Trauma, posttraumatische Belastungsstörung und Somatisierung

 

 Buy Article Permissions and Reprints

Zusammenfassung

In einer konsekutiven Querschnittstudie wurden 483 Patienten (Alter: 35,8 ± 13,2 Jahre) der psychosomatischen Ambulanz einer Universitätsklinik mittels einer standardisierten, störungsspezifischen Testbatterie untersucht. 63,1 % der Patienten gaben an, mindestens ein traumatisches Erlebnis in ihrem Leben gehabt zu haben. Bei 10,1 % der Patienten war testpsychometrisch von einer posttraumatischen Belastungsstörung (PTB) auszugehen. Im Vergleich zu nicht traumatisierten Patienten berichteten PTB-Patienten signifikant häufiger über somatoforme Beschwerden. Auch der Vergleich von traumatisierten Patienten mit und ohne PTB zeigte eine signifikant ausgeprägtere Somatisierungstendenz bei PTB-Patienten. Im Vordergrund der somatoformen Beschwerden standen neurologische Symptome, gefolgt von gastrointestinalen, kardiopulmonalen Symptomen, Schmerzsensationen und sexuellen Dysfunktionen. Die Ergebnisse unterstreichen den engen Zusammenhang von Somatisierung und PTB-Symptomatik, was im Hinblick auf den diagnostischen Prozess innerhalb der Psychotraumatologie stärker berücksichtigt werden sollte.

Abstract

In a cross-sectional study, 483 patients (age: 35.8 ± 13.2 years) of an outpatient psychosomatic university clinic were investigated using a standardized disorder-specific set of tests. 63.1 % of the patients reported to have experienced at least one traumatic event in their life. Test-psychometrically, a posttraumatic stress disorder (PTSD) could be assumed in 10.1 %. Compared to non-traumatized patients, patients with a PTSD reported significantly more frequently somatoform symptoms; even the comparison of traumatized patients with and without PTSD demonstrated a pronounced tendency to somatize in PTSD patients. Neurologic, gastrointestinal and cardiopulmonary symptoms, as well as pain sensations and sexual dysfunctioning were predominantly reported as somatoform complaints. The results emphasize the close connection between somatization and PTSD symptoms; this should be increasingly taken into consideration in the diagnostic process within psychotraumatology.

