Poll Should the APA include the CPTSD DX in the DSM?

[Craig.Fredrickson]

Nah. Funding comes from expectation of future returns, or tax breaks on charity. Not academic, nor proactive/practical interest.

Ever had a salmonella vaccine? Unless you’ve lived in Latin America, you probably haven’t. As no one in the USA -nor any other first world country- could give a f*ck about diarrhea. It’s DEADLY where there isn’t clean water, on tap, and Gatorade for sale. The US? Has both tapwater & Gatorade, so the vaccine didn’t spend a BILLION DOLLARS getting approved by the FDA, there. Even though it was created by 2 Ivy League American Microbiologists…. They only spent a few hundred grand on creating & living it, and receive less than a hundred bucks a year on tens of millions of vax’s. One of them? Was my micro prof. I didn’t ACTAULLY get extra-credit for having received the vaccine working in Latin America. But as the only one in my class, who had it on my Vax card??? I like to think I at least got a wink.

You want FUNDING??? You need to go somewhere your research matters to more than just single digit rejects and acceptable losses. That’s what PTSD is to mega-Nations with hundreds of millions -or billions- of people. Places where individuals & their families matter. That’s not the US. Although the US military occasionally takes stabs at reducing their recruitment & minimizing their aftercare expenses, that’s all the military gives a damn about… their bottom line. Even though their bottom line is a fraction of socialized medicine countries, who take care of their vets.

India, China, the US, & Indonesia? Could. Give. A. Flying. f*ck. About anything that affects such a teeny tiny fraction of their people. Population numbers are simply too damn big. Hundreds of millions & Billions??? Mean that the people effected by almost anything NICHE are more than the sum populations of most other nations. And, as such, are acceptable losses. Fringe interests, at best. Even such GIANT things, like homelessness, which effect a thousand times more people than any single disorder or condition, are a back burner issue, on the world stage.

You want FUNDING? Seek private interests, and small nations, where tens of millions of people… hundreds of millions of people…matter. And aren’t acceptable losses.

Wow, incredibly insightful comments, and very valid point taken. Thank you for sharing!

 

[Sideways]

Until there are different TREATMENTS? It’s the same durn disorder.

Yup.

And distinguishing it without different evidence-based treatment? Just adds a layer of stigma that hasn’t helped in other forms of mental illness with poor treatment prognosis (specifically when we’re talking about the DSM). Complex ptsd would become ‘the ptsd that can’t treated’, and the people labelled with it get burdened with that.

If the best evidence-based treatment currently available for cptsd is the same as the evidence-based treatment currently available for ptsd (which it is, right?)…then, steer clear of the label that differentiates you as ‘the group that doesn’t respond well to treatment’!

This will change. I think we’re getting there slowly. But not there yet. And I think the treatments will be more effective if we can do better than the just the simple/complex dichotomy.

 

[Craig.Fredrickson]

Yup.

And distinguishing it without different evidence-based treatment? Just adds a layer of stigma that hasn’t helped in other forms of mental illness with poor treatment prognosis (specifically when we’re talking about the DSM). Complex ptsd would become ‘the ptsd that can’t treated’, and the people labelled with it get burdened with that.

If the best evidence-based treatment currently available for cptsd is the same as the evidence-based treatment currently available for ptsd (which it is, right?)…then, steer clear of the label that differentiates you as ‘the group that doesn’t respond well to treatment’!

This will change. I think we’re getting there slowly. But not there yet. And I think the treatments will be more effective if we can do better than the just the simple/complex dichotomy.

I completely agree with your perspective. However, in the U.S., many individuals with PTSD have already fought and continue to fight the strong stigma associated with their diagnosis. And fighting that of CPTSD would merely be an extension of that, IMO

What people are asking for is not to create further diagnostic division, but to be seen. Recognition, as it exists in much of the world through the ICD-11, would allow CPTSD to be included in the curriculum of higher education and professional training programs. This visibility would engage more students, researchers, and clinicians, fostering new innovative perspectives, treatment modalities, and even potentially new pharmacological interventions designed specifically to address the impacts of complex trauma.

