Compreensões Fenomenológicas da Reexposição ao Trauma Sexual com Base nos Relatos de Mulheres / Phenomenological Understandings About Sexual Trauma Re-Exposure Based on Women's Reports / Comprensiones Fenomenológicas de la Reexposición al Trauma Sexual Basada en Informes de Mujeres

Esta pesquisa foi desenvolvida a partir do projeto temático "Transtorno de estresse pós-traumático e neuroprogressão: trauma e estresse no aumento da carga alostática e aceleração do processo de envelhecimento", realizado com mulheres vítimas de violência sexual e que desenvolveram estresse pós-traumático no estado de São Paulo. Neste estudo, são apresentados relatos de violência sexual na infância e na adolescência e sua reexposição na vida adulta e, com isso, tem como objetivo trazer à luz compreensões acerca dessa vivência a fim de abrir possibilidades de intervenções adequadas. Foram realizadas entrevistas reflexivas com quatro colaboradoras que, na triagem do Projeto Temático, responderam positivamente a um questionário de abuso e negligência durante a infância e na adolescência. Na análise fenomenológica, seus discursos foram separados em oito categorias de sentido (Afeto, Culpa, Mundo familiar, Não dito, Racismo, Profissionais, Hoje e Reexposição à violência sexual). Concluiu-se que a violência sexual diz respeito a uma responsabilidade política, uma vez que as colaboradoras culpam-se por acreditarem que a vulnerabilidade delas reside em algum comportamento provocado por elas mesmas e não por mais um dispositivo de violência contra a mulher.

This paper was developed based upon a thematic project "Posttraumatic stress disorder and neuroprogression: trauma and stress increasing load allostatic and accelerating the aging process", conducted with women who suffered sexual assault and developed post-traumatic stress disorder in the state of São Paulo. This study has reports about sexual violence in childhood and adolescence and its re-exposures in adulthood and seeks to bring up understandings about this experience in order to open possibilities for a more appropriate intervention. Reflective interviews were made with four collaborators that previously answered positively to a questionnaire of abuse and neglect during childhood and adolescence in the screening of the Thematic Project. With the phenomenological analysis their speech was split into eight categories (Affections, Guilt, Familiar world, Unsaid, Racism, Health professionals, Today and Sexual violence re-exposure). It has been concluded that sexual violence concerns to a political responsibility, once the collaborators blamed themselves for they believe that their vulnerability was their fault instead of a tradition of gender violence.

Esta investigación se desarrolló a partir del proyecto temático "Trastorno de estrés postraumático y neuroprogresión: el trauma y el estrés en el aumento de la carga alostática y la aceleración del proceso de envejecimiento", realizado con mujeres víctimas de violencia sexual y que desarrollaron estrés postraumático, en el estado de São Paulo. En este estudio, se presentan relatos de violencia sexual en la infancia y en la adolescencia y su reexposición en la edad adulta y, con ello, se pretende sacar a la luz comprensiones acerca de esa experiencia, para abrir posibilidades de intervenciones adecuadas. Se realizaron entrevistas reflexivas con cuatro colaboradoras que, en el triaje del Proyecto Temático, respondieron positivamente a un cuestionario sobre abuso y negligencia en la infancia y la adolescencia. En el análisis fenomenológico, sus discursos se separaron en ocho categorías de sentido (Afecto, Culpa, Mundo Familiar, No Dicho, Racismo, Profesionales, Actualidad y Reexposición a la Violencia Sexual). Se concluyó que la violencia sexual tiene que ver con una responsabilidad política patriarcal, ya que las colaboradoras se culpan a sí mismas por creer que su vulnerabilidad radica en algún comportamiento causado por ellas mismas y no por más un dispositivo de violencia contra las mujeres.

The anxiolytic effect of cannabidiol depends on the nature of the trauma when patients with post-traumatic stress disorder recall their trigger event

Objectives: We assessed whether administering cannabidiol (CBD) before recalling the traumatic event that triggered their disorder attenuates anxiety in patients with post-traumatic stress disorder (PTSD). As an exploratory pilot analysis, we also investigated whether this effect depends on the nature of the event (sexual vs. nonsexual trauma). Methods: Thirty-three patients of both sexes with PTSD were recruited and randomized 1:1 into two groups. One group received oral CBD (300 mg), and the other received a placebo before listening to a digital audio playback of their previously recorded report of the trigger event. Subjective and physiological measurements were taken before and after recall. We analyzed the data in two subsamples: trigger events involving sexual and nonsexual trauma. Results: In the nonsexual trauma group, the differences between measurements before and after recall were significantly smaller with CBD than placebo; this held true for anxiety and cognitive impairment. However, in the sexual trauma group, the differences were non-significant for both measurements. Conclusion: A single dose of CBD (300mg) attenuated the increased anxiety and cognitive impairment induced by recalling a traumatic event in patients with PTSD when the event involved nonsexual trauma.

