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Identification of the marks of psychic trauma in spoken language: Definition of the “SPLIT-10” diagnostic scale - 13/03/22

Doi : 10.1016/j.amp.2021.09.016 
Frédérique Gayraud a, Yann Auxéméry b, c,
a Laboratoire dynamique du langage, UMR 5596, CNRS, université Lyon-II, Lyon, France 
b Centre hospitalier de Jury-les-Metz, centre de réhabilitation pour adultes, hôpital de jour, 12, rue des Treize, 57070 Metz, France 
c Équipe EPSAM, EA 4360 APEMAC « adaptation, mesure et évaluation en santé. Approches interdisciplinaires », université de Lorraine, Metz, France 

Corresponding author at: Centre hospitalier de Jury-les-Metz, centre de réhabilitation pour adultes, hôpital de jour, 12, rue des Treize, 57070 Metz, France.Centre hospitalier de Jury-les-Metz, centre de réhabilitation pour adultes, hôpital de jour12, rue des TreizeMetz57070France

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Abstract

Problematic

The search for understanding psychological trauma has grown considerably over the past fifteen years, leading to a real conceptual revolution at the crossroads of psychiatry, psychology, neurobiology, sociology, and anthropology, among others. However, despite the wealth of semiological descriptions, the under-diagnosis and late diagnosis of post-traumatic disorders, at the stage of intense suffering, remain numerous. This could be because the traumatic origins of the disorders remain unclear, due to their clinical characteristics–that is, the “unspeakable experience” of dissociation in language–, or because the healthcare system and the networks of practitioners come up against conceptual impasses that undoubtedly reflect the psychotraumatic process present even in theoretical discourse, to the point of rendering it ineffective. Now is the time to build a new model. Based on a linguistic methodology, the standardized computerized and manual study of the speech of psychically injured patients recently enabled us to define the notion of traumatic psycholinguistic syndrome (SPLIT).

Objectives

Our new perspective aims to overcome the diagnostic and therapeutic obstacles that too many people with mental health injuries still face. More objective than semiological and psychometric approaches, linguistic markers pave the way for the digital phenotyping of post-traumatic stress disorder and make it possible to better assess the recommended care. After discussing the pioneering work in the literature, we build a psycholinguistic tool allowing for the identification of psychically injured subjects.

Methods

The exploratory analysis material includes two corpora of traumatic event narratives called “Bataclan” (n=20 collected among survivors of the Paris attacks in 2015) and “Afghanistan War” (n=15 collected among French soldiers deployed), which are matched to a control group. The narratives were transcribed and segmented into clauses and the following linguistic characteristics were analyzed: disfluencies (silent pauses, hesitation pauses, vocalic lengthenings, incomplete words, incomplete utterances, contiguous word repetitions). Narrative coherence, certain lexical fields (concerning death, emotions, etc.), spatio-temporal references, references to the person (personal and generic pronouns in particular), and non-literal language were also taken into account. In order to confirm the validity of the SPLIT-10 scale, we tested it on two additional corpora of traumatic narratives: the “Nice” corpus (n=20) collected in the days following the attack perpetrated in Nice (July 14, 2016) and the “sexual assault” corpus (n=20) composed of testimonies from people who were victims of a single sexual assault that occurred during adulthood.

Results

Linguistic characteristics that proved irrelevant either because they were insignificant, or because they were too frequent and/or difficult to discriminate in practice were eliminated: lexicon of emotions, verbal tenses, non-generic pronouns, narrative coherence. Conversely, the criteria that appear to be the most relevant for differentiating between traumatic and non-traumatic narratives were the following ones: lexicon concerning death, body parts, and unreality; verbs of perception, movement, or position of the body; spatial context including the appreciation of distances; generic pronouns; mention of the time and duration of the event; incomplete utterances; repetitions; and non-literal language. These criteria constitute a 10-item scale for which we will give examples for each criterion, then present as a global test. The results show that the SPLIT-10 scale significantly discriminates between traumatic and non-traumatic narratives.

Discussion

The SPLIT-10 items correspond to 5 psycholinguistic sub-syndromes: reference to death (item 1), derealization (items 2 to 4), depersonalization (items 5 to 7), flashbacks (items 8 and 9) and unspeakability (item 10). While these items turn out to be compatible with the criteria for PTSD retained by the DSM-5 (like those concerning acute stress disorder), the linguistic markers that we have identified appear to be much more detailed and specific to the psychological trauma than the usually described psychiatric symptoms. Because it accurately accounts for dissociation, SPLIT-10 is syndromically more consistent than the definition of PTSD in the nosography. It would be useful to replicate our study by considering larger multicenter corpora by controlling comorbidities, by varying the types of unique and complex traumatic events, and by focusing specifically on traumas occurring in childhood when language is still being constructed. In addition, the cut-off point of 5 on the 10-point scale could be revised upwards, or even be adapted according to the length of the verbal production. Moreover, a feasibility analysis should be carried out in current clinical practice measuring the effectiveness of practitioners trained in the use of this new tool. Finally, beyond the 10 items that we have retained, it would be interesting to develop a more complex scale that could be used for fundamental research purposes by integrating many other linguistic characteristics.

Conclusion

Due to its infiltration of the theoretical discourse that attempts to grasp it, traumatic dissociation has until now remained a difficult notion to model. As a new clinical approach to dissociation, traumatic psycholinguistic syndrome reflects the “linguistic wound” constitutive of trauma. The definition of the SPLIT-10 scale appears more objective than the usual clinical analysis or the scales and questionnaires based on the nosography, which call for the subjective assessment of symptoms by the patient and/or the practitioner. Nevertheless, far from denying all subjectivity, the semantic analysis of discourse, in tandem with lexical and syntactic linguistic approaches, also offers to better characterize the specificity of what caused the trauma in a singular subject. Finally, the pragmatic analysis of the dialogical interaction between the patient and the clinician will prove to be fundamental in our understanding of the effective therapeutic mechanisms that allow patients to move beyond their traumatic dissociation.

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Keywords : Assessment Scale, Post-traumatic stress disorder, Psychic trauma, Psycholinguistics, Testimony


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Vol 180 - N° 3

P. 195-212 - mars 2022 Retour au numéro
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