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| Treatment Early intervention after a traumatic incident, known as Critical Incident Stress Managemen (CISM) is often used to reduce traumatic effects of an incident, and potentially prevent a full-blown occurrence of PTSD. There have been scores of treatments suggested for the treatment of PTSD. One technique specifically targeted at the disorder is Eye Movement Desensitization and Reprocessing (EMDR) . Traumatic Incident Reduction is another, more controversial targeted method of treatment. Relationship based treatments are also often used. Johnson, S., (2002). Emotionally Focused Couples Therapy with Trauma Survivors. NY: Guilford, is one example. These, and other approaches, such as Dyadic Developmental Psychotherapy use attachment theory and an attachment model of treatment. The treatment of complex trauma often requires a multi-modal approach. PTSD is usually treated by a combination of psychotherapy (cognitive-behavioral therapy, group therapy, and exposure therapy are popular) and psychotropic drug therapy (antidepressant or atypical antipsychotics, e.g. brand names such as Prozac (fluoxetine), Effexor (venlafaxin), Zoloft (sertraline), Remeron (mirtazapine), Zyprexa (olanzapine), or Seroquel (quetiapine)). Talk therapy may prove useful, but only insofar as the individual sufferer is enabled to come to terms with the trauma suffered and successfully integrate the experiences in a way that does not further damage the psyche. Forbes, et al, (2001) [5] have shown that a technique of "rewriting" the content of nightmares through imagery rehearsal so that they have a resolution can not only reduce the nightmares but also other symptoms. The US Food and Drug Administration (FDA) recently approved a clinical protocol that combines the drug MDMA ("Ecstasy") with talk therapy sessions. Basic counseling for PTSD includes education about the condition and provision of safety and support (Foa 1997). Cognitive therapy shows good results (Resick 2002), and group therapy may be helpful in reducing isolation and Stigma (Foy 2002). Dr. Jan Bastiaans of the Netherlands has developed a form of psychedelic psychotherapy involving LSD, with which he has successfully treated concentration camp survivors who suffer from PTSD. PTSD is often co-morbid with other psychiatric disorders such as depression, substance abuse and other addictive behaviors. Currently under scrutiny is the inclusion of Complex Post Traumatic Stress in the 2006 revision of the DSM-IV-TR. This is a variant of PTSD that includes the breakthrough of Borderline Personality traits. Law If the acts and omissions of an individual suffering from PTSD result in consequences that breach the criminal law, there may be levels of confusion that prevent the formation of the relevant mens rea (the Latin for "guilty mind") so mistake or reasonable excuse may be a defence. In more extreme cases, the defence of automatism may be available, with particular conditions discussed at automatism (case law). But there is a danger that although the initial cause of the disorder will be external, it may produce an internal defect of reason or an abnormality of mind within the meaning of the M'Naghten Rules (redefined as a mental disorder defence in some criminal jurisdictions) that define insanity as an excuse. The difference is that whereas defences that negate the mens rea and automatism result in an acquittal, insanity or mental disorder leaves the "offender" available for sentencing by the court. In the event that a death has resulted, diminished responsibility may be available as an alternative to insanity. This defence reduces what would otherwise have been murder to manslaughter. For a detailed discussion of a sometimes related condition, see battered woman syndrome and, more generally, the abuse defense in the U.S. |