Does anyone else have PTSD from different traumatic experiences?

[HealingMama]

Thank you for your reply. Has this actually been confirmed by your T that it doesn't qualify anymore? Because...I think (obviously I'm not a professional, so really these are just my thoughts) things like heart attack etc. would qualify as "accidental"?

Because, otherwise...what constitutes "accidental"? Just actual, literal, accidents? Car, plane, work etc. ? Seems very very limiting. I'm not a native speaker but to me "accidental" implies "unexpected".

@joeylittle @Friday @Justmehere Any insight would be highly appreciated :)

@HealingMama Either way, I'm sorry this has happened to you because regardless of whether or not the event still qualifies under Criterion A, I'm more than certain it was very traumatic.

I have access to expertise on this topic. Hopefully the following will help.

A catastrophic health crisis could be criterion A for the individual experiencing it. But a long-term difficult experience wouldn't be. So a pulmonary embolism counts as criterion A but a terminal cancer battle does not.

From a white paper published by Pai, Sirius and North in 2017 in the journal Behavioral Science:

"Medical incidents involving natural causes, such as a heart attack, no longer qualify (with the stated exception of life-threatening hemorrhage in one's child, as described in the text accompanying the criteria)."

My husband almost dying when he crashed my car into someone's front porch would meet criterion A, even though he didn't even go to the hospital. My father's unexpected fatal heart attack doesn't count. It's pretty invalidating for those of us that have the symptoms of trauma, but I work with therapists that don't get caught up in the labels and I don't get caught up in them either. I just want to get better.

 

[Friday]

@siniang The way ‘accident’ is used in this context is indicative of : car accident, bike accident, skiing accident, climbing accident, work accident, boating accident, etc... a more British English word would be ‘misadventure’, specifically ‘death by misadventure’.

Natural Causes (including unexpected ones like heart attack, stroke, etc.) are specifically ruled out for several reasons, mostly because the symptom set / timeline for recovery (and therefore expectations and treatment) is different. Shock & profound grief can both be lethal (both in the moment/ acutely & over time/ long term), and both often have devastating consequences.

Just a few examples amongst many?

Someone who’s just lost a child/spouse/parent? Is FAR more likely to attempt to kill themselves, or attempt to kill others, than someone who has just witnessed a lethal car accident or been in a bank robbery or been raped. Regardless of whether it was an expected death or a sudden death of their loved one; or how much of a bloodbath the bank robbery or car accident was, or how violent the rape. Grief and madness are so intertwined it’s both expected and near always forgiven (legally speaking) if someone loses their mind and assaults or attempts to kill -and sometimes even if they succeed- in the moment that they’d just lost their child, they’d just lost their wife, they’d just lost their dad. It’s been understood -anecdotally- since the dawn of recorded history that there are several kinds of associated madness tied to grief. The more we study it scientifically? The more that’s been proven correct.

Sure, grief of many kinds is often a component of trauma victims. But victims OF grief? That’s a whole ‘nother ball game.

Adding trauma AND grief together? <low whistle> That gets dangerously complicated, fast. And is faaaaaaaar more likely to be the kind of thing involving armed takedown teams and -these days... IF you’re in the right neighborhood- highly trained negotiators. (Wrong neighborhood and it’s “just” another armed reprisal / gangland revenge shooting. Victims of trauma, especially long term violent trauma, have a habit of being able to keep it together in the moment only to explode into violence against others or themselves in fairly short order. The same latitude that’s given to a grieving parent/spouse/child in the moment of their loss? Is NOT given in the hours and days following the event. To anyone. Even though that’s when trauma victims tend to lose their minds having experienced the same shock. For arguably very good reason. It’s a 3rd kind of thing, when you have 2 different disorders/conditions reacting together to create a composite type event. ((For one thing, when people lose their minds in the moment of loss? It’s an instant thing. (Regardless of whether they have a trauma history or not) There is no escalation. It’s a SNAP! thing, that has to be instantly reacted to, by the people around them. (Ideally, shooting them up with a sedative, but failing the snap happening in a hospital, like when your kid dies of cancer, throwing them down and sitting on them until someone can shoot them up with a sedative.) Meanwhile, someone who has the buffer of trauma between them and madness? (Tends to) Escalate. A negotiator is useless with someone who has simply snapped in the moment. But a highly trained negotiatior CAN de-escalate someone who is building up to snapping. Help them make a different choice.