The effect of trauma type on the severity of Post-Traumatic Stress Disorder (PTSD) symptoms

Abstract Objective: The high prevalence of trauma exposure calls for detailed research on how trauma type affects the development of Post-Traumatic Stress Disorder (PTSD). Therefore, the aim of our study was to investigate the effects of the type of trauma on the severity of symptoms, anxiety, depression, and dissociative experiences in the PTSD patient population. Method: The sample of the study consists of 80 volunteer PTSD patients (20 sexual trauma, 20 work accidents, 20 traffic accidents and 20 combat related trauma). Once the severity of symptoms was determined in all subjects by the Clinician-Administered PTSD Scale (CAPS), Beck Depression Inventory, Beck Anxiety Inventory and Dissociative Experiences Scale (DES) were applied. Results: A statistically significant difference were found between trauma types with regard to age, time without treatment, and the total and subscale scores obtained in DES and CAPS. It was found that in the group that has PTSD diagnosis related to sexual trauma, the length of the time without treatment, DES and CAPS scores. Conclusion: The study we conducted showed that PTSD continued more severe and resistant after a sexual trauma. Moreover, specific type of trauma was significant in PTSD patients.

Medo, o representante da morte: a insídia da violência deixando haveres terroríficos na mente e no viver / Fear, the representative of death: the insidiousness of violence that causes "terrifying possessions" in mind and in living / Miedo, el representante de la muerte: la insidia de violencia dejando "terroríficos activos" en la mente y en el vivir / Peur, le représentant de la mort: le piège de la violence en laissant des "avoirs terrorisants" dans l'esprit et le vivre

Este trabalho tem como objetivo contribuir, através de seu vértice clínico-teórico, para a ampliação dos estudos psicanalíticos no que concerne ao sofrimento psíquico ocasionado pela violência e pelo terror claustrofóbico: terror sem nome. Inicialmente faz-se uma retomada histórica sobre o medo terrorífico por meio da abordagem psicanalítica, a qual considera esse sentimento/sensação uma grande inquietação ante o perigo e o desamparo, orgânico e psíquico, cujas raízes remontam às relações primevas. Na sequência busca-se mostrar os desdobramentos do terror sem nome e da condição claustrofóbica, principalmente quando a estes é acrescido o abuso sexual na infância. A partir daí constrói-se uma ponte entre os achados ferenczianos e os bionianos. Finalmente apresentam-se as interfaces de um atendimento clínico, no qual se enfatiza a procura da dupla analítica pela libertação do claustro terrorífico e pelo resgate da identidade da analisanda.

The purpose of this paper is to contribute, from a theoretical and practical perspective, to the expansion of psychoanalytic studies about the mental suffering that is caused by violence and claustrophobic terror: "nameless dread". First, the author provides a historical resume about terrifying fear by using a psychoanalytic approach. Psychoanalysis considers this feeling-sensation a deep concern over the idea of danger and helplessness which is both organic and psychic and whose source lies in primitive relationships. Then, the author connects Ferenczi's and Bion's thinking. Finally, she analyzes the interfaces of a clinical case in which she emphasizes the attempt of the psychoanalytic pair to be released from the terrifying cloister and to rescue the patient's identity.

El presente trabajo pretende contribuir, a través de su vértice teórico y clínico para la expansión de los estudios psicoanalíticos con respecto al sufrimiento psíquico causado por la violencia y el terror claustrofóbico: "terror sin nombre". Inicialmente se hará un resumen histórico sobre el miedo terrorífico desde el enfoque psicoanalítico, que considera este sentimiento-sensación una gran inquietud antes de la noción de peligro y desamparo, orgánico y psíquico cuyas raíces datan de las primeras relaciones. Después, se presentan los desdoblamientos del "terror sin nombre" y de la condición claustrofóbica especialmente cuando a estas se suma el abuso sexual en la infancia. Desde allí se construye un puente entre los estudios ferenczianos y los bionianos. Finalmente se presentan las interfaces de un atendimiento clínico en el cual se enfatizó la búsqueda del par analítico para la liberación del claustro terrorífico y para el rescate de la identidad de la analizada.

