In the third issue of the magazine, World Psychiatry for 2013 (currently available only to English language, the translation into Russian is preparing) The Working Group on the preparation of the Diagnostic Criteria of the ICD-11 for stress disorders submitted its draft of the new section of the International Classification.

PTSD and adaptation disorder are among the most widely used diagnoses in the assistance system for mental disorders around the world. However, approaches to the diagnosis of these states for a long time remain the subject of serious disputes due to the non-specificity of many clinical manifestations, difficulties with the distinction of painful states with normal reactions to stressful events, the presence of significant culture features in responding to stress, etc.

Many critical comments were expressed in the address of the criteria for these disorders in, DSM-IV and DSM-5. So, for example, according to members working Group, Adaptation disorder is a mental disorder with one of the worst definitions, which is why this diagnosis is often described as a certain "trash can" in the Psychiatric Classification scheme. D. jagnos PTSD is criticized for a wide combination of various symptom clusters, a low diagnostic threshold, a high level of comorbidity, and in relation to the DSM-IV criteria for the fact that more than 10 thousand different combinations of 17 symptoms can lead to the formulation of this diagnosis.

All this was the reason for a sufficiently serious processing of the criteria for this group of disorders in the draft ICD-11.

The first innovation concerns the name for a group of disorders caused by stress. In the ICD-10 there is a heading F43 "Reaction to heavy stress and adaptation violations "belonging to the section F40 - F48" Neurotic, associated with stress and somatoform disorders ". The Working Group recommends avoiding widely used, but contributing, the term" disorders associated with stress", Due to the fact that numerous disorders may be associated with stress (for example, depression, disorders associated with the use of alcohol and other psychoactive substances, etc.), but most of them may also occur in the absence of stressful or traumatic life. events. In this case, we are talking only about disorders, stress for which is the mandatory and specific reason for their development. An attempt to emphasize this moment in the ICB-11 project was the introduction of the term "Disorders Specifically Associated with Stress", which is probably most accurately translated into Russian as " disorders, directly associated with stress" Such a name is planned to give a section where the disorders considered below will be placed.

The proposals of the Working Group concerning individual disorders include:

• more narrow concept of PTSRwhich does not allow for a diagnosis based on only nonspecific symptoms;
• new category " comprehensive PTSR"(" Complex PTSD "), which, in addition to the rod symptoms of PTSD, additionally includes three groups of symptoms;
• new diagnosis prolonged burning reaction"Used to characterize patients who experience intensive, painful, leading to disability and an abnormally persistent response to a difficult loss;
• a significant revision of the diagnosis " adaptation disorders", Which includes the specificization of symptoms;
• revision concepts« acute reaction to stress"In line with ideas about this condition, as a normal phenomenon, which, however, may require clinical intervention.

In the generalized form of the proposal of the working group can be represented as follows:

