Understanding the psychodynamic functioning of patients with PTSD and CPTSD: qualitative analysis from the OPD 2 interview

Abstract

The traumatic event produces intolerable excitations to the psychic apparatus that searches to relief them through the production of symptoms. When established, patients with post-traumatic stress disorders (PTSD) and complex post-traumatic stress disorder (CPTSD) may experience flashbacks, somatizations, negative emotions about themselves, and difficulty in social contact. This work seeks to understand how the psychodynamic functioning of women victims of interpersonal and urban violence, diagnosed with these disorders, is organized, identifying traumatic experiences, ways of interpersonal relationships, conflicts and psychic structures and use of defense mechanisms, and for peculiarities that may differentiate these disorders. The qualitative transversal method was used through the content analysis of clinical interviews based on the Operationalized Psychodynamic Diagnosis (OPD-2). The sample of this study consisted of five women with PTSD and five with CPTSD. The following categories were created: reasons for seeking care, symptoms and desire for treatment, traumatic developmental events, and characteristics of the psychic functioning. Early trauma generates psychic organizations with greater disintegration. A new traumatic event destabilizes the psychic organization and intensifies symptoms. Relationships were marked by dependence and isolation. Participants with CPTSD presented tendency to disintegration related to the object relation regulation and the psychic conflict was of Individuation versus Dependence, with more primitive flaws in object representations, existential need for the other and direct discharge of impulses. Participants with PTSD had moderate to low level of object relation integration and the conflict was need to be care of versus self-sufficiency, with self-representations being fragile and with reduced capacity to manage impulses. Thus, it could be observed that OPD-2 is capable of assessing in a broad and deep way patients with traumatic disorders, in addition to identifying essential peculiarities to guide health professionals towards treatment in the search for better quality of life for patients.

Relationship between psychodynamic functioning, defensive mechanisms and trauma in patients with PTSD

“…felt as a threat, a negligence, with the occurrence of withdrawal. Such characteristics confirm and strengthen what was identified by Both et al41 and Favaretto et al19 in studies on trauma patients.…”

“…In addition to ITE, patients revealed that they had experienced trauma prior to the event that caused PTSD, which supports different studies. 2,19,39 Trauma can become devastating, especially in childhood, as object representations become unstable, making it difficult to organize a sense of identity and the ability to reflect/mentalize. 40 The absence or fragility of the object's response to accept, interpret and satisfactorily respond to traumatic experiences, combined with the individual's responses to the experienced situation can lead to feelings of helplessness and abandonment, reactivated in other stressful situations.…”

“…18 However, in many cases, the use of defense Trends Psychiatry Psychother -Pre-Proof -http://doi.org/10.47626/2237-6089-2022-0546 mechanisms is not effective, resulting in the persistence of symptoms, social withdrawal and, consequently, low quality of life. 14 In this context, in a complex disorder like PTSD, a broad and deep evaluation about vulnerabilities and individual and interpersonal skills is recommended for treatment planning and intervention , seeking greater adherence, relief of symptoms and better condition of global well-being 19 . Thus, the Operationalized Psychodynamic Diagnosis (OPD-2) stands out as a multiaxial system that promotes, in addition to the nosological diagnosis, the understanding of the psychodynamic functioning of patients through a survey of their subjective suffering, resources and vulnerabilities, patterns of relational interaction, conflicts and personality structure.…”

The Self-Administered Version of the Structured Interview for Disorders of Extreme Stress (SIDES-SR) in a Clinical and Non-Clinical Portuguese Sample

“…Considering that most adults with DESNOS also meet PTSD criteria [ 11 ], the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [ 9 ] has included DESNOS psychopathology outcomes as specific features of PTSD. However, findings from clinical and research studies suggest that a PTSD diagnosis fails to adequately capture DESNOS’ constellation of symptoms [ 1 , 2 , 3 , 4 , 5 , 8 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ] as PTSD emerges as a consequence of single-event traumas, or type I traumas [ 5 ], not directly attributed to another person’s abuse or neglect (e.g., natural disasters, vehicle accidents). PTSD psychopathology outcomes include intrusive memories, avoidance of the stimuli associated with the traumatic event, emotional numbing, arousal and emotional reactivity associated with the traumatic event [ 22 ].…”