Literatur

• 1 Kessler R C, Sonnega A, Bromet E, Hughes M, Nelson C B. Posttraumatic stress disorder in the national comorbidity sample.  Arch Gen Psychiatry. 1995;  52 1048-1060
  Google Scholar
• 2 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), 3^th ed. Washington, DC; American Psychiatric Press 1987
  Google Scholar
• 3 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Washington, DC; American Psychiatric Press 1994
  Google Scholar
• 4 Stein M B, Walker J R, Hazen A L, Forde D R. Full and partial posttraumatic stress disorder: findings from a community survey.  Am J Psychiatry. 1997;  154 1114-1119
  PubMedGoogle Scholar
• 5 Breslau N, Davis G, Andreski P, Federman B, Anthony J C. Epidemiological findings on posttraumatic stress disorder and co-morbid disorders in the general population. In: Dohrenwend BP (ed) Adversity, Stress and Psychopathology. New York; Oxford University Press 1998: 319-330
  Google Scholar
• 6 Resnick H S, Kilpatrick D G, Dansky B S, Saunders B E, Best C L. Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women.  J Consult Clin Psychol. 1993;  61 984-991
  CrossrefPubMedGoogle Scholar
• 7 Breslau N, Davis G C, Andreski P, Peterson E L, Schultz L R. Sex differences in posttraumatic stress disorder.  Arch Gen Psychiatry. 1997;  54 1044-1048
  Google Scholar
• 8 Rothbaum B O, Foa E B, Riggs D, Murdock T, Walsh W. A prospective examination of post-traumatic stress disorder in rape victims.  J Trauma Stress. 1992;  5 455-475
  CrossrefPubMedGoogle Scholar
• 9 Kilpatrick D G, Resnick H S. Posttraumatic stress disorder associated with exposure to criminal victimization in clinical and community populations. In: Davidson JRT, Foa EB (eds) Posttraumatic stress disorder: DSM-IV and Beyond. Washington, DC; American Psychiatric Press 1993: 113-143
  Google Scholar
• 10 Basoglu M, Paker M, Paker O, Ozmen E, Marks I, Incesu C. Psychological effects of torture: a comparison of tortured with non-tortured political activists in Turkey.  Am J Psychiatry. 1994;  151 76-81
  PubMedGoogle Scholar
• 11 Giaconia R M, Reinherz H Z, Silverman A B, Pakiz B, Frost A K, Cohen E. Traumas and Posttraumatic Stress Disorder in a community population of older adults.  J Am Acad Child Adolesc Psychiatry. 1995;  34 1369-1380
  PubMedGoogle Scholar
• 12 Davidson J RT, Connor K M. Management of posttraumatic stress disorder: diagnostic and therapeutic issues.  J Clin Psychiatry. 1999;  60 33-38
  PubMedGoogle Scholar
• 13 Switzer G E, Dew M A, Thompson K, Goycoolea J M, Derricott T, Mullins S D. Posttraumatic stress disorder and service utilization among urban mental health center clients.  J Trauma Stress. 1999;  12 25-39
  CrossrefPubMedGoogle Scholar
• 14 Perkonnig A, Kessler R C, Storz S, Wittchen H U. Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity.  Acta Psychiatr Scand. 2000;  101 46-59
  CrossrefPubMedGoogle Scholar
• 15 Brady K T, Killeen T K, Brewerton T, Lucherini S. Comorbidity of psychiatric disorders and posttraumatic stress disorder.  J Clin Psychiatry. 2000;  61 22-32
  PubMedGoogle Scholar
• 16 Solomon Z, Mikulincer M. Combat stress reaction, posttraumatic stress disorder and somatic complaints among Israeli soldiers.  J Psychosom Res. 1987;  31 131-137
  CrossrefPubMedGoogle Scholar
• 17 Shalev A, Bleich A, Ursano R J. Posttraumatic stress disorder: somatic comorbidity and effort tolerance.  Psychosomatics. 1990;  31 197-203
  PubMedGoogle Scholar
• 18 Decoufle P, Holmgreen P, Boyle C A, Stroup N E. Self-reported health status of Vietnam Veterans in relation to perceived exposure to herbicides and combat.  Am J Epidemiol. 1992;  135 312-323
  PubMedGoogle Scholar
• 19 Solomon Z. The effect of combat-related posttraumatic stress disorder on the family.  Psychiatry. 1988;  51 323-329
  PubMedGoogle Scholar
• 20 Kulka R A, Schlenger W E, Fairbank J A, Hough R J, Jordan B K, Marmar C R, Weiss D S. Trauma and the Vietnam War generation: Report of findings from the National Vietnam Veterans Readjustment Study. New York; Brunner & Mazel 1990
  Google Scholar
• 21 Wolfe J, Schnurr P, Brown P, Furey J. Posttraumatic stress disorder and war zone exposure as correlates of perceived health in female Vietnam War veterans.  J Consult Clin Psychol. 1994;  62 1235-1240
  CrossrefPubMedGoogle Scholar
• 22 Beckham J C, Crawford A L, Feldman M E, Kirby A C, Hertzberg M A, Davidson J RT, Moore S D. Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans.  J Psychosom Res. 1997;  43 379-389
  CrossrefPubMedGoogle Scholar
• 23 Labbate L A, Cardena E, Dimitreva J, Roy M, Engel C C. Psychiatric syndromes in Persian Gulf War veterans: an association of handling dead bodies with somatoform disorders.  Psychother Psychosom. 1998;  67 275-279
  PubMedGoogle Scholar
• 24 Escobar J J, Canino G, Rubio-Stipec M, Bravo M. Somatic symptoms after a natural disaster: a prospective study.  Am J Psychiatry. 1992;  149 965-967
  PubMedGoogle Scholar
• 25 McFarlane A C, Atchison M, Rafalowicz E, Papay P. Physical symptoms in post-traumatic stress disorder.  J Psychosom Res. 1994;  38 715-726
  CrossrefPubMedGoogle Scholar
• 26 Andreski P, Chilcoat H, Breslau N. Post-traumatic stress disorder and somatization symptoms: A prospective study.  Psychiatry Res. 1998;  79 131-138
