Abstract
We report a case of the debilitating and lifelong complex post traumatic stress disorder. Data on rape/defilement-related complex post traumatic stress disorder (PTSD) is rare due to low reporting rates and misdiagnosis in Kenya. Childhood complex PTSD is compounded by its symptomatic overlap with rape trauma syndrome (RTS) and attention deficit hyperactivity disorder (ADHD). This case demonstrated the difficulties involved in making the correct diagnosis while at the same time it brought to the fore clearly the features of complex PTSD as opposed to ordinary PTSD. Strengths in management depended on making appropriate diagnosis based on concerted efforts by clinicians, comprehensive care, team work, sensitivity to age and sex, winning trust of the child and the care taker among others and bearing in mind the in-ward handling of the trauma by the rape/defilement victims. This case shared a lot with other cases of complex PTSD in its presentation, course of illness, diagnosis and response to management protocol instituted yielding positive results. Using the lessons learnt from this case, her response was satisfactory based on her improved social and occupational functioning. The patient continues to respond well to treatment to date, bearing in mind that her presentation and age within a dysfunctional family background did not offer good prognosis, especially if the management and social support system will not be steadfast and innovative.
Highlights
According to Dr Judith Herman of the Harvard University (1997), complex post traumatic stress disorder describes the symptoms of long-term or prolonged trauma, not adequately defined by ordinary posttraumatic stress disorder (PTSD)
This case of childhood complex PTSD due to defilement presents one of the major challenges in psychiatry when making a diagnosis in a case which presents with symptoms simulating attention deficit hyperactivity disorder (ADHD), PTSD and rape trauma syndrome (RTS)
The patient was initially managed as a case of ADHD and she was treated with methylphenidate (Ritalin) and imipramine (Tofranil) given the overlap of some symptoms between PTSD and ADHD, leading to a decline in hyperactivity and relief in symptoms prior to disclosure about her defilement experience later
Summary
According to Dr Judith Herman of the Harvard University (1997), complex post traumatic stress disorder describes the symptoms of long-term or prolonged trauma, not adequately defined by ordinary PTSD. The rape/ defilement victim’s experiences in complex PTSD constitute a collection of symptoms described as rape trauma syndrome (RTS) and posttraumatic stress disorder (PTSD). Defilement, defined as any unwanted intercourse or penetration (vaginal, anal, or oral) obtained by force, threat of force, or when the victim is an under-age and unable to consent [2]-[4], while post traumatic stress disorder is defined as the human response to overwhelming life experience as an anxiety disorder and an illness of the mind [5]. Studies have shown that most (66.0%) of the female commercial sex workers in the United States of America had been sexually abused by their fathers or father-figures and one in every five children would be sexually abused by the 18th birthday, of whom 85.0% would be abused by adults known to them
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