DÄ internationalArchive27-28/2014Critical Additions Required
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In Stuttgart, Germany, hospital physicians and outpatient care providers have joined in an initiative that aims to improve healthcare for persons who have been through trauma, because the sequelae of trauma are still being overlooked in primary healthcare and are not treated in a manner that is sensitive to trauma. The article is welcome but requires some additions:

  • In your article, you warn against possible inflation of the term trauma, but you abbreviate this to “life-threatening or potentially life-threatening external events and those associated with serious injury … .” In the German S3 guideline on post-traumatic stress disorder, the underlying trauma is described more comprehensively as “ … reaction following one or more traumatic events, for example the experience of physical or sexual violence, even in childhood …, rape, violent attacks against self …” (followed by a list of traumatic situations) “that may be experienced by oneself but also by others. In many cases this results in feelings of helplessness and … a shock to the perception of self and of the world.” It is not only the threat of death and serious physical injury, but also sexualized violence and witnessing such traumatic experiences that can lead to PTSD. DSM-V even includes reports of such experiences gained first-hand as the trauma that triggered PTSD. Unfortunately, neglect and psychological violence in childhood are not included.
  • The article does not clarify that SSRIs can be helpful in treating the associated depression, but only in combination with trauma-specific psychotherapy.
  • Psychodynamic-imaginative trauma therapy has proved to be successful, especially in complex post-traumatic disorders. Criteria setting out which therapy is most effective for which constellation of symptoms should be developed for the purposes of assessing therapeutic effectiveness.

DOI: 10.3238/arztebl.2014.0488b

Dr. Gabriele Weigel

Specialist in neurology and psychiatry, Stuttgart

dr.g.weigel@web.de

Conflict of interest statement

The author declares that no conflict of interest exists.

1.
Guido Flatten (eds.): Posttraumatische Belastungsstörung. Leitlinie und Quellentext. Stuttgart: Schattauer Verlag, 2013.
2.
American Psychiatric Association: www.DSM5.org (last accessed on 23 May 2014)
3.
Luise Reddemann: Psychodynamisch imaginative Traumtherapie PITT – das Manual. 7th edition. Stuttgart, Klett-Cotta 2012.
4.
Frommberger U, Angenendt J, Berger M: Post-traumatic stress disorder—a diagnostic and therapeutic challenge. Dtsch Arztebl Int 2014; 111: 59–65. VOLLTEXT
1.Guido Flatten (eds.): Posttraumatische Belastungsstörung. Leitlinie und Quellentext. Stuttgart: Schattauer Verlag, 2013.
2.American Psychiatric Association: www.DSM5.org (last accessed on 23 May 2014)
3.Luise Reddemann: Psychodynamisch imaginative Traumtherapie PITT – das Manual. 7th edition. Stuttgart, Klett-Cotta 2012.
4.Frommberger U, Angenendt J, Berger M: Post-traumatic stress disorder—a diagnostic and therapeutic challenge. Dtsch Arztebl Int 2014; 111: 59–65. VOLLTEXT

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