Complex post-traumatic stress disorder (Complex PTSD) in pediatric patients is challenging to manage, particularly when conventional therapeutic approaches are insufficient. We report the case of Miss A, a 15-year-old girl with a history of severe neglect and abuse, adopted at age 5, who presented with frequent reliving of trauma memories, significant emotional dysregulation, dissociative episodes, recurrent self-harm, and aggression. Her treatment was complicated by comorbid mild-grade learning disability and suspected autism spectrum disorder. Initial management with promethazine, melatonin, and lorazepam, and later aripiprazole and fluoxetine provided limited relief. Following hospital readmission, guanfacine, an alpha-2 adrenergic agonist, was initiated. Miss A demonstrated a marked reduction in emotional dysregulation, self-harm, aggression, and suicidal thoughts, suggesting that guanfacine may offer significant benefits for managing Complex PTSD in such cases. This case underscores the difficulties in treating Complex PTSD with comorbid conditions, and highlights guanfacine as a potential adjunct therapy. However, further research is required to validate its efficacy and safety.

Complex post-traumatic stress disorder (Complex PTSD) in pediatric patients is challenging to manage, particularly when conventional therapeutic approaches are insufficient. We report the case of Miss A, a 15-year-old girl with a history of severe neglect and abuse, adopted at age 5, who presented with frequent reliving of trauma memories, significant emotional dysregulation, dissociative episodes, recurrent self-harm, and aggression. Her treatment was complicated by comorbid mild-grade learning disability and suspected autism spectrum disorder. Initial management with promethazine, melatonin, and lorazepam, and later aripiprazole and fluoxetine provided limited relief. Following hospital readmission, guanfacine, an alpha-2 adrenergic agonist, was initiated. Miss A demonstrated a marked reduction in emotional dysregulation, self-harm, aggression, and suicidal thoughts, suggesting that guanfacine may offer significant benefits for managing Complex PTSD in such cases. This case underscores the difficulties in treating Complex PTSD with comorbid conditions, and highlights guanfacine as a potential adjunct therapy. However, further research is required to validate its efficacy and safety.

Complex post-traumatic stress disorder (Complex PTSD) in pediatric patients is challenging to manage, particularly when conventional therapeutic approaches are insufficient. We report the case of Miss A, a 15-year-old girl with a history of severe neglect and abuse, adopted at age 5, who presented with frequent reliving of trauma memories, significant emotional dysregulation, dissociative episodes, recurrent self-harm, and aggression. Her treatment was complicated by comorbid mild-grade learning disability and suspected autism spectrum disorder. Initial management with promethazine, melatonin, and lorazepam, and later aripiprazole and fluoxetine provided limited relief. Following hospital readmission, guanfacine, an alpha-2 adrenergic agonist, was initiated. Miss A demonstrated a marked reduction in emotional dysregulation, self-harm, aggression, and suicidal thoughts, suggesting that guanfacine may offer significant benefits for managing Complex PTSD in such cases. This case underscores the difficulties in treating Complex PTSD with comorbid conditions, and highlights guanfacine as a potential adjunct therapy. However, further research is required to validate its efficacy and safety.