12-093 心療内科領域でのトラウマ臨床としてのEMDRの有用性 臨床的外傷 心身医学 12-093 Usefulness of EMDR for clinical trauma in the area of psychosomatic internal medicine (Psychosomatic medicine has a key role in the near future medical care

心療内科の領域で臨床を行っていると，頭痛など の身体痛やしびれ，息苦しさ， 全身倦怠感などの身 体症状を主訴に受診する患者が多い．彼らは，アト ピー性皮膚炎や気管支喘息など古典的な心身症とい われてきた病態を呈することもあるが，多くはより 未分化で疾患を特定しにくいか， あるいは疾患共存 の形態で表現されることが多く，身体表現性障害と してカテゴライズされることも多い．それらの問題 は，いわゆるヒステリー病態の取扱いに帰着する． 何れにしても，症状は慢性化を呈し，症候移動もあ り，臨床上絶えず問題が提起される病態であり，治 癒に至らしめるという意味での治療は1木灘であると されてきた．一方， トラウマ臨床の進歩は近年注日 を浴びている．その治療技法の 一 つであるEMDR は， 単純なPTSD のみならず，外傷理論を根幹に病理を 考えれば，上記に示したような病態でも活用できる のではないか．医療臨床上，EMDR はとても有用で あることを，1，暴漢に襲われたPTSD 症例，2．交 通事故後の慢性疼痛例， 3．数年来症状が続いた強 迫性障害例，4．身体症状と健忘が主症状で性的被 害歴をもった解離性障害例を通しながら，身体症状 を呈した患者へのEMDR 治療の可能性について示し たい．

In the field of psychosomatic medicine, many patients seek treatment for physical symptoms such as headaches, numbness, shortness of breath, and general fatigue. While some present with classic psychosomatic conditions like atopic dermatitis or bronchial asthma, many exhibit undifferentiated or overlapping symptoms that are difficult to diagnose and are often categorized as somatoform disorders. These cases are closely related to what has traditionally been called “hysterical” conditions, and they tend to be chronic, shift in presentation, and pose ongoing clinical challenges. Historically, achieving full recovery has been considered difficult. However, recent advances in trauma-informed care have drawn attention, particularly the use of Eye Movement Desensitization and Reprocessing (EMDR). Although EMDR is commonly applied to straightforward PTSD cases, this paper explores its potential for treating complex psychosomatic presentations when viewed through the lens of trauma theory. Through four clinical cases—a PTSD patient assaulted by a stranger, a chronic pain case following a traffic accident, a long-term obsessive-compulsive disorder case, and a dissociative disorder case involving physical symptoms and amnesia with a history of sexual trauma—the paper demonstrates the therapeutic possibilities of EMDR for patients with prominent physical symptoms.

Journal

Japanese

Chikara Yamaguchi

Yamaguchi, C. (2009, June). [12-093 Usefulness of EMDR for clinical trauma in the area of psychosomatic internal medicine (Psychosomatic medicine has a key role in the near future medical care]. Japanese Journal of Psychosomatic Medicine, 49(6), 580. Japanese