	Previous μb-10 codes	Basic diagnostic signs in the new edition
Post-traumatic stress disorder (PTSD)		Disorder that develops after the impact of an extreme threatening or terrifying event or a series of events, and is characterized by three "rod" manifestations: re-experiencing a traumatic event(IY) in the present time in the form of bright obsessive memories, accompanied by fear or horror, flashbakes or nightmares; avoiding thoughts and memories about the event (yach), or avoiding activities or situations resembling an event (s); state of subjective feeling persistent threat In the form of hypervaluity or reinforced fright reactions. Symptoms should last at least a few weeks and cause significant deterioration in operation. Introduction The criterion of functioning disorders is necessary to increase the diagnostic threshold. In addition, the project authors are also trying to increase the simplicity of diagnosis and reduce the comorbidity by identifying rod elements PTSD, and not lists of equivalent "typical signs" of disorder, which, apparently, is a kind of retreat from the Operational approach to the ICD in diagnostics to closest people for domestic psychiatry About syndrome.
Complex post-traumatic stress disorder		Disorder that occurs after the impact of the emergency or long in nature, the impact of which is difficult to get rid of or impossible. Disorder is characterized the main (rod) symptoms of PTSD (See above), as well as (in addition to them) the development of persistent, end-to-end violations in the affective sphere, attitude to itself and in social functioning, including: difficulties in regulation of emotions, feeling like a humiliated, defeated and nothing worthy person difficulties in maintaining relationships Comprehensive PTSD is a new diagnostic category, she replaces the category of ICD-10 overlappingF62.0. "Persistent identity change after the experience of the catastrophe", which could not attract scientific interest and did not include disorders arising from long stress in early childhood. This symptoms may occur after the impact of a single traumatic stressor, but more often arises after severe prolonged stress or multiple or repeating undesirable events, to avoid the impact of which is not possible (for example, the impact of genocide, sexual abuse of children, finding children in war, cruel domestic violence , torture or slavery).
Prolonged burning reaction		Disorder, in which after the death of a close person, persistent and comprehensive sadness and longing for the deceased or constant immersion in the thought of deceased are preserved. Estimation data: an abnormally long period continues compared to the expected social and cultural norm (for example, at least 6 months or more depending on cultural and contextual factors), they are strongly expressed in order to cause significant deterioration in the functioning of a person. These experiences can also be characterized as the difficulties of making death, the feeling of loss of part of itself, anger in relation to the loss, a sense of guilt or difficulty in engaging in social and other activities. Immediately several sources of evidence indicate the need to introduce a prolonged reaction of grief: The existence of this diagnostic unit was confirmed in a wide range of cultures. Factor analysis has repeatedly demonstrated that the central component of the prolonged grief reaction (longing for the deceased) is independent of nonspecific symptoms of anxiety and depression. In this case, the experiencing data does not respond to antidepressants treatment (while depressive syndromes associated with loss are responding), and psychotherapy, which is strategically aimed at the symptoms of the prolonged burning reaction, demonstrates greater efficiency in facilitating its manifestations than the treatment aimed at depression. People with a prolonged reaction of grief have serious psychosocial problems and health problems, including other mental health problems, such as suicidal behavior, psychoactive substance abuse, self-destructive behavior or somatic disorders, such as high arterial pressure and increased frequency of cardiovascular diseases There are special brain dysfunctions and cognitive patterns associated with the prolonged reaction of grief
Adaptation disorder		The reaction of insufficient adaptation to the stress event, on continuing psychosocial difficulties or a combination of stressful life situations, which, as a rule, occurs within a month after the impact of the stressor and tends to resolve for 6 months if the stressful factor is not preserved for a longer period. The reaction to the stressor is characterized by symptoms of concern to the problem, such as excessive concern, recurrent and painful thoughts on the stressor or constant reflection on its consequences. There is an inability to adapt, i.e. symptoms interfere with everyday functioningThere are difficulties with a concentration of attention or sleep disruption, resulting in disruption. Symptoms may also be associated with loss of interest in work, social life, care for others, conducting leisure, leading to a violation in social or professional functioning (restriction of the circle of communication, conflicts in the family, skill at work, etc.). If the diagnostic criteria are suitable for another disorder, this disorder should be diagnosed instead of adaptation disorder. According to the authors of the project, evidence of the validity of the subtypes of the adaptation disorder, described in the ICD-10, is absent, in connection with this they will be removed from the ICD-11. Such subtypes may be misleading by paying special attention to the dominant content of the distress, thereby flap to the underlying community of these disorders. Subtypes are not related to the selection of treatment and are not related to a specific forecast.
Reactive disorder of attachments
Distribution disorder by defined type		See Rutter M, Uher R. Classification Issues and Challenges in Childhood and Adolecent Psychopathology. INT REV PSYCHIATRY 2012; 24: 514-29
States that are not disorders and included in the "Factors affecting the health of the population and appeal to health care institutions" (Chapter Z in the ICD-10)
Acute reaction to stress		Refers to the development of transient emotional, cognitive and behavioral symptoms in response to the exceptional stress, such as an extreme traumatic experience that entails serious harm or a threat to the security or physical integrity of a person, or people close to him (for example, natural disasters, accidents, military Actions, robbery attacks, rape), or unexpected and threatening the danger of changes in the social situation and / or environment of an individual, such as loss of their family as a result of a natural disaster. Symptoms are considered as a normal spectrum of reactionscaused by the extreme severity of the stressor. Symptoms are usually detected for a period from several hours to several days From the impact of stressful incentives or events, and, as a rule, begin to weaken during the week after this event or after eliminating the threatening situation. According to the authors of the project, offered for the ICD-11 description of the acute reaction to stress " does not comply with the requirements of the definition of mental disorder ", And the duration of symptoms will help distinguish acute reactions to stress from pathological reactions associated with more severe disorders. However, if you remember, for example, classic descriptions of these states E. Srecmer (which the authors of the project apparently did not read the last edition of his "hysteria" on english language Dated 1926), all the same, their expansion of pathological states causes some doubt. Probably following this analogy, from the list of pathological conditions and the CCB headings should have to withdraw hypertensive crisis or hypoglycemic states. They are also only transit states, but not "disorders". In this case, fuzzy from a medical point of view The term disorder (disorder) The authors are interpreted closer to the concept of illness than the syndrome, although according to the general (for all specialties) of the conceptual model used to prepare the ICD-11, the term "disorder" may include as Diseases and syndromes.

The following steps in the development of the ICB-11 project on disorders directly related to stress will be its public discussion and testing in the "field" conditions.

Acquaintance with the project and discussion of proposals will be carried out with the help of beta platform ICD-11 ( http://apps.who.int/classifications/icd11/browse/f/en.). Field studies will evaluate clinical acceptability, clinical utility (for example, ease of use), reliability and, as far as possible, validity of draft definitions and diagnostic manuals, in particular, compared to ICD-10.

WHO will use two main approaches to approbate the projects of sections of the ICD-11: Internet research and research in clinical conditions. Internet research will be carried out primarily within which more than 7,000 psychiatrists and primary medical care doctors are currently consisting. The study of disorders directly related to stress is already scheduled. Research in clinical conditions will be carried out through the international network of cooperating centers of clinical research WHO.

The Working Group hopes to cooperate with colleagues around the world in testing and further clarification of proposals relating to diagnostic instructions for disorders directly related to stress in ICD-11.

Liked: 3.

