Notre objet de recherche porte sur les hypothèses étiopathogéniques du trouble de stress post-traumatique d’apparition retardée.

Une revue de la littérature psychiatrique a été réalisée concernant le trouble de stress post-traumatique d’apparition retardée. Des hypothèses issues de la littérature psychanalytique ont été discutées, ainsi que des hypothèses neuroscientifiques.

Ce diagnostic comporte deux définitions possibles : une émergence réellement différée des symptômes, ou bien la présence de symptômes précoces peu spécifiques et non attribués aux effets de l’événement à potentialité psychotraumatique sur le psychisme. Les hypothèses étiologiques retrouvées dans la littérature psychiatrique font intervenir le rôle du déni, du détachement émotionnel, de l’évitement précoce. Ont été également mis en avant le rôle de la survenue d’un événement déclencheur ultérieur, de l’intensité de l’événement à potentialité psychotraumatique, le rôle protecteur du soutien social, et des hypothèses en lien avec le vieillissement cognitif. Sur un plan psychanalytique, le concept freudien central d’après-coup constitue une hypothèse explicative fondamentale. La mise en place de plusieurs mécanismes de défense psychiques pourrait expliquer la survenue différée des symptômes. Dans une perspective interdisciplinaire, l’étude du concept de trace, développé par F. Ansermet et P. Magistretti, nous a permis d’éclairer notre sujet.

La question de l’émergence retardée des symptômes met en exergue le caractère mouvant et indéterminé de la vie psychique, et la difficile prédictibilité des troubles psychotraumatiques.

The temporality of the emergence of symptoms following exposure to a potentially traumatic event is variable.

The purpose of our research is to investigate the etiopathogenic hypotheses concerning the question of the latency phase which sometimes precedes the emergence of post-traumatic stress disorders.

We conducted a review of the psychiatric literature concerning delayed-onset post-traumatic stress disorders. Hypotheses from the psychoanalytic literature were then discussed, as well as neuroscientific hypotheses.

This diagnosis has two possible definitions: a considerable delay in the emergence of symptoms, or the presence of early symptoms that are not very specific and not attributed to the effects of the event on the psyche. The etiological hypotheses found in the literature involve the role of denial, emotional detachment, and early avoidance. The role of the occurrence of a later triggering event, the intensity of the event with psychotraumatic potential, the protective role of social support systems, and the hypotheses related to cognitive aging were also highlighted. Furthermore, numerous studies have shown that the subjective experience of a perceived threat was a more reliable predictor of the likelihood of developing post-traumatic stress disorders than a supposedly objective assessment of danger. From a neuroscientific perspective, a study published by Smid and al. in 2022 found that since different traumatic experiences share common elements, each new event with psychotraumatic potential would activate the same memory structure, which would reinforce the interconnections of this memory network. This could explain the role of a later triggering event in the development of delayed post-traumatic disorders. On a psychoanalytical level, according to the Freudian concept of après-coup, the first event is initially without consequence, but it is transformed by a second event, and it becomes retroactively traumatic. We discussed two hypotheses: either the first event left an unsymbolized trace, it was not integrated into the signifying chain, and it was subsequently integrated later on due to the second event, either the first event was symbolized at the moment of its occurrence, and in the light of a second subsequent event, it assumed a new meaning. The establishment of several psychic defense mechanisms could also explain the delayed onset of symptoms. From an interdisciplinary perspective, the study of the concept of trace, developed by researchers such as F. Ansermet and P. Magistretti, has enabled us to shed light on our subject. The experience transcribed in the form of traces could undergo changes due to plasticity, the trace being thus able to associate with other traces on the occasion of exposure to other events.

The question of the delayed emergence of symptoms highlights the shifting and indeterminate nature of psychic life, and the difficulty in predicting post-traumatic stress disorders.