Fantasies

Nature of the Problem

In evaluating and treating stress response syndromes, including posttraumatic stress disorder (PTSD), clinicians may encounter intrusive and persistent thoughts of vengeance associated with feelings of rage at perpetrators (1 – 3) . The inciting stressors can be injuries, rape, mugging, rejection, divorce, physical abuse, insulting criticism, deliberate neglect, or betrayal of promises. Symptomatic revengefantasies go beyond normal bitter thoughts; they are unwanted, uncontrollable, dangerous, or intensely evocative of shame or guilt. Revenge fantasies also may permeate the thinking of people with paranoid traits when they feel under stress.

Revenge fantasies are common but not specific to PTSD, complicated grief, or other stress response syndromes. The patient may expect to be judged critically for such hostility and may not divulge the fantasies. Direct questions may open the door to disclosure. Revenge fantasies may even include rage at the self and lead to suicidality.

Revenge fantasies have been discussed in the literature on PTSD (1 , 4 , 5)...