The reactions to heavy stress is currently (according to the ICD-10) are divided into the following:

Acute reactions to stress;

Post-traumatic stress disorders;

Adaptation disorders;

Dissociative disorders.

Acute reaction to stress

Transient disorder of significant severity, which develops in individuals without visible mental disorder in response to an exceptional physical and psychological stress and which usually passes within hours or days. Stress can be a strong traumatic experience, including the threat of safety or the physical integrity of an individual or a beloved person (for example, a natural disaster, an accident, battle, criminal behavior, rape) or an unusually sharp and threatening change in the social situation and / or surrounding the patient, for example, Loss of many close or fire in the house. The risk of disorder development increases with physical exhaustion or the presence of organic factors (for example, in elderly patients).

In the emergence and severity of acute reactions to stress play the role of individual vulnerability and adaptive abilities; This is evidenced by the fact that this disorder is not developing in all people who have undergone severe stress.

Symptoms detect a typical mixed and changing picture and include the initial state of "stunning" with some narrowing of the field of consciousness and decline in attention, inability to adequately respond to external incentives, and disorientation. This condition may be accompanied by or further departure from the surrounding situation up to a dissociative stupor or a fitting and hyperactivity (escape or fugance reaction).

Often there are vegetative signs of panic alarms (tachycardia, sweating, redness). Usually symptoms develop within minutes after the impact of stressful stimuli or events and disappear within two or three days (often hours). A partial or complete dissociative amnesia may be present.

Acute reactions to stressthey occur in patients immediately after psychotrambulating impact. They are short, from several hours to 2-3 days. Vegetative violations, as a rule, are mixed in nature: there is an increase in the frequency of heart abbreviations and blood pressure and along with this - the pallor of the skin and the profuse sweat. Motor disorders are manifested either with a sharp excitation (throwing) or intensity. Among them are the affective shock reactions described at the beginning of the 20th century: hyperkinetic and hypokinetic. With a hyperkinetic version, patients are not safely moving, make chaotic unfinished movements. The questions, the more persuasion of the surrounding they do not react, the orientation in the surrounding them is clearly upset. In the hypokinetic version, patients are sharply injected, they do not react to the surrounding, do not answer questions, stunned. It is believed that in the origin of acute reactions to stress play not only a powerful negative impact, but also the personal features of victims - elderly or adolescence, weakening with any somatic disease, such character features as increased sensitivity and vulnerability.

In the ICD-10 concept post-traumatic stress disordersunites disorders that develop not immediately after the impact of the psychotrauming factor (settled) and ongoing weeks, and in some cases a few months. This includes: the periodic appearance of acute fear (panic attacks), heavy sleep disorders, obsessive memories of the psychotracting event, from which the victim can not get rid of the persistent avoidance of places and people associated with the psychotrauming factor. This also includes a long-term preservation of the gloomy-dreary mood (but not to the level of depression) or apathy and emotional inappropriate. Often, people in such a state avoid communicating (children).

Post-traumatic stress disorder is an unexicotic delayed response to traumatic stress that can cause mental disorders from almost any person.

Historical studies in the field of post-traumatic stress developed regardless of stress research. Despite some attempts to bring theoretical bridges between "stress" and post-traumatic stress ", these two areas and today have little in common.

Some of the well-known stress researchers, such as Lazarus, being followers G. Siele, for the most part ignore PTSP, like other disorders, as possible consequences of stress, limiting the field of attention to the research of the singularities of emotional stress.

Stress studies are experimental using special experimental plans under controlled conditions. Studies in the field of post-traumatic stress, on the contrary, are naturalistic, retrospective and for the most part can be attributed to observation.

Criteria of post-traumatic stress disorder (according to ICD-10):

1. The patient must be exposed to the stressful event or situation (both short and long) exclusively threatening or catastrophic nature, which is capable of calling distress.

2. Resistant memories or "revival" of the stressor in obsessive reminiscences, bright memories and repetitive dreams, or re-experience of grief when exposed to situations resembling or associated with stressor.

3. The patient should detect actual avoidance or desire to avoid circumstances resembling either associated with stressor.

4. Any of two:

4.1. Psychogeneic amnesia, or partial or complete, with respect to important periods of the stressor.

4.2. Resistant symptoms of increasing psychological sensitivity or excitability (not observed before the action of the stressor) represented by any two of the following:

4.2.1. Difficulty falling asleep or save sleep;

4.2.2. irritability or outbreak of anger;

4.2.3. difficulty concentration;

4.2.4. raising the level of wakefulness;

4.2.5. reinforced reflex quadcency.

Criteria 2,3,4 occur within 6 months after a stressful situation or at the end of the period of stress.

Clinical symptoms at PTSP (for B.Chodzin)

1. Unmotivated vigilance.

2. "Explosive" reaction.

3. Pump out of emotions.

4. Aggressiveness.

5. Disorders of memory and concentration of attention.

6. Depression.

7. Overall anxiety.

8. Fire attacks.

9. Abuse of narcotic and medicinal substances.

10. Inspected memories.

11. Hallucinatorious experiences.

12. Insomnia.

13. Thoughts about suicide.

14. "Wines of the survivor".

