Medical Genital exam as a child.. QUESTIONS

[joeylittle]

The diagnostic criteria actually do not define criterion A trauma as any situation where one fears for their lives or feels xyz way at the time of the event for good cause. It’s not based on the at-the-time feelings about an event, but the event itself.

Bolded for emphasis. That's it, in a sentence.

For example if someone was assaulted without actual physical consequences (threat of serious injury, possibly death or sexual violence?) and they don't realize the "what could've been" (subconscious denial?), could PTSD still develop from the potential of such threat?

Our understanding of the physical components of the acute stress response - the adrenal overactivity, cortisol flooding, amygdala hyperarousal - is it's own kind of physical injury, even if externally the body remains unharmed. Internally, there's been a profound chain reaction.

It's an interesting hypothetical - I think that in the moment of those cascading physiological events, it would be difficult for the person to be completely unaware of that physiological response. Probably not impossible, though.

And certainly, we're all very familiar with the concepts of how the mind then attempts to right itself, and hyper-normalizing is part of that. Denial, diminishment, compartmentalization...I've read some compelling studies suggesting PTSD is instigated in that aftermath phase of the acute stress response, and that those avoidance/denial ways of coping - pushing the experience down and away, mentally - are part of how PTSD gets "made". Folks going down that research alley are connected to those who are working on a chemical sort of antidote to PTSD formation - a drug meant to extinguish the fear response - as an early-intervention tool to help mitigate the aftereffects of trauma.

Or in less words - you got someone who was just in a serious auto accident? Administer the anti-PTSD med as a way of blocking the development of the long-lasting, problematic neurological effects that make up this disorder.

 

[siniang]

Thank you, both!

The diagnostic criteria actually do not define criterion A trauma as any situation where one fears for their lives or feels xyz way at the time of the event for good cause. It’s not based on the at-the-time feelings about an event, but the event itself.

I re-read the thread I had in mind and I must apologize for I remembered it incorrectly. You are absolutely correct, of course. What I meant, though, wasn't that any given situation where someone fears for their life etc. is classified as criterion A trauma, but that within those defined trauma possibilities, the severity is subjective to the individual person (how, upon experiencing the specific trauma, the person "felt" - hence why some go on to develop PTSD while others don't). Not sure if I'm making sense ?

Our understanding of the physical components of the acute stress response - the adrenal overactivity, cortisol flooding, amygdala hyperarousal - is it's own kind of physical injury, even if externally the body remains unharmed. Internally, there's been a profound chain reaction.

It's an interesting hypothetical - I think that in the moment of those cascading physiological events, it would be difficult for the person to be completely unaware of that physiological response. Probably not impossible, though.

Here is another example of what I'm thinking of: a predator has the intend of raping the victim (sexual violence) but before he could act, gets disturbed upon approach for whatever reason and the victim does not realize the theoretical threat of rape (though does notice the predator), does that still qualify under Criterion A trauma, as there never was an actual threat of thereof, just the intend, which the victim may or may not be aware of? Because subconsciously, the victim realized that something was off and later goes on to develop PTSD symptoms, but would it be PTSD with Criterion A trauma?

I guess I'm wondering what constitutes "threat". Is an intend of an action already a threat?

What I'm saying is, of course PTSD won't be diagnosed without the other symptoms in the here and now, that's why there are the different diagnostic criteria. But what I got from this and other threads is that, even in the presence of all other symptoms, it will not be PTSD if there was no 0.Criterion A trauma, which is very specific and pretty well-defined.

But I guess in my thought experiment, subconscious denial does indeed play a large part.

I've read some compelling studies suggesting PTSD is instigated in that aftermath phase of the acute stress response, and that those avoidance/denial ways of coping - pushing the experience down and away, mentally - are part of how PTSD gets "made". Folks going down that research alley are connected to those who are working on a chemical sort of antidote to PTSD formation - a drug meant to extinguish the fear response - as an early-intervention tool to help mitigate the aftereffects of trauma.

