Do concepts of childhood trauma and dissociation provide an epistemological linkage between schizophrenia and PTSD?

Zusammenfassung

Hintergrund: Seit Bleuler und Janet wurde der Betrachtung von Schizophrenie als dissoziatives Phänomen wenig Beachtung geschenkt. Eine strikte Trennung zwischen Schizophrenie als ausschließlich biologischen Prozess und dissoziativen Störungen als alleinige Folge von traumatischen Erlebnissen in der Kindheit ist inzwischen überwunden. Methode: Die Autoren wählen eine narrative Literaturübersicht, die mögliche Zusammenhänge zwischen Kindheitstraumata, dissoziativen Störungen und psychotischen Symptomen in der Allgemeinbevölkerung als auch bei an Schizophrenie leidenden Menschen empirisch untersuchen. Wissenschaftstheoretische Partikularitäten postulierter Zusammenhangsannahmen werden diskutiert. Ergebnisse: Die untersuchte Literatur legt die Annahme nahe, dass schizophrene Menschen, die gleichzeitig dissoziative Störungen aufweisen, unter stärkeren positiven psychotischen Symptomen, häufiger Komorbidität und höherer Krankheitsbelastung leiden. Andererseits weisen Patienten mit „strukturellen dissoziativen Störungen“ phänomenologische Ähnlichkeiten mit schizophrenen Patienten. Gemeinsame biologische als auch psychologische Erklärungsansätze werden diskutiert. Schlussfolgerungen: Anhand der hier diskutierten empirischen Ergebnissen darf beim heutigen Wissensstand davon ausgegangen werden, dass sowohl posttraumatische Belastungsstörungen (PTSD) als auch schizophrene Psychosen auf biologischen als auch auf eine das Selbst vor unerträglichen Bedrohungen schützende Abwehrfunktionen basieren, jedoch klinisch und phänomenologisch unterschiedlich zum Ausdruck kommen.

Summary

Background: The possible nature of schizophrenia as somewhat dissociative has been paid less attention since Bleuler and Janet. Today, the strict dichotomy between schizophrenia as a solely biological process and dissociative disorders as a psychological consequence of traumatic events in childhood has been widely discredited. Method: In this section, there is a discussion on the extensive literature about associations between trauma in childhood, dissociative disorders, and psychotic symptoms in the general population and in people suffering from schizophrenia. Intrinsic epistemological difficulties are discussed. Results: Studies suggest that schizophrenic patients showing dissociative symptoms suffer from more severe positive psychotic symptoms and a higher comorbidity as well as the burden of the disease; otherwise, patients suffering from so-called ‘structural dissociative disorders’ show phenomenological similarities with schizophrenic patients. Different possible biological as well as psychological pathways were discussed. Conclusions: Probably, both posttraumatic stress disorder (PTSD) and schizophrenia stem from a biological basis as well as a dissociative processing of psychological threats for the self, but in a phenomenological different way. The overlapping symptoms and risk factors stated in the literature give an important impetus to the epistemological as well as the ontological discussion in psychiatry and medicine.

Schlüsselwörter

Dissoziation - Wissenschaftstheorie - psychotische Symptome - Schizophrenie - Kindheitstraumata

Keywords

Dissociation - epistemology - psychotic symptoms - schizophrenia - trauma

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