Razi Journal of Medical Sciences

fa نقش تجارب ناگوار دوران کودکی در بروز بیماری‌های روان‌تنی و مرگ زودهنگام از منظر روانکاوی کلاسیک و معاصر The Role of Adverse Childhood Experiences in Psychosomatic Diseases and Premature Death from Classical and Contemporary Psychoanalysis Perspectives روانشناسی بالینی Clinical Psychiatry پژوهشي Research <div style="text-align: justify;">زمینه و هدف: تجربیات ناگوار دوران کودکی همبستههای قدرتمندی برای ایجاد بیماری‌های جسمانی و روانتنی و مرگ زودهنگام هستند. بنابراین هدف اصلی این پژوهش بررسی نقش تجارب ناگوار دوران کودکی در بروز بیماری‌های روان‌تنی و مرگ زودهنگام از منظر روانکاوی کلاسیک و معاصر بود. روش کار: تحقیق حاضر، با استفاده از روش تحلیلی – توصیفی انجام شده است. اطلاعات حاصل از این تحقیق با استفاده از روش اسنادی – کتابخانهای بدست آمدهاند<a name="_Hlk175307949">.</a> یافته‌ها: نتایج نشان داد که تروماهای دوران کودکی موجب نقایصی در رشدِ طبیعیِ سیستم عصبی و دستگاه روان شده و بخش مهمی از روان تحت عنوان "خود" که در تحمل و تنظیم عواطفِ نیرومند، احساس ارزشمندی و سرزندگی و روابط معنادار با دیگران نقش ایفا می‌کند، به صورت منسجمی شکل نگرفته و بسیار شکننده و مستعد ازهمگسستگی میشود. در نتیجهی این "خود" شکننده، فرد جهت تنظیم خود و غلبه بر احساسهای تهی بودن و مُردگی، سبک زندگی ناسالمی را پیش می‌گیرد. نتیجه‌گیری: به طور کلی میتوان گفت که از منظر روانکاوی کلاسیک و معاصر تجارب ناگوار دوران کودکی منجر به افزایش فراوانی گزینش رفتارهای تهدید کنندهی سلامت شده که احتمال ابتلا به بیماریهای جسمانی و روانتنی را افزایش داده و میتواند مرگ زودهنگام را در پی داشته باشد. از نقطه نظر دیگر، تکرار جبرگونه تروماهای دوران کودکی در سایر روابط بزرگسالی، فرد را در مسیر خودویرانگری و مرگ قرار خواهند داد. <a name="_Hlk81950314"></a></div> <div style="text-align: justify;">Background & Aims: Adverse childhood experiences are strongly correlated with the development of physical and psychosomatic diseases and Premature death. The statistics related to the prevalence of misbehavior and abuse in childhood globally and in Iran are very horrifying.  According to a report published by the World Health Organization in 2017, one in four adults experienced physical abuse as a child. The statistic for sexual abuse is one in every five women and one in every thirteen men. In 2017, 26% of all children who abused globally were sexually abused. Additionally, 36% of children experienced emotional abuse and 16% experienced physical neglect. Every year, approximately 41,000 children under the age of 15 are murdered. However, many deaths and instances of abuse go unreported for various reasons. Therefore, the main goal of this research was to examine the role of unfortunate childhood experiences in the occurrence of psychosomatic diseases and premature death from the perspective of classical and contemporary psychoanalysis. Methods: This research was conducted using the analytical-descriptive method. The information obtained was gathered through a document-library method. The sources for this research included books, articles, websites, and reliable scientific portals inside and outside the country. Results: The results showed that childhood traumas cause defects in the natural development of the nervous system and the mental apparatus. An important part of the psyche, called “self”, which plays a role in tolerating and regulating strong emotions, developing a sense of worth and vitality, and maintaining meaningful relationships with others, does not form coherently and becomes fragile and prone to fragmentation. As a result of this fragile “self”, individuals may adopt unhealthy lifestyles as a means to regulate themselves and cope with feelings of emptiness and death. The study related to adverse childhood experiences and their effects on health problems demonstrate that having four or more traumatic experiences during childhood (from birth to the age of 18) leads to neuropsychological disorders, resulting in developmental defects in the nervous system. These defects in a person's social, emotional, and cognitive development, contribute to the adaptation of health- threatening behaviors. As a result of these choices, it is not long before symptoms and physical, and mental illnesses, disabilities or social problems emerge, which will have no end other than increasing the probability of premature death. Types of childhood traumatic experiences, health-threatening behaviors, and common diseases and physical conditions related to this study are shown in Table 1. Conclusion: In general, it can be said that, from the perspective of classical and contemporary psychoanalysis, adverse childhood experiences lead to an increase in the frequency of choosing health-threatening behaviors, which in turn raises the risk of physical and psychosomatic diseases and it can lead to premature death. From another point of view, the inevitable repetition of childhood traumas in adult relationships places individuals on a path toward self-destruction and death. Adverse childhood experiences are an interfering factor in the natural flow of mental and physical development. The