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Esta pesquisa foi desenvolvida a partir do projeto temático "Transtorno de estresse pós-traumático e neuroprogressão: trauma e estresse no aumento da carga alostática e aceleração do processo de envelhecimento", realizado com mulheres vítimas de violência sexual e que desenvolveram estresse pós-traumático no estado de São Paulo. Neste estudo, são apresentados relatos de violência sexual na infância e na adolescência e sua reexposição na vida adulta e, com isso, tem como objetivo trazer à luz compreensões acerca dessa vivência a fim de abrir possibilidades de intervenções adequadas. Foram realizadas entrevistas reflexivas com quatro colaboradoras que, na triagem do Projeto Temático, responderam positivamente a um questionário de abuso e negligência durante a infância e na adolescência. Na análise fenomenológica, seus discursos foram separados em oito categorias de sentido (Afeto, Culpa, Mundo familiar, Não dito, Racismo, Profissionais, Hoje e Reexposição à violência sexual). Concluiu-se que a violência sexual diz respeito a uma responsabilidade política, uma vez que as colaboradoras culpam-se por acreditarem que a vulnerabilidade delas reside em algum comportamento provocado por elas mesmas e não por mais um dispositivo de violência contra a mulher.

This paper was developed based upon a thematic project "Posttraumatic stress disorder and neuroprogression: trauma and stress increasing load allostatic and accelerating the aging process", conducted with women who suffered sexual assault and developed post-traumatic stress disorder in the state of São Paulo. This study has reports about sexual violence in childhood and adolescence and its re-exposures in adulthood and seeks to bring up understandings about this experience in order to open possibilities for a more appropriate intervention. Reflective interviews were made with four collaborators that previously answered positively to a questionnaire of abuse and neglect during childhood and adolescence in the screening of the Thematic Project. With the phenomenological analysis their speech was split into eight categories (Affections, Guilt, Familiar world, Unsaid, Racism, Health professionals, Today and Sexual violence re-exposure). It has been concluded that sexual violence concerns to a political responsibility, once the collaborators blamed themselves for they believe that their vulnerability was their fault instead of a tradition of gender violence.

Esta investigación se desarrolló a partir del proyecto temático "Trastorno de estrés postraumático y neuroprogresión: el trauma y el estrés en el aumento de la carga alostática y la aceleración del proceso de envejecimiento", realizado con mujeres víctimas de violencia sexual y que desarrollaron estrés postraumático, en el estado de São Paulo. En este estudio, se presentan relatos de violencia sexual en la infancia y en la adolescencia y su reexposición en la edad adulta y, con ello, se pretende sacar a la luz comprensiones acerca de esa experiencia, para abrir posibilidades de intervenciones adecuadas. Se realizaron entrevistas reflexivas con cuatro colaboradoras que, en el triaje del Proyecto Temático, respondieron positivamente a un cuestionario sobre abuso y negligencia en la infancia y la adolescencia. En el análisis fenomenológico, sus discursos se separaron en ocho categorías de sentido (Afecto, Culpa, Mundo Familiar, No Dicho, Racismo, Profesionales, Actualidad y Reexposición a la Violencia Sexual). Se concluyó que la violencia sexual tiene que ver con una responsabilidad política patriarcal, ya que las colaboradoras se culpan a sí mismas por creer que su vulnerabilidad radica en algún comportamiento causado por ellas mismas y no por más un dispositivo de violencia contra las mujeres.

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Objectives: We assessed whether administering cannabidiol (CBD) before recalling the traumatic event that triggered their disorder attenuates anxiety in patients with post-traumatic stress disorder (PTSD). As an exploratory pilot analysis, we also investigated whether this effect depends on the nature of the event (sexual vs. nonsexual trauma). Methods: Thirty-three patients of both sexes with PTSD were recruited and randomized 1:1 into two groups. One group received oral CBD (300 mg), and the other received a placebo before listening to a digital audio playback of their previously recorded report of the trigger event. Subjective and physiological measurements were taken before and after recall. We analyzed the data in two subsamples: trigger events involving sexual and nonsexual trauma. Results: In the nonsexual trauma group, the differences between measurements before and after recall were significantly smaller with CBD than placebo; this held true for anxiety and cognitive impairment. However, in the sexual trauma group, the differences were non-significant for both measurements. Conclusion: A single dose of CBD (300mg) attenuated the increased anxiety and cognitive impairment induced by recalling a traumatic event in patients with PTSD when the event involved nonsexual trauma.

