A Posttraumatic Stress Disorder (PTSD) Case
The psychiatric complaints of the 30 year old single woman with no background of any physical illness were as follows:
Frequently recurring depression, fixation characterized by an inability to let go of some nonsensical ideas, distrustfulness towards people, being startled easily, very frequent nightmares.
The patient had a past history of sexual assault. She was reluctant to talk about it, but as the consultation continued a good doctor-patient relationship developed and in her own words ‘once she started feeling trust which she had not felt before in any other doctor ‘ she was able to reveal the details of the incident. The assault happened when she was 6 years old, by her older brother who is 10 years older than her. There was no penetration. A few years later the patient started to feel the effect the incident had on her and experienced her first bout of depression.
It became apparent that during her deep psychiatric history the patient had taken many different drugs but said that none of these had helped. In her history she mentioned frequently recurring thoughts of suicide. She smoked 2 packets of cigarettes a day. She had difficulty falling asleep, her appetite was much reduced and her libido very low. The patient whose general appearance was in line with the socio-cultural norm, had greatly increased psychomotor activity, in other words she was fidgeting. At the beginning of the consultation she felt uneasy but gradually relaxed. Her emotional state was tense, angry and sad. She said that her emotions were very changeable, that she frequently went between a state of happiness and unhappiness. The content of her ideas showed that she believed people were plotting against her (ideas of reference) and she had obsessions (of a controlling nature). Furthermore, as perceptual deficit she had auditory and visual illusions. Attention, concentration and memory were greatly affected. The patient, who had a normal economic status, had very limited social relations. She had ordinary hobbies but had lately been unable to make time for them. Because of the sexual assault her childhood had been an unhappy one. Her relationship with her mother was not good, she believed her mother favored her older brother and she felt very unhappy about this. For many years she had not mentioned the assault to anyone. Her father had died when she was ten years old. She said she hated her brother.
The patient was diagnosed with Post-Traumatic Stress Disorder and prescribed an antidepressant, a mood altering drug and an antipsychotic drug. In addition she was advised EMDR therapy. One months later at the consultation the patient stated that she feels 80% better, she no longer had flash-backs, she enjoyed normal sleep and the nightmares had stopped. Her other symptoms had also greatly improved. Two months later her libido and attention, concentration and memory had also improved markedly and she felt 100% well. Compared to the beginning her quality of life had greatly improved. When the patient’s data is assessed by means of certain scales the outcome is really a happy one.