CINSEL TRAVMA MAĞDURU KADINLARDA TRAVMATIK STRES BELIRTILERI ILE DIĞER TIBBI NEDENLERLE AÇIKLANAMAYAN BELIRTILER VE ALEKSITIMININ İLIŞKISI

Yıl 2022, Cilt: 6 Sayı: 1, 13 - 24, 30.03.2022

Ahmet Tamer Aker Feyza Çelik Nermin Gündüz

https://doi.org/10.5455/car.105-1658143599

Öz

Amaç: Bu çalışmanın amacı cinsel travmaya maruz kalmış 18 yaş ve üzerindeki kadınlar arasında travma sonrası stres belirtileri, diğer tıbbi nedenlerle açıklanamayan belirtiler ve aleksitimi arasındaki ilişkiyi araştırmaktır. Yöntem: Çalışmaya cinsel travma maruziyeti olan 30 kadın hasta ile kontrol grubu olarak cinsel travma dışında travma yaşantısı olan 30 katılımcı dahil edilmiştir. Veri toplama aracı olarak Olayların Etkisi Ölçeği-R (OEÖ), "Belirti Tarama Listesi (SCL-90-R) Somatizasyon Alt Ölçeği", "İşlevsel Somatik Sendromlar Listesi" (İSS), "Somatizasyon ile İlişkili Ruhsal Bozukluklar Listesi" (SRB), Toronto Aleksitimi Ölçeği-R (TAÖ-20) kullanılmıştır. Bulgular: Hasta grubunun OEÖ toplam ve alt ölçek puan ortalamaları, SCL-90 somatizasyon alt ölçeği puan ortalamaları ile aleksitimik kişi sayısı kontrol grubundan anlamlı düzeyde yüksek bulunmuştur. OEÖ toplam puanı, OEÖ yeniden yaşama ve aşırı uyarılmışlık alt ölçekleri ile SCL-90 somatizasyon alt ölçeği toplam puanı ve TAÖ toplam puanı arasında istatistiksel olarak aynı yönde anlamlı ilişki bulunmuştur. OEÖ kaçınma alt ölçeği ile SCL-90 somatizasyon alt ölçeği ve TAÖ-20 arasında istatistiksel olarak anlamlı ilişki saptanmamıştır. Sonuç: Çalışmamızda cinsel travma mağdurlarında travmatik stres belirtileri, diğer tıbbi nedenlerle açıklamayan belirtiler ve aleksitiminin birbirleriyle ilişkili olduğunun bulunması bu hasta grubunun tanımlanması ve tedavi planlamasında önemlidir.

Anahtar Kelimeler

Cinsel travma, travmatik stres belirtileri, diğer tıbbi nedenlerle açıklanamayan belirtiler, aleksitimi.

