Ethics Commentary: Treatment of PTSD Empirically Based and Ethical Clinical Decision Making

Abstract

A physician has just completed an assessment of a female survivor of a rape that occurred 6 months earlier. She meets full criteria for chronic posttraumatic stress disorder (PTSD) and major depressive disorder of moderate severity. Although she does not meet criteria for alcohol dependence, she has a history of episodic binge drinking that has increased in frequency since the assault. Also since the assault, she has had intermittent bouts of suicidal ideation but denies any intent or specific plan and has no history of past suicide attempts or nonsuicidal self-injury. The patient indicates a clear preference for psychotherapy overmedication as a startingpoint for treatment, but is willing to consider medication if psychotherapy is not a practical option or psychotherapy proves inadequate. The physician does not feel personally qualified to provide psychotherapy for PTSD and the patient asks the physician for a referral, with a plan for a follow-up visit in 3months to reconsider themedication option.What kind of referral should the physician provide and what ethical issues should be considered inmaking the referral?