[Response of traumatized patients with depersonalization --from the perspective of attachment theory]

We recognized that several traumatized individuals re-lived the danger associated with trauma on recollecting the original traumatic event; moreover, some of them experienced a similar traumatic event. In this article, we report these cases and show that this tendency is exhibited more frequently in victims of sexual abuse. Van der Kolk, who treated veteran soldiers who served in Vietnam, became aware of the compulsion of patients to repeat their trauma through treatment. He expressed this repetition compulsion as re-enactment or re-victimization of past traumatic experiences, showing how the trauma was repeated at a behavioral level in his article. After their treatment, he published his research on traumatized people as Post-Traumatic Stress Disorder in the 1980's. Nowadays, generally, this repetition compulsion behavior is not included as a symptom of PTSD in Japan. Van der Kolk insisted that these repetition compulsions caused further suffering for victims and their relations. We also thought that these repetition compulsions can disturb rehabilitation. In our article, we expressed the condition as active compulsion repetition. We considered that it should be distinguished from passive conditions including instructive symptoms such as repetitive nightmare and flashback. We also represented how active compulsion was repeated in our cases, which was not consistent with the concept of PTSD on DSM-IV. When the active repetition compulsion was acted, we noticed that patients showed depersonalization. We thought that an understanding of the depersonalization following reenactment and re-vicitimization was important in order to comprehend the mechanism of PTSD.