Kaynakça

• 1. Brady KT, Killeen TK, Brewerton T ve ark. Comorbidity of Psychiatric Disorders and Posttraumatic Stress Disorder. J Clin Psychiatry. 2000 ; 61 [suppl 7]:22-32. 2. Sikharulidze G, van Geloven N, Gugushvili Nve ark. Post-Traumatic stress disorder and comorbidity : the role of mediation and relation between PTSD and somatic complaints in mental health management. Georgian Med News. 2018 ;98-105. 3. Cheung Chung M, AlQarni N, AlMazrouei M ve ark. The impact of trauma exposure characteristics on post-traumatic stress disorder and psychiatric co-morbidity among Syrian refugees. Psychiatry Res. 2018 ; 259:310-315. 4. Thapa P, Acharya L, Bhatta BD ve ark. Anxiety, Depression and Post-Traumatic Stress Disorder after Earthquake. J Nepal Health Res Counc. 2018 ; 16(1):53-57. 5. Aker T (2006). Travma Sonrası Stres Bozukluğu. Ed. Tükel R, Alkın T. Anksiyete bozuklukları. 6. Kuwert P, Glaesmer H, Eichhorn S ve ark. Longterm effects of conflict-related sexual violence compared with non-sexual war trauma in female World War II survivors: a matched pairs study. Arch Sex Behav. 2014 ; 43(6):1059-64. 7. Smith HL, Summers BJ, Dillon KHve ark. Is worstevent trauma type related to PTSD symptom presentation and associated features? J Anxiety Disord. 2016 ; 38:55-61. 8. Dworkin ER. Risk for Mental Disorders Associated With Sexual Assault: A Meta-Analysis. Trauma Violence Abuse. 2018 ; 25:1524838018813198. 9. Dworkin ER, Menon SV, Bystrynski J ve ark. Sexual assault victimization and psychopathology: A review and meta-analysis. Clin Psychol Rev. 2017 ; 56 :65– 81. 10. Afzali MH, Sunderland M, Batterham PJ ve ark. Trauma characteristics, post-traumatic symptoms, psychiatric disorders and suicidal behaviours: Results from the 2007 Australian National Survey of Mental Health and Wellbeing. Aust NZJ Psychiatry, 2017 ; 51(11):1142-1151. 11. Gilmore AK, Brignone E, Painter JM ve ark. Military Sexual Trauma and Co-occurring Posttraumatic Stress Disorder, Depressive Disorders, and Substance Use Disorders among Returning Afghanistan and Iraq Veterans. Womens Health Issues. 2016 ; 26(5):546-54. 12. Barth j, Bermetz L, Heim E ve ark. The current pre valence of child sexual abuse worldwide a systematic review and meta-analysis. Int J Public Health. 2013 ; 58(3):469-483. 13. Burman MA, Sorenson SB. Sexual Assault History and Use of Health and Mental Health Services. Am J Community Psychol, 1998 ; 16(5):625-44. 14. Hidalgo BR, Davidson JRT (2000) Posttraumatic Stress Disorder: Epidomiology and Health-Related Considerations. J. Clin Psychiatry. 2000 ; 61(suppl 7);5-13. 15. Nyboe L, Bentholm A, Gyllensten AL. Bodily symptoms in patients with post traumatic stress disorder : A comparative study of traumatized refugees, Danish War veterans, and healthy controls. J Body Mov Ther. 2017 ; 21(3):523-527. 16. Escobar JI, Hoyos-Nervi C, Gara M. Medically Unexplained Physical Symptoms in Medical Practice: A Psychiatric Perspective. Environ Health Perspect, 2001 ; 110(Suppl 4):631-636. 17. Kandemir G, Ak İ. Tıbben Açıklanamayan Belirtilerin Psikiyatrik Yönü. Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry. 2013 ; 5(4):479-506. 18. Sayar K. Tıbben Açıklanamayan Belirtiler. Turk Psikiyatri Derg. 2002 ;13 (3):222-231. 19. Park J, Jun JY, Lee YJ ve ark. The association between alexithymia and posttraumatic stress symptoms following multiple exposures to traumatic events in North Korean refugees. J Psychosom Res. 2015 ;78(1):77-81. 20. Pacella ML, Hruska B Delahanty DL. The physical health consequences of PTSD and PTSD symptoms: a metaanalytic review. J. Anxiety Disord. 2013 ; 27(1):33-46. 