Speaking, in particular, on adaptation disorders, it is impossible not to stop in more detail on such concepts as depression and anxiety. After all, they always accompany stress.

Earlier dissociative disordersdescribes as hysterical psychosis. It is understood that at the same time the experience of the psychotrauming situation is supplanted from consciousness, but is transformed into other symptoms. The emergence of very bright psychotic symptoms and loss of sound in the experiences of transferred psychological impact of a negative plan and marvel dissociation. The same group of experiences include states previously described as hysterical paralysis, hysterical blindness, deafness.

The secondary benefit for patients of manifestations of dissociative disorders is emphasized, that is, they also arise by the mechanism of flight into the disease, when psychotrambulating circumstances are for the fragile nervous system unbearable, super-violent. A common feature of dissociative disorders is the tendency to recurrence.

The following forms of dissociative disorders differ:

1. Dissociative amnesia. The patient forgets about the psychotracting situation, avoids places and people associated with it, a reminder of psychotrame meets violent resistance.

2. Dissociative stupor, often accompanied by the loss of pain sensitivity.

3. Puerylism. Patients in response to psychotrayma show child behavior.

4. Pseudo-degeneration. This disorder flows against the background of light stun. Patients are confused, puzzily look around and show the behavior of the poor and imperfect.

5. Hanzer Syndrome. This state resembles the previous one, but includes miming, that is, patients are not answering the question ("What is your name?" - "far from here"). It is impossible not to mention the neurotic disorders associated with stress. They are always acquired, and not observed constantly from childhood and to old age. In the origin of neuroses, purely psychological causes (overwork, emotional stress) are important, and not organic influences on the brain. Consciousness and self-consciousness in neurosis are not broken, the patient is aware that he is sick. Finally, with adequate treatment, neurosis is always reversible.

Adaptation disorderit is observed during the adaptation period to a significant change in social status (the loss of close or long-term separation with them, the position of the refugee) or the stressful life event (including a serious physical illness). In this case, the temporal connection between stress and the arising disorder should be proven - not Over 3 months from the beginning of the stressor.

For adaptation disordersin the clinical picture are observed:

depressive mood

• anxiety

  feeling inability to cope with the situation, adapt to it

  some reducing productivity in everyday affairs

  dramatic behavior

  flashing aggression.

According to the prevailing attribute, the following adaptation disorders:

short term depressive reaction (no more than 1 month)

prolonged depressive reaction (no more than 2 years)

mixed alarming and depressive reaction, with a predominance of disturbing other emotions

reaction with the predominance of violation of behavior.

Among other reactions to severe stress, there are also noose reactions (develop due to severe somatic disease). Alsamate also acute reactions to stress, which develop as a reaction to an extremely strong, but short-term (within hours, days) a traumatic event that threatens the mental or physical integrity of the individual.

Under the affect, it is customary to understand the short-term strong mental excitement, which is accompanied not only by an emotional reaction, but also by the initiation of all mental activities.

Highlight physiological affectfor example, anger or joy, not accompanied by the permanent of consciousness, automatisms and amnesia. Asthenic Affect- Quickly depleting affect, accompanied by a depressed mood, a decrease in mental activity, well-being and a vital tone.

Stenical affectit is characterized by increased well-being, mental activity, a sense of its own strength.

Pathological Affect- short-term mental disorder arising in response to intensive, sudden mental trauma and expressed in concentration of consciousness on traumatic experiences with subsequent affective discharge, followed by general relaxation, indifference and often deep sleep; It is characterized by partial or complete amnesia.

In some cases, the pathological affect is preceded by a long psychotrauming situation and the pathological affect itself arises as a reaction to some "last drop".

This group of disorders differs from other groups by the fact that it includes disorders identified not only on the basis of symptoms and the nature of the flow, but also on the basis of the evidence of the influence of one or even both reasons: an exceptionally unfavorable event in life, which caused an acute stress reaction, or significant Changes in life leading to prolonged unpleasant circumstances and impaired adaptation disorders. Although less severe psychosocial stress (life circumstances) can accelerate the beginning or contribute to the manifestation of a wide range of disorders presented in this class of diseases, its etiological significance is not always clear, and in each case, dependence on the individual will be recognized, often from its hypersensitivity and vulnerability (T .. Life events are not mandatory or sufficient to explain the emergence and form of disorder). Disorders collected in this category, on the contrary, are always considered as a direct consequence of acute severe stress or long-term injury. Stressful events or prolonged unpleasant circumstances are the primary or predominant causal factor and the disorder could not arise without their influence. Thus, the disorders classified in this heading can be considered as perverted adaptive reactions to a heavy or long stress, while they interfere with successfully cope with stress and, therefore, lead to social functioning issues.

