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Trouble de Stress Post-Traumatique : analyser et comprendre le rétablissement pour optimiser la réinsertion : étude exploratoire auprès de militaires et civils français

Abstract : Post-Traumatic Stress Disorder (PTSD) develops following a traumatic confrontation. It is characterized by a clinical tetrad: avoidance behaviors, hypervigilance, revivals and cognitivo- emotional impairments. PTSD has a prevalence of 1 to 7% in Europe (lifetime), and 20% in the military depending on the missions. The clinical course, regardless of the care, shows that more than 20% of subjects are resistant to treatment and that about 40% of subjects who recover relapse at some point. Thus, for a significant part of PTSD patients arise as a chronic disease. This finding questions the recovery mechanisms in these patients that could allow satisfactory socio-professional reintegration.Recovering process from this chronic pathology involves the interplay of psychological, cognitive and social resources. The data available in patients suffering from chronic illness point to the importance of psychological resources which allow a capacity for autonomy and social commitment. It is clear that in the context of PTSD, the psychological resources supporting recovery need further investigation. On a neurocognitive level, PTSD is characterized by executive cognitive impairment affecting in particular the memory, often associated with neurological complaints that are still little explored. These neurocognitive disorders are risk factors for chronic PTSD, impacting not only the patients' quality of life and also their socio-professional reintegration possibilities. Finally, on the social level, the course of recovery and reintegration involves satisfactory socialization. Socialization is not a linear process but it is subject to constant perpetual changes in the quality of social interactions, a key feature in this process. While the hypothesis of an impact of clinical symptoms of PTSD in the socialization of these is legitimate, the available data are scarce. This issue is all the more important for soldiers with chronic PTSD, since most of them will have to leave the military environment and re-socialize in civilian world. This doctoral work aims to better understand the psychoneurosociological mechanisms of the recovery trajectory in patients suffering from chronic PTSD. More specifically, it focuses on 4 issues. The first one is theoretical. It aims to analyze the data in the literature on recovery, and its dimensions, in chronic mental illnesses in order to propose a theoretical framework for recovery and interventionsthat could be assessed in PTSD (article 1). Three issues on the subject of field studies: a) What are the important psychological resources for the recovery and reintegration of PTSD? ; b) What are the neurological signs of interest for better understanding the evolutionary trajectory of the patient suffering from PTSD? ; and c) What are the core characteristics (pro and cons) of socialization for patients suffering from PTSD? At the end of this exploratory work, carried out mainly on soldiers suffering from chronic PTSD, we propose lines of work/evidence and recommendations for intervention to improve course of their socio-professional reintegration.
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https://docnum.univ-lorraine.fr/ulprive/DDOC_T_2020_0270_BELROSE.pdf
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https://hal.univ-lorraine.fr/tel-03199162
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Submitted on : Thursday, April 15, 2021 - 1:58:15 PM
Last modification on : Friday, April 16, 2021 - 3:29:01 AM

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  • HAL Id : tel-03199162, version 1

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Célia Belrose. Trouble de Stress Post-Traumatique : analyser et comprendre le rétablissement pour optimiser la réinsertion : étude exploratoire auprès de militaires et civils français. Psychologie. Université de Lorraine, 2020. Français. ⟨NNT : 2020LORR0270⟩. ⟨tel-03199162⟩

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