BRUXISMO: DEFINIZIONE DEL FENOMENO
Il bruxismo (etimologicamente: “digrignare i denti”), è un disturbo caratterizzato da una risposta muscolare involontaria, che si verifica perlopiù nelle ore notturne, durante la masticazione di cibi o nei momenti di maggiore stress e consiste nel serrare i denti delle arcate inferiori e superiori e nel farle sfregare tra loro con movimenti avanti/indietro. Il contatto delle arcate produce un rumore simile ad uno squittìo, spesso fastidioso per chi è vicino al soggetto, il quale però ne è generalmente inconsapevole.
EZIOLOGIA: FATTORI PSICOLOGICI E COMORBILITÀ
Il bruxismo è considerato una patologia ad eziologia multifattoriale, che può colpire adulti e bambini. Tuttavia, i bambini ne sono maggiormente interessati e studi scientifici hanno dimostrato che la componente psicologica sia la causa scatenante più frequente.
In prima istanza, fattori che scatenano reazioni di stress e risposte d’ansia, sono all’origine immediata del disturbo. Nelle ore diurne, è tipico osservare il comportamento del digrignare i denti in situazioni impegnative, quali la scuola per il bambino o il contesto lavorativo per l’adulto.
L’incidenza appare significativa in chi abbia una familiarità con il disturbo ed in soggetti con altri disturbi psicologici, in prevalenza i disturbi d’ansia.
Ma si osservano comorbilità anche con i disturbi post-traumatici da stress, dove il sintomo diviene una manovra difensiva in risposta a un evento stressante e non elaborato; i disturbi del sonno, di fatti, tale sintomo spesso si presenta di notte, nella seconda fase del sonno; i disturbi del comportamento alimentare, assumendo il significato ‘surrogato’ della masticazione. In quest’ultimo caso, infatti, il cibo e dunque l’area della bocca appaiono sovrainvestiti dal soggetto e densi di significati.
Altre correlazioni si riscontrano in generale con i disturbi della personalità, dove il bruxismo interviene come sintomo secondario, ma può comunque risultare particolarmente invalidante nella vita di chi ne soffre.
IL SOGGETTO BRUXISTA
Un funzionamento ossessivo è tipico di alcuni soggetti che soffrono di bruxismo, in quanto il comportamento ripetuto ha la finalità di “scarica” della tensione interna – attraverso un atto motorio – su una zona del corpo, come è tipico della nevrosi ossessiva, ed ha dunque un intento autoconsolatorio. Il sintomo è funzionale ad abbassare i livelli di tensione psichica, che diviene somatica poiché insufficiente è l’elaborazione psichica di tale tensione. Ne deriva una percezione di appagamento e controllo, in tal caso tramite il tenere serrati i denti e farli stridere. L’esito è una sensazione calmante per la persona ed il ripristino dell’omeostasi interna in risposta alla tensione accumulata.
ASPETTI SIMBOLICI DEL SINTOMO
In uno dei precedenti articoli (ndr) sul significato dei denti in sogno, si è sviscerato l’aspetto simbolico dei denti. Allo stesso modo, avviene nella formazione di un sintomo. Come accade per i sogni, ciò avviene al di sotto della soglia di consapevolezza.
Pertanto, sottesi al disturbo vi sono numerosi significati emotivi inconsci.
Tipicamente, digrignare i denti è un comportamento che investe l’area orale: primo stadio nello sviluppo psicosessuale di un soggetto, secondo Freud, e dunque collegata ad aspetti di voracità, introiezione e rigetto, la regressione alla fase orale rappresenta spesso la causa psicologica di sintomi come il bruxismo e, in generale, di comportamenti – anche simbolici – che richiamano l’oralità e l’area della bocca, che diviene una modalità di comunicazione.
I denti, nello specifico, sono strettamente connessi alla facoltà di mordere e sminuzzare, dunque simbolicamente legati all’aggressività.
Se il comportamento è reiterato e compulsivo, può assumere il senso di un iper-controllo della propria pulsione aggressiva accumulata, nella modalità e nella conversione sintomatica del funzionamento ossessivo descritto. Il Super-io rigido, censore, non consente di esprimerla ma induce a “trattenere”.
Come, del resto, è tipico del detto “tenere i denti stretti”.
DIAGNOSI DIFFERENZIALE E TRATTAMENTO
Occorre precisare che si parla di disturbo vero e proprio se vi è una diagnosi che esclude problemi mandibolatorio-articolatori, neurologici o di altro tipo, che non consentano una corretta occlusione in condizioni normali, dunque solo se il riflesso involontario sia condizionato tout court da fattori psicologici.
Inoltre, è diagnosticabile se il sintomo si ripresenta nel tempo e non in modo occasionale.
Alle origini del comportamento, come descritto, vi è un accumulo di tensione che necessita di essere “scaricata”. Individuare quegli elementi che la generano – di cui spesso si è inconsapevoli – attraverso la psicoterapia è metodo elettivo.
In casi gravi, soprattutto se si presenta il rischio di compromissione dei denti o delle articolazioni della mandibola, i soggetti potrebbero necessitare di un bite “bloccante”, mediante interventi di competenza del dentista.
Ancora una volta si rivela fondamentale un approccio multidisciplinare per condizioni complesse e con potenziali cause e conseguenze multiple come quella del bruxismo.
Dott.ssa Simona Galietto
Psicologa
SITOGRAFIA
https://www.my-personaltrainer.it/benessere/bruxismo.html
BIBLIOGRAFIA
American Psychiatric Association (APA) (2013). DSM-5. Manuale diagnostico e statistico dei
disturbi mentali, tr. it. Raffaello Cortina, Milano, 2014.
Freud, S. (2011). Tre saggi sulla teoria sessuale. Bur.
Gabbard, G.O. (2014). Psichiatria Psicodinamica. Cortina Editore, Milano.
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