greater the frequency and intensity of these experiences, the more severe the resulting damage. An unhealthy lifestyle is a common consequence in adulthood, leading to physical and mental diseases. The road that leads to this destination is of great importance, as the nervous system undergoes through influential events. The present study aimed to investigate and explain this path from an analytical point of view. In fact, psychoanalytic theories consider the early growth environment and the child's initial experiences with significant people in their life as crucial factors in the formation of healthy and pathological personality structures, and also because of the deep and retrospective view they have of the adulthood dysfunctions to examine the pathological effects of Childhood traumatic experiences are highly practical and helpful on the quality of life in adulthood. For this purpose, Freud's theory of death drive as the most fundamental theory of classical psychoanalysis with an individual and intrapsychic perspective, and Kohut's theory of “self-psychology” as a pioneering theory in contemporary psychoanalysis with a relational and intersubjective perspective. “Self-psychology” considers health- threatening behaviors in people with a history of trauma as strategies for maintaining the integrity of the empty "self" which is extremely fragile and is constantly threatened with disintegration, considering that these behaviors are seen as strategies used to cope with negative emotions and manage emotional regulation. Although Freud's compulsion to repeat theory was never acknowledged by Kohut, in recent years, “self-psychologists” have revisited the concept of compulsion to repeat from their perspective and a convergence between Freud's and Kohut's theories has been established. In this view, the traumatized person unconsciously repeats the atmosphere of the past traumatic experiences in the hope of creating new, restorative experiences in a safe, empathic, and containing environment, while there is a fear of being disappointed and repeating the trauma. In the historical division of psychoanalytic schools into classical and contemporary approaches, different theorists and analytical theories not only vary in their interpersonal and relational attitudes toward humans and human issues, but also diverge in their details within each category. Preventing the occurrence of traumatic childhood experiences, preventing the adoption of health-threatening behaviors in response to these traumatic experiences, and ultimately helping to change these risky behaviors and treating adult diseases are essential strategies for addressing the long-term consequences of childhood traumas. Additionally, psychoanalytic interventions, given their historical and retrospective approach to treatment, are particularly suitable for preventing and addressing the physical and psychosomatic symptoms and diseases rooted in childhood. Because childhood traumas create permanent wounds in the mental apparatus, psychoanalytic interventions can be effective at all three levels of prevention. Based on these findings, studies with diverse and appropriate designs are recommended to assess the applicability and effectiveness of preventive or therapeutic interventions with psychoanalytic approaches for the mentioned population at all levels. </div> تجارب ناگوار دوران کودکی, بیماری‌های روان‌تنی, مرگ زودهنگام, انسجام خود, آن سوی اصل لذت Adverse Childhood Experiences, Psychosomatic Diseases, Premature Death, Self-Cohesion, Beyond the Pleasure Principle 479 485 http://rjms.iums.ac.ir/browse.php?a_code=A-10-8278-1&slc_lang=fa&sid=1 Saeid Dabagh Ghazvini سعید دباغ قزوینی 3900319475328460083386 3900319475328460083386 No Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran کاندیدای دکتری روانشناسی سلامت، گروه روانشناسی واحد کرج، دانشگاه آزاد اسلامی، کرج، ایران Mahdieh Moinalghorabaei مهدیه معین الغربایی Moin_drm@yahoo.co.uk 3900319475328460083387 3900319475328460083387 Yes Tehran University of Medical Sciences, Psychistrist and Psychoanalytic Psychotherapist, Tehran, Iran استادیار دانشگاه علوم پزشکی تهران، روانپزشک و رواندرمانگر تحلیلی، تهران، ایران Bahador Baharestani بهادر بهارستانی F_ameni@yahoo.com 3900319475328460083388 3900319475328460083388 No Cardiovascular Surgery Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran دانشیار فوق تخصص گروه جراحی قلب و عروق، دانشگاه علوم پزشکی ایران، بیمارستان قلب شهید رجایی، بخش جراحی قلب، تهران، ایران Alireza Alizadeh Ghavidel علیرضا علیزاده قویدل Khalili.forgh@gmail.com 3900319475328460083389 3900319475328460083389 No Cardiac Surgery, Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran استاد جراحی قلب، مرکز تحقیقات بیماریهای دریچه قلب، مرکز آموزشی تحقیقاتی و درمانی قلب و عروق شهید رجایی، دانشگاه علوم پزشکی ایران، تهران، ایران. Tahereh Ranjbaripour طاهره رنجبری پور 3900319475328460083390 3900319475328460083390 No Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran استادیار گروه روانشناسی، واحد کرج، دانشگاه آزاد اسلامی، کرج، ایران