Si le terme de décompensation passionnelle tend à disparaître de la nosologie psychiatrique, en pratique clinique, nombreux sont les patients qui présentent une ou plusieurs idées prévalentes exprimées avec une intense participation émotionnelle souvent au détriment des autres secteurs de la vie psychique. Pour les patients blessés psychiques, si des thèmes revendicatifs sont fréquemment observés dans les différentes procédures visant à la reconnaissance et à la réparation de l’affection, ils éclipsent parfois d’autres problématiques, telles l’élaboration d’un deuil ou la restauration narcissique qui constituent les véritables enjeux thérapeutiques.

L’objectif de cette étude clinique est de proposer un panorama de situations cliniques posant la question de l’intrication de symptômes du registre passionnel et traumatique en interrogeant les rapports des uns aux autres et à l’état antérieur.

Il s’agit tout à la fois de proposer un retour d’expérience, des pistes de réflexion psychothérapeutique, voire pourquoi pas d’ouvrir sur de nouvelles perspectives.

The term passionate decompensation is used less and less in psychiatry. In classical French nosology, it designates delusions occurring in sectors on very specific themes (of claim, jealousy, erotomania, sensitive) of prevailing intuitive and interpretative mechanisms. In international literature, we speak rather of persistent delusional disorders and/or psychotic disorders congruent or not to the mood in the event of thymic disorders. In patients with post-traumatic stress disorder, it is not uncommon to observe a change in character associated with a stiffening of social relationships and themes of claim that may suggest delusional decompensation. The objective of this work is to propose a psychopathological reflection based on different clinical cases allowing to identify psychotherapeutic issues.

In this chapter, we present three clinical cases. One asking the question of the decompensation of a delusion of claim, a second that of a hypochondriac complaint and a third that of the emergence of a passion in the sense of investing in a new activity in a patient in phase of stabilisation of his affection. These different clinical cases allow us to discuss the relationship between the symptoms of the passion register and the premorbid personality, the impact of psychological trauma as a triggering factor, but also the psychopathological and psychotherapeutic issues underlying these symptomatic manifestations. Indeed, the question of recognition and reparation is often associated with the work of working through the mourning of the previous state, restoring the self-image and recovering a new balance. In some cases, the need for reparation is such that it turns into an emotional quest that can lead to conflicts with those around them. Finally, the lack of control related to the circumstances of the trauma can lead as a reaction to an excessive desire for control and mastery of the environment.

Very often in the development of psychologically injured patients, there is a transitional phase of claiming and/or of excessive rigidification of relationships with others, which in fact testifies to a work of mourning and narcissistic restoration. If these phenomena become chronic, it is advisable to question their relationship with the pre-morbid personality and/or to look for signs in favour of psychotic decompensation. In some cases, however, the newfound ability to commit to a cause, to bear witness to one's experience, to invest in a life project makes it possible to restore meaning to an existence shattered by trauma.