  CrossrefPubMedGoogle Scholar
• 27 Ford C V. Somatic symptoms, somatization, and traumatic stress: An overview.  Nord J Psychiatry. 1997;  51 5-13
  PubMedGoogle Scholar
• 28 Gündel H, Siess M, Ehlert U. Epidemiologie und gesundheitsökonomische Relevanz der somatoformen Störung. In: Kapfhammer HP, Gündel G (Hrsg) Psychotherapie der Somatisierungsstörungen. Stuttgart; Thieme Verlag 2001: 49-55
  Google Scholar
• 29 Loewenstein R J. Somatoform disorders in victims of incest and child abuse. In: Kluft RP (ed) Incest related syndromes of adult psychopathology. Washington, DC; American Psychiatric Press 1990: 75-112
  Google Scholar
• 30 Irwin C, Falsetti S A, Lydiard R B, Ballenger J C, Book C D, Brener W. Comorbidity of posttraumatic stress disorder and irritable bowel syndrome.  J Clin Psychiatry. 1996;  57 576-581
  PubMedGoogle Scholar
• 31 Egle U T, Hoffmann S O, Joraschky P. Sexueller Missbrauch, Misshandlung, Vernachlässigung. Stuttgart; Schattauer 1997
  Google Scholar
• 32 Drossman D A. Sexual and physical abuse and gastrointestinal illness.  Scand J Gastroenterol. 1995;  208 90-96
  PubMedGoogle Scholar
• 33 Leserman J, Drossman D A, Li Z, Toomey T C, Nachman G, Glogau L. Sexual and physical abuse history in gastroenterology practice: How types of abuse impact health status.  Psychosom Med. 1996;  58 4-15
  PubMedGoogle Scholar
• 34 Schofferman J, Anderson D, Hines R, Smith G, Keane G. Childhood psychological trauma and chronic refractory low-back-pain.  Clin J Pain. 1993;  9 260-265
  PubMedGoogle Scholar
• 35 Boscarino J A. Diseases among men 20 years after exposure to severe stress: implications for clinical research and medical care.  Psychosom Med. 1997;  59 605-614
  CrossrefPubMedGoogle Scholar
• 36 Dilling H, Mombour W, Schmidt M H. Internationale Klassifikation psychischer Störungen, ICD-10. Bern, Göttingen, Toronto; Verlag Hans Huber 1991
  Google Scholar
• 37 Rief W, Hiller W, Heuser J. SOMS - Das Screening für Somatoforme Störungen. Manual zum Fragebogen. Bern; Hans Huber 1997
  Google Scholar
• 38 Hessel A, Geyer M, Schumacher J, Brähler E. Somatoforme Beschwerden in der Bevölkerung Deutschlands.  Z psychosom Med Psychother. 2002;  48 38-58
  PubMedGoogle Scholar
• 39 Ehlers A, Steil R, Robins L N, McEvoy L. Deutsche Übersetzung der Posttraumatic Stress Diagnostic Scale (PDS). Oxford; Department of Psychiatry, Warnford Hospital, University Oxford 1996
  Google Scholar
• 40 Maercker A, Schützwohl M. Erfassung von psychischen Belastungsfolgen: Die Impact of Event Skala-revidierte Version (IES-R).  Diagnostica. 1998;  44 130-141
  Google Scholar
• 41 Weiss D S, Marmar C R. The Impact of Event Scale-Revised. In: Wilson J P, Keane TM (eds) Assessing psychological trauma and PTSD. New York; Guilford Press 1996: 399-411
  Google Scholar
• 42 Margraf J, Schneider S, Ehlers A. Diagnostisches Interview bei psychischen Störungen: DIPS. Berlin; Springer 1991
  Google Scholar
• 43 Bühl A, Zöfel P. SPSS Version 10. München; Addison-Wesley 2000
  Google Scholar
• 44 Rief W, Hessel A, Brähler E. Somatization symptoms and hypochondrical features in the general population.  Psychosom Med. 2001;  63 595-602
  PubMedGoogle Scholar
• 45 Helzer J E, Robins L N, McEnvoy L. Post-traumatic stress disorder in the general population.  New Engl J Med. 1987;  317 1630-1634
  PubMedGoogle Scholar
• 46 Mueser K T, Goodman L B, Trumbetta S L, Rosenberg S D, Osher F C, Vidaver R, Auciello P, Foy D W. Traumatic and posttraumatic stress disorder in severe mental illness.  J Consult Clin Psychol. 1998;  66 493-499
  CrossrefPubMedGoogle Scholar
• 47 Fiedler P. Dissoziative Störungen und Konversion. Trauma und Traumabehandlung. Weinheim; Psychologie-Verlags-Union 2001
  Google Scholar
• 48 Ford J D, Campbell K A, Storzbach D, Binder L M, Anger W K, Rohlman D S. Posttraumatic stress symptomatology is associated with unexplained illness attributed to persian gulf war military service.  Psychosom Med. 2001;  63 842-849
  PubMedGoogle Scholar
• 49 Breslau N, Davis G C, Andreski P, Peterson E. Traumatic events and posttraumatic stress disorder in an urban population of young adults.  Arch Gen Psychiatry. 1991;  48 216-222
  Google Scholar
• 50 Costa P T, McCrae R R. Hypochondrias, neuroticism and aging.  Am J Psychol. 1985;  40 19-28
  PubMedGoogle Scholar
• 51 Davidson J, Smith R. Traumatic experiences in psychiatric outpatients.  J Trauma Stress. 1989;  3 459-475
  PubMedGoogle Scholar
• 52 Samson A Y, Benson S, Beck A, Price D, Nimmer C. Posttraumatic stress disorder in primary care.  J Fam Pract. 1999;  48 222-227
  PubMedGoogle Scholar
• 53 Zimmerman M, Mattia J I. Is posttraumatic stress disorder underdiagnosed in routine clinical settings?.  J Nerv Ment Dis. 1999;  187 420-428
  CrossrefPubMedGoogle Scholar
• 54 Tagay S, Langkafel M, Wackernagel K, Kutscher S, Senf W. Traumatic events and posttraumatic stress disorder in three clinical samples: prevalence, service utilization and predictors.  European Psychotherapy/Special Edition. 2003;  4 146
  PubMedGoogle Scholar

Dipl.-Psych. Sefik Tagay

Klinik für Psychosomatische Medizin und Psychotherapie · Rheinische Kliniken/Universitätsklinik Duisburg-Essen

Virchowstraße 174

45219 Essen

Email: sefik.tagay@uni-essen.de