Anxiety, depression, stress … What are the psychological effects of confinement? Can this seclusion lead to post-traumatic stress disorder? Muriel Salmona, psychiatrist specialized in psychotrauma and president of the association Mémoire Traumatique et Victimologie, responds to Figaro.
LE FIGARO. – How to define a post-traumatic stress disorder and what impacts can it cause?
Muriel SALMONA. – This disorder is the result of a series of neuro-psychological consequences that manifest themselves in a person who has experienced a traumatic event. This traumatic event imposed significant stress on this person, living a situation that put him or her loved ones in danger.
This disorder results in a breakdown of thought that does not allow to control extreme stress. At the level of the brain, this triggers neurological safeguard mechanisms which, to extinguish stress, cause our emotional circuits to break down. We can observe in the most serious trauma, neurological damage with neuronal losses which can cause the disappearance of 30% of the volume of certain brain structures which are essential. Thus, some experience a loss of concentration or even memory problems. But all this can be treated: there is an incredible capacity for neurological repair. Do not hesitate to make an appointment, post-traumatic stress can be treated by teleconsultation.
Is it true that after ten days of confinement, a person can develop post-traumatic stress disorder?
We must differentiate acute stress from post-traumatic stress. The latter is a constituted psychotraumatic disorder. Clearly, it is identified a month after the traumatic event. Initially, the event in question reveals significant psychological distress but which will not turn into post-traumatic stress syndrome. Thus, if one can observe a state of acute stress after 10 days, one cannot speak of a state of post-traumatic stress constituted until beyond thirty days. This disorder can then settle over time.
Everyone’s confinement is different. For some, it is stable while for others, it turns out to be violent. Do we all develop the same kind of anxiety?
There are traumatic events that will cause psychological distress for everyone: when we experience an attack, from near or far, we all develop more or less significant post-traumatic stress. The same goes for containment. It all depends on exposure to stress: does your job require you to explode yourself with the virus? If you are confined and have to telecommute, do you have to take care of your children at the same time? Are your loved ones exposed to the virus? Do you spend most of your time on social media or watching television? The degree of stress depends on all of these factors. Note that confinement can reactivate some past violence. We note that since the beginning of confinement, there has been a significant increase in domestic, family and sexual violence.
If we are confined to a safe and healthy place, can we develop post-traumatic stress disorder?
If we have no traumatic history, if we do not live in a stressful situation due to exposure to the virus due to our profession, if we are not exposed to new violence, we have less risk develop post-traumatic stress disorder. But we cannot be fully protected. We are in an uncontrolled, global situation, so it is okay to be anxious. It is a normal reaction to an abnormal situation. According to a Chinese study published in the journal General Psychiatry, 35% of people will develop psychological distress which can later constitute a state of stress. Another study in the Journal of the American Medical Association states that this figure rises to 75% for caregivers on the front line.
How is post-traumatic stress disorder detected?
This can be manifested by mental suffering, great anxiety, hypervigilance but also, cardiovascular disorders with palpitations. Some people may experience sleeplessness or nightmares. Many feel a sense of oppression, the feeling of being overwhelmed by a situation they cannot control. And then, it is possible to develop phobias or obsessive-compulsive disorders: some people start cleaning all the time in an irrational way. Depressive ideas can appear. Having continuous anxiety, having eating disorders, not being hungry, no longer having a taste for things: all of these should alert us.
Are there more discreet signs that it is important to identify?
If a person is too exposed to stress, they can disconnect from the event and be indifferent to it. It is a defense mechanism that we call “traumatic dissociation”: because there is too much stress, the brain disconnects the emotional circuit and we anesthetizee.
Who are the people most vulnerable to post-traumatic stress disorder?
First there are the women. This is because they experience more violence and in particular, sexual or marital violence. They are three times more at risk of developing psycho-traumatic disorders. In addition, they are much more in a care situation: they have to take care of a lot of people. A woman in confinement with children experiences a great mental load, so she is more exposed. There are also people with disabilities, autistic people who develop much more post-traumatic stress than others because they experience more violence from childhood.
How to deal with this state of extreme stress?
You have to make sure you are surrounded, speak, maintain a form of solidarity. It’s a good treatment! This allows us to project ourselves into a world that can always improve. And then, make sure to read the right information, understand that it is normal to be anxious and know the psycho-traumatic disorders that can develop. The explanation for these disorders alone, the way they manifest, is 50% of the care. The more people understand, the more it helps to deal with the initial stress and amazement.
How is this disorder treated?
Those who experience post-traumatic stress develop a “traumatic memory”. This memory haunts a person with flashbacks, reminiscences, like a time machine, with the same distress as if the traumatic event happened again. It is not an integrated memory like an autobiographical memory. It is a memory that gives rise to stress and as soon as a link recalls the event or a potential danger occurs.
By treating traumatic memory, people are prevented from developing obsessive-compulsive disorder, alcohol or drug dependence – which allows them to feel nothing. About 30 to 50% of individuals with psycho-traumatic disorders have addictive behaviors. Thus, immediate stress must be treated, by giving beta-blockers or psychotropic drugs, while practicing breathing and relaxation exercises. Finally, transform the traumatic memory into psychotherapy.