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Childhood abuse has been linked to problematic drinking in adulthood. It is also documented that people living with HIV have higher rates of alcohol use than the general population. In Haiti, a total of 25% of women living with HIV have experienced childhood sexual abuse (CSA), which puts them at an increased risk for alcohol abuse. CSA has also been associated with anxiety disorders in adulthood. Therefore, it is critical to understand the relationship between CSA, anxiety, and alcohol use among women living with HIV. A total of 244 women living with HIV participated in this study, with 35% reporting CSA. Alcohol abuse was measured with the AUDIT, anxiety with the State-Trait Anxiety Inventory test, and sexual abuse with the Childhood Trauma Questionnaire. Compared to participants who did not experience childhood sexual abuse, participants who experienced childhood sexual abuse reported greater levels of alcohol use [(17.0, SD = 9.1) (11.9, SD = 8.6) p =.001] and anxiety [(55.8, SD = 9.8) (48.9 SD = 8.3) p =.001] respectively. The indirect effect of anxiety on the association between CSA and alcohol use was significant [(ß =.19 p =.05) 95% bootstrap CI.019 -.13] Thus, women who reported being sexually abused as children reported anxiety, which in turn, was associated with an increased risk for alcohol abuse. Results demonstrate that alcohol may be used as a negative coping mechanism to alleviate anxiety symptoms triggered by CSA. These findings elucidate the need for further research examining the impact that sexual trauma has on mental health.

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Abstract Objective: The high prevalence of trauma exposure calls for detailed research on how trauma type affects the development of Post-Traumatic Stress Disorder (PTSD). Therefore, the aim of our study was to investigate the effects of the type of trauma on the severity of symptoms, anxiety, depression, and dissociative experiences in the PTSD patient population. Method: The sample of the study consists of 80 volunteer PTSD patients (20 sexual trauma, 20 work accidents, 20 traffic accidents and 20 combat related trauma). Once the severity of symptoms was determined in all subjects by the Clinician-Administered PTSD Scale (CAPS), Beck Depression Inventory, Beck Anxiety Inventory and Dissociative Experiences Scale (DES) were applied. Results: A statistically significant difference were found between trauma types with regard to age, time without treatment, and the total and subscale scores obtained in DES and CAPS. It was found that in the group that has PTSD diagnosis related to sexual trauma, the length of the time without treatment, DES and CAPS scores. Conclusion: The study we conducted showed that PTSD continued more severe and resistant after a sexual trauma. Moreover, specific type of trauma was significant in PTSD patients.

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Research shows that in the Caribbean one-third of people living with HIV continue to engage in unprotected sexual practices. Childhood sexual abuse (CSA) and HIV-related risk behaviors have been found to play a contributory role in HIV transmission. We aimed to analyze gender differences in the association between CSA and substance use and sexual risk behaviors among Haitians living with HIV. A total of 276 HIV-positive individuals participated in this study with 56% experiencing sexual abuse during childhood. Results showed that participants who experienced CSA had increased odds of hazardous drinking compared to those who did not experience CSA; men (OR 2.9, 95% CI 1.2-7.3) and women (OR 2.5, 95% CI 1.2-5.6). While, marijuana use was only significantly associated in women (OR 5.2, 95% CI 2.1-13.5). For sexual risk behaviors, unprotected sex was significantly associated in both men (OR 3.0, 95% CI 1.3-7.1) and women (OR 2.0, 95% CI 1.5-7.7) who experienced CSA. Results of this study underscore the need for further research to better understand the role of gender in the relationship between CSA and risky behaviors among PLWH.