21. Punamäki RL, Qouta SR, El Sarraj E. Nature of torture, PTSD, and somatic symptoms among political ex-prisoners. J Trauma Stress, 2010 ; 23(4):532-536. 22. Aragona M, Catino E, Pucci D ve ark. The Relationship Between Somatization and Posttraumatic Symptoms Among Immigrants Receiving Primary Care Services. J Trauma Stress, 2010 ; 23(5):615- 622. 23. Paras ML, Murad MH, Chen LP ve ark. Sexual Abuse and Lifetime Diagnosis of Somatic Disorders. A Systematic Review and Meta-analysis. JAMA. 2009 ; 302(5):550-561. 24. Polusny MA, Dickinson KA, Murdoch M ve ark. The role of cumulative sexual trauma and difficulties identifying feelings in understanding female veterans’ physical health outcomes. Gen Hosp Psychiatry. 2008 ; 30(2):162-170. 25. Van den Berg B, Grievink L, Yzermans J ve ark. Medically unexplained physical symptoms in the aftermath of disasters. Epidemiol Rev, 2005 ; 27:92-106. 26. Escolona R, Archilles G, Waitzkın H ve ark. PTSD and Somatization in Women Treated at a VA Primary Care Clinic. Psychosomatics, 2004 ; 45(4):291-296. 27. Lecrubier Y. Posttraumatic Stress Disorder in Primary Care: A Hidden Diagnosis. J Clin Psychiatry. 2004 ; 65(suppl 1):49-54. 28. Engel CC, Lıu X, McCarthy BD ve ark. Relationship of Physical Symptoms to Posttraumatic Stress Disorder Among Veterans Seeking Care for Gulf War-Related Health Concerns. Psychosom Med, 2000 ; 62(6):739-745. 29. Solomon SD, Davidson JR. Trauma: Prevalence, Impairment, Service Use, and Cost. J Clin Psychiatry. 1997 ; 58(suppl 9):5-11. 30. Koçak R. Aleksitimi: Kuramsal Çerçeve Tedavi Yaklaşımları ve İlgili Araştirmalar. Ankara Üniversitesi Eğitim Bilim Fakültesi Derg, 2002 ; 35(1-2):183–212. 31. Sifneos PE. Alexithymia: past and present. Am J Psychiatry. 1996 ; 153(7 Suppl):137-142. 32. Lesser IM. A Review of the Alexithymia Concept. Psychosom Med, 1981 ; 43(6):531-543. 33. Ahrens S, Deffner G. Empirical study of alexithymia: methodology and results. Am J Psychother. 1986 ; 40:430-447. 34. Dereboy F. Aleksitimi: Bir Gözden Geçirme Turk Psikiyatri Derg. 1990 ; 1(3):157-65. 35. De Gucht V, Heiser W. Alexithymia and somatisation: quantitative review of the literature. J Psychosom Res. 2003 ; 54(5):425-34. 36. Zeitlin SB, McNally RJ, Cassiday KL. Alexithymia in victims of sexual assault: an effect of repeated traumatization? Am J Psychiatry. 1993 ; 150(4):661-663. 37. Cloitre M, Scarvalone P, Difede J. Posttraumatic stress disorder, self- and interpersonal dysfunction among sexually retraumatized women. J Traum Stress, 1997 ; 10 (3):437-452 38. McLean LM, Toner B, Jackson J ve ark. (2006) The relationship between childhood sexual abuse, complex post-traumatic stress disorder and alexithymia in two outpatient samples : examination of women treated in community and institutional clinics. J Child Sex Abus, 2006 ; 15(3):1-17. 39. Zlotnick C, Zakriski AL, Shea MT ve ark. The longterm sequelae of sexual abuse: Support for a complex posttraumatic stress disorder. J Trauma Stress. 1996 ; 9(2):195–205. 40. Frewen PA, Dozois DJA, Neufeld RWJ ve ark. Meta-Analysis of Alexithymia in Posttraumatic Stress Disorder. J Trauma Stress. 2008 ; 21(2):243–246. 41. Declercq F, Vanheule S, Deheegher J. Alexithymia and Posttraumatic Stress: Subscales and Symptom Clusters. J Clin Psychol. 2010 ; 66(10):1076–1089. 42. Kusevic Z, Civljak M, Rukavina TV ve ark. The Connection between Alexithymia and Somatic Morbidity in a Population of Combat Veterans with Chronic PTSD. Acta Inform Med. 2013 ; 21(1): 7-11. 43. Mc Caslin SE, Metzler TJ, Best SR ve ark. Alexithymia and PTSD symptoms in urban police officers: Cross sectional and prospective findings. J Trauma Stress. 2006 ; 19 (3) :361–373. 