What would be the diagnosis and treatment?

Peter is a 40 year old male who came to the office withcomplaints of anxiety, sadness, nightmares, and difficultiesconcentrating. He also reported poor memory, low libido, feelingsof guilt, despair, hopelessness and helplessness and occasionalsuicidal thoughts. In addition, he has difficulties in hismarriage. He had been married for 10 years to a woman 15 years hissenior. His wife is a very attractive woman, who looks younger thanher age. For over three years he has been unable to have sexualintimacy with her, but he added he always had sexual difficultiesin his marriage to her. Yet, he says he loves her and she is “themost beautiful woman in the world for him”. He had quit his jobafter suffering a severe stress reaction when his boss ridicule himin front of other managers and told him he would never amount toanything. His mental status revealed a slightly overweight malesuperficially pleasant, but guarded. He was restless and constantlymoved in his seat. His mood was anxious, depressed and angry andhis affect constricted in range. He denied psychotic symptoms andhis thinking was linear and goal directed. He reported occasionalsuicidal thoughts with no plan.

In terms of history he reported a lonely and difficultchildhood. His father was aloof and uninvolved and his mother wasphysically and sexually abusive of him. Her sexual seduction andsubsequent abuse started during late elementary school and lasteduntil early adolescence. As soon as he could, he left his home,joined the Marines and began his adult life. He was able to do wellin the military. Upon discharge he went to college graduating witha business degree and found a job in management. He had a couple oflong-term relationships while in college, but never thought aboutmarrying until he met his wife. However, during his first majorprofessional job, a “sadistic, mean boss” drove him to the verge ofsuicide. He left that job and since then (now 5 years) he has beenunable to go back to work. He has difficulties with sleep,overeats, has frequent nightmares, intense startle response, andhis anxiety is “over the top”. He has been on various SSRIsmedications with only limited success, and wants therapy to helphim sort out his problems.