Post-traumatic stress disorder

Post-traumatic stress disorder

Disorders related to traumatic or stressful events represent one of the most complex areas of psychopathology, involving both the psyche and the body. Psychoanalysis emphasizes unconscious processes and the individual history of the subject in order to explain the underlying causes of symptomatology of traumatic origin.

Trauma in Psychoanalytic Theory

From the psychoanalytic perspective, trauma is not only an objectively stressful event, but a breakdown in the ego’s ability to integrate experience. Freud, in his studies on trauma, distinguishes between the concept of “real trauma” and “psychic trauma.” The former refers to dramatic external events, while the latter concerns the subjective effect the event has on the psyche, often reactivating unresolved unconscious conflicts.

Trauma is formed when the individual is exposed to an experience that exceeds his or her capacity for psychic processing. In particular, Freud and Ferenczi emphasize the role of surprise and helplessness in rendering an event traumatic. If an intense experience cannot be mentalized or integrated into the subject’s psychic history, it remains split from consciousness, resurfacing in the form of symptoms or unprocessed distress.

Coercion to Repeat: The Trauma that Reproduces Itself

In “Beyond the Pleasure Principle” (1920), Freud introduced the concept of repetition compulsion, emphasizing how traumatized subjects tend to compulsively relive trauma in different forms. This occurs because the trauma, neither symbolized nor processed, remains active in the psyche as a foreign core seeking expression. Repetition compulsion manifests itself in different ways:

• Traumatic dreams: the subject relives the traumatic experience during sleep.
• Repetitive choices and relationships: the individual may unconsciously recreate situations similar to the trauma, trying to master it without succeeding.
• Self-destructive behaviors: trauma can lead to repetition of self-damaging acts without a clear awareness of their connection to past experience.

Repetition compulsion can be seen as an attempt by the unconscious to reprocess trauma, but until the experience is transformed into a symbolized narrative, it is repeated without resolution.

The Different Forms of Post-Traumatic Disorders.

Psychoanalysis has identified several ways in which trauma manifests itself in psychic life:

• Traumatic neurosis: characterized by persistent anxiety, nightmares, and dissociative symptoms, in which the subject feels invaded by unprocessed traumatic memories.
• States of depersonalization and derealization: defense mechanisms to protect the subject from the emotional impact of trauma.
• Somatic symptoms: somatic conversions that allow psychic pain to be expressed through the body.

According to Ferenczi’s perspective, in cases of childhood trauma, a kind of identification with the aggressor occurs, in which the child internalizes the traumatic experience in the form of self-accusations or self-destructive behavior. Winnicott, on the other hand, emphasizes the role of “environmental holding” and the risk of developing a false self in individuals exposed to early traumatic experiences.

The Processing of Trauma and the Analytic Process.

In the psychoanalytic treatment of post-traumatic disorders, the goal is not only to alleviate symptoms, but to allow the integration of the traumatic experience within the subject’s psychic history.

• Transference reprocessing: the patient tends to replay in the relationship with the analyst the dynamics of the trauma. The analyst acts as witness and emotional container, helping to transform what was passively experienced into a narratable and symbolizable experience. Transference allows unconscious relational patterns to be brought to light, giving the patient the opportunity to experience them in a safe context and gradually modify them.
• The function of language: putting the traumatic experience into words allows it to be processed and removed from compulsive repetition. The act of naming the trauma helps reinsert it into the continuum of autobiographical memory, making it less fragmented and more integral to one’s life narrative.
• Symbolization work: trauma often presents itself in the form of unprocessed distress and bodily symptoms. Through analytic work, the subject can develop symbolic skills that transform the traumatic experience into meanings accessible to consciousness.
• The importance of the therapeutic relationship: the constant and welcoming presence of the analyst represents a new relational model, which can enable the patient to overcome the sense of isolation and recover trust in the other. An empathetic and stable environment can help rebuild a base of emotional security, which is essential for processing trauma.

Conclusions

Psychoanalysis offers a profound key to understanding disorders related to traumatic or stressful events, highlighting the role of the past, the unconscious dimension and relational dynamics. The processing of trauma requires time, listening and a safe environment in which the subject can progressively regain ownership of his or her history, transforming pain into a narrative with meaning.

Lo Studio of Psychology, Psychotherapy Dr. Pedrazin is located in Milan, via Procaccini 11; the doctor receives in the office and online.