Efficacy of Various Treatments for PTSD in Battered Women: Case Studies

Article excerpt

Spousal abuse and other forms of domestic violence can lead to posttraumatic stress disorder (PTSD). Little is known about how to best treat this form of PTSD. The current case series, based on data collected as part of a larger clinical trial, was designed to evaluate the effectiveness of exposure therapy, Eye Movement Desensitization and Reprocessing (EMDR), or relaxation therapy. Three woman with battered-spouse-related PTSD were assigned to one of these treatments. The patient receiving exposure responded well to treatment and no longer met the criteria for PTSD at post-treatment or at 3-month follow-up. The battered women in the other two conditions continued to meet the criteria for PTSD at post-treatment and at followup. The patterns of treatment response were similar to those experienced by individuals with other forms of PTSD ( N = 42) examined in the larger trial. The results of these case studies encourage further studies of exposure therapy for battered-spouse-related PTSD.

Keywords: posttraumatic stress disorder; battered women; exposure therapy; relaxation training; eye movement desensitization and reprocessing; domestic violence

Posttraumatic stress disorder (PTSD) typically develops following exposure to a situation or event that is, or is perceived to be, threatening to the safety or physical integrity of one's self or others. The symptoms, as presented in the current Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV-TR ), are classified into three domains: Reexperiencing of the event (e.g., recurrent and intrusive thoughts, distressing dreams), avoidance and emotional numbing (e.g., avoidance of reminders of the traumatic event, restricted range of affect), and hyperarousal (e.g., sleep difficulties, exaggerated startle response). Recent evidence suggests that avoidance and numbing are separate constructs (Asmundson et al., 2000; Asmundson, Stapleton, & Taylor, 2003; Taylor, Kuch, Koch, Crockett, & Passey, 1998). Support for the separation of avoidance and numbing stems from findings that they are factor analytically distinct, differ in external correlates, and differ in prognostic significance and patterns of treatment response (Asmundson et al., 2003).

The types of trauma that people experience are wide ranging. Examples include physical assault, sexual assault, combat, tragic death, terrorism, motor vehicle accidents, and natural disasters (Norris, 1992). Meadows and Foa (1999) note in their review of cognitive behavioral treatments for PTSD that different trauma populations may benefit from different interventions. For example, Foa and colleagues (Foa, Rothbaum, Riggs, & Murdock, 1991) have shown that female victims of both sexual and nonsexual assault respond more positively to prolonged exposure than to stress inoculation training (SIT) and supportive counseling. Likewise, in a study conducted with victims of motor vehicle accidents and nonsexual assaults, imaginal exposure therapy, coupled with cognitive restructuring, was more efficacious in reducing PTSD symptoms than imaginal exposure alone and supportive counseling (Bryant, Moulds, Guthrie, Dang, & Nixon, 2003). There is, unfortunately, little information on the comparative effectiveness of different PTSD treatments for battered women.

Studies by Hughes and Jones (2000) and O'Keefe (1998) have provided data on the occurrence and nature of PTSD symptoms in battered women. Hughes and Jones (2000) report that 1.9 million women are raped or physically assaulted by a partner annually in the United States. Of the 8,000 women that responded to a national survey, 25% reported that they had been raped or assaulted by a partner at some time in their lives. In addition to this, O'Keefe (1998) reported that approximately 50% of a sample of battered women incarcerated for killing their abusive spouse met the criteria for a probable diagnosis of PTSD.

When treating battered women with PTSD, it is important to note that there are factors that can complicate the treatment process. …