Diagnosis and treatment of PTSD-related compulsive checking behaviors in veterans of the Iraq war: the influence of military context on the expression of PTSD symptoms.
ABSTRACT This case study presents an overview of the conceptualization and treatment of two veterans of the Iraq War who presented for combat-related treatment at a Veterans Administration Medical Center. In addition to posttraumatic stress disorder (PTSD) symptoms of reexperiencing, arousal, and avoidance, the veterans exhibited compulsive checking behaviors that appear to be influenced by theater-specific combat duties and traumatic events. These cases represent what the authors believe to be an increasingly common expression of PTSD in veterans of the Iraq and Afghanistan wars. Both veterans were treated with prolonged exposure therapy, which includes imaginal and in vivo exposure to anxiety-provoking stimuli, processing of traumatic events, and self-assessment of anxiety. Treatment also included in vivo exposure with response prevention techniques borrowed from the literature on obsessive-compulsive disorder to address compulsive checking behaviors within the ecological context of each patient's symptom presentation. Measures related to PTSD and depression were obtained before, during, and after treatment. Treatment was associated with significant declines in symptom severity and improved functioning for both veterans. The unique nature of the conflict in the Middle East represents role challenges for soldiers that affect symptom presentation. Variations in symptom presentation can in turn complicate efforts to identify and appropriately address PTSD-related health concerns in this population. Thus, clinicians and researchers must remain cognizant of how theater-specific duties influence the manifestation and treatment of PTSD in order to provide optimal care to a new generation of veterans.
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ABSTRACT: Post-traumatic stress disorder (PTSD) is a serious behavioural and psychological abnormality that occurs after perceived or actual exposure to unusual, severe, acute stressful events. In addition to returning soldiers from war front, PTSD is also occur in civilian victims of wars, terrorist attacks, serious accidents, sexual abuse/rape, or other violent episodes, and following school and workplace bullying or harassments. However, early diagnosis, individualized effective therapies and appropriate follow-up programs could effectively lead to cure. In addition, to psychotherapy and pharmacotherapy, out of the box approaches need to be explored including meditation, music therapy, and relaxation methods. Not only is PTSD underdiagnosed, but it also misdiagnosed or mislabelled, including as depression or adjustment disorders. Treatment of PTSD needs to be well-coordinated with all stakeholders taking active part, synergistically, maximizing utilization of resources to prevent recurrences. However, mislabelling PTSD as a diagnosis, prevents patients getting effective therapy and thereby may harm them and their families. The provision of timely, effective therapeutic plans not only alleviates the PTSD symptoms, but also prevents recurrences; thus facilitating their return to normal productive lives. Several novel neurohormonal and structural brain abnormalities have been identified in patients with PTSD, allowing further understanding, and identifying new medications and management options to help PTSD victims.Comprehensive Research Journal of Medicine and Medical Science (CRJMMS). 01/2013; 1(2):1-12.
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ABSTRACT: Anxiety disorders during pregnancy are highly prevalent and associated with serious and enduring consequences for both mother and child. Exposure-based cognitive behavioral (CBT) and behavioral therapies (BT) represent the most empirically supported psychosocial treatments for anxiety disorders in general adult samples. Pregnant women, however, generally have been excluded from this body of research. Evidence that pregnant women inhabit a unique biological context combined with untested assumptions that exposure would unduly stress or harm the fetus have likely prohibited inquiry. This paper seeks to remedy this gap by integrating findings from obstetric, psychiatric, and psychological research to inform central questions regarding exposure-based treatment of anxiety disorders during pregnancy. Based on available evidence, we consider the potential risks and benefits of CBT/BT for anxiety disorders during pregnancy relative to other currently available treatment options. From a multidisciplinary research perspective, we argue that exposure-based therapies are likely to be safe during pregnancy, particularly relative to the alternatives. However, we also highlight critical questions for future research to directly test the biopsychological impact of exposure-based therapies among pregnant women.Archives of Women s Mental Health 09/2012; · 2.01 Impact Factor
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ABSTRACT: In patients with co-morbid obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD), repetitive behavior patterns, rituals, and compulsions may ward off anxiety and often function as a coping strategy to control reminders of traumatic events. Therefore, addressing the traumatic event may be crucial for successful treatment of these symptoms. In this case report, we describe a patient with comorbid OCD and PTSD who underwent pharmacotherapy and psychotherapy. Case Report. A 49-year-old Dutch man was treated for severe PTSD and moderately severe OCD resulting from anal rape in his youth by an unknown adult man. The patient was treated with paroxetine (60 mg), followed by nine psychotherapy sessions in which eye movement desensitization and reprocessing (EMDR) and exposure and response prevention (ERP) techniques were applied. During psychotherapy, remission of the PTSD symptoms preceded remission of the OCD symptoms. This study supports the idea of a functional connection between PTSD and OCD. Successfully processing the trauma results in diminished anxiety associated with trauma reminders and subsequently decreases the need for obsessive-compulsive symptoms.European Journal of Psychotraumatology 01/2013; 4.