Multimodal Treatment With ECT for Identity Integration in a Patient With Dissociative Identity Disorder, Complex Post-traumatic Stress Disorder, and Major Depressive Disorder: A Rare Case Report

The Role of Electroconvulsive Therapy in Posttraumatic Stress Disorder: A Systematic Review

ABSTRACT

Posttraumatic stress disorder (PTSD) is associated with a high burden of disability and mortality. Despite standard treatments with antidepressants and/or psychotherapy, remission is often difficult to achieve. Electroconvulsive therapy (ECT) is an effective treatment for mood disorders but is currently not recognized as a treatment modality for PTSD. The literature about its potential role in the management of PTSD is growing. Thus, we aim to systematically review the available evidence for the role of ECT in PTSD.Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guidelines, we performed a systematic literature search from 1958 to December 2023 using PubMed, Embase, Web of Science, Cochrane Central Register of Controlled trials databases, and the Clinicaltrials.gov-registry.Eighteen studies met our inclusion criteria: 1 meta-analysis, 2 randomized control trials, 2 prospective, 4 retrospective studies, 8 case reports, and 2 reviews.Accumulating evidence suggests that ECT might have a beneficial effect on the core symptoms of PTSD with comorbid conditions, such as depression or schizophrenia. Although in some studies, the effect on core PTSD symptoms was not related to an antidepressant effect of ECT, these findings need further replication. Nevertheless, in severe and intractable cases, ECT can be considered, especially in the presence of comorbid depression. Further research in patients without comorbidity is warranted.

Adjunctive electroconvulsive therapy in the treatment of a patient with comorbid major depressive disorder, posttraumatic stress disorder, and anorexia nervosa - a case report

Purpose

Posttraumatic stress disorder (PTSD) is still-underdiagnosed and often accompanied by other psychiatric disorders affecting treatment and outcomes.

Case description

Here we present a case report of a 28-year-old female patient with comorbid PTSD, major depressive disorder (MDD), and anorexia nervosa (AN). The patient had been treated with various medications and attended trauma-focused psychotherapy. Because none of these treatments yielded satisfying improvement, the patient was referred for electroconvulsive therapy (ECT). We had to overcome challenges such as the patient's false assumptions about ECT, the simultaneous use of benzodiazepines and the management of the side effects of ECT. The symptoms of MDD and PTSD improved after 12 treatment sessions.

Comment

Our report suggests that ECT may be a safe and effective method for treating patients with PTSD and comorbid MDD and AN.

Dissociative Identity Disorder: A Review of Research From 2011 to 2021

ABSTRACT

Dissociative identity disorder (DID) has historically been one of the most controversial topics in the study of psychopathology. Building on a previous review of empirical research on DID from 2000 to 2010, the present review examined DID research from 2011 to 2021. The research output included 56 case studies and 104 empirical studies. Within the empirical studies, approximately 1354 new cases of DID emerged, which resulted in an average samples of approximately 20. Reanalysis of previous samples was standard in the literature with only 40% of reported cases being new. Studies emerged from dozens of countries across the world, but the majority of cases were from Western counties, especially the United States. Diagnosis primarily relied upon validated measures, but 74% of all new cases came from six research groups. Overall, research on DID is steady but methodologically limited in ways that make generalization, especially about etiology, difficult.

Treatment of Trauma: Imaginative Minds of Dissociative Identify Disorder

If childhood trauma leads to dissociation, then this coping mechanism is powered by the imagination, creativity, consciousness, and similar areas of cognitive function. The goal of this article is to promote the treatment of trauma with particular emphasis on humanistic psychotherapy and behavioral therapy, such as “Play Therapy” for pediatric populations. It will thoroughly describe the multiple personality states within dissociative identity disorder, including the individualized sense of “self.” The diagnostic criteria of this mental disorder will be covered, along with assessment techniques that evoke a deeper understanding of dissociative disorders. It will also discuss comorbidities that present with dissociative disorders, such as posttraumatic stress disorder. This scholarly article suggests that dissociative disorders may result from experiencing tragic events and therefore need treatment for trauma to relieve negative symptoms of dissociation. The multidimensional aspects of dissociation are emphasized in their relation to the treatment of trauma.