Acute reaction to stress

The transient disorder that develops in humans without any other manifestations of mental disorders in response to an unusual physical or mental stress and usually subsides in a few hours or days. In the prevalence and severity of stressful reactions, individual vulnerability and ability to own themselves are important. Symptoms show a typical mixed and changeable picture and include the initial state of "stunning" with some narrowing of the area of \u200b\u200bconsciousness and attention, the inability to fully realize stimuli and disorientation. This condition may be accompanied by subsequent "departure" from the surrounding situation (to the state of dissociative stupor - F44.2) or assestation and superphanitivity (flight reaction or fugue). Usually there are separate features of panic disorder (tachycardia, excessive sweating, redness). Symptoms usually manifests itself a few minutes after the impact of stressful incentives or events and disappears in 2-3 days (often in a few hours). Partial or complete amnesia (F44.0) may be present on the stressful event. If the above symptoms are stable, it is necessary to change the diagnosis. Acute: crisis reaction reaction to stress, nervous demobilization, crisis condition, mental shock.

A. Impact of an exclusively medical or physical stressor.
B. Symptoms arise immediately after exposure to the stressor (within 1 hour).
B. Two groups of symptoms are distinguished; The reaction to acute stress is divided:
F43.00 Light only the following criterion 1)
F43.01 Moderate criterion is performed 1) and there are any two symptoms from the criterion 2)
F43.02 heavy criterion is performed 1) and there are any 4 symptoms from the criterion 2); Or there is a dissociative stupor (see F44.2).
1. Criteria b, B and g are performed for generalized anxiety disorder (F41.1).
2. a) Care from the upcoming social interactions.
b) narrowing attention.
c) manifestation of disorientation.
d) anger or verbal aggression.
d) despair or hopelessness.
e) inadequate or aimless hyperactivity.
g) uncontrollable and excessive experience of grief (considered in accordance with
Local culture standards).
If the stress is transient or may be facilitated, the symptoms should start
It is no more than eight hours to decrease. If the stressor continues to act,
Symptoms should begin to decrease no more than 48 hours.
D. The most commonly used exception criteria. The reaction should develop in
The absence of any other mental or behavioral disorders in the ICD-10 (with the exception of P41.1 (generalized alarming disorders) and F60- (personality disorders)) and at least three months after the episode is completed by any other mental or behavioral disorder.

Post-traumatic stress disorder

It occurs as a delayed or protracted response to a stress event (short or long) exclusively threatening or catastrophic nature, which can cause deep stress in almost everyone. Pre-providing factors, such as personal features (compulsiveness, asthenic) or the nervous disease in history, can reduce the threshold for the development of syndrome or aggravate its course, but they are never necessary or sufficient to explain its occurrence. Typical signs include episodes of repeating experiences of the traumatic event in obsessive memories ("frames"), thoughts or nightmares that appear on a sustainable background of a feeling of stupor, emotional inhibition, alienation from other people, unrequency for the surrounding and avoiding actions and situations that resemble injury. Usually overexcitation and expressed superpost, increased reaction to fright and insomnia. Anxiety and depression are often associated with the aforementioned symptoms, and the ideas of suicide are not rare. The appearance of symptoms of disorder is preceded by a latent period after injury, hesitating from a few weeks to several months. The disorder is different, but in most cases you can expect recovery. In some cases, the state can take the chronic flow for many years with a possible transition to a steady identity change (F62.0). Traumatic neurosis

A. The patient must be exposed to the stressful event or situation (both short and for a long time) exclusively threatening or catastrophic nature, which is able to cause a common distress for almost any individual.
B. Persistent memories or "revival" of the stressor in obsessive reminissates, bright memories or repetitive dreams, or re-experiences grief when exposed to circumstances resembling or associated with stressor.
V. The patient should detect the actual avoidance or the desire to avoid circumstances resembling, or associated with stressor (which was not observed before the impact of the stressor).
G. Any of two:
1. Psychogenic amnesia (F44.0), or partial, or complete in relation to the important aspects of the period of exposure to the stressor;
2. Resistant symptoms of increasing psychological sensitivity or excitability (not observed before the action of the stressor) represented by any two of the following:
a) the difficulty of falling asleep or save sleep;
b) irritability or outbreak of anger;
c) difficulty concentration of attention;
d) raising the level of wakefulness;
e) reinforced reflex quadcency.
The criteria B, B, and G arise within six months of a stressful situation or at the end of the period of stress (for some purposes the beginning of the disorder set for more than six months may be included, but these cases must be accurately defined separately).

Adaptive reaction disorder

The state of the subjective distress and emotional disorder, creating difficulties for social activities and actions arising during the adaptation period to a significant change in life or stressful event. Stressful event can disrupt the integrity of social relations of the individual (severe loss, separation) or a wide system of social support and values \u200b\u200b(migration, refugee status) or represent a wide range of changes and fractures in life (admission to school, acquiring parent status, failure in achieving the cherished personality Goals, resignation). Individual predisposition or varying play an important role in the risk of occurrence and form of manifestation of adaptive reactions, however, it is not possible to occur in such disorders without a traumatic factor. The manifestations are very variable and include the depression of mood, alertness or anxiety (or complex of these states), the feeling of the inability to cope with the situation, to plan everything in advance or decide to remain in the present situation, and also includes some degree of reduction in the ability to act in everyday life. At the same time, behavior disorders can be joined, especially in youthful age. A characteristic feature can be a brief or long depressive reaction or violation of other emotions and behaviors: cultural shock, grief reaction, hospitalism in children. Excluded: alarming disorder in children caused by separation (F93.0)