While I absolutely agree that stigma remains a major societal challenge, millions of Americans meet criteria for CPTSD under the ICD framework and are seeking care tailored to their needs. These individuals have often experienced prolonged or repeated exposure to trauma, frequently across multiple domains, including Adverse Childhood Experiences (ACEs).

Yet, the first-line PTSD treatments currently available in the U.S., such as Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Eye Movement Desensitization and Reprocessing (EMDR) are primarily designed for single-incident trauma. For many with CPTSD, these modalities do not adequately address the complex interplay of emotional regulation, self-concept, and relational difficulties that define this distinct disorder.

Additionally, clinician proficiency and training gaps remain significant barriers to effective care in the U.S. This lack of proficiency in tailoring PTSD treatments to the needs of CPTSD patients largely stems from two issues: (1) limited institutional education on CPTSD, which results from its lack of national recognition, and (2) the continued reliance on single-event trauma models in therapy, again a direct consequence of the absence of formal diagnostic inclusion here.

There is, however, growing support for research into innovative interventions particularly psychedelic-assisted therapies using substances such as MDMA and ibogaine which have shown potential to enhance neuroplasticity and recalibrate physiological fear responses. I have personally witnessed promising outcomes in a colleague who traveled abroad to receive such treatment and returned with profound and sustained improvement. I’m genuinely curious to hear thoughts and experiences from this highly knowledgeable and thoughtful community here. Best!

 

[Roland]

I think that the way the DSM & ICD have split the difference… makes a helluva lotta sense.

The ICD included it, as presentation is so different.
The DSM discluded it, as treatment is identical.

That said? I strongly suspect, sometime in the next 50 years, we’ll see PTSD/CPTSD split 5 or 6 different ways, not 2.

- ACUTE : As we stand, the overwhelming majority of people diagnosed with PTSD are 100% better within 6mo of their trauma, with ZERO intervention. Right now? Only people better within 30 days, qualify for “Acute Stress Disorder”. Yep. An even greater percentage are all better within 30 days. Why? Because. It’s. A. Normal. Response. To. Trauma. (IMO). The NEXT largest group? Are all better inside of 6 months. Again, with zero intervention. I would also posit that’s a normal response to trauma, just with a “life destroying timetable” … so some kind of Dx needs to be made available for soulless corporations to not fire their employees who have suffered something that will “only” take them a few months to process through. Hello! Cause. Not character. Like any injury that unemployment insurance will pay for, for up to 2 years, theoretically.

- PTSD, served neat. 6+ months of your life going increasingly sideways. Usually from a single trauma.

- PTSD, from complex trauma. No one knows when your life with blow up. If/when it does? It’s gonna take a couple years to set straight, even with every advantage. Longer with normal life f*cking things up worse.

- PTSD, from developmental trauma.

- PTSD, from durational trauma. (These would cover all the people who THINK they have CPTSD, but meet none of the additional symptoms; because they have years/decades of the exact same trauma, from the exact same people, so it’s faaaaaaawking harder to deal with. For dayum good reason. Because 10,000-50,000 rapes is more than a single rape, which is enough for PTSD to happen, AND has different & more prolonged/nuanced consequences. But still? None of the actual symptoms of CPTSD are met, except duration

- ????? <<< Start finding better/more treatments? Start defining shit better.

^^^

Until there are different TREATMENTS? It’s the same durn disorder.

This is pretty much what I think. Yes, there's a lot of different nuances there, but a therapist that specializes in PTSD is able to treat and understand those nuances. But the nuances aren't so great that they require a separate diagnosis in my opinion.

Calling it cPTSD annoys me because it's not a real diagnosis, it's a commonly used nuance when there's a bunch of other ones like Friday said. I think combat PTSD is it's own kind as well.

But people with PTSD can relate on the symptoms because it's the same disorder.

Since all kinds of PTSD can be treated with the same types of therapy I really see no reason for separate diagnosis'. It's just dividing up where there doesn't need to be.