AGAIN... this is just ONE pathway, a few of the differences/divergences, between victims of grief and trauma victims. There are dozens and dozens of different pathways people take in both... like the branching of a tree. Sometimes, even often, those branches overlap. Or, like trees growing right next to each other, actually grow together... forming something very different than they’d be individually, yet still retaining components of each.

 

[siniang]

It's pretty invalidating for those of us that have the symptoms of trauma, but I work with therapists that don't get caught up in the labels and I don't get caught up in them either.

I'm glad you have this support :hug: I totally get the invalidating part.

From a white paper published by Pai, Sirius and North in 2017 in the journal Behavioral Science:

Thank you for the paper. I've scanned it and will read it in more detail later.

@siniang The way ‘accident’ is used in this context is indicative of : car accident, bike accident, skiing accident, climbing accident, work accident, boating accident, etc... a more British English word would be ‘misadventure’, specifically ‘death by misadventure’.

Natural Causes (including unexpected ones like heart attack, stroke, etc.) are specifically ruled out for several reasons, mostly because the symptom set / timeline for recovery (and therefore expectations and treatment) is different. Shock & profound grief can both be lethal (both in the moment/ acutely & over time/ long term), and both often have devastating consequences.

@Friday Genuinely thank you for your reply. I always appreciate you taking the time to answer my stupid questions. Though I have to admit, most of it felt somewhat tangential to my initial question (and I mean, yeah, broken-heart syndrome is a thing. I never doubted the impact and fallout grief, with or without trauma, can have)

I genuinely don't mean to be difficult. I'm really trying to understand. Because, I do fail to see the biological difference between:

Grief due to child/spouse/sibling/close friend dying suddenly and unexpectedly to "natural" causes (heart attack, stroke, ...suicide?)

Grief due to child/spouse/sibling/close friend dying suddenly und unexpectedly from "violent or accidental causes" (being shot, in an accident, natural disasters?...)

Why would the grief, the impact on the bereaved be different? The person is still dead. The result the same. Both can be (and probably are) equally traumatic to the person. So, how can the sheer fact that a loved one is dead (or faced a threat thereof) cause different reactions in the person not directly affected based on the causes?

Because, to bring in another example, that would also exclude complications from child-birth, which has previously been linked to having the potential of causing PTSD in women?

Off the top of your head, would you have any peer-reviewed publications on the reasoning to restrict it like this? (other than criterion creep) I don't really have time right now to do an extensive literature review and didn't find anything right away while briefly looking.

But at least to me, that doesn't seem very logical (In contrast to the other example we talked about the other day, the bad drug trip - because it happened to the person experiencing it and claiming to have PTSD, not the bystander)

And, then, what about the Ts/PsyDocs/Countries/... that don't use the DSM-5 to diagnose?

I get the argument that people misdiagnosed with PTSD and in the absent of a qualifying Criterion A trauma could probably have an Adjustment Disorder or an Anxiety Disorder (once we move outside the timeframe for Acute Stress Disorder) - but neither of them have Criterion B symptoms as diagnostic criteria, for example, do they (please, tell me if I'm mistaken). I still fail to see the significance of someone meeting all other Criterions B-F, but failing to get a diagnosis (and potentially help) because they don't have Criterion A (anymore after chance from 4 to 5). And so do the studies, actually, that have shown that hardly ever does someone meet B-F, but not A ...but that gets tricky when A changes to suddenly exclude previously qualifying events, case in point: @HealingMama (word of caution in her case: trauma pre-dating her dad, as far as I remember, so my argument is somewhat weak :oops: ).

