Post traumatic stress disorder: an eclectic approach.

A number of victims of post traumatic stress disorder, apart from the rest of their symptom constellation, suffer flashbacks. These flashbacks occur during the waking state and frequently are very disabling. From among this group of patients, we have identified a few who demonstrate epileptiform discharge emanating from temporal lobe foci. We have postulated that indeed the flashbacks might represent an amalgam of abnormal neuronal firing along with the expression of a dynamically charged event. Eight cases are documented which illustrate this pattern. In all eight cases, the flashbacks were completely controlled through the use of anticonvulsant medication (carbamazepine and one case of valproate). Other symptoms were treated more traditionally. A modification to a conventional psychotherapeutic approach is introduced which does not merely foster abreaction but also introduces a process of desensitization to the highly charged events. The sessions during which the patient relives the precipitant to the syndrome are audiotaped. Following the experience of working through in therapy, the patient is encouraged to replay the tape(s) repeatedly over several months to facilitate flooding/desensitization. The two case summaries which are presented illustrate the integration of pharmacotherapeutic intervention, a focal short-term dynamic approach, and a behavioral model.