Psychosocial and other nonbiological therapies and interventions Prolonged exposure (PE) application in a case of posttraumatic stress disorder with dissociation: indication or contraindication?

Prolonged exposure (PE) is a method of psychotherapy, which has shown to be effective in the treatment of PTSD. In this article, a patient who developed psychotic disorder after being diagnosed with PTSD, undergoing PE therapy is presented. A 25 years old man had a gunshot injury on the right shoulder six months ago. While he was being treated in a rehabilitation center, he had complaints of anger mismanagement, re-experiencing an event in the form of dissociative episodes and antidepressant treatment and PE therapy was started. The therapy often failed due to severe dissociative seizures of the patient. At the second admission of the patient to the rehabilitation center, similar symptoms and the same treatment have been continuing. He was referred to our clinic due to behavioral abnormalities and severe dissociative symptoms. Persecutive delusions and Schneiderian findings were added in the clinical picture and combined antipsychotic and antidepressant treatment with the diagnosis of Psychotic Disorder and PTSD was initiated. In his psychometric examination, the scores were measured as CHANCE: 30 SAPS: 53 BPRS: 46, respectively. In the PE guidelines, the application of PE is stated to be contra-indicated in the cases that dissociation is at the forefront. Our case showed that PE therapy, the patient’s symptoms should be held carefully before