44. Schnurr PP, Green BL. Understanding relationships among trauma, post-tramatic stress disorder, and health outcomes. Adv Mind Body Med. 2004 ; 20: 18-29. 45. Krystal JH, Giller EL, Jr., Cicchetti DV. Assessment of alexithymia in posttraumatic stress disorder and somatic illness: introduction of a reliable measure. Psychosom Med. 1986 ; 48(1-1):84-94. 46. Cloitre M, Koenen KC, Cohen LR ve ark. Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. J Consult Clin Psychol. 2002 ; 70 (5):1067-1074. 47. Calhoun PS, Bosworth HB, Grambow SC ve ark. Medical service utilization by veterans seeking help for posttraumatic stress disorder. Am J Psychiatry. 2002 ; 159(12):2081–86. 48. Horowitz M, Wilner N, Alvarez W. Impact of Event Scale: a measure of subjective stress. Psychosom Med. 1979 ; 41: 209-218. 49. Çorapçıoğlu A, Yargıç İ, Geyran P ve ark. “Olayların Etkisi Ölçeği” (IES-R) Türkçe Versiyonunun Geçerlilik ve Güvenilirliği. New/Yeni Symposium Journal. 2006 ; 44(1): 14–22. 50. Derogatis LR (1997) SCL-90: Administration, Scoring and Procedure Manual-I for the Revised Version. Baltimore, MD: John Hopkins Univ, School of Medicine, Clinical Psychometrics Unit. 51. Dağ İ. Belirti Tarama Listesi (SCL-90-R)’nin üniversite öğrencileri için güvenirliği ve geçerliği. Turk Psikiyatri Derg, 1991 ; 2(1): 5-12. 52. Henningsen P, Zipfel S, Herzog W. Management of functional somatic syndromes. Lancet, 2007 ; 369:946-55. 53. Bagby RM, Parker JD, Taylor GJ. The twenty-item Toronto Alexithymia Scale--I. Item selection and cross-validation of the factor structure. J Psychosom Res. 1994a ; 38(1):23-32. 54. Bagby RM, Taylor GJ, Parker JD. The Twenty-item Toronto Alexithymia Scale--II. Convergent, discriminant, and concurrent validity. J Psychosom Res. 1994b ; 38(1):33-40. 55. Güleç H, Köse S, Yazıcı GM. Yirmi soruluk Toronto Aleksimi Ölçeği’nin Türkçe uyarlamasının geçerlik ve güvenirliğinin incelenmesi. Klinik Psikofarmakoloji Bülteni, 2009 ; 19(3):213-9. 56. Kimerling R, Calhoun KS. Somatic Symptoms, Social Support, and Treatmaent Seeking Among Sexual Assault Victims. J Consult Clin Psychol. 1994 ; 62(2) :333-340. 57. Hulme PA. Symptomatology and Health Care Utilization of Women Primary Care Patients Who Experienced Childhood Sexual Abuse. Child Abuse Negl. 2000 ; 24(11):1471-1484. 58. Romans S, Belaise C. Martin J ve ark. Childhood Abuse and Later Medikal Disorders in Women. Psychother Psychosom. 2002 ; 71(3):141–150. 59. Walker EA, Katon WJ, Hansom J. Medical and Psychiatric Symptoms in Women with Childhood Sexual Abuse. Psychosom Med. 1992 ; 54(6):658- 664. 60. Stein MB, Lang AJ, Laffaye C ve ark. Relationship of sexual assault history to somatic symptoms and health anxiety in women. Gen Hosp Psychiatry. 2004 ; 26(3):178-183. 61. Sack M, Boroske-Leiner K, Lahmann K. Association of nonsexual and sexual traumatizations with body image and psychosomatic symptoms in psychosomatic outpatients. Gen Hosp Psychiatry. 2010 ; 32(3):315-320. 62. Samelius L, Wijma B, Wingren G ve ark. Somatization in Abused Women. J Womens Health. 2007 ; 16(6):909-918. 63. Gündüz N, Polat A, Erzincan E ve ark. Psychiatric comorbidity and childhood trauma in fibromyalgia syndrome, Turk J Phys Med Rehab. 2018 ; 64(2):91- 99. 64. Chen LP, Murad MH, Paras ML ve ark. Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clin Proc. 2010 ;85(7): 618–629. 65. Badura AS. Theoretical and empirical exploration of the similarities between emotional numbing in posttraumatic stress disorder and alexithymia. J Anxiety Disord. 2003 ; 17(3):349–360. 66. Monson CM, Price JL, Rodriguez BF ve ark. Emotional Deficits in Military-Related PTSD : An Investigation of Content and Process Disturbances. J Trauma Stress. 