Avoidance Symptoms in the Context of Differing Clinical Pictures

Financed by: The Foundation to Promote University Psychoanalysis

Until 2017 / Project Head: Prof. Dr. Lutz Wittmann


Abstract

Victims of traumatic experiences can experience symptoms of re-living, avoidance, and change in emotions and cognitions, as well as psychophysiological hyper arousal, which are summarised as post-traumatic stress disorders (APA, 2013). With a lifetime prevalence of 7.8% (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995), posttraumatic stress disorders (PTSD) are counted among the most frequently psychiatric diagnoses or clinical pictures. In this regard however, PTSD does not typically arise in isolation, but is frequently accompanied by comorbid clinical pictures: "A lifetime history of at least one other disorder was present in 88.3% of the men with lifetime PTSD and 79% of the women with lifetime PTSD." (Kessler et al., 1995, S. 1055). A further important aspect of the comorbidity rate is the indication of diagnostic artefacts resulting from the overlapping of symptoms between differing diagnoses (McMillen, North, Mosley, & Smith, 2002). This phenomenon is also of critical importance for classifying the high comorbidity rates of PTSD with anxiety disorders such as social phobia (SP) or agoraphobia (AP) (e.g. Alonso et al., 2004; Davidson, Hughes, Blazer, & George, 1991; Davis et al., 2012; Zhang, Ross, & Davidson, 2004), because all three diagnoses attribute a central position to avoidance symptoms.

The study proposed would like to make a contribution to understanding avoidance symptoms in the conflicting areas between PTSD, AP und SP. The intention is to examine in the context of a qualitative pilot project if and to what extent with female and male German Bundeswehr army soldiers who have been diagnosed with PTSD and/or AP and/or SP, the avoidance symptoms concern differing phenomena or the same, repeatedly diagnosed symptoms.

Main Study Centre

Dr. med. Helge Höllmer, Department Head
Dr. Robert. J. Gorzka, Head of Clinical Psychology

Centre for Mental Health
Bundeswehrkrankenhaus Hamburg army hospital
Lesserstraße 180, 22049 Hamburg, Abteilung VIb dept.

Study Centre Berlin

Prof. Dr. phil. Lutz Wittmann
Nikolas Heim, BA

International Psychoanalytic University Berlin gGmbH
Stromstr. 1, 10555 Berlin
Tel. +49 30 300 117-810
www.ipu-berlin.de

Literature

  • Alonso, J., Angermeyer, M. C., Bernert, S., Bruffaerts, R., Brugha, T. S., Bryson, H., . . . EsemeD/Mhedea Investigators, E. S. o. t. E. o. M. D. P. (2004). 12-Month comorbidity patterns and associated factors in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl(420), 28-37. doi: 10.1111/j.1600-0047.2004.00328.x
  • APA. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington DC: Author.
  • Davidson, J. R., Hughes, D., Blazer, D. G., & George, L. K. (1991). Post-traumatic stress disorder in the community: an epidemiological study. Psychological Medicine, 21(3), 713-721.
  • Davis, L. L., Leon, A. C., Toscano, R., Drebing, C. E., Ward, L. C., Parker, P. E., . . . Drake, R. E. (2012). A randomized controlled trial of supported employment among veterans with posttraumatic stress disorder. Psychiatr Serv, 63(5), 464-470. doi: 10.1176/appi.ps.201100340
  • Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048-1060.
  • McMillen, C., North, C., Mosley, M., & Smith, E. (2002). Untangling the psychiatric comorbidity of posttraumatic stress disorder in a sample of flood survivors. Comprehensive Psychiatry, 43(6), 478-485.
  • Zhang, W., Ross, J., & Davidson, J. R. (2004). Posttraumatic stress disorder in callers to the Anxiety Disorders Association of America. Depression and Anxiety, 19(2), 96-104. doi: 10.1002/da.10138