Someone with PTSD should learn the implications of their own situation because it absolutely makes a difference. Therapists needs to be experienced and trained.

I had a therapist that didn't seem to understand PTSD from multiple ACEs and childhood, and it showed in the way she talked to me and treated me. Now I have one that has many years of experience and both specialize in PTSD. So we all know not every therapist is equal value. There are definitely specific implications but like I said I don't see a reason for separate diagnosis'.

I wish there were less diagnosis' in general, I feel like some of them are the same thing.

 

[Friday]

I think combat PTSD is it's own kind as wel

It’s nearly always complex trauma… as people are experiencing & witnessing dozens of different types of trauma, even in the same theater, over a very short time period… push that to thousands plus, of dozens to hundreds or types of trauma, experienced & witnessed across multiple theaters, or multiple years. Tens of thousands over decades, for the career folk.

It’s relatively similar to big city police or firefighters, experiencing & witnessing tens of thousands of traumas over years and decades. In a much more compressed timescale.

Combat PTSD = Complex Trauma not only for the fighters in that conflict… but also the civilians, journalists, etc. who are living through it, as much on the sidelines as they can be. Ever doubt if civilians in combat zones have trauma-trauma??? Watch The Walking Dead. The major difference being that live people? Are waaaaaaaay more dangerous, (and rapey, and burny), & brutal than mindless zombies who only want to eat you. “NORMAL” people, in conflict areas??? Will cut the arms off your wife, whilst they rape your kids to death, then pour gasoline on the lot of you & set you on fire. “Normal” people. Not combatants. Your neighbors you’ve known for years. As well as roving gangs, etc. ANARCHISTS??? Overwhelmingly Come from first world countries, with clean water, food, medicine, good roads, & the power on, & shops with things you want & need open for business with reasonable rates…all existing in the background … who’ve never lived through real anarchy, nor real martial law / military overthrow.

One upside of complex trauma? It reeeeeeeally pushes you to define who you are, as a person. As you’re given soooooo many chances to make different choices. Often ending up with the exact same result. Which is another lesson, learned.

 

[Roland]

It’s nearly always complex trauma… as people are experiencing & witnessing dozens of different types of trauma, even in the same theater, over a very short time period… push that to thousands plus, of dozens to hundreds or types of trauma, experienced & witnessed across multiple theaters, or multiple years. Tens of thousands over decades, for the career folk.

It’s relatively similar to big city police or firefighters, experiencing & witnessing tens of thousands of traumas over years and decades. In a much more compressed timescale.

Combat PTSD = Complex Trauma not only for the fighters in that conflict… but also the civilians, journalists, etc. who are living through it, as much on the sidelines as they can be. Ever doubt if civilians in combat zones have trauma-trauma??? Watch The Walking Dead. The major difference being that live people? Are waaaaaaaay more dangerous, (and rapey, and burny), & brutal than mindless zombies who only want to eat you. “NORMAL” people, in conflict areas??? Will cut the arms off your wife, whilst they rape your kids to death, then pour gasoline on the lot of you & set you on fire. “Normal” people. Not combatants. Your neighbors you’ve known for years. As well as roving gangs, etc. ANARCHISTS??? Overwhelmingly Come from first world countries, with clean water, food, medicine, good roads, & the power on, & shops with things you want & need open for business with reasonable rates…all existing in the background … who’ve never lived through real anarchy, nor real martial law / military overthrow.

One upside of complex trauma? It reeeeeeeally pushes you to define who you are, as a person. As you’re given soooooo many chances to make different choices. Often ending up with the exact same result. Which is another lesson, learned.

Yes, but as in the stress cup analogy, isn't there the added rage container added by military training? Do you think combat PTSD veterans have any nuances specific to them outside of cPTSD?

I had a friend that was raised in South America as a missionary kid and she told me about the wars there and yes it's definitely trauma too and survival will drive people to do anything.

 

[Friday]

Do you think combat PTSD veterans have any nuances specific to them outside of cPTSD?

I think ALL trauma types… and there are tens of thousands… have nuances specific to them.