Pai et al. 2017:

A DSM-IV/DSM-5 comparison study conducted by Kilpatrick and colleagues [20] using highly structured self-report inventories demonstrated that 60% of PTSD cases that met DSM-IV but not proposed DSM-5 PTSD criteria were excluded from theDSM-5 because the traumatic events involved only nonviolent deaths.

[20] Kilpatrick et al. 2014: National Estimates of Exposure to Traumatic Events and PTSD Prevalence Using DSM-IV and DSM-5 Criteria

So, since we always say it doesn't matter how traumatic it "felt", what matters is how it impacts the Amygdala, that's where I'm wondering about the biology behind it (see above, how are the two events having the same result different and impacting the Amygdala differently based on the causes or whether or not it just comes down to assumptions (hence my question re publications).

Frankly, sometimes I feel this comes down to insurances and money and disability decisions and fails to ignore the biology behind it (god forbid we could diagnose and support just ONE person falsely - yes, I'm being smug. Sorry :oops: ).

https://www.ptsd.va.gov/professional/articles/article-pdf/id35490.pdf

On the other hand, concern has been expressed about the greater number of qualifying A1 events in DSM-IV in comparison to DSM-III. It has been argued that expansion of qualifying A1 events has diluted the basicPTSD construct and permitted people to receive thePTSD diagnosis for less threatening events that should really be associated with an adjustment disorder or
anxiety disorder NOS.[25] This expansion has been called ‘‘bracket creep’’[23] or ‘‘criterion creep’’[26] and is presumed to have a particularly adverse impact in forensic settings or disability evaluations where it has been blamed for frivolous tort or compensation claims.

 

[HealingMama]

Complications from childbirth means exposure to actual or threatened death. That is a clear cut criterion A.

What isn't criterion A can still be highly distressing. An unwanted c section where the mother felt bullied into it or unheard etc is very distressing.

Luckily EMDR doesn't have to have criterion A. Other evidence based therapies are built so that they cannot work unless it is criterion A.

My mother is a narcissist who was verbally and emotionally abusive so I would have had trauma without my dad dying.

I think the guidelines on criterion A changed because of diagnostic creep as you said. The course of grief is fundamentally going to be straightforward or complicated. More likely complicated when the relationship is damaged or the death is unexpected.

Fear for your life or bodily harm is what is activating that threat response. As far as I'm aware, grief doesn't even do that. But losing a parent means your life is in danger. I slept in my abusive mother's bed as an 8 year old, for an embarrassingly long time. I was truly terrified that she would die too and I would be alone. I was afraid for my survival.

If an adult dies by natural causes then a surviving adult is less likely to have that threat response and more likely to be grieving. Grief can certainly produce stress hormones and depression but I don't believe it hits the fear response. I mean certainly a survivor will worry. But not necessarily be afraid to die.

 

[siniang]

Complications from childbirth means exposure to actual or threatened death. That is a clear cut criterion A.

What isn't criterion A can still be highly distressing. An unwanted c section where the mother felt bullied into it or unheard etc is very distressing.

Right. When happening to the mother. But not for complications to the baby (such as having a preemie) - which is still very distressing. As is is neither accidental nor violent. Could be considered "natural" - or at least as natural as having a heart attack.

Fear for your life or bodily harm is what is activating that threat response. As far as I'm aware, grief doesn't even do that.

[...]

If an adult dies by natural causes then a surviving adult is less likely to have that threat response and more likely to be grieving. Grief can certainly produce stress hormones and depression but I don't believe it hits the fear response. I mean certainly a survivor will worry. But not necessarily be afraid to die.

So. By that logic, why include death/threat thereof that is violent or accidental, but not unexpected natural?