A. The development of symptoms should occur within one month after exposure to an identifiable psychosocial stressor, which is not an unusual or catastrophic type.
B. Symptoms or violation of behavior on type detected with other affective disorders (F30-F39) (with the exception of nonsense and hallucinations), any disorders in F40-F48 (neurotic, associated with stress and somatoform disorders) and behavior disorders (F91-) But in the absence of criteria for these specific disorders. Symptoms can be variable in shape and gravity. The prevailing features of symptoms can be determined using the fifth sign:
F43.20 short depressive reaction.
Transient lightweight depressive condition, duration of no more than one month
F43.21 Prolonged depressive reaction.
Easy depressive state resulting from a prolonged action of a stress situation, but a duration of no more than two years.
F43.22 Mixed alarming and depressive reaction.
Symptoms and alarms, and depressed are clearly expressed, but in terms of level not higher than defined for mixed alarm and depressive disorder (F41.2) or other mixed disturbing disorders (F41.3).
F43.23 with the predominance of disorders of other emotions
Symptoms are usually several emotional types, such as anxiety, depression, concern, tensions and anger. The symptoms of alarm and depression can meet the criteria for mixed anxious-depressive disorder (F41.2) or other mixed disturbing disorders (F41.3), but they are not so dominant that other more specific depressive or alarming disorders could be diagnosed. This category should also be used to reactions in children who also have regressive behavior, such as enuresis or sucking fingers.
F43.24 with a predominance of violation of behavior. The main violation affects the behavior, for example, in adolescents, the reaction of grief is manifested by aggressive or asocial behavior.
F43.25 with mixed disorders of emotions and behavior. And emotional symptoms, and behavioral violations are clearly expressed.
F43.28 with other refined predominant symptoms
B. Symptoms do not continue more than six months after the cessation of stress or its consequences, with the exception of F43.21 (prolonged depressive reaction), but this criterion should not prevent the preliminary diagnosis.

Each of us wants to live life calmly, happily, without excesses. But, unfortunately, almost everyone experiences dangerous moments, exposed to powerful stress, threats, up to attacks, violence. What to do a person who has transferred post-traumatic stress disorder? After all, the situation does not always pass without consequences, many suffer from serious mental pathologies.

So that it is clear to those who do not have medical knowledge, it is necessary to clarify what PTSD means, what is his symptoms. First you need to imagine at least for a second the state of a person who survived a terrible incident: a car accident, beating, rape, robbery, the death of a loved one, etc. Agree, it is difficult to submit this, and scary. At such moments, any reader will immediately contact a prayer about the past - God forbid! And what to talk about those who really turned out to be a victim of a terrible tragedy, how to forget about everything. The man is trying to switch to other classes, captivate the hobby, all free time to communicate with loved ones, friends, but everything is in vain. Heavy, irreversible acute reaction to stress, terrible moments and causes a stress disorder, post-traumatic. The reason for the development of pathology is the impossibility of the reserves of the human psyche to cope with the situation transferred, it goes beyond the accumulated experience that a person can survive. It often does not occur immediately, but about 1.5-2 weeks after the event, for this reason, the post-traumatic one is called.

A man who suffered a serious injury may suffer from post-traumatic stressful disorder

Traumizing the psychic situations, single or repeating capable of violating the normal work of the mental sphere. The provoking situations include violence, complex physiological injuries, finding in the man-made, natural disaster in the zone, etc. Directly at the time of danger, a person is trying to gather, save their own life, loved ones, tries not to panic or is in a state of stupor. After a short time, obsessive memories of what happened, from which the victim is trying to get rid of. Post-traumatic stressful disorder (PTSD) is a refund to a difficult point, "tested" the psyche so much that serious consequences arise. According to the international classification, the syndrome refers to a group of neurotic states caused by stress and somatoform disorders. A visual example of PTSD - servicemen who served in the "hot" points, as well as civilians who were in such areas. According to statistics, after experiencing stress, the PTSD occurs about 50-70% of cases.

Mental traumatization is more susceptible to the most unprotected categories: children and elderly people. In the first, the protective mechanisms of organisms are not enough formed, in the second due to the rigidity of the processes in the mental sphere, the loss of adaptation abilities.

Post-traumatic stress disorder - PTSD: Causes

As already mentioned, the factor in the development of PTSD is the disasters of a massive nature, from which real threat Life:

• war;
• natural and technogenic cataclysms;
• terrorist attacks: Finding in captivity as a prisoner, experienced torture;
• severe diseases of loved ones, their own health problems, threatening life;
• physical loss of relatives relatives;
• survived violence, rape, robbery.

In most cases, the intensity of anxiety, the experiences directly depends on the characteristics of the individual, its degree of susceptibility, impressionability. Also, half of a person, its age, physiological, mental state. If traumatization of the psyche occurs regularly, the depletion of mental reserves is formed. The acute response to stress, the symptoms of which are frequent companion of children, women who survived the domestic violence, in prostitutes, may arise from police, firefighters, rescuers, etc.

Experts allocate another factor contributing to the development of PTSP - it is neurotic, in which obsessive thoughts about bad events arise, there is a tendency to the neurotic perception of any information, a painful desire to constantly reproduce a terrible event. Such people always think about the dangers, talk about serious consequences even with not threatening situations, all thoughts are only about the negative.

