Wow - The Apa Really Got The New Ptsd Diagnosis Right

[zaniara]

Thank you Safenow! :) I am so greatful for my T and finally getting this help!

And some still don't get it.

That's just so scary and tragic!

 

[zaniara]

I've realized that I misunderstood it all. And that it wont be a complex PTSD diagnose in the new DSM, just some more text in the PTSD diagnose. (but I don't think it cover it all) :( I think it's a pity. I wish there would be two diagnoses, since "simple PTSD" is not really the same thing as "complex PTSD"(not a 'legal diagnose'). It would simplify for people to get the right kind of care, since in my country "if it's not on paper you can't get any help at all'. They do treat PTSD; but it feels like they are missing out on things a person with "complex PTSD" need to get well.

I'm really lucky to have found a therapist who DO understand and treat me accordingly to what I suffer from and how I "work/don't work". But that's not in "the system" so to speak.. And people with "complex PTSD" get all kinds of misleading diagnoses: like Borderline personality disorder, for one thing.. Thus they don't, most of the time, get the care they really need. Sometimes they do get some help with the issues from having suffered from a lot of early childhood trauma, but then they're supposed to be "alright" even though they suffer from PTSD as well. (Wouldn't it be more accurate to call it complex PTSD from the start; and not messing it all up by giving a person 2, 3 or more diagnoses??)

 

[Pencil]

"simple PTSD" is not really the same thing as "complex PTSD"(not a 'legal diagnose'). It would simply-fie for people

Zaniara, this is it exactly, and what the argument in the thread on 'comparing rape to cheating' (I can't remember the exact phrasing of the title now, and if I check I'll lose this) has been about. I think it is extremely important for the APA to get it right eventually, and for sufferers to be better informed.

 

[anthony]

The APA pretty much DO have it right now. Don't confuse the cause (type of trauma) with the diagnostic application. That is where people get themselves into trouble, and where exactly CPTSD as an attempted diagnosis got itself into trouble. It attempted to cross into Axis II disorders, right out of the realm of Axis I disorders. Many disorders have cross symptoms, but they do so typically within their own categorisation of Axis I or II.

A person with severe dissociation is now covered under the PTSD diagnosis. A person who steps into the realm of BPD or fits an actual dissociative disorder uniquely, should be diagnosed with those disorders appropriately, and not this attempt at trying to get every possible symptoms into a single disorder, which is what CPTSD attempted, and failed as a result.

There are more specific disorders already present to adequately cover specific issues. If you have severe dissociation, then you can fit under PTSD from your primary trauma, however; if your dissociation is simply beyond the realms of your trauma, and stands as such a problem it competes with your trauma, then that is where a separate diagnosis is applied, because you have two major, yet equally important issues that need be dealt with. Not just PTSD.

CPTSD has always been wrong in every way because of the above. It tried to complicate PTSD from trauma types, instead of compliment it, as a comorbid / multiple diagnosis achieves.

There is no 'simple' or 'complex' PTSD. There is 'severity' of PTSD. PTSD is far from simple if you have it. Symptom severity is what changes.

You could say there is abnormal trauma and abnormally complex trauma. But these have to do with the cause, not the symptoms. A diagnosis is about the symptoms, not the cause. The cause is only a qualifier, nothing more, nothing less.

 

[Pencil]

Anthony, I get this, even though I've been liberally referring to 'simple' and complex PTSD recently, with messy results. The problem is, however, that mental health professionals, or mine anyway, won't come up with a clear diagnosis, or diagnoses. I think there are others on this forum who also try to navigate these waters in an attempt to get clarity, only to get stuck in mud.

The professional attitude of 'I don't believe in labels', or 'You are more than your symptoms' is kind, but not helpful. I think the professionals avoid making multiple diagnoses by referring to 'complex trauma', most probably because many of them follow the Herman model for treating trauma.

(I coach/assist students in thesis writing. Some of my clients study applied psychology, and so I've become familiar with the approaches to treating trauma.)

 

[zaniara]

'simple' or 'complex' PTSD

Oh, when I wrote it like that it really sounded so wrong; I didn't mean that any real trauma, even when there is "only" one big one, is a "small" or "simple" thing. :sorry:

Thank you for clarifying those things. But I do disagree with you. And I do fit into to PTSD diagnose, but not in one of the "dissociation diagnoses", and know the PTSD diagnose covers more of my problems now. But not all of them. And I do think it's a pity people should have to have both a PTSD and for example a borderline personality disorder, since I do think you can have a borderline personality disorder without being severely traumatized in the way a person with "c-ptsd"(non existing in legal terms) has been. I think some of the symptoms are the same, but not due to exactly the same causes. (There are some people who believe that some children are born with a higher risk of developing borderline personality disorder; even under less unlucky circumstances than those who suffers from "c-ptsd".) In my country you can have big difficulties to get trauma-therapy when you get the diagnose borderline personality disorder, since those persons are considered to fragile to handle trauma-therapy. And having that diagnose often give you a hard time getting any help at all. Since those persons are considered "difficult to treat".

Me, my self, I do show some symptoms that might be considered fitting in the borderline personality disorder, but not to the extent of having that diagnose. Those symptoms, which I believe comes from being so severely traumatized at a very early age and repeatedly through my childhood years by the caregiver I was most dependent on, are not covered though completely by this updated PTSD diagnose. (I'm thinking of the attachment-problems for instance.)