Genuinely trying to understand the biology/reasoning behind this :) (because, otherwise, it feels arbitrary)

 

[Chris-duck]

So. By that logic, why include death/threat thereof that is violent or accidental, but not unexpected natural?

I think it's very situation specific. The idea is that while there you feel like your life/wellbeing is also at risk. So say someone is shot in front of you, but you are uninjured, the risk of you being shot is still there. If someone has a heart attack in front of you, it can still be traumatic but doesn't meet crit A because the risk of you *also* having a heart attack at that time is low.
Edit: or maybe it does. I lose track of the ever changing critA tbh...

 

[siniang]

I think it's very situation specific. The idea is that while there you feel like your life/wellbeing is also at risk. So say someone is shot in front of you, but you are uninjured, the risk of you being shot is still there. If someone has a heart attack in front of you, it can still be traumatic but doesn't meet crit A because the risk of you *also* having a heart attack at that time is low.
Edit: or maybe it does. I lose track of the ever changing critA tbh...

If someone is shot in front of you, you're physically there, hence it's A1 and 2. You're in threat of your life yourself, or as a minimum you're witnessing it.

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

1. Directly experiencing the traumatic event(s),
2. Witnessing, in person, the event(s) as it occurred to others

If you merely "learn about" it (A3), you're >not< in danger. You weren't there. Not in the shooting. Not in the car. Not in the natural disaster. The likelihood of you being in real danger as a result isn't higher than you dying of a heart attack (which can have a genetic component), or is it? That's what I'm wondering and asking whether actual studies exist.

 

[Chris-duck]

If someone is shot in front of you, you're physically there, hence it's A1 and 2. You're in threat of your life yourself, or as a minimum you're witnessing it.

Yeah

If you merely "learn about" it (A3), you're >not< in danger. You weren't there. Not in the shooting. Not in the car. Not in the natural disaster. The likelihood of you being in real danger as a result isn't higher than you dying of a heart attack

I honestly dunno of studies. But I learnt of my mates brother having a car accident. It's impossible to tell if it woulda given me PTSD, since I already had it. But I still get anxious in cars.

I'm not meaning to be dismissive. Sorry. I'm just blahblahing

 

[HealingMama]

Right. When happening to the mother. But not for complications to the baby (such as having a preemie) - which is still very distressing. As is is neither accidental nor violent. Could be considered "natural" - or at least as natural as having a heart attack.



So. By that logic, why include death/threat thereof that is violent or accidental, but not unexpected natural?

Genuinely trying to understand the biology/reasoning behind this :) (because, otherwise, it feels arbitrary)

You can get treatment for stress associated with having a child in the NICU without being diagnosed with PTSD. Your child being sick doesn't make you afraid that you'll die. It's just awful.

What do you feel people can receive with a diagnosis of PTSD that they can't from Adjustment disorder, Other Stress Related Disorder, etc?

 

[HealingMama]

Let me ask a different way. The change in criteria is probably related to diagnostic creep and possibly related to financial and legal issues. But a good provider will treat the symptoms regardless of the label given. So I'm just a bit confused why this is an issue for you.

 

[Sideways]

What do you feel people can receive with a diagnosis of PTSD that they can't from.adjustment disorder, Other Stress Related Disorder, etc?

What a relief to read this!

The stigma on this thread is palpable. If you have had a “traumatic” experience, and it’s not PTSD, but some other disorder, it’s some other disorder. It isn’t more or less valid. That’s just plain old stigma, that somehow a PTSD diagnosis is more valid than another diagnosis.

I was in hospital once and the lady in the bed next to me had MDD because her husband had died (natural causes). Her suffering? Was no less valid than mine. Just had different letters on her medical file.

 

[Ronin]

If you merely "learn about" it (A3), you're >not< in danger.

That assumes too much.

Too many types of job?

Your colleague assassinated on another continent *means* your life (and/or) those you need to protect/are in charge of, is in very real danger.

Where your train of thought goes with this is if you think mostly civilian & noncrime related risks.