Hypothèses étiopathogéniques du trouble de stress post-traumatique d’apparition retardée

Abstract

Background

The temporality of the emergence of symptoms following exposure to a potentially traumatic event is variable.

Objectives

The purpose of our research is to investigate the etiopathogenic hypotheses concerning the question of the latency phase which sometimes precedes the emergence of post-traumatic stress disorders.

Materials and methods

We conducted a review of the psychiatric literature concerning delayed-onset post-traumatic stress disorders. Hypotheses from the psychoanalytic literature were then discussed, as well as neuroscientific hypotheses.

Results

This diagnosis has two possible definitions: a considerable delay in the emergence of symptoms, or the presence of early symptoms that are not very specific and not attributed to the effects of the event on the psyche. The etiological hypotheses found in the literature involve the role of denial, emotional detachment, and early avoidance. The role of the occurrence of a later triggering event, the intensity of the event with psychotraumatic potential, the protective role of social support systems, and the hypotheses related to cognitive aging were also highlighted. Furthermore, numerous studies have shown that the subjective experience of a perceived threat was a more reliable predictor of the likelihood of developing post-traumatic stress disorders than a supposedly objective assessment of danger. From a neuroscientific perspective, a study published by Smid and al. in 2022 found that since different traumatic experiences share common elements, each new event with psychotraumatic potential would activate the same memory structure, which would reinforce the interconnections of this memory network. This could explain the role of a later triggering event in the development of delayed post-traumatic disorders. On a psychoanalytical level, according to the Freudian concept of après-coup, the first event is initially without consequence, but it is transformed by a second event, and it becomes retroactively traumatic. We discussed two hypotheses: either the first event left an unsymbolized trace, it was not integrated into the signifying chain, and it was subsequently integrated later on due to the second event, either the first event was symbolized at the moment of its occurrence, and in the light of a second subsequent event, it assumed a new meaning. The establishment of several psychic defense mechanisms could also explain the delayed onset of symptoms. From an interdisciplinary perspective, the study of the concept of trace, developed by researchers such as F. Ansermet and P. Magistretti, has enabled us to shed light on our subject. The experience transcribed in the form of traces could undergo changes due to plasticity, the trace being thus able to associate with other traces on the occasion of exposure to other events.

Conclusions

The question of the delayed emergence of symptoms highlights the shifting and indeterminate nature of psychic life, and the difficulty in predicting post-traumatic stress disorders.