Trouble de stress post-traumatique et symptômes dépressifs : « comorbidités » ou formes cliniques du trauma ? Description de la dépression dissociative.

Abstract

We investigate the epidemiology of depressive disorders, on the one hand, and post-traumatic disorders, on the other hand, in order to better understand the relationship between the two. The evolution of a semiological and a psychopathological understanding of post-traumatic psychic disorders, which cannot be reduced to post-traumatic stress disorder alone, allows us to understand the nosographic framework of post-traumatic depression. Over time, under the effect of traumatic dissociation, the cardinal symptoms of reliving, avoidance and hypervigilance can give way to various syndromes whose psychotraumatic origins remain unknown. This is no doubt the cause of many cases of resistant depression. These are neither depressive “comorbidities” nor “complications” but authentic clinical forms resulting from trauma and remaining linked to it by anamnestic, psychopathological and neurobiological factors. In this study, we enumerate the now classic post-traumatic depressions: (i) psychophysiological exhaustion in the face of the trauma and its consequences, (ii) mood-congruent psychotic characteristics, (iii) depressions masked by somatic suffering, (iv) those that involve post-traumatic grief. Also, we suggest that pathological dissociation creates depressogenic cognitive patterns to the point of leading to “dissociative depressions”. We then discuss the therapeutic perspectives of pharmacological and psychotherapeutic treatments, and finally address research strategies based on psycholinguistics, and in particular the description of traumatic psycholinguistic syndrome (SPLIT). We conclude with a discussion of the medico-legal issues.