas en la Infancia y/o Adolescencia (ACE, por sus siglas en inglés), con el fin de medir la amplitud de la exposición al abuso emocional, físico y sexual, así como la disfunción familiar en estas etapas de la vida. El instrumento comprende siete categorías: 1. abuso psicológico; 2. abuso físico; 3. abuso sexual; 4. violencia conyugal contra la madre; 5. vivir con padres o adultos con problemas de alcoholismo y/o que eran abusadores de sustancias; 6. vivir con padres o adultos con trastornos mentales o suicidas; 7. vivir con padres que fueron encarcelados. Resultado Se estudiaron dos grupos, el primero de casos integrado con 89 embarazadas con ITS viral y el segundo fue el grupo control integrado también con 89 gestantes, sin ITS. Se obtuvieron diferencias significativas en el nivel socioeconómico. Así mismo hubo una asociación significativa entre los padres de las mujeres con ITS que tuvieron algún problema con la ley por lo que habían sido encarcelados por un determinado periodo de tiempo (la razón de momios fue 3.311); y los que manifestaron leves problemas de alcoholismo (RM 2.073). Hubo una asociación significativa en: abuso pasivo, físico, emocional y sexual, donde destaca que la relación entre estas categorías y padecer una ITS por virus es altamente significativa. El grupo de las gestantes con ITS presentó un mayor número de problemas traumáticos (69.9%) en comparación con el grupo sin ITS que fue de 48.3%. Conclusiones De las experiencias adversas en la infancia y/o adolescencia, que pudieron estar en el origen o haber sido un factor iniciador para adquirir posteriormente una ITS de origen viral en la edad adulta, fueron significativas haber convivido con un adulto cercano con problema de abuso del alcohol y haber sido víctima de descuido, abuso físico, emocional o sexual.