PTSD and acute stress disorder — structured clinical viva

This presentation maps to chronic PTSD after prolonged interpersonal trauma with features that ICD-11 would conceptualise as complex PTSD if PTSD core plus DSO (affect dysregulation, negative self-concept, relational disturbance) are confirmed. DSM-5-TR may still diagnose PTSD with dissociative features/specifiers and comorbid personality or depressive patterns — state which system you are using.^[4]

Safety first. Clarify whether IPV is ongoing; if yes, protection planning precedes exposure homework. Assess suicide/self-harm risk, substance use, and dependents.^[4]

Treatment framing. Validate fear of exposure; explain that trauma-focused therapies are structured, collaborative and effective for many, and that phase-based models (STAIR then exposure) have RCT support in childhood-abuse-related PTSD for building regulation skills before trauma processing. Avoid both forced flooding and indefinite delay of effective therapy when she is stable enough.^[1]

Medication. An SSRI such as sertraline can be offered for PTSD and comorbid depression/anxiety with clear start dose and monitoring; it is not a substitute for trauma processing if she wants recovery of trauma memories' grip. Prazosin may be discussed for nightmares with honest equipoise after the large negative multi-site veteran trial.^[2][3]