2004 ; 17(3):275–9. 67. Sondergaard HP Theorell T. Alexithymia, emotions and PTSD: Findings from a longitudinal study of refugees. Nord J Psychiatry. 2004 ; 58(3):185–191. 68. Fukunishi I, Sasaki K, Chishima Y ve ark. Emotional disturbances in trauma patients during the rehabilitation phase :studies of posttraumatic stress disorder and alexithymia. Gen Hosp Psychiatry. 1996 ; 18(2):121-7. 69. Cordova MJ, Studts JL, Hann DM ve ark. Symptom structure of PTSF following breast cancer. J Trauma Stress. 2000 ; 13(2):301–319. 70. Marshall GN. Posttraumatic stress disorder symptom check-list: Factor structure and English-Spanish measurement invariance. J Trauma Stress. 2004 ; 17(3): 223–230. 71. Mc Williams LA, Cox BJ, Asmundson GJG. Symptom structure of posttraumatic stress in a nationally representative sample. J Anxiety Disord. 2005 ; 19(6): 626–641. 72. Simms LJ, Watson D, Doebbeling BN. Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War. J Abnormal Psychol. 2002 ; 111(4) :637–647. 73. Witteveen AB, Van der Ploeg E, Bramsen I ve ark. Dimensionality of the posttraumatic stress response among police officers and fire fighters: An evaluation of the two self-report scales. Psychiatric Res. 2006 ; 141(2).213–228. 74. Litz BT. Emotional numbing in combat-related posttraumatic stress disorder: A critical review and reformulation. Clin Psychol Rev. 1992 ; 12(4) :417–432. 75. Gross JJ, Levenson RW. Emotional suppression: Physiology, self-report and expressive behaviour. J Pers Soc Psychol. 1993 ; 64(6) :970–986. 76. Eadie EM, Runtz MG S-RJ. Posttraumatic Stress Symptoms as a Mediator Between Sexual Assault and Adverse Health Outcomes in Undergraduate Women. J Trauma Stress. 2008 ; 21(6):540–547. 77. Smith BN, Shipherd JC, Schuster JL ve ark. Posttraumatic Stress Symptomatology as a Mediator of the Association Between Military Sexual Trauma and Post-Deployment Physical Health in Women. J Trauma Dissociation. 2011 ; 12(3) :275-289. 78. Shipherd JC, Pineles SL, Gradus JL. Sexual Harrassment in the Marines, Posttraumatic Stress Symptoms, and Percived Health: Evidence for Sex Differences. J Trauma Stress. 2009 ; 22(1):3-10. 79. Campbell R, Greeson MR, Bybee D ve ark. The Co-Occurence of Childhood Sexual Abuse, Adult Sexual Assault, Intimate Partner Violence, and Sexual Harassment: A Mediational Model of Posttraumatic Stress Disorder and Physical Health Outcomes. J Consult Clin Psychol. 2008 ; 76(2) :194-207 80. Asmundson GJG, Katz J. Understanding th co-occurrence of anxiety disorders and chronic pain: Stateof-the-art. Depress Anxiety. 2009 ; 26(10):888-901. 81. Sharp TJ, Harvey AG. Chronic pain and posttraumatic stress disorder: mutual maintenance? Clin Psychol Rev. 2001 ; 21(6):857-877. 82. Buitenhuis J, Jong PJ, Jaspers JPC ve ark. Relationship between post traumatic stress disorder symptoms and the course of whiplash complaints. J Psychosom Res. 2006 ; 61(5):681-689. 83. Porcelli P, Bagby RM, Taylor GJ ve ark. Alexithymia as predictor of treatment outcome in patients with functional gastrointestinal disorders. Psychosom Med. 2003 ; 65(5): 911- 918. 84. Ogrodniczuk JS, Piper WE, Joyce AS (2011) Effect of alexithymia on the process and outcome of psychotherapy: A programmatic review. Psychiatry Res 190(1):43–48. 85. Naugle AE, Bell KM, Polusny MA. Clinical considerations for treating sexually revictimized women. Natl Cent PTSD Clin Q. 2003 ; 12:12–16. 86. Van der Kolk BA. The body keeps the score: memory and the evolving psychobiology of posttraumatic stress. Harv Rev Psychiatry. 1994 ; 1(5):253-65. 87. Wessley S, Nimnuan C, Sharpe M. Functional somatic syndromes: one or many? Lancet. 1999 ; 354(9182):936-39.