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Community Mental Health Journal

, Volume 32, Issue 2, pp 173–189 | Cite as

PTSD diagnosis and treatment for mental health clinicians

  • Matthew J. Friedman
Article

Abstract

This article focuses on four issues: PTSD assessment, treatment approaches, therapist issues, and current controversies. Important assessment issues include the trauma history, comorbid disorders, and chronicity of PTSD. Effective intervention for acute trauma usually requires a variant of critical incident stress debriefing. Available treatments for chronic PTSD include group, cognitive-behavioral, psychodynamic, and pharmacological therapy. Therapist self-care is essential when working with PTSD patients since this work may be functionally disruptive and psychologically destabilizing. Current controversies include advocacy vs. therapeutic neutrality, eye movement desensitization and reprocessing (EMDR), the so-called false memory syndrome, and the legitimacy of complex PTSD as a unique diagnostic entity.

Keywords

False Memory Critical Incident Mental Health Clinician Trauma History Ptsd Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Abueg, F. & Fairbank, J. (1991). Behavioral treatment of the PTSD substance abuser, inPost-traumatic stress disorder: A behavioral approach to assessment and treatment. Edited by Saigh, P.A. New York: Pergamon Press.Google Scholar
  2. American Psychiatric Committee on Nomenclature and Statistics (1980).Diagnosis and statistical manual of mental disorders, third edition. Washington, DC: American Psychiatric Association.Google Scholar
  3. American Psychiatric Committee on Nomenclature and Statistics (1987).Diagnosis and statistical manual of mental disorders, third edition-revised. Washington, DC: American Psychiatric Association.Google Scholar
  4. American Psychiatric Committee on Nomenclature and Statistics (1994).Diagnosis and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.Google Scholar
  5. Archibald, H.C. & Tuddenham, R.D. (1965). Persistent stress reaction after combat: A 20 year follow-up.Archives of General Psychiatry, 12, 475–481.Google Scholar
  6. Armstrong, K., O'Callahan, W. & Marmar, C.R. (1991). Debriefing Red Cross disaster personnel: The multiple stressor debriefing model.Journal of Traumatic Stress, 4, 481–491.Google Scholar
  7. Beck, J.C. & van der Kolk, B. (1987). Reports of childhood incest and current behavior of chronically hospitalized psychotic women.American Journal of Psychiatry, 144, 1474–1476.Google Scholar
  8. Boudewyns, P.A., Swertka, S.A., Hyer, L.A., et al. (1993). Eye movement desensitization for PTSD of combat: A treatment outcome pilot study.The Behavior Therapist, 16, 29–33.Google Scholar
  9. Breslau, N., Davis, C.G., Andreski, P., et al. (1991). Traumatic events and post-traumatic stress disorder in an urban population of young adults.Archives of General Psychiatry, 48, 216–222.Google Scholar
  10. Courtois, C.A. (1988).Healing the incest wound: Adult survivors in therapy. New York: W.W. Norton.Google Scholar
  11. Craine, L.S., Henson, C.B., Colliver, J.A., et al. (1988). Prevalence of a history of sexual abuse among female psychiatric patients in a state hospital system.Hospital and Community Psychiatry, 39, 300–304.Google Scholar
  12. Danielli, Y. (1988). Confronting the unimaginable: Psychotherapist's reactions to victims of the Nazi Holocaust inHuman adaptation to extreme stress from the Holocaust to Vietnam. Edited by Wilson, J.P., Harel, Z. & Kahana, B. New York: Plenum Press.Google Scholar
