Psychotraumatisme, fonctionnement limite et addiction à l’adolescence : réévaluation de la notion de « comorbidité » pour l’hypothèse d’un « complexe » symptomatique et une nouvelle explicitation des perspectives thérapeutiques

High-risk sexual behaviours, from the neurotica to complex trauma: Psychopathologies of repetition

In adolescent psychiatry, when patients present high-risk sexual behaviours, analysing the symptoms usually leads back to a traumatic sexual event in childhood. These clinical situations include a first stage in which the trauma is constituted and a second adolescent stage in which the mnemic trace can lead to the traumatic experience being reproduced within a destructured psychic apparatus that is seeking restructuration through actions. These two psychopathological stages are examined in the light of the connection between Freud's two paradigms of the neurotica and the theory of fantasy, focusing therapeutically either on the primacy of sexual abuse or on the psychic representation of a traumatic sexuality, respectively. Here, the elaboration of these behaviours relates either to the individual traumatic history or the transgenerational history, or to both histories, intermingled or even undifferentiated. The repetition processes and the temporary loss of reality-testing in these clinical situations are analysed there, including by the yardstick of the psychopathology of complex trauma, as well as by that of containment in the familial and therapeutic environment, from which the subject will benefit in the context of the revelation processes.