Ce travail a pour but de contribuer, par son côté clinico-théorique, pour l'élargissement des études psychanalytiques dans ce qui concerne la souffrance psychique causé par la violence et par la terreur claustrophobique: "la terreur sans nom". D'abord on fait une reprise historique sur le fait de la peur terrorisant d'après l'approche psychanalytique qui considère ce sentiment-sensation une grande inquiétude face à la notion de danger et de délaissement, organique et psychique, dont les racines remontent aux rapports premiers. Ensuite on cherche à présenter les dédoublements de « la terreur sans nom ¼ et de la condition claustrophobique, en spécial lorsque l'on ajoute à celles-ci l'abus sexuel dans l'enfance. À partir de là, on construit un pont entre les trouvailles ferencziennes et les bioniennes. Enfin, on présente les interfaces d'un soin clinique dans lequel on met en évidence la recherche du duo analytique au moyen du claustro terrorisant et de la reprise de l'identité de l'analysante.

Diagnosis and Management of Genital Ulcers.

Herpes simplex virus infection and syphilis are the most common causes of genital ulcers in the United States. Other infectious causes include chancroid, lymphogranuloma venereum, granuloma inguinale (donovanosis), secondary bacterial infections, and fungi. Noninfectious etiologies, including sexual trauma, psoriasis, Behçet syndrome, and fixed drug eruptions, can also lead to genital ulcers. Although initial treatment of genital ulcers is generally based on clinical presentation, the following tests should be considered in all patients: serologic tests for syphilis and darkfield microscopy or direct fluorescent antibody testing for Treponema pallidum, culture or polymerase chain reaction test for herpes simplex virus, and culture for Haemophilus ducreyi in settings with a high prevalence of chancroid. No pathogen is identified in up to 25 percent of patients with genital ulcers. The first episode of herpes simplex virus infection is usually treated with seven to 10 days of oral acyclovir (five days for recurrent episodes). Famciclovir and valacyclovir are alternative therapies. One dose of intramuscular penicillin G benzathine is recommended to treat genital ulcers caused by primary syphilis. Treatment options for chancroid include a single dose of intramuscular ceftriaxone or oral azithromycin, ciprofloxacin, or erythromycin. Lymphogranuloma venereum and donovanosis are treated with 21 days of oral doxycycline. Treatment of noninfectious causes of genital ulcers varies by etiology, and ranges from topical wound care for ulcers caused by sexual trauma to consideration of subcutaneous pegylated interferon alfa-2a for ulcers caused by Behçet syndrome.

O trauma sexual e a angústia de castração: percurso freudiano à luz das contribuições de Lacan / Sexual trauma and castration anguish: freudian courses in light of Lacan's contributions

Este trabalho tem como objetivo articular os conceitos de trauma sexual e angústia de castração a partir dos textos freudianos e à luz das contribuições de Lacan. Em Freud, estes conceitos acompanham a construção da psicanálise enquanto campo de investigação do inconsciente. O inconsciente nos indica o vazio fundamental que movimenta o desejo, a ausência do objeto. A fantasia, através do que se orienta o desejo, representa a permanência do objeto faltoso, a alienação do eu no Ideal de um gozo fálico. A angústia de castração funciona como sinal para a atuação dos mecanismos de defesa do eu, cujo último véu é a reivindicação fálica. Esta, articulada à angústia de castração, surge como "limite intransponível" da psicanálise. A proposta de Lacan é ir para além da angústia de castração, retornando, ao seu modo, ao conceito de trauma sexual.

The objective of the present study is to articulate the definition of sexual trauma and castration anguish according to Freudian texts and Lacan's contributions. For Freud, these definitions follow psychoanalysis as a field that investigates the unconscious. The unconscious indicates the fundamental emptiness that moves the desire, the absence of the object. Fantasy, as a desire guide, represents the permanence of the missing object, the alienation of the ego within the ideal of the phallic pleasure. Castration anguish works as a sign for ego defense mechanisms to come into play, in which the last instance is the phallic pleasure. This, articulated to castration anguish, comes as a "non trespassing border" of psychoanalysis. Lacan's proposal is to go beyond castration anguish, returning, on his way, to the definition of the sexual trauma.

La mujer como víctima de trauma sexual / Women as victims of sexual trauma

Se revisa el tema de las consecuencias físicas que la práctica sexual puede acarrear sobre las diferentes estructuras genitales y anorrectales de la mujer.

ABSTRACT Physical consequences of different modalities of sexual practice on female genital and anorectal structures are reviewed