Pharmacology for post-traumatic stress disorder related to childhood sexual abuse: a literature review

TOPIC. Post-traumatic stress disorder (PTSD) related to pharmacotherapy responses in general and specifically to noncombat symptomatology related to childhood sexual abuse. PURPOSE. To explore findings related to pharmacological advances in the treatment of PTSD and relate the findings to the treatment of childhood sexual abuse. SOURCES. Published literature. CONCLUSIONS. The literature on pharmacotherapy for PTSD in general and childhood trauma and PTSD in particular is small and inconsistent, but we need to be aware of any and all advances. Search terms: Neurobiology, pharmacotherapy, sexual abuse, PTSD, trauma ********** During both world wars, the Korean War, and the Vietnam War, there was recognition of the similarities of the impact of trauma on soldiers (Braun, 1993; Solomon, 1993). In 1984, criteria describing the posttraumatic stress disorder (PTSD) syndrome were published in the Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DMS-III) (American Psychiatric Association [APA], 1984), providing an organized schema to demonstrate the relationship between trauma and PTSD. In recent years, the literature has identified the post-trauma response of victims to life events other than war. Trauma can be an acute, one-time event, such as a natural disaster; a man-made disaster involving fire, nuclear power, or toxic chemicals; airline crashes; or traumas such as rape, physical assault, and terrorist attacks (Kleinman, 1989). Traumatic events also can be chronic, such in the Holocaust (van der Kolk & Fisher, 1995), childhood neglect and abuse (Chu, 1997), combat, or being a prisoner of war (Bremner & Brett, 1997). For the purpose of this article, childhood sexual abuse (CSA) is defined as intrafamilial or extrafamililial sexual imposition involving a child under 18 years of age. Sexual imposition includes behaviors that range from exhibitionism, voyeurism, or seductive speech to fondling, sodomy, oral-genital contact, and intercourse. The DSM-IV-TR (APA, 2000) identified three symptom clusters for the client with PTSD. The first is reexperiencing symptoms such as intrusive memories, nightmares, and dissociative flashbacks. The second cluster is hyperarousal/hyperactivity symptoms such as tension, irritability, anxiety, vigilance, poor sleep, and impaired concentration. Avoidant symptoms that make up the third cluster include emotional numbing, social isolation, and lack of life progress. The prevalence of PTSD varies according to source and definition. The DSM-IV-TR (APA, 2000) reports it affecting 8% of the adult population in the United States. Among individuals with one or more traumatic events, a prevalence of 23.6% to 25% showed evidence of PTSD (Breslau, Davis, Andreskin, & Peterson, 1991; Green, 1994). A study of 4,000 adult female civilians revealed that 69% had exposure to traumatic events (Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993). The National Co-Morbidity Survey (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995) reported rates of exposure to one or more traumatic events to be 51.2% in females and 60.6% in males. Women, although seemingly less exposed to trauma than men, consistently suffer more PTSD symptoms as a result of exposure to trauma. This may be related to the types of trauma women are more likely to experience such as rape, sexual abuse, and battering. Herman (1992) suggested an expanded version of the disorder called complex PTSD for victims of prolonged or early childhood trauma, since they exhibit considerable affect dysregulation. Wolfsdorf and Zlotnick (2001) define affect dysregulation as the inability to adaptively manage or tolerate intense emotion, van der Kolk et al. (1996) investigated the complexity of adaptation to trauma and found 77% of participants with early childhood trauma suffer affect dysregulation compared with 37% of disaster survivors. …