Treatments for PTSD, Complex PTSD & Dissociative Disorders


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    Treatment for Posttraumatic Stress Disorder

    PTSD Treatment guidelines have been produced by the International Society of Traumatic Stress Studies, with separate guidelines for both adults and adolescents/children. The information below applies to adults only.

    Therapy for PTSD

    The extensive PTSD guidelines cover different types of talking therapy, including Cognitive-Behavioral Therapy, Eye Movement Desensitization and Reprocessing, Psychodynamic Therapy, Psychosocial Rehabilitation, hypnosis (used alongside other therapies but not a therapy on itself), Couple and Family Therapy and Creative Therapies. Psychological Debriefing (also known as Critical Incident Stress Debriefing) is not recommended, and clinicians are advised to be cautious with patients who want to use hypnosis to access "unremembered" episodes of past abuse. [7]

    Medication for PTSD

    The only drugs that are currently FDA-approved for PTSD (in the United States) are two SSRIs: Paroxetine (Paxil) and Sertraline (Zoloft), although other drugs may be prescribed for "off-label" use.[10] The strongest evidence for medication involves two classes of anti-depressant; SSRIs and SNRIs (e.g, Venlafaxine). The atypical anti-depressant Mirtazapine (Remeron) has also been shown to be effective, although there is some evidence for other anti-depressants. For people who have only a limited response to SSRIs, atypical anti-psychotics may be used in addition, for example Risperidone/Olanzapine (Zyprexa) or Quetiapine (Seroquel). [7]:563-564,566, [10] Atypical antipsychotics can be helpful in PTSD for people with extreme hypervigilance/paranoia, physical aggression and trauma-related psychosis; conventional antipsychotics are not recommended. [7]:566

    Antiadrenergic drugs can reduce arousal (e.g., hypervigilance), reexperiencing and possibly dissociative symptoms caused by PTSD. Prazosin (minipress), a medication licensed for high blood pressure and other physical conditions, is known to reduce trauma-related nightmares, sleep problems, and overall PTSD symptoms.

    Benzodiazepines (e.g., Alprazolam and Clonazepam) are not recommended, especially if used as the only medication. They can increase depression, slow physical movements, and do not reduce re-experiencing (e.g., flashbacks). They are known to be problematic for people with a history of alcohol or drug abuse/dependence.[7]:566

    Although some medication is recognized as a "Level A" treatment, meaning there is good evidence that it works, medication is generally considered less effective than some Cognitive-Behavioral Therapies, both in United States and British treatment guidelines.[7], [9] All medications can cause side effects, and symptoms may return after medication is discontinued. [7]:567

    Disclaimer: The information above should not be considered advice. It is a summary of existing treatment guidelines which does not take into account a person's current symptoms or medical history. Make sure you speak to a clinician for advice before making any medication or treatment decisions, or discontinuing existing medication.

    Recovery without treatment
    A recent review of 42 evidence-based studies into long-term and spontaneous recovery in PTSD found that 44% of people in studies no longer had PTSD after an average of 3 years and 3 months without treatment. Recovery rates vary with the type of trauma; PTSD caused by a natural disaster had the highest recovery (remission) rates when untreated, at 60%. PTSD from physical disease had the lowest rates (31.4%) when untreated. [8]

    Treatment for Complex PTSD

    Complex PTSD is harder to treat/recover from than 'simple' PTSD; not only are there multiple traumas but the interpersonal and long term nature of the traumas lead to additional symptoms. Repeated child abuse is the most common cause of Complex PSTD. The International Society of Traumatic Stress Studies publishes Complex Posttraumatic Stress Disorder treatment guidelines which are based on psychotherapy using a three-phase approach.[11]
    • Phase 1 focuses on improving the individual’s safety, reducing symptoms and skills training, which increases the person's emotional, social and psychological competencies. This often involves medication. Improving safety refers to reducing unsafe behaviors, e.g. self harm, and risk taking, and if possible establishing a safe enviroment.
    • Phase 2 focuses on processing and reappraisal of the unresolved trauma memories. This results in memories being integrated into an "adaptive representation of self, relationships and the world" and should be done using individual rather than group therapy.
    • Phase 3 involves consolidating treatment gains, including using these gains to engage more in interpersonal relationships, work/education, and the community/life in general [11]:5-9

    Treatments for Dissociative Disorders

    Dissociative Identity Disorder and similar forms of Other Specified Dissociative Disorder/DDNOS share the same Adult Treatment Guidelines, these are produced by the International Society for the Study of Trauma and Dissociation (ISST-D) and are based on expert consensus.[1] The main treatment involves psychotherapy (talking therapy) and uses a three-phase treatment model very similar to that recommended for Complex PTSD.[1]

    Separate Child and Adolescent Treatment Guidelines also exist.[6]

    References

    1. International Society for the Study of Trauma and Dissociation. (2011). Guidelines For Treating Dissociative Identity Disorder In Adults, Third Revision: Summary Version. Journal of Trauma & Dissociation,12(2), 188-212. DOI: 10.1080/15299732.2011.537248.
    2. World Health Organization. (2014) Classification of Diseases (ICD). Retrieved November 16, 2014, from http://www.who.int/classifications/icd/revision/en/
    3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). Washington, D.C.: American Psychiatric Association. ISBN 0890425558.
    4. World Health Organization. (1992). The ICD-10 Classification of Mental and Behavioural Disorders. Version: 2015. Retrieved November 21, 2014, from http://apps.who.int/classifications/icd10/browse/2015/en#/F44.0
    5. World Health Organization. (November 15, 2014). ICD-11 Beta Draft (Joint Linearization for Mortality and Morbidity Statistics).
    6. International Society for the Study of Trauma and Dissociation. Dissociation FAQ's Retrieved November 21, 2014, from http://www.isst-d.org/default.asp?contentID=76
    7. Foa, E., Keane, T., Friedman, M., & Cohen, J. (Eds.). (2009). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies (2nd ed.). New York: Guilford Press. ISBN 9781606237922. Available online from the International Society for Traumatic Stress Studies.
    8. Morina, N., Wicherts, J. M., Lobbrecht, J., & Priebe, S. (2014). Remission from post-traumatic stress disorder in adults: A systematic review and meta-analysis of long term outcome studies. Clinical Psychology Review, 34(3), pp.249-255. doi 10.1016/j.cpr.2014.03.002.
    9. Bisson, J. I. (2007) Pharmacological treatment of post-traumatic stress disorder. Advances in Psychiatric Treatment, 13 (2) pp.119-126; DOI: 10.1192/apt.bp.105.001909.
    10. Jeffreys, M. (2009). Clinician’s guide to medications for PTSD. National Center for PTSD. US Department of Veterans Affairs. Retrieved May 28, 2016.
    11. Cloitre, M., Courtois, C.A., Ford, J.D., Green, B.L., Alexander, P., Briere, J., Herman, J.L., Lanius, R., Stolbach, B.C., Spinazzola, J., Van der Kolk, B.A., Van der Hart, O. (2012). The ISTSS Expert Consensus Treatment Guidelines for Complex PTSD in Adults. Retrieved May 28, 2016 from https://www.istss.org/ISTSS_Main/media/Documents/ISTSS-Expert-Concesnsus-Guidelines-for-Complex-PTSD-Updated-060315.pdf

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