A Simple Algorithm for Medication of Patients with Complex Trauma-Related Disorder

Abstract

The benefit of various psychiatric drugs for mitigation of irrational fear, anger, anxiety and impulsivity during episodes of complex traumarelated disorder is well documented. Those episodes consist of frantically making unreasonable demands, alternating with just as frantic acts of repentance and ingratiation during a crisis of trust in a current relationship. They also include flashbacks that rehearse a similar scenario retrospectively, for past experiences of traumatic betrayal. In mitigating such emotions, medication expedites psychotherapy. It restores patients’ ability to discern good will and expertise in others’ offer to jointly reappraise a patient’s reasons to cope with danger of betrayal in that manner. Psychodynamic therapists then help patients retrieve and reappraise reasons that often are latent to patients themselves. This paper notes the similarity of episodic disorder, as well as the similarity of pharmacotherapy’s outcomes among patients diagnosed variously with Complex Posttraumatic Stress Disorder, Borderline Personality Disorder or Dissociative Identity Disorder. The author proposes that these three disorders are causally related, all variants of “complex trauma-related disorder.” Therefore, it is reasonable to cite findings from the treatment of patients with all three disorders interchangeably. In summary, it is intriguing that various psychiatric drugs, i.e., antianxiety drugs, antidepressants, antipsychotics and mood stabilizers, all selectively mitigate irrational anxiety, fear, anger and impulsivity, regardless of the family name that they earned in the treatment of other disorders. In contrast, for patients with complex trauma-related disorder, the evidence for benefit strictly according to a drug’s family name (except for antianxiety drugs) has been inconsistent beyond comprehension. This paper presents an algorithm that simplifies reasoning about the order in which we test drugs by relinquishing expectations for an effect by a drug’s family name, e.g., “antidepressant,” in addition to mitigating irrational anxiety, fear, anger and impulsivity, which all four families do, more or less. This algorithm simply chooses depending on a drug’s potency, speed and duration of action, and desired or undesirable side-effects. In addition to the algorithm, this paper clarifies the logic of comparing symptom changes with and without a certain medication, in order to continue it, change the dosage or replace it. To attribute symptom changes to medication changes, we must control for symptom changes in the disorder’s natural course. Symptoms wax and wane with bad and good turns in patients’ judgment of others’ trustworthiness, which often greatly mask the true effect of medication changes