Cases of post-traumatic disorder are often diagnosed in people who survived the war

Important: The number of people suffering from narcissism, any type of drug addiction, alcoholism, protracted depressions, excessive hobbies of psychotropic, neuroleptic, rejection drugs, also belong to the number of prone to PTSP.

Post-traumatic stress disorder: symptoms

The answer of the psyche for heavy, experienced stress is manifested by certain features of behavior. The main ones are:

• state of emotional stupor;
• constant reproduction in thoughts of the experience of the event;
• detachment, care from contacts;
• the desire to avoid important events, noisy companies;
• disgracement from the society in which the inconsistent happened again;
• excessive excitability;
• anxiety;
• panic attacks, anger;
• a feeling of physical discomfort.

The state of PTSD, as a rule, is developing through some period of time: from 2 weeks to 6 months. Mental pathology can persist months, years. Depending on the severity of manifestations, specialists allocate three types of PTSD:

1. Sharp.
2. Chronic.
3. Delayed.

A sharp type lasts for 2-3 months, a long period of time is saved in chronic symptoms. When the post-traumatic stressful disorder may manifest itself through a long period of time after a dangerous event - 6 months, year.

A characteristic symptom of PTSD is a disgrace, alienation, the desire to avoid others, that is, there is an acute reaction to stress and adaptation disorders. There are no elementary types of reactions to events that cause great interest from ordinary people. Not depending on the fact that the situation injured the psyche is already far behind, patients with PTSD continue to worry, suffer that causes the rational resources that can perceive and handle the fresh information flow. Patients lose interest in life, they are not able to enjoy anything, refuse the joys of life, become poor, are distinguished from former friends close to.

The characteristic symptom of the PTSD is the disgrace, alienation and the desire to avoid others.

Acute Stress Reaction (ICD 10): Views

With post-traumatic condition, there are two types of pathologies: obsessive thoughts about the past and obsessive thoughts about the future. At the first form, a person constantly "scrolls" as a film event that injured his psyche. Along with this, the memories can "connect" and other personnel from life, which brought emotional, mental discomfort. It turns out a whole "compote" from disturbing memories causing persistent depression and continuing to injury. For this reason, patients suffer:

• violation of food behavior: overeating or loss of appetite:
• insomnia;
• nightmares;
• outbreaks of anger;
• somatic failures.

The obsessive thoughts about the future are manifested in fears, phobias, unfounded foresight of the repetition of dangerous situations. The condition is accompanied by such signs as:

• anxiety;
• aggression;
• irritability;
• closed;
• depression.

Often victims are trying to disconnect from negative thoughts through drug use, alcohol, psychotropic drugs, which significantly worsens the state.

Emotional burnout syndrome and post-traumatic stress disorder

Often, two types of disorders - CEV and PTSR are confused, however, each pathology has its roots and is treated in different ways, although there is a certain similarity in the symptoms. Unlike stressful disorder after an injury caused by a dangerous situation, tragedy, etc., emotional burnout can occur with a completely cloudless, joyful life. The cause of the CMEA may be:

• monotony, repeating, monotonous actions;
• tense rhythm of life, work, study;
• undeserved, regular criticism from the side;
• uncertainty in the tasks assigned;
• sense of undervaluation, unnecessaryness;
• the lack of material, psychological promotion of work performed.

CEV is often called chronic fatigue, due to which people may have insomnia, irritability, apathy, loss of appetite, mood swings. The syndrome is more often subject to faces with characteristic features of character:

• maximets;
• perfectionists;
• overly responsible;
• prone to refuse their interests for the sake of the case;
• dreamy;
• idealists.

Often, housewives come to specialists with CMEV, every day engaged in the same, routine, monotonous business. They are almost always alone, there is a shortage of communication.

Emotional burnout syndrome is almost the same as chronic fatigue

The risk group of pathology includes creative personalities, abuse of alcoholic beverages, drugs, psychotropic drugs.

Diagnosis and treatment of post-traumatic stressful situations

The specialist puts the diagnosis of PTSD, based on complaints of the patient and analyzing his behavior, collecting information about the suffered psychological, physical injuries. The criterion for the installation of an accurate diagnosis is also a dangerous situation capable of causing horror and stupid from almost all people:

• flash becks arising both in a state of sleep and wakefulness;
• the desire to avoid moments resembling a stress experience;
• excessive excitation;
• partial erasing from the memory of a dangerous moment.

Post-traumatic stress disorder whose treatment is prescribed by a specialist - psychiatrist requires an integrated approach. An individual approach to the patient is needed, taking into account the characteristics of his personality, such as disorder, the general state of health and additional types of dysfunction.

Cognitive behavioral therapy: The doctor spends the sessions with the patient, in which the patient completely talks about his fears. The doctor helps him in a different look at life, rethink his actions, directs negative, obsessive thoughts into a positive direction.

Hypnotherapy is provided for acute phases of PTSD. The specialist returns the patient at the moment of the situation and makes it possible to understand how lucky to the surviving person who survived stress. At the same time, thoughts switched to positive aspects of life.

