Introduction/Objectives:
A life-threatening trauma, i.e. the one jeopardizing someone's existence is a cause to an acute and chronic posttraumatic stress disorder. Apart from the classical PTSD and the symptoms belonging to anxiety – and depression – related disorders, a chronic condition may also lead to psycho-somatic disturbances and, frequently, to psychotic reactions. Changes within the mouth which are somatically not defined, in particular stomatopyrosis and stomatodynia, are sometimes a manifestation of a chronic PTSD (with 8%). Addiction, as comorbidity, is also common. A long-term PTSD may severely damage the patient's ego, which results in personality change, with a dominant feature of maladaptation. Varieties of the problems related to PTSD make the dominant trauma difficult to establish, which is a significant factor while assessing invalidity and damages compensation especially if the primary trauma was experienced a long time ago. Namely, there is always a possibility of secondary traumas. However, secondary traumas lead to stress, due to sensibilization of the subject by the primary trauma, secondary traumas lead to stress.
Participants, Materials/Methods:
When discussing personality changes, there is a dilemma regarding the extent to which they emerge as the consequence of heredity. Every illness has in its origin a hereditary inclination for its emerging. Heredity does not exclude trauma as the cause of the stress; it facilitates it, or even makes it possible. As other forms of personality changes also have maladaptation as the primary symptom, there is a possibility we might encounter while trying to make differential diagnoses. Patients with a chronic PTSD and a permanent change of personality which is the consequence of a PTSD often have difficulties in either returning to work or finding a job, and they perceive invalidity retirement as the only solution. In that case, they are thought to be fake invalids, which is not true. Fake invalidity is tertiary gain, and many people with F 43.1 and F 62.0 have secondary gain. Secondary gain deals with work incapability stemming from unconscious motives which are mostly the consequence of a familial, social or work-related re-traumatization.
Results:
We studied altogether 312 patients, 156 of whom were diagnosed with F 43.1 and 156 with F 62.0. All of them had, apart from usual problems, problems related to emotional communication, and we were quite often in a dilemma whether or not the majority of those with F 43.1 could be diagnosed with F 62.0 as well, but then we gave it up whenever there was a smaller intensity of maladaptation, i.e. when a person's ego was better preserved. 81% of the ones diagnosed with F 43.1 and 89% of the ones with F 62.0 were unemployed and the majority of them demanded invalidity retirement.
Conclusions:
We might conclude that in order for PTSD to be diagnosed, the vital factor is the existential trauma experienced by the patient, and as far as F 62.0 is concerned, the vital factor is the maladaptation syndrome. Secondary gain is a pretty common symptom and should not be considered as an aggravation.