Interesting theories, indeed. It's like our ghosts do come haunt as if we just try to ignore them, and the harder we try, the harder they'll push back. But since denial/avoidance are part of the diagnostic critera, it makes sense that they play some role in the development of PTSD. Though this becomes a chicken-egg problem real fast.

I wonder what the evolutionary significance of this is.

 

[Juso]

I would say that the DSM is a little outdated, at least from what I've learned during my neuroscience and psychology studies. Keeping in mind that CPTSD is not even in the DSM but has a considerable amount of empirical support, I tend to not think of the DSM as the holy grail.
Of course it lays a good foundation and keeps the diagnosis simple and concise, but there are many aspects to what a brain "files" as traumatic that are not taken into account. What your brain categorizes as a serious threat or violation depends on so many factors. I don't think that you can get PTSD from one genital exam, but I also don't know anything about this incidence. Apparently the person who was in this situation did not know back then that this was normal. He or she might have felt threatened, especially cause the mother consented for him or her. Of course this is a necessary procedure but if you don't know that, the whole experience can feel very different. Maybe the doctor wasn't gentle and the mother wasn't present during the exam. Maybe the doctor was indeed a pedophile, which is not unlikely looking at statistics, and is-it-just-me could sense that. We also don't know his or her age at that time. Like I said, there are many factors influencing the perception of such a situation.
I still think it is very unlikely that is-it-just-me has PTSD but the fact that he or she has problems with sexual intimacy due to the memory of that incidence shows that the whole experience was not processed properly. And not processing an experience properly indicates that the experience was very stressful. I think if we would have greeted this person with compassion instead of judgement this conversation might have been different.

 

[Juso]

I also don't think that you either have PTSD or not, I think PTSD is a spectrum. A brain isn't clearly ill or not, it's not that black and white. PTSD is about how your brain is wired due to highly stressful experience(s) and that "way of wiring" is very difficult to categorize.

 

[Gs172003]

Apparently not everybody is on board with the dsmV changes :

Researchers critique DSM-5 changes to PTSD, call for action

 

[EveHarrington]

Here is another example of what I'm thinking of: a predator has the intend of raping the victim (sexual violence) but before he could act, gets disturbed upon approach for whatever reason and the victim does not realize the theoretical threat of rape (though does notice the predator), does that still qualify under Criterion A trauma, as there never was an actual threat of thereof, just the intend, which the victim may or may not be aware of?

No.

Thinking of raping someone cannot give them PTSD.

You’re extrapolating things too far.

 

[siniang]

IMaybe the doctor was indeed a pedophile, which is not unlikely looking at statistics, and is-it-just-me could sense that.

No.

Thinking of raping someone cannot give them PTSD.

You’re extrapolating things too far.

So, you're essentially saying we cannot sense threat? Or that sensing a potential threat would not be traumatic enough? My example may not be clear enough, but my point really touches on not, at least consciously, realizing the potential or real severity of a threat (which I'm sure most children don't). I'm not saying the perpetrator was merely "thinking" about it, but had every intend to act upon it and started acting on it, just couldn't follow through. Since Criterion A trauma specifically includes not only the actual event but also the threat thereof as well as witnessing or even just as much as learning about it. I wonder where the line is drawn.

I know someone who developed PTSD after an unexpected advance was made on them. Nothing physical or sexual happened (as far as I know), but it was a severe (you could say traumatic) breach of trust for that person. I don't know if that event was the cause or just a trigger (stressor?) for some earlier traumatic event to finally slip into PTSD, but that person did become suicidal and developed all PTSD symptoms and was officially diagnosed. Now, of course the diagnosis could be wrong.

Keeping in mind that CPTSD is not even in the DSM but has a considerable amount of empirical support,

I think this is an important point. Also, as was pointed out, that diagnostic criteria changed over time. In the past, PTSD was an anxiety disorder, now it's a trauma disorder. Those things are not rigid and we continue to keep learning about our brains and minds.

In the case of OP, there was no mention of any other symptoms, so I too doubt the PTSD diagnosis, but to disregard it from the get go because the specific trauma is not part of Criterion A, might be judging too fast. Remember, in the past most of the traumas now included weren't considered "trauma" for PTSD, as it was restricted to war veterans...