Medical therapy: Reception of antidepressants, tranquilizers, beta-blockers, neuroleptics are assigned only during acute necessity.

Psychological assistance in post-traumatic situations may include group sessions of psychotherapy with persons who also survived the acute response at a dangerous moment. In such cases, the patient does not feel "abnormal" and understands that a large mass of people with difficulty is experiencing threatening life tragic events and can not cope with them.

Important: The main thing to consult a doctor on time, with the manifestation of the first signs of the problem.

PTSP treatment is carried out by a qualified psychotherapist

By eliminating the beginning of the problems with the psyche, the doctor will warn the development of mental illness, facilitates life and will help easily and quickly survive the negative. The behavior of a close suffering person is important. If he does not want to contact the clinic, visit the doctor yourself and consult him, putting the problem. You should not try to distract him from hard thoughts yourself, to speak in his presence of an event that caused a mental disorder. Heat, care, general hobbies and support will be as impossible, by the way, and the black stripe will quickly change to light.

This group of disorders differs from other groups by the fact that it includes disorders identified not only on the basis of symptoms and the nature of the flow, but also on the basis of the evidence of the influence of one or even both reasons: an exceptionally unfavorable event in life, which caused an acute stress reaction, or significant Changes in life leading to prolonged unpleasant circumstances and impaired adaptation disorders. Although less severe psychosocial stress (life circumstances) can accelerate the beginning or contribute to the manifestation of a wide range of disorders presented in this class of diseases, its etiological significance is not always clear, and in each case, dependence on the individual will be recognized, often from its hypersensitivity and vulnerability (T .. Life events are not mandatory or sufficient to explain the emergence and form of disorder). Disorders collected in this category, on the contrary, are always considered as a direct consequence of acute severe stress or long-term injury. Stressful events or prolonged unpleasant circumstances are the primary or predominant causal factor and the disorder could not arise without their influence. Thus, the disorders classified in this heading can be considered as perverted adaptive reactions to a heavy or long stress, while they interfere with successfully cope with stress and, therefore, lead to social functioning issues.

Acute reaction to stress

The transient disorder that develops in humans without any other manifestations of mental disorders in response to an unusual physical or mental stress and usually subsides in a few hours or days. In the prevalence and severity of stressful reactions, individual vulnerability and ability to own themselves are important. Symptoms show a typical mixed and changeable picture and include the initial state of "stunning" with some narrowing of the area of \u200b\u200bconsciousness and attention, the inability to fully realize the stimuli and disorientation. This condition may be accompanied by subsequent "departure" from the surrounding situation (to the state of dissociative stupor - F44.2) or assesenixation and supercittivity (flight response or fugth). Usually there are separate features of panic disorder (tachycardia, excessive sweating, redness). Symptoms usually manifests itself a few minutes after the impact of stressful incentives or events and disappears in 2-3 days (often in a few hours). Partial or complete amnesia (F44.0) may be present on the stressful event. If the above symptoms are stable, it is necessary to change the diagnosis.

• crisis reaction
• reaction to stress

Nervous demobilization

Crisis Condition

Mental shock

Post-traumatic stress disorder

It occurs as a delayed or protracted response to a stress event (short or long) exclusively threatening or catastrophic nature, which can cause deep stress in almost everyone. Pre-providing factors, such as personal features (compulsiveness, asthenic) or the nervous disease in history, can reduce the threshold for the development of syndrome or aggravate its course, but they are never necessary or sufficient to explain its occurrence. Typical signs include episodes of repeating experiences of the traumatic event in obsessive memories ("frames"), thoughts or nightmares appearing on a sustainable background of a feeling of stupor, emotional inhibition, alienation from other people, unrequency for the surrounding and avoiding actions and situations that resemble injury. Usually overexcitation and expressed superpost, increased reaction to fright and insomnia. Anxiety and depression are often associated with the aforementioned symptoms, and the ideas of suicide are not rare. The appearance of symptoms of disorder is preceded by a latent period after injury, hesitating from a few weeks to several months. The disorder is different, but in most cases you can expect recovery. In some cases, the state can take the chronic flow for many years with a possible transition to a steady identity change (F62.0).

Traumatic neurosis

Adaptive reaction disorder

The state of the subjective distress and emotional disorder, creating difficulties for social activities and actions arising during the adaptation period to a significant change in life or stressful event. Stressful event can disrupt the integrity of social relations of the individual (severe loss, separation) or a wide system of social support and values \u200b\u200b(migration, refugee status) or represent a wide range of changes and fractures in life (admission to school, acquiring parent status, failure in achieving the cherished personality Goals, resignation). Individual predisposition or varying play an important role in the risk of occurrence and form of manifestation of adaptive reactions, however, it is not possible to occur in such disorders without a traumatic factor. The manifestations are very variable and include the depression of mood, alertness or anxiety (or complex of these states), the feeling of the inability to cope with the situation, to plan everything in advance or decide to remain in the present situation, and also includes some degree of reduction in the ability to act in everyday life. At the same time, behavior disorders can be joined, especially in youthful age. A typical feature can be a brief or long depressive reaction or violation of other emotions and behavior.