A car accident, an attack, a sudden bereavement, a natural disaster, repeated violence, certain events leave deep traces that do not disappear over time. Post-traumatic stress disorder (PTSD) is not a sign of weakness: it is the neurobiological consequence of a brain that has not been able to normally process an experience beyond its adaptive capacity at the time of the event. According to INSERM, around 8% of the general population develops PTSD during their life, with much higher rates in certain exposed professions (first aiders, caregivers, military, police). The good news: Treatments for PTSD are among the most effective in all of psychiatry, with high cure rates.
1. Psychological trauma: neurobiological mechanisms
Faced with an event threatening life or physical or psychological integrity, the brain triggers an emergency response: the amygdala (danger detection center) is massively activated and inhibits the prefrontal cortex (rational thought) and the hippocampus (normal memory consolidation).
Under normal conditions, the hippocampus contextualizes and encodes the event in autobiographical memory, giving it a temporal dimension (it happened in the past). In trauma, this consolidation is disrupted: the memory remains fragmented, sensory and not contextualized. It is not stored as an ordinary memory, it is stored as a present and active danger, which explains the relivings and intense fear reactions to stimuli reminiscent of the trauma.
| Cluster | Symptoms | Concrete examples | |
|---|---|---|---|
| Reexperiences (intrusions) | Flashbacks, nightmares, intense distress in the face of reminders of the trauma, involuntary physical reactions | Finding yourself reliving the event as if it were happening now; jump at the sound of a car | |
| Avoidance | Avoidance of thoughts, memories, people, places or situations reminiscent of the trauma | No longer being able to take the metro after a aggression; avoid talking about it | |
| Cognitive and emotional alterations | Negative beliefs about self or the world, shame, guilt, anhedonia, emotional detachment | Permanent feeling of danger; inability to feel positive emotions #B2DFDB;color:#374151;vertical-align:top;background:#F4FBFA">Hypervigilance, exaggerated startle reactions, irritability, sleep problems, difficulty concentrating | Inability to relax; chronic insomnia; explosive anger |
2. PTSD symptoms: the three clusters
The diagnosis of PTSD (DSM-5) requires the presence of symptoms in four groups, for more than a month, causing significant distress:
3. Simple PTSD, complex PTSD and developmental trauma
Simple PTSD: results from a single, delimited traumatic event (accident, assault, catastrophe). The symptoms correspond to the four clusters described above.
Complex PTSD (PTSC): recognized in the ICD-11, it results from repeated, prolonged or cumulative trauma, generally interpersonal (domestic violence, childhood abuse, prolonged harassment). In addition to the symptoms of simple PTSD, it includes disruptions in emotional regulation, identity, and relationships.
Developmental trauma: trauma occurring during childhood, in primary attachment relationships. They have an impact on brain development itself and are the cause of many personality disorders and emotional dysregulation in adulthood.
4. Reference treatments: EMDR, CBT-T and beyond
EMDR (Eye Movement Desensitization and Reprocessing): Developed by Francine Shapiro, EMDR uses bilateral eye movements or other forms of bilateral stimulation while the person accesses the traumatic memory. It allows the brain to reprocess and contextualize the memory in autobiographical memory. Recommended by the WHO, HAS and INSERM, with effectiveness demonstrated in numerous meta-analyses.Trauma-Focused CBT (T-CBT): specific protocols including prolonged exposure (PE) and cognitive processing therapy (CPT). Prolonged exposure involves revisiting the traumatic memory in a controlled manner to habituate the brain and reduce the fear response. Effectiveness demonstrated in 60 to 80% of patients.
Somatic therapy (Somatic Experiencing, EMDR, Sensorimotor Psychotherapy): approaches that work on bodily memories of trauma, particularly useful when the trauma is stored in the body more than in words.
Drug treatment: SSRIs (sertraline, paroxetine) are approved for PTSD and can reduce symptoms, particularly as a complement to psychotherapy. They are prescribed and monitored by a psychiatrist.
5. Recognize untreated trauma and consult
Many people live with the after-effects of untreated trauma without putting words to it. Signals that deserve professional assessment:
- ●Intense and unexplained emotional or physiological reactions to certain stimuli (sounds, smells, situations).
- ●Recurring nightmares or intrusive images linked to a past event.
- ●Emotional numbness, a feeling of detachment or of no longer recognizing myself since a difficult event.
- ●Permanent hypervigilance, an inability to feel safe even in objectively safe environments.
My general practitioner can carry out an initial assessment and refer to a trauma specialist (psychiatrist, psychologist trained in EMDR or CBT-T). Early treatment significantly improves the prognosis.
In the event of acute distress following a recent traumatic event, contact the SAMU (15) or 3114. Early treatment (within 72 hours) can prevent the development of chronic PTSD.
💡 tips to remember
- PTSD is not a sign of weakness: it is the neurobiological consequence of a brain that has not been able to normally process an experience beyond its adaptive capacity. It's an invisible wound, and it heals.
- EMDR and trauma-focused CBT are the gold standard treatments recommended by the WHO and HAS, with success rates of 60 to 80%. Old trauma can be treated effectively, even decades later.
- Intense emotional reactions to certain stimuli, recurring nightmares, or persistent numbness since a difficult event merit professional evaluation, even if the event was a long time ago.
- Treatment within 72 hours after a traumatic event can prevent the development of chronic PTSD. In the event of acute distress, SAMU (15) or 3114 can provide rapid referral.
- Complex PTSD, linked to repeated trauma, requires longer specialist care. Healing is possible, but it requires support adapted to the nature of the injuries.