I hope it's okay to disagree.. :)

A diagnosis is about the symptoms,

I do agree on that one. I'm thinking of the symptoms a person who have suffered so many early and severe traumas so often suffers from, and the new PTSD diagnose covers more of them, but not all of them as I know them. And I think they should be included for the diagnose to be a good tool to help those people have the help and resources they need to heal. I guess I'm mainly think of the attachment issues so many of the people in this category suffers from. (But not all of them to the extent of fitting in to for example the borderline personality disorder.)

 

[zaniara]

the borderline personality disorder

Besides(but this is off topic) a personality disorder is a pretty negative thing in my mind if you label people with it when they actually can get well from the problems they are having, and don't have a lifelong personality disorder at all. (As I've understood it a personality disorder is considered lifelong.)

 

[anthony]

People with BPD are difficult to treat. This isn't assumption, it's factual. A countries ignorance on how they treat trauma doesn't negate how mental health is diagnosed, it's simply your country has ignorance. Changing diagnoses doesn't change ignorance.

BPD can be treated, and is treated, though the sufferers are as a majority extremely difficult to treat due to what BPD is. Calling it something else won't change a thing. Those with complex trauma are often quite difficult to treat, and as a majority, will not accept treatment / will fail most treatment options based on symptom severity.

Complex trauma sufferers take time to treat, but they aren't that difficult. BPD... well, again, as a 'majority' it is a very difficult disorder to treat. It is perfectly normal to hear BPD sufferers say just the opposite, though when hands on occurs, they become resistant to treatment, argumentative about doing, and more.

Personality disorders don't have to exist with trauma. That is fallacy. Most personality disorders exist in combination with trauma because they have to have formed in childhood, before adolescence. They form in those years where the personality simply becomes wrongly wired, along with the brain, thus very treatment resistant through no fault other than the circumstances the person unfortunately endured growing up. Personality disorders as a majority exist due to underlying trauma, because it is rare otherwise. There is normally some type of maladjusted upbringing, emotional, psychological type abuse / neglect that adapt. Some people simply are born with such a disorder... and any trauma surrounding them is often due to already faulting wiring / they cause the trauma themselves.

I don't disagree that your country has difficulties with trauma diagnoses, as I've read the same thing from several people from your country. A pattern seems to repeat with the ignorance of trauma treatment compared to other countries, where ignorance is more the treating physician, not the countries model of treatment.

The problem is, however, that mental health professionals, or mine anyway, won't come up with a clear diagnosis, or diagnoses. I think there are others on this forum who also try to navigate these waters in an attempt to get clarity, only to get stuck in mud.

I absolutely agree that this is now becoming an issue within itself. They've tried a more delicate approach in belief of removing labels helps remove stigma, however; they've created a far worse issue for those who truly are ill and need direction within their brain, which is most with actual PTSD. The brain needs clear answers, not what if's, because what if type thoughts are already a major issue part and parcel with PTSD.

I think some are mixing too much counselling with psychotherapy, and the result is not the best. Counselling, being to keep stigmatisation completely away, is person centred. Psychotherapy needs that, plus it needs more education based theory along with the truth. Psychotherapy is not meant to be easy... and whilst stigmatisation is kept to a minimum, the client needs to know the truth at all times in order to heal... not just fuzzy warm stuff they discard instantly when out the door, back into reality. Fuzzy comfort doesn't help in the real world. Feels great in therapy, then reality hits, and it's useless.

 

[zaniara]

A pattern seems to repeat with the ignorance of trauma treatment compared to other countries, where ignorance is more the treating physician, not the countries model of treatment.

At least I'm lucky enough to have met a therapist who do have the skills, and wish, to help me(and it's not an easy task and I do work my but off to stay in treatment even when it gets rough), so I'm one of the lucky ones.

 

[Pencil]

BPD can be treated, and is treated, though the sufferers are as a majority extremely difficult to treat due to what BPD is. Calling it something else won't change a thing. Those with complex trauma are often quite difficult to treat, and as a majority, will not accept treatment / will fail most treatment options based on symptom severity.

And this of course is another diagnostic problem: there is overlap and lack of clear boundaries between complex trauma and BPD. Like many others, I have some BPD traits, but no-one seems to know whether I have BPD or not, and shy away from working towards establishing exactly what I have. I've read somewhere, and I don't remember where, that attachment issues point towards BPD. This simple lack of clarity makes it difficult for me to deal with the issues. It also makes it difficult to start therapy with a new therapist. I can't transfer with a clear diagnosis, I have to rehash everything for the new therapist to come up with his/her own fuzzy picture, in lieu of a diagnosis, once again. And this, I believe, is a universal problem. Hopefully the APA will, in time, sort this out.

 

[Abstract]

(Note: spontaneous and intrusive memories may not necessarily appear distressing and may be expressed as play reenactment.)

I wonder if you would mind clarifying what they mean by this Anthony? I am not sure I understand if they are saying it is or is not relevant.

 

[Abstract]

that attachment issues point towards BPD

Hi Pencil,
I understand what you are saying here. I however don't think that attachment issues equal borderline personality disorder at all even though everyone with borderline personality disorder will have attachment issues.

And I do think many PTSD symptoms especially of the " Posttraumatic Stress Disorder With Prominent Dissociative Symptoms/Complex trauma" variety are like borderline traits. There is a different between some traits and the actual disorder of course.

There are many different patterns of unstable attachment and the push pull of borderline is one of them but there is much more to BPD than that. I think Pete Walker describes some of this quite well. http://www.pete-walker.com/fourFs_TraumaTypologyComplexPTSD.htm

I hope its Ok to have posted this as I know these wounds are deep and you have been trying to put it to rest a little. I hope it doesnt open things up.

I hear you that you want answers and a recipe for someone to help you. I believe things will work out and you are doing a great job bravely working through things on this site.