TRAVMA VE DİSSOSİYATİF BOZUKLUKLAR: GENEL BİR BAKIŞ

Yıl 2018, Cilt: 3 Sayı: 3, 71 - 76, 29.12.2018

Mustafa Şahin Özden

Öz

    Travma, doğal afetler, trafik kazaları, savaş, işkence ve çocukluk çağında yaşanan ihmal ve istismar gibi akut

veya kronik travmatik olaylar sonucunda kişinin yetersizliği ile yüz yüze gelmesi ve öznel baş etme gücünü aştığı

durumlarda oluşmaktadır. Travma sonrası kişilerde en sık görülen psikiyatrik tablolardan biri dissosiyatif

bozukluklardır. Normalde uyuma hizmet eden bir mekanizma olarak her bireyde bulunan disosiyasyon, özellikle

çocukluk çağı travmaları sonucunda travmatik yaşantının üstesinden gelme çabası olarak kullanılarak patolojik

bir sürece dönüşmektedir. Bu patolojik sürecin ileri bir formu olan dissosiyatif bozukluklar, kişilik altında yer

alan kontekste stresli yaşam olaylarına karşın verilen akut tepkilerdir. Bir başka ifadeyle dissosiyatif

bozukluklar kişinin yaşadığı travmaya yönelik bir çeşit savunma mekanizmasıdır. Dissosiyatif bozukluklar

normalde bütünleştirici olan bilinç, bellek, kimlik, emosyon, algı, beden temsili, motor kontrol ve davranışlarda

bozulma ve kesinti meydana gelmesi ile karakterizedir (APA, 2013). Bu bozukluk, ani başlangıçlı veya aşamalı

olabileceği gibi kısa süreli veya kalıcı da olabilmektedir. Dissosiyatif bozuklukların uzun bir tarihsel arka planı

bulunmaktadır. Günümüzde dissosiyatif bozukluklara psikiyatri, klinik psikoloji ve adli bilimler alanında verilen

ilgi ve önem giderek artmaktadır. Son yıllarda adli psikoloji ve adli psikiyatride bilirkişilik kapsamında

dissosiyatif bozukluklar psikoz‐nevroz ayrımı, ceza sorumluluğu, malulen emeklilik ve malpraktis gibi

konularda yapılan değerlendirmeler büyük önem taşımaktadır. Ruhsal bozukluklar içerisinde çocukluk çağı

travmaları ile en yakın ilişkiyi gösteren dissosiyatif bozuklukların genelde erken yaşta başlaması, intihar

girişimleri ve kendine zarar verme gibi davranışların sık görülmesi, yol açtığı çeşitli yaşamsal sorunlar,

psikiyatrik eş tanısının yüksek olması, klinik ve travma odaklı uygun psikoterapi yöntemleriyle tam olarak

tedavi edilebilmesiyle koruyucu sağlık hizmetleri açısından önem taşımaktadır.

Anahtar Kelimeler

Travma, Dissosiyasyon, Dissosiyatif Bozukluklar, Tedavi, Psikoterapi

TRAUMA AND DISSOCIATIVE: AN OVERVIEW

Öz

    Trauma occurs in the situations that the person faces with his/her inadequacy and goes beyond his/her

subjective coping efforts in consequence of acute and chronic traumatic events like natural disasters, traffic

accident, war, torture and childhood abuse and neglect. Dissociative disorders are one of the most frequent

psychiatric symptoms are seen among people after trauma. Dissociation which is present in every person as a

mechanism to serve adaptation normally, converts to a pathological process by using as an effort to handle

particularly traumatic experience as a result of childhood trauma. Dissociative disorders which is an advanced

form of this pathologic process, rather as acute reactions to stressful life events in the context of a certain

underlying personality. In other words, disassociative disorders are a kind of defence mechanism oriented to

traumatic experiences. Dissociative disorders are characterized by a disruption of and/or discontinuity in the

normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control

and behavior (APA, 2013). This disorders, can start suddenly or permanently and also can be short‐term or

permanent. Dissociative disorders have a long historical background. Today, dissociative disorders attract great

attention and the importance of this cluster of the disorder has been increased in the field of psychiatry, clinical

psychology and forensic sciences. In recent years, in the scope of expertise in forensic psychology and forensic

psychiatry, the assessment on topics like difference of psychosis‐neurosis, disability retirement, criminal responsibility and malpractice in respect to disassociative disorders has a great importance. Dissociative

disorders which indicate the close relationship with childhood traumatization among all kinds of mental

disorders usually appear in the early ages, suicide attempts and self harming behaviors appeared frequently

cause several vital complications, have high comorbidity and are treated completely by applying clinical and

trauma‐centered psychotherapy methods, thus it has substantial importance in terms of preventative

healthcare.

Anahtar Kelimeler

Trauma, Dissociation, Dissociative Disorders, Treatment, Psychotherapy

Kaynakça

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