  13. Davidson, J., Kudler, H., Smith, R., et al. (1990). Treatment of post-traumatic stress disorder with amitriptyline and placebo.Archives of General Psychiatry, 47, 259–266.Google Scholar
  14. Fesler, F.A. (1991). Valproate in combat-related post-traumatic stress disorder.Journal of Clinical Psychiatry, 52(9), 361–364.Google Scholar
  15. Figley, C.R. (1995).Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner/Mazel.Google Scholar
  16. Foa, E.B. & Riggs, D.S. (1993). Post-traumatic stress disorder in rape victims, inAmerican psychiatric press review of psychiatry, volume 12. Edited by Oldham, J., Riba, M.B., & Tasman, A. Washington, DC: American Psychiatric Press.Google Scholar
  17. Foa, E.B., Rothbaum, B.O., Murdock, T, et al. (1991). The treatment of PTSD in rape victims.Journal of Consulting and Clinical Psychology, 59, 715–723.Google Scholar
  18. Foa, E.B., Rothbaum, B.O., Molnar, C. (1995). Cognitive-behavioral therapy of PTSD, inNeurobiological and clinical consequences of stress: from normal adaptation to PTSD. Edited by Friedman, M.J., Charney, D.S., & Deutch, A.Y. Philadelphia: Lippincott-Raven, 483–494.Google Scholar
  19. Friedman, M.J. (1990). Interrelationships between biological mechanisms and pharmacotherapy of posttraumatic stress disorder, inPosttraumatic stress disorder: Etiology, phenomenology, and treatment. Edited by Wolf, M.E. & Mosnaim, D.A. Washington, DC: American Psychiatric Press.Google Scholar
  20. Friedman, M.J. (1991). Biological approaches to the diagnosis and treatment of post-traumatic stress disorder.Journal of Traumatic Stress, 4(1), 67–91.Google Scholar
  21. Friedman, M.J., Charney, D.S. & Deutch, A.Y. (1995).Neurobiology and clinical consequences of stress: From normal adaptation to PTSD. Philadelphia: Lippincott-Raven.Google Scholar
  22. Friedman, M.J. & Southwick, S.M. (1995). Towards pharmacotherapy for PTSD, inNeurobiological and clinical consequences of stress: From normal adaptation to PTSD. Edited by Friedman, M.J., Charney, D.S., & Deutch, A.Y. Philadelphia: Lippincott-Raven, 465–482.Google Scholar
  23. Gusman, F.D., Abueg, F.R. & Friedman, M.J. (1991).Operation Desert Storm clinician packet. Palo Alto: National Center for PTSD.Google Scholar
  24. Herman, J.L. (1992).Trauma and recovery. New York: Basic Books.Google Scholar
  25. Herman, J.L. & Schatzow, E. (1987). Recovery and verification of memories of childhood sexual trauma.Psychoanalytic Psychology, 4, 1–14.Google Scholar
  26. Horowitz, M.J. (1986).Stress response syndromes (2nd edition). New York: Jason Aronson.Google Scholar
  27. Hyer, L. (1994).Trauma victim: Theoretical issues and practical suggestions. Muncie, IN: Accelerated Development, Inc.Google Scholar
  28. Jordan, K., Schlenger, W., Hough, R., et al. (1991). Lifetime and current prevalence of specific psychiatric disorders among Vietnam veterans and controls.Archives of General Psychiatry, 48, 207–215.Google Scholar
  29. Kofoed, L., Friedman, M.J. & Peck, R. (1993). Alcoholism and drug abuse in patients with PTSD.Psychiatric Quarterly, 64, 151–171.Google Scholar
  30. Koller, P., Marmar, C.R. & Kanas, N. (1992). Psychodynamic group treatment of post-traumatic stress disorder in Vietnam veterans.International Journal of Group Psychotherapy, 42, 225–246.Google Scholar
  31. Kulka, R.A., Schlenger, W.E., Fairbank, J.A., et al. (1990).Trauma and the Vietnam War generation. New York: Brunner/Mazel.Google Scholar
  32. Lindy, J.D. (1988).Vietnam: A casebook. New York: Brunner/Mazel.Google Scholar
  33. Lindy, J.D. (1993). Focal psychoanalytic psychotherapy, inThe international handbook of traumatic stress syndromes. Edited by Wilson, J.P. & Raphael, B. New York: Plenum Press.Google Scholar
