The relative short-term efficacy and long-term benefits of pharmacologic versus psychotherapeutic interventions have not been studied for posttraumatic stress disorder (PTSD). This study compared the efficacy of a selective serotonin reuptake inhibitor (SSRI), fluoxetine, with a psychotherapeutic treatment, eye movement desensitization and reprocessing (EMDR), and pill placebo and measured maintenance of treatment gains at 6-month follow-up. Method: Eighty-eight PTSD subjects diagnosed according to DSM-IV criteria were randomly assigned to EMDR, fluoxetine, or pill placebo. They received 8 weeks of treatment and were assessed by blind raters posttreatment and at 6-month follow-up. The primary outcome measure was the Clinician-Administered PTSD Scale, DSM-IV version, and the secondary outcome measure was the Beck Depression Inventory-II. The study ran from July 2000 through July 2003. Results: The psychotherapy intervention was more successful than pharmacotherapy in achieving sustained reductions in PTSD and depression symptoms, but this benefit accrued primarily for adultonset trauma survivors. At 6-month follow-up, 75.0% of adult-onset versus 33.3% of child-onset trauma subjects receiving EMDR achieved asymptomatic end-state functioning compared with none in the fluoxetine group. For most childhood-onset trauma patients, neither treatment produced complete symptom remission. Conclusions: This study supports the efficacy of brief EMDR treatment to produce substantial and sustained reduction of PTSD and depression in most victims of adult-onset trauma. It suggests a role for SSRIs as a reliable first-line intervention to achieve moderate symptom relief for adult victims of childhood-onset trauma. Future research should assess the impact of lengthier intervention, combination treatments, and treatment sequencing on the resolution of PTSD in adults with childhood-onset trauma.

This article reviews the complexity of adaptation and symptomatology in adult survivors of childhood neglect and abuse who meet criteria for the proposed diagnosis of Complex Posttraumatic Stress Disorder (Complex PTSD), also known as Disorders of Extreme Stress, Not Otherwise Specified (DESNOS). A specific EMDR protocol, Resource Development and Installation (RDI), is proposed as an effective intervention in the initial stabilization phase of treatment with Complex PTSD/DESNOS. Descriptive psychometric and behavioral outcome measures from two single case studies are presented which appear to support the use of RDI. Suggestions are offered for future treatment outcome research with this challenging population.

A s research data on traumatic stress and posttraumatic adaptations have accumulated over the past several decades, it has become increasingly evident that the diagnosis of posttraumatic stress disorder (PTSD), as currently delineated in the DSM-IV (American Psychiatric Association, 1994), fails to account for the complex symptomatology that emerges following chronic interpersonal traumatization. Chronic abuse, often coupled with failures in attachment, appear to have a profound effect on cognitive, affective, and psychosocial development, leading to an inadequate sense of self, impaired schemas, defi cits in affect regulation and impulse control, and problems in forming and maintaining healthy, secure attachments in adulthood.

Researchers have published evidence supporting both the “working memory” and the “REM/Orienting Response” hypotheses as mechanisms underlying the documented treatment effects of EMDR on patients with posttraumatic stress disorder. Hornsveld et al. (2011) provide additional evidence of the impact of eye movements (EMs) on aspects of positive memory recall, but overstate their findings relevance to resource development and installation (RDI: Korn & Leeds, 2002) and to the interhemispheric interaction hypothesis (Propper & Christman, 2008). Most likely multiple mechanisms underlie the observed effects of EMDR and RDI. The needed RDI test is to randomly assign patients with Disorders of Extreme Stress not Otherwise Specified with measured coping difficulties to alternate conditions: one an RDI procedure without bilateral (or other distracting) sensory stimulation and one with bilateral EMs.

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