Trauma exposure therapy in a pregnant woman suffering from complex posttraumatic stress disorder after childhood sexual abuse: risk or benefit?. Issue 1 (31st December 2020)

• Record Type: Journal Article
• Authors: Becker-Sadzio, Julia; Gundel, Friederike; Kroczek, Agnes; Wekenmann, Stefanie; Rapp, Alexander; Fallgatter, Andreas J.; Deppermann, Saskia
• Is Part Of: European journal of psychotraumatology. Volume 11:Issue 1(2020)
• Publication Date: 2020-12-31
• Subjects: Trauma exposure therapy during pregnancy -- complex posttraumatic stress disorder -- trauma focused dialectical behaviour therapy -- transgenerational effects of PTSD -- treatment-induced transgenerational effects; Terapia de exposición al trauma durante el embarazo -- trastorno de estrés postraumático complejo -- terapia dialéctica conductual centrada en el trauma -- efectos transgeneracionales del TEPT -- efectos transgeneracionales inducidos por el tratamiento; 妊娠期创伤暴露疗法 -- 复杂性创伤后应激障碍 -- 聚焦创伤的辩证行为疗法 -- PTSD的跨代效应 -- 治疗引起的跨代效应; Post-traumatic stress disorder -- Periodicals; Stress Disorders, Post-Traumatic; Post-traumatic stress disorder; Electronic journals; Periodicals; Periodicals; Fulltext; Internet Resources; Periodicals; 616.8521
• DOI: 10.1080/20008198.2019.1697581
• Languages: English
• ISSNs: 2000-8198

Abstract

ABSTRACT: Background: Mental disorders during pregnancy are common and affect the health of mother and child. Despite a relatively high prevalence rate, treatment options have not been investigated systematically. Particularly symptoms of posttraumatic stress disorder (PTSD) may increase significantly during the course of pregnancy. However, proper guidelines for psychotherapeutic treatment of PTSD during pregnancy do not exist. Objective: In this article, we aimed at discussing the effects of untreated PTSD on pregnancy and postpartum mother-child bonding as well as exposure therapy during pregnancy. Method: To do so, we present the case of a pregnant woman with complex PTSD following childhood sexual abuse. At the time of hospitalization, the patient was pregnant in the second trimester and reported intrusive re-experiencing of the traumatic events, nightmares, anxiety and helplessness as well as an impairing level of irritability during social situations. After a careful discussion of the case within our department and at the annual conference of the German Association of Psychiatry, Psychotherapy and Psychosomatics, we decided to treat the patient with dialectical behavior therapy for PTSD (DBT-PTSD) including exposure therapy under the regular observation of a gynecologist. Psychometric measurements (Davidson Trauma Scale (DTS) and Borderline Symptom- List-23 (BSL-23) were used to observe the course of treatment regarding common PTSD-symptoms and disturbances in self-organization (DSO). Results: The intensity of intrusions and hyperarousal increased from the date of admission, reached the maximum when exposure started and decreased below baseline-level at the end of treatment. Avoidance behavior continually decreased from the beginning until the end of therapy. Decreased BSL-23 values show major improvements regarding DSO. To our knowledge, the course of pregnancy was not affected by treatment-induced psychological and physical symptoms.Conclusions : DBT- PTSD is a potential treatment option for patients suffering from PTSD during pregnancy. Yet, further (epigenetic) research in this field is urgently needed. HIGHLIGHTS: Exposure-based DBT-PTSD is a potential treatment option during pregnancy. Within this context, exposure-induced psychological distress and its potential (epigenetic) effects on the unborn child should be considered. On the other hand, the risk of impaired postpartum mother-child bonding due to untreated PTSD symptoms has to be taken into account. Future research should focus on case-control studies to investigate transgenerational epigenetic changes in mothers and their children with regard to long-term child development.