  34. Loftus, E.F. (1993). The reality of repressed memories.American Psychologist, 48, 418–537.Google Scholar
  35. Marmar, C.R. (1991). Brief dynamic psychotherapy of post-traumatic stress disorder.Psychiatric Annals, 21, 405–414.Google Scholar
  36. Marmar, C.R., Foy, D., Kagan, B., et al. (1993). An integrated approach for treating post-traumatic stress, inAmerican psychiatric press review of psychiatry, volume 23. Edited by Oldham, J.M., Riba, M.B. & Tasman, A. Washington, DC: American Psychiatry Press.Google Scholar
  37. Marmar, C.R., Weiss, D.S. & Pynoos, R.B. (1995). Dynamic psychotherapy of post-traumatic stress disorder, inNeurobiological and clinical consequences of stress: From normal adaptation to PTSD. Edited by Friedman, M.J., Charney, D.S., & Deutch, A.Y. Philadelphia: Lippincott-Raven, 495–506.Google Scholar
  38. McCann, L. & Pearlman, A. (1990). Vicarious traumatization: A framework for understanding the psychological effects of working with victims.Journal of Traumatic Stress, 3, 131–149.Google Scholar
  39. Mitchell, J. (1983). When disaster strikes ... The critical incident stress debriefing process.Journal of Emergency Medical Services, 8, 36–39.Google Scholar
  40. Murburg, M.M. (1994).Catecholamine function in post-traumatic stress disorder: Emerging concepts. Washington, DC: American Psychiatric Press.Google Scholar
  41. Pitman, R.K., Orr, S., Altman, B., et al. (1993, October). A controlled study of eye movement desensitization/reprocessing (EMDR) treatment for post-traumatic stress disorder. Paper presented at the Annual Meeting of the International Society For Traumatic Stress Studies, San Antonio, TX.Google Scholar
  42. Raphael, B. (1985).When disaster strikes. New York: Basic Books.Google Scholar
  43. Rothbaum, B.O., Fog, E.B., Riggs, D.S., et al. (1992). A prospective examination of post-traumatic stress disorder in rape victims.Journal of Traumatic Stress, 5, 455–475.Google Scholar
  44. Schnurr, P.P. (1991). PTSD and combat-related psychiatric symptoms in older veterans.PTSD Research Quarterly, 2(1), 1–6.Google Scholar
  45. Scurfield, R. (1993). Treatment of PTSD in Vietnam veterans, inThe international handbook of traumatic stress syndromes. Edited by Wilson, J.P. & Raphael, B. New York: Plenum Press.Google Scholar
  46. Shapiro, F. (1989). Efficacy of eye movement desensitization procedure in the treatment of traumatic memories.Journal of Traumatic Stress, 2, 199–233.Google Scholar
  47. Southwick, S.M., Krystal, J.H., Johnson, D.R., et al. (1992). Neurobiology of post-traumatic stress disorder, inAnnual review of psychiatry, volume II. Edited by Tasman, A. Washington, DC: American Psychiatric Press.Google Scholar
  48. van der Kolk, B.A., Dryfus, D., Michaels, M., et al. (1994). Fluoxetine in post-traumatic stress disorder.Journal of Clinical Psychiatry, 55, 517–522.Google Scholar
  49. Williams, M.B. & Sommer, J.F. (1994).Handbook of post-traumatic therapy. Westport, CT: Greenwood Press.Google Scholar
  50. Williams, L.M. (1994). Recall of childhood trauma: A prospective study of women's memories of child sexual abuse.Journal of Consulting and Clinical Psychology, 62, 1167–1176.Google Scholar
  51. Yassan, J. (1993). Group work with clinicians who have a history of trauma.NCP Clinical Newsletter, 3, 10–11.Google Scholar

Copyright information

© Human Sciences Press, Inc. 1996

Authors and Affiliations

  • Matthew J. Friedman
    • 1
  1. 1.VA Medical Center (1160)White River Junction

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