Zusammenfassung
Der vorliegende Beitrag befasst sich mit dem Stand des Wissens zu Gewalt- und Traumafolgen. Traumata werden definiert als Ereignisse von außergewöhnlicher Bedrohung oder katastrophalem Ausmaß. Hierzu zählt auch die Verletzung der physischen Integrität durch physische und sexualisierte Gewalt. Neben der Posttraumatischen Belastungsstörung (PTBS) kann es in der Folge extrem belastender Erfahrungen auch zur Entwicklung einer komplexen PTBS, einer anhaltenden Trauerstörung oder einer Anpassungsstörung kommen. Als indirekte Traumafolgestörungen zählen u. a. Depression, Substanzabhängigkeit und Persönlichkeitsstörungen. Diese treten oft gemeinsam (komorbid) mit einer PTBS auf. Die Wahrscheinlichkeit, jemals im Leben eine PTBS zu entwickeln, liegt in Deutschland zwischen 1 und 4 %. Eine PTBS wird diagnostiziert, wenn über einen längeren Zeitraum die traumatische Situation unwillkürlich wiedererlebt wird (z. B. in Bildern oder Träumen), mögliche Hinweisreize vermieden werden, die allgemeine Reagibilität abgeflacht ist und eine permanente Überregung vorliegt. Die Intensität, Dauer und Häufigkeit von traumatischen Ereignissen stellen ebenso Risikofaktoren für die Entwicklung einer PTBS dar wie eine mangelnde soziale Unterstützung nach dem Trauma. In den letzten beiden Jahrzehnten wurden erfolgreich Methoden zur Therapie der PTBS entwickelt. Die Exposition gegenüber dem traumatischen Ereignis steht im Mittelpunkt der als erfolgreich evaluierten Psychotherapien. Die beste Wirksamkeit bei der Behandlung einer PTBS weisen verhaltenstherapeutische Ansätze auf. Ein besseres Verständnis der Folgen von Gewalt und Traumata könnte uns in Zukunft helfen, Personen mit einem besonderen Risiko für Traumafolgestörungen frühzeitig zu erkennen.
Abstract
This paper addresses consequences of exposure to violence and trauma. Traumata are defined as events with an extraordinary threat or catastrophic extent. Beside Posttraumatic Stress Disorder (PTSD), affected people may develop Complex PTSD, Prolonged Grief Disorder or Adjustment Disorder as direct consequences of exposure with extreme stress. Indirect trauma-related disorders are amongst others Major Depression, Substance Dependency and Personality Disorders. These disorders develop often comorbid to PTSD. The likelihood to develop a PTSD at one point during the life course is 1–4 % in Germany. A PTSD is diagnosed if for any length of time the traumatic situation is re-experienced (e.g. in pictures or nightmares), potential triggers are avoided, emotional reactivity is numb and a permanent hyperarousal is experienced. The intensity, the duration and the frequency of traumatic experiences as well as the lack of social support after the trauma are important risk factors for the development of a PTSD. In the last two decades successful treatment approaches for PTSD have been developed. The main focus of all evidence-based treatment approaches is the exposure in sensu of the traumatic experiences. Behavioral therapy approaches have shown to be most effective in the treatment of PTSD. A better understanding of the consequences of exposure to violence and trauma may help us to identify people at risk for developing trauma-related disorders already at an early stage.
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A. Maercker und T. Hecker geben an, dass kein Interessenskonflikt bestehen.
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Maercker, A., Hecker, D. Trauma- und Gewaltfolgen – psychische Auswirkungen. Bundesgesundheitsbl. 59, 28–34 (2016). https://doi.org/10.1007/s00103-015-2259-6
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DOI: https://doi.org/10.1007/s00103-015-2259-6