 

[EveHarrington]

I know someone who developed PTSD after an unexpected advance was made on them.

An unexpected advance cannot cause ptsd. The “advance” would have to rise to the level of being an assault but as you said, it was not. This event was most likely the trigger to previous trauma.

 

[siniang]

But see, that's the thing. What might be an advance to you and me might already be an assault to someone else? I do think cultural and personal differences do play a big role.

I don't want to speculate as I don't know more details. Just thinking out loud, and really, mostly about the real and existing potential of a threat of a specific action (which itself would qualify under Criterion A) rather than the threat itself.

 

[siniang]

I wanted to add, that while we're referencing the DSM-5, there also is the ICD-10, which some psychologists/psychiatrist may be using, Reading those criteria, some people might be diagnosed with PTSD that would not under DSM-5. For example, the traumatic events are not as defined/restricted as under DSM-5.

Exhibit 1.3-5, ICD-10 Diagnostic Criteria for PTSD - Trauma-Informed Care in Behavioral Health Services - NCBI Bookshelf

Interesting to see, that there apparently were significant changes for ICD-11.

ICD-11: Fewer PTSD Diagnoses Under New, Stricter Criteria

 

[EveHarrington]

So, you're essentially saying we cannot sense threat?

Please stop twisting my words and making incorrect inferences from what I say. Please read up on PTSD for yourself from scholarly sources in order to gain a greater understanding of the disorder.

But see, that's the thing. What might be an advance to you and me might already be an assault to someone else?

No, just no.

If a woman feels “assaulted” by a guy who (god forbid) tries to hold her hand, for example, then there’s more going on in her past that makes her feel unsafe from such a benign action.

“Assault” is a legal term so you can’t paint an ordinary advance as assault.

Please go read up on PTSD from scholarly sources. You’ll get what you’re looking for there.

 

[siniang]

It was never my intention to twist your words, I was genuinely asking. I really just wanted to talk about it, not argue or even fight.

I've read a lot on PTSD over the past few weeks, but some things remained unclear for me, that's why I asked in a community with more insight, to hopefully get some answers or someone help explain it to me. For example what constitutes "threat". And how much of a trauma can be experienced subconsciously. How much of a threat can be subconsciously/potential rather than real. What is "real" in this regard? I've gotten very helpful replies on that. I thought that's what a community is for. To talk, even discuss, about things. For an exchange of thoughts and ideas, even if they're wrong at first.

I really didn't want to fight. I also didn't mean to question any legal definitions (please stop twisting my words ;) ).

I still think that we shouldn't completely disregard cultural differences when defining those trauma categories. For example, when someone grows up in a culture where marital rape and domestic violence is culturally accepted, will they experience it as traumatic? Will they still cause the same physical changes to the body from the stress response? Will there be a stress response when it inherently isn't regarded as something "wrong"? Again, not arguing, asking. "Advances" are made very very differently in different cultures. I'm not saying they'll ever be traumatic or were in that case I referred to (never did! Please don't make incorrect interferences from what I say ;) I actually clearly mentioned that I think it may have triggered something else - and there also is the possibility that I just don't know all the details, which I pointed out ), but even within sexual harassment, there's quite a spectrum. For some people it starts at as much as a hand on a thigh or a kiss that they feel genuinely violated, for others "only" at groping or rape. What might be an "ordinary advance" (what defines ordinary?) and benign for you (and your legal system), might already be very uncomfortable for someone from a different culture - or not obvious enough for someone from yet another. While there may me legal definitions, and that's perfectly fine and very important that they exist, it doesn't change the subjective component. This became very clear with the #meToo movement. Juso made a very good point about thinking of this as a black and white thing. I think when clinging too much too black-white definitions, me might forget the very personal component to it. Yes, it might not cause PTSD, there might be something else going on (in the past or a different disorder), but we should be careful with our words to reject the specific feelings of the person who experienced it.

Again, absolutely not trying to fight, genuinely trying to have a conversation about this.