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Este trabalho tem como objetivo contribuir, através de seu vértice clínico-teórico, para a ampliação dos estudos psicanalíticos no que concerne ao sofrimento psíquico ocasionado pela violência e pelo terror claustrofóbico: terror sem nome. Inicialmente faz-se uma retomada histórica sobre o medo terrorífico por meio da abordagem psicanalítica, a qual considera esse sentimento/sensação uma grande inquietação ante o perigo e o desamparo, orgânico e psíquico, cujas raízes remontam às relações primevas. Na sequência busca-se mostrar os desdobramentos do terror sem nome e da condição claustrofóbica, principalmente quando a estes é acrescido o abuso sexual na infância. A partir daí constrói-se uma ponte entre os achados ferenczianos e os bionianos. Finalmente apresentam-se as interfaces de um atendimento clínico, no qual se enfatiza a procura da dupla analítica pela libertação do claustro terrorífico e pelo resgate da identidade da analisanda.

The purpose of this paper is to contribute, from a theoretical and practical perspective, to the expansion of psychoanalytic studies about the mental suffering that is caused by violence and claustrophobic terror: "nameless dread". First, the author provides a historical resume about terrifying fear by using a psychoanalytic approach. Psychoanalysis considers this feeling-sensation a deep concern over the idea of danger and helplessness which is both organic and psychic and whose source lies in primitive relationships. Then, the author connects Ferenczi's and Bion's thinking. Finally, she analyzes the interfaces of a clinical case in which she emphasizes the attempt of the psychoanalytic pair to be released from the terrifying cloister and to rescue the patient's identity.

El presente trabajo pretende contribuir, a través de su vértice teórico y clínico para la expansión de los estudios psicoanalíticos con respecto al sufrimiento psíquico causado por la violencia y el terror claustrofóbico: "terror sin nombre". Inicialmente se hará un resumen histórico sobre el miedo terrorífico desde el enfoque psicoanalítico, que considera este sentimiento-sensación una gran inquietud antes de la noción de peligro y desamparo, orgánico y psíquico cuyas raíces datan de las primeras relaciones. Después, se presentan los desdoblamientos del "terror sin nombre" y de la condición claustrofóbica especialmente cuando a estas se suma el abuso sexual en la infancia. Desde allí se construye un puente entre los estudios ferenczianos y los bionianos. Finalmente se presentan las interfaces de un atendimiento clínico en el cual se enfatizó la búsqueda del par analítico para la liberación del claustro terrorífico y para el rescate de la identidad de la analizada.

Ce travail a pour but de contribuer, par son côté clinico-théorique, pour l'élargissement des études psychanalytiques dans ce qui concerne la souffrance psychique causé par la violence et par la terreur claustrophobique: "la terreur sans nom". D'abord on fait une reprise historique sur le fait de la peur terrorisant d'après l'approche psychanalytique qui considère ce sentiment-sensation une grande inquiétude face à la notion de danger et de délaissement, organique et psychique, dont les racines remontent aux rapports premiers. Ensuite on cherche à présenter les dédoublements de « la terreur sans nom ¼ et de la condition claustrophobique, en spécial lorsque l'on ajoute à celles-ci l'abus sexuel dans l'enfance. À partir de là, on construit un pont entre les trouvailles ferencziennes et les bioniennes. Enfin, on présente les interfaces d'un soin clinique dans lequel on met en évidence la recherche du duo analytique au moyen du claustro terrorisant et de la reprise de l'identité de l'analysante.

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PROBLEM: The preceding article presented a glimpse of deployed women veterans, their military culture, and their experiences in the Global War on Terror (Iraq and Afghanistan) to assist civilian nurses to gain significant rapport and provide important culturally sensitive care. METHODS: Pertinent literary sources were reviewed to gather applicable data about the problem. FINDINGS: A confirmatory answer from the assessment question of "Have you served in the military?" and the use of the Military Health History Pocket Card for Clinicians (available at http://www.va.gov.oaa/pocketcard) will assist with revealing possible health risks from the increased amounts of military men and women veterans seeking (and/or returning to) a variety of community-based health services. This article about deployed women veterans examines their specific health differences (e.g., research literature, post-traumatic stress disorder, and military sexual trauma), difficulties (e.g., reproductive, gynecologic, urinary, suicide), and gender disparities (varied treatment patterns). CONCLUSION: Understanding these gender situations, civilian nurses can better advocate with increasing evidence-based decisions that their physical and behavioral responses were different from their male counterparts. Continual assessment, knowledgeable care, ongoing literature review, interdisciplinary health team development, and the presence of resourceful community agencies should be a significant part of their holistic care. Conard Armstrong.

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O traumatismo sexual aparece na ordem do irrepresentável. Sua clínica implica a interpretação de seus danos e de suas formas silenciosas de manifestação tais como somatizações, déficits de aprendizagem, comportamento agressivo, além de manifestações difusas no campo do sensorial e do cinestésico. O traumatismo sexual, antes de tudo, é um traumatismo dos afetos e das expressões mais rudimentares da sensorialidade. O conteúdo traumático guarda as aglutinações sensoriais e sensitivas do trauma. Encarna verdadeiramente a onipresença do trauma independentemente da distância temporal e corporal entre os fatos ocorridos e a psicoterapia. O crime sexual continua atual, mesmo após anos ou décadas. Este artigo apresenta uma proposta terapêutica de base psicanalítica para a clínica do traumatismo sexual, que inicia com a apresentação ao traumatismo e caminha para o desengajamento do conteúdo traumático. Com o objetivo de separar a vítima do agressor e a vítima da agressão, apresentamos ainda, neste artigo, a proposta terapêutica da criação de um espaço de mediação, necessário para o distanciamento psíquico, tendo por base o modelo dos espaços transicionais proposto por Winnicott.(AU)

The sexual traumatism appears in the order of the unrepresentable. Their clinic presentation involves the interpretation of their injuries and their silent forms of manifestation such as somatization, learning deficits, aggressive behavior, and diffuse manifestation in the sensory and kinesthetic field. Sexual traumatism, after all, is a trauma of the affections and the most rudimentary expressions of the senses. The traumatic content saves clumps of the feelings and of the sensitivity of the trauma. It truly embodies the ubiquity of the trauma regardless of the temporal distance between the body, the events and the psychotherapy. The sex crime continues fresh, even after years or decades of its occurrence. This paper proposes a therapy based in psychoanalysis for the clinic of sexual trauma that begins with the presentation to the traumatism and walks to the disengagement of the traumatic content. With the aim of separating the victim from the aggressor and from the aggression, we present in this article, a therapeutic proposal for the creation of a mediation space necessary for the psychic distance, based on the model of transitional spaces proposed by Winnicott.(AU)

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Este trabalho tem como objetivo articular os conceitos de trauma sexual e angústia de castração a partir dos textos freudianos e à luz das contribuições de Lacan. Em Freud, estes conceitos acompanham a construção da psicanálise enquanto campo de investigação do inconsciente. O inconsciente nos indica o vazio fundamental que movimenta o desejo, a ausência do objeto. A fantasia, através do que se orienta o desejo, representa a permanência do objeto faltoso, a alienação do eu no Ideal de um gozo fálico. A angústia de castração funciona como sinal para a atuação dos mecanismos de defesa do eu, cujo último véu é a reivindicação fálica. Esta, articulada à angústia de castração, surge como "limite intransponível" da psicanálise. A proposta de Lacan é ir para além da angústia de castração, retornando, ao seu modo, ao conceito de trauma sexual.

The objective of the present study is to articulate the definition of sexual trauma and castration anguish according to Freudian texts and Lacan's contributions. For Freud, these definitions follow psychoanalysis as a field that investigates the unconscious. The unconscious indicates the fundamental emptiness that moves the desire, the absence of the object. Fantasy, as a desire guide, represents the permanence of the missing object, the alienation of the ego within the ideal of the phallic pleasure. Castration anguish works as a sign for ego defense mechanisms to come into play, in which the last instance is the phallic pleasure. This, articulated to castration anguish, comes as a "non trespassing border" of psychoanalysis. Lacan's proposal is to go beyond castration anguish, returning, on his way, to the definition of the sexual trauma.

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Se revisa el tema de las consecuencias físicas que la práctica sexual puede acarrear sobre las diferentes estructuras genitales y anorrectales de la mujer.

ABSTRACT Physical consequences of different modalities of sexual practice on female genital and anorectal structures are reviewed

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