From the Guidelines
Trauma can indeed have a profound impact on mental health, and for this 30-year-old patient with CPTSD and recurrent depression, the winter deterioration likely represents an anniversary reaction to childhood traumas that occurred during those months. The patient's post-laparoscopy crisis demonstrates how medical situations can trigger similar trauma responses due to feelings of invalidation and vulnerability, mirroring earlier experiences. This occurs through implicit memory systems that operate below conscious awareness, as discussed in the study by 1. The body remembers trauma through physiological responses (increased cortisol, heart rate, muscle tension) that can be triggered by sensory cues like weather changes, lighting, smells, or situations that resemble past trauma contexts.
Key Considerations
- The study by 1 suggests that the evidence does not currently support the recommendation for a stabilization phase prior to providing trauma-focused treatment in persons with cPTSD.
- The study by 1 found that trauma-focused treatments can be effective in many PTSD patients with complex presentations, and that delaying trauma-focused treatment could be demoralizing to patients.
- The most recent study by 1 found that secondary prevention for posttraumatic stress and related symptoms among women who have experienced a recent sexual assault can be effective, with a small to moderate effect size.
Treatment Recommendations
- Treatment should focus on trauma-focused therapy like EMDR or CPT to process these memories, combined with medication management that might include an SSRI like sertraline (50-200mg daily) or an SNRI like venlafaxine (75-225mg daily) for depression and anxiety symptoms.
- Adding prazosin (1-15mg at bedtime) can help with trauma-related nightmares and hyperarousal.
- The patient would benefit from developing a winter preparation plan with their treatment team, including increased therapy sessions, light therapy (30 minutes daily of 10,000 lux light exposure), vitamin D supplementation (2000-4000 IU daily), and mindfulness practices to recognize early warning signs of deterioration.
- Understanding that these reactions are normal trauma responses rather than personal failings can help reduce shame and increase self-compassion during difficult periods, as noted in the study by 1.
From the Research
Trauma and Seasonal Deterioration
- The patient's experience of deterioration every winter, despite not lamenting over the past, suggests a complex relationship between trauma and seasonal patterns 2.
- Research on post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) highlights the importance of considering the impact of trauma on an individual's mental health, regardless of the time of year 3, 4.
- The patient's symptoms, including extreme mental pain, severe anxiety, and intense fear, are consistent with those experienced by individuals with CPTSD 2.
Medical Trauma and Crisis
- The patient's medical trauma, including a laparoscopy, triggered a crisis response, characterized by panic, crying, and feelings of low self-worth 2.
- This response is consistent with the idea that medical trauma can exacerbate existing mental health conditions, including CPTSD 5.
- The patient's experience of feeling like they are not believed or are being accused of hypochondria or attention-seeking is a common theme in individuals with CPTSD 2.
Treatment and Management
- Research suggests that trauma-focused psychological interventions, such as cognitive behavioral therapy with a trauma focus (CBT-TF), are effective in treating PTSD and CPTSD 4, 2.
- Pharmacological approaches, including selective serotonin reuptake inhibitors (SSRIs), may also be effective in managing symptoms of PTSD and CPTSD 3, 5, 6.
- A modular approach to treatment, incorporating empirically supported interventions, may be beneficial for individuals with CPTSD 2.