Violence and Traumatic Stress

Roberto Sivak (1)

1- Psychic trauma is defined as that event which by its magnitude, the quality (threat to the
psychophysical and moral integrity) by the fact surpass the possibilities of psychic elaboration or
its aftermath psychophysical causes clinically important effects

2- Hundred years ago Freud considered psychic trauma as a cause among others of hysteria and
traumatic neurosis later (in this case the fact is objectified as the case of the aftermath of combat
in World War II. The concept of traumatic neurosis was intensely debated upon thousands of
inquiries on the line for silence, blindness, pseudo-seizures, paralysis, insomnia, scenes repeated
intrusive memories or nightmares of combat

3- The symptoms comprise three groups still valid since: hyper autonomic arousal avoidance
(anhedonia, avoidance of places, ideas or conversations related to the original trauma situation)
intrusive memories (nightmares, memories lived in waking and repeated sensory memories -
visual, auditory or olfactory) linked to the fact

4- interpersonal violence situations have shown to be the source of the most severe cases of
traumatic neurosis greater than the effects of catastrophes or natural disasters.

5- The clinical picture of PTSD has served as a reference for both diagnosis and for claiming
compensation. The three groups of symptoms remain broadly. However clinical modalities like
somatizadora, depressive, borderline, and personality changes (avoidant, paranoid or psychotic)
modifications described in the movie "Days of Rage" are added.

6- The technical and ethical problems take over 100 years for the technique of free association,
taking or not about the traumatic situation, the timing and the role of the transfer (Freud-Ferenczi
controversy) is common in patients claim or be questioned repeatedly about the trauma or else
the therapist or analyst privilege history or primary bonds. Also it should be noted that the
persistent blindness prejudicially contributions disqualifies schools as cognitive, behavioral,
relaxation techniques or pharmacotherapy in pathologies of difficult access to the word.

7- In thirty years of existence the team Posttraumatic Stress Alvarez Hospital has treated victims of
events that span the history of Argentina: political repression, survivors of attacks AMIA and Israeli
Embassy, veterans of the Falklands, gender and family violence, urban violence (assaults,
entraderas and salideras) and harassment and violence against professional education and health.

8- The changing social contexts and others have been correlated with untimely dismissals,
resignations and attrition to achieve / or inquisitorial together beyond the evidence of the medical
consequences.
9- The risks of delayed diagnosis or inadequate treatment are depression, resignation, substance
abuse, ideation or suicide completion

10- The victims are unaware of the by requiring psychological or psychiatric treatment favoring
their basic needs (shelter, food, shelter, or grant justice to their claims) 70% evolves
spontaneously improve its box. 30% vulnerability factors (genetic, previous trauma, dysfunctional
family, social isolation) tends to become chronic table.

11- To be mentioned among the factors resilient optimism, hope, unconditional support of the
family, relational networks and find social legitimacy to damage.

12- The diagnosis requires the active search for victims after a disaster and the subsequent follow-
up years (consider the suicides of veterans of the Falklands or current depressive homeless Cro-
Magnon)

13. The therapeutic approach should be general, psychiatric, psychological, legal, medical
interdisciplinary, occupational therapy, psychology, social work is important groups with self-help
techniques In many cases the victim is only able to accept psychotherapy few months later.
Priority should be given to the needs and times of the victim.

14. Prevention requires truthful, accurate, non-sensational, guidance information. The media can
generate retraumatization by improper handling or repetition of violent scenes

BIBLIOGRAFIA
Sivak R., Libman J. (comp) 2007 Estrés, trauma y desastres Ed. Akadia Buenos Aires
Sivak R., Ponce A. Diaz Tolosa P., Horikawa C. Zukerfeld R. Zonis de Zukerfeld R.(2007)
Redes vinculares y desarrollos resilientes en damnificados de Cromañon. Premio APSA
Congreso